Three Little Words “In, And, On” and their use in Medical Transcription

(Excerpted from e-PERSPECTIVES, September 2009 by Linda Campbell)

Vera Pyle (1917 – 1998, regular columnist in The AAMT Newsletter) once commented that “in,” “and” and “on” caused more confusion than any complex medical term. (To this I would add “of.) The misuse of a little word is often a clue that a concept is misunderstood, even if on the whole these errors are not significant in the report and don’t change medical meaning. Little errors may be a sign that a significant piece of medical knowledge is missing.

Here are some actual errors made by both students and practitioners; insight offered as to why the student may have erred; and suggestions for teaching moments.

Correct: There was a contracture in flexion.
Error: There was a contracture and flexion.
Misperception: Flexion is an abnormality.
Teaching moment: The contracture is the abnormal finding. Flexion (toward the body) is simply the direction of the contracture. Hold your arm out in front of you. Bend it at the elbow to touch your forehead. That is flexion. A contracture is an abnormal position of a muscle, often caused by scarring. A contracture is either pulled toward the body (in flexion) or pulling away from the body (extension).

Correct: The left leg demonstrated a contracture and varus knee.
Error: The left leg demonstrated a contracture in varus knee.
Misperception: The patient has a contracture within the varus knee.
Teaching moment: There is a contracture causing the knee to turn out abnormally (varus knee, or bowed leg). A normal knee is aligned straight with the hip and ankle.
Using a rubber band, hold each end vertically (floor to ceiling) with the thumbs and pull taut. The top end represents the hip; the bottom end is the ankle. Using a free finger, gently pull the middle of the rubber band (the knee) to one side. This is how a contracture can affect the vertical alignment of the knee. If the knee is not aligned normally, it is either varus (bowed out, or bow-legged) or valgus (bowed in, or knock-kneed). A contracture can pull a knee out of proper alignment.

Correct: There was a sensation of a mass on abdominal examination.
Error: There was a sensational mass on abdominal examination.
Misperception: The doctor is using a colloquial English word in a medical way.
Teaching moment: Subjective words like sensational are seldom used in an objective examination. Objective findings on physical examination are described with precise terms: size, look, feel, consistency. Look up sensational in Merriam Webster‘s online dictionary (www.m-w.com). There are three entries listed. Do any of these really fit the description of a tumor?
1. Of or relating to sensation or the senses;
2. Arousing or tending to arouse (as by lurid details) a quick, intense, and usually superficial interest, curiosity, or emotional reaction;
3. Exceedingly or unexpectedly excellent or great; arousing or tending to arouse (as by lurid details) a quick, intense, and usually superficial interest, curiosity, or emotional reaction.

Correct: There was a pseudoaneurysm of the arteriovenous (AV) fistula.
Error: There was a pseudoaneurysm and the arteriovenous (AV fistula).
Misperception: An arteriovenous fistula is a disease condition.
Teaching moment: An arteriovenous fistula is surgically created when an artery is joined with a vein. It is not a disease. A novice may overlook the bigger picture: an arteriovenous fistula is created to facilitate dialysis. To clean the blood artificially, since the kidneys don’t work well enough, the technicians must have access to the blood so that they can hook up the “blood cleaner”—the dialysis machine. The blood vessel that blood is taken from must have a great deal of blood flow to make the process work efficiently. The best source of such blood flow is derived from an artery. The most common arteries used are the ones located in the arm and typically at the wrist. It is not safe or practical to stick an artery, particularly as frequently as needed for hemodialysis (typically 3 times per week). Thus, a means is needed to bridge between the high pressure and flow of the arterial system and the low pressure and slower flow of the venous system. A surgical procedure is performed wherein the surgeon links an artery and vein deliberately to form a junction where there ordinarily isn’t one (artery and vein joined surgically is called an arteriovenous fistula). The techs can now access the blood to hook up the dialysis machine and clean the blood of waste products (dialyze the patient).

Check our medical transcription dictation tips next month to learn more.

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