Grand Rounds Vol. 5, No. 43 is Up

This week's edition of Grand Rounds is hosted by Joe Kim at the Medicine and Technology blog.

This week's episode includes my latest post on finding the optimal background music for dictating ICU chest films.

What is the Best Background Music for Dictating ICU Chest Films?

I was on call this weekend, where I dictated reports on about two hundred ICU chest films. This turned out to be a fine time to test an iPhone app called White Noise, which was a software pick of the week on last week's MacBreak Weekly podcast by Scott Bourne and Alex Lindsay.

White Noise generates random background sounds to replace the background sounds you already have, but don't want. Besides playing actual white noise, this app also plays brown, pink, blue and violet noise as well as other sounds, including 6 different intensities of rainstorm.

Even in my relatively quiet reading room, there was a surprising variety of annoying background noises this weekend, and White Noise did a fine job of covering them all. This got me to thinking about another topic from the same podcast, where Scott and Alex debated whether there were optimal background sounds for different activities. What would be the best background for dictating ICU chest films?

I listen to a lot of audiobooks and podcasts when performing mindless tasks like laundry, dishwashing or commuting. However, I find these way too distracting for cognitive work like film interpretation. So, I designed a quick and dirty controlled study on myself (n = 1), pitting White Noise against three different styles of music: Cajun/swing (Red Stick Ramblers), heavy metal (Metallica), and baroque (Glenn Gould playing Bach's Goldberg Variations).


My results are summarized in the bar chart above, where the vertical axis shows the number of minutes it took me to read 10 ICU chest cases while listening to a particular background. Despite my dubious experimental design, the results are intriguing: I seem to be about twice as efficient while listening to Bach as I am while listening to Cajun/swing. Just in case the first run of Bach was a fluke, I did an additional run of 10 films on a few more of the Goldberg variations. This second run was pretty similar to the first Bach run. However, before I could replicate runs on other styles of music, I ran out of films to interpret.

Taking this at face value, maybe these results are not so surprising. Maybe Lewis Thomas was right when he said:

Music is the effort we make to explain to ourselves how our brains work. We listen to Bach transfixed because this is listening to a human mind.

A quick googling of this topic shows that I am not the first to tread this ground. I quickly found a paper by Cassidy and MacDonald, titled "The effect of background music and background noise on the task performance", published in 2007 in the journal Psychology of Music (vol. 35; pp 517-537). One of their conclusions:

In conclusion, the current study has highlighted the detrimental effect of sound (noise and music) on task performance, in comparison to silence...

(Oops -- forgot to collect data for silence alone...)

They also found that introverts (e.g. radiology nerds) find music and noise more distracting than extroverts (e.g. orthopedic surgeons). Hmmm...

I also ran across a recent article on the work of Warren Brodsky of Ben-Gurion University, who has studied the effects of music on high-risk driving behavior. In a nutshell: fast music makes you drive faster -- and less safely.

For example, while listening to a piece of music, drivers are immersed in much cognitive work including aural analysis and processing of the music components at various levels related to understanding, operations of short- and long-term memory, emotions, and of course extra-musical associations which continually surface from music stimuli.

In other words, music may not relax your brain -- it may make it work even harder.

Nevertheless, I'm not quite ready to give up on music just yet. So, to add some rationality to my rationale, I'll collect some more data the next time I'm on call. Just in case silence is actually golden, I will add an arm to the study in which I dictate to silence alone. However, despite the growing evidence that background music is distracting, I secretly hope that Bach wins again.

Grand Rounds - Vol 4, no. 48

I'm in back in town from one final week of summer vacation and am belatedly posting a link to this week's edition of Grand Rounds, hosted this week by Kerri at the Six Until Me blog.

My contribution is yet another round of medical dictation errors: Normal Sphincter and Nose Coordination.

Normal Sphincter and Nose Coordination

More medical malaprops courtesy of a friendly mole in the world of medical transcription:

Normal sphincter and nose coordination bilaterally. (finger-to-nose)

We will place him at bed rest with his eggs elevated.

The patient's gray cat with white paws and crossed eyes is still living in Prague with friends.

Last summer, she had an injury to her right knee when her left knee was on a boat.

Blood pressure elevated by the nurse at 160/96 today.

Patient respiratory Martian artifact degrades image quality. (motion artifact)

This patient from a small town in Alaska with no history of cardiac disease developed severe recurrent chest pain on the day of admission

Past Medical History: Spleen apnea. (sleep apnea).

Upon awakening, he removed all his extremities. (moved)

Works as a night-stalker in a grocery store. (night stocker)

Patient has one sister and three brothers who are all diseased. (deceased)

Chief complaint: Foreign body in esophaguts. (esophagus)

Next is history of, uh . . . next is history of, uh . . . next is history of, uh . . . next is history of, uh . . . . . learning disability.

Predictive Text Swearing

I use voice dictation systems to transcribe all of my radiology reports these days. The system I use at one hospital works quite well, and saves me lots of time. The one chosen by our other hospital is about the worst piece of software I've ever been forced to use.

The following video clip probably explains why the words "ducking piece of pigt" appear in the second system's transcriptions so frequently...



(via Daring Fireball)

The CT Showed Marked Brain Enema

Yet more more dictation errors, courtesy of a transcriptionist friend:

The patient sustained a displaced skull fracture and a subarachnoid hemorrhoid.

The patient broke his wrist when he fell rollerblading on an outstretched right wrist.

He looked like a kidney stone when he arrived.

She injured her ankle. She has been keeping it home since that time.

She fell and hit the back of her chest.

The patient looks older than her stated age. (97 y/o)

The patient has a relatively constipated gynecologic history.

The CT showed marked brain enema. (edema)

The Patient Underwent a Baloney Amputation

Here are a few tasty medical malaprops, courtesy of a transcriptionist friend.

Paramedics were called and he appeared to be pulseless and nonverbal.

Patient has minimal facial grimace in the upper and lower extremities.

He plans to go swimming in the Caribbean, looking for a sunken Spanish gold bullion carrying Spanish galleon.

After testing for adequate anesthesia and waiting a few more months for that to take effect, the procedure was begun.

Mild dementia related to his prostatism (parkinsonism).

We got descent of the maternal buttocks, but we did not get descent of the fetal head.

The patient is undergoing hysterectomy by Dr. ______ who has had ongoing incontinence for several years.

The patient states he is tired of breathing.

The patient underwent a baloney amputation. (below knee)

Voiding Satisfactorily and Passing Grass

It's been yet another full, rich week filled with way too many activities.

My son graduated from middle school, my niece graduated from college, my residents and fellows are graduating in about 2 weeks, and all of our residents passed the Awfully Big Radiology exam last week in Louisville.

In honor of all these graduates, I thought I'd share another batch of medical malaprops. Again, these are courtesy of a good friend who is also my personal mole in the world of medical transcription.

The patient was hypomagnasemic, hypomagnasemic; he had a low magnesium.

Diagnoses include potassiumemanemia.

No evidence of stereoagnosis or graphesthesia in both stereognosis, no evidence of stereoagnosis, graphesthesias, and, or rather graphesthesia or graphesthesia, I should say, in the upper and lower extremities.

The patient was not able to visually see her family member; however, she had on her husband’s glasses, which could explain why she was not able to see.

The uterus was entered in the midline, extended laterally with a Band-Aid.

Hypopharynx and laryngeal exam is entirely normal today and she has absolutely beautiful mucosa.

The patient’s activity prior to the event was over-extending: trying to clean snow in the cold weather.

The patient is wondering whether he might have a personality disorder like a borderline personality disorder.

Her last colonoscopy was in the year 703.

She was voiding satisfactorily upon discharge and was passing grass.

Review of systems was unavoidable due to mental status changes.

The patient may have a subtle torus fracture of the distal radius. The family was contacted. They were placed in a metal splint.

The lesion is essentially necrotic and melodious (malodorous).

X-rays of both knees show moderately severe osteoarthritis with joint space narrowing medially -- mild -- with -- with moderate joint space mediately -- moderate medial joint space me -- - ahh -- narrowing bilaterally.

Chief Complaint: Airway in the foreign body

HPI: The patient is a 62 y/o right-handed gentleman. FAMILY HISTORY: The patient has a 60 y/o twin.

Complications: None from procedures but ultimately, death.

Impression: Fat-containing ventral hernias. Findings discussed with Dr. Hernia.

Intermittent Leftness of His Numb Hand

Even radiologists have to periodically relive the old story of John Henry vs. the Steam Drill.

My personal steam drill is the voice recognition system I use to dictate my reports. What it achieves in efficiency it lacks in even rudimentary human common sense. The dictation software is not the only thing lacking common sense. The humans who compiled its expensive "medical" dictionary option put in zillions of highly inappropriate words. It is unlikely that I will ever use "Microsoft", "Mickey Mouse" or "Godzilla" in an X-ray report, yet they visit my dictations all too often. I really miss John Henry.

I have a good friend who is a medical transcriptionist. Annually she and her plural of transcriptionists assemble months of medical malaprops into a canonical collection that they share with the rest of the hospital. She was kind enough to pass these on to me.

The patient's first name is Margaret, with an M, like in Margaret.

Complains of intermittent leftness of his numb hand.

Complains of some difficulty breathing for the last couple of hours with some shortness of breath which she says is only present when she breathes.

Recommendations: I have told the patient if she has another seizure and becomes unconscious, she is to call 911 immediately

The lower extremity was then carefully moved with the patient to the bed maintaining abduction and neutral rotation.

He normally will blink his eyes to say "yes" and will frown to say "no", but that is the extent of his verbal abilities.

Delightful elderly gentleman (56 y/o)

Conscious sedation was delivered by a registered nurse during conscious sedation.

Neosporin to his buttocks, 1 PO bid

The patient has evidence of a limping date. (gait)

Patient had circumcision in 1998 secondary to recurrent otitis. (balanitis)

She will have a blood taste today. (test)

The patient’s urine put-put was adequate. (out-put)