Can You Spell That?

Showing my age a bit, I remember when we used corded phones. Heck, I can recall when the sound of ringing at the other end was actually bell-like and varied depending on who you were calling, rather than the universal computerized sound effect that replaced it. (And yes, I even remember sharing ‘party lines’ with neighbors, lest someone ask.)

As digital replaced analog, cordless replaced corded, and finally cell phones replaced landlines, there was progressive loss of sound quality. Sometimes it stood out more than others. For instance when my old-timey answering machines migrated from cassette-tapes to digital recordings, it got a lot easier to be misunderstood, and oft impossible to convey subtle inflection.

Still, more was gained than lost by this “progress,” at least in the eyes of the Powers That Be, and while I’m sure one could still scour the Earth to find actual analog devices instead of the ubiquitous digital ones, I’m not so sure the infrastructure still exists to faithfully support it. Bottom line is that, short of in person, we don’t seem to be communicating as clearly as we used to.

I’m not even talking about voice recognition software; God knows I’ve pummeled that dead horse in this column previously, and I’ll probably flog it a few times more before all is said and done. No, I’m currently talking about actual phone conversations, whether with honest-to-goodness humans or machines pretending to take their place.

The machines you already know about and probably hate. They’re the ones that field your calls when you’re trying to get something resolved with your credit card, utility company, or airline. They replaced the already annoying touchtone maze (“press 1 for English,” “press 2 to make a payment,” etc.) with a voice rec bot that claims to understand whatever you want to say: “In a few words, please tell me the nature of your problem,” invariably followed by “I’m sorry, I didn’t understand that. Please try again.”

The humans have other issues. Sooner or later, you’re having to convey to them (or them to you) proper nouns, numbers, or other things that need to be accurately written or entered into a computer. And, whether in an effort to be super careful or because our phone connections have gotten sufficiently lousy that actual incomprehension results, that means it’s time to play spelling bee.

Names, account numbers, addresses, phone numbers, and emails are more than enough sources of hassle. Believe it or not, in hunting for my now current home, the names of my potential streets and towns were factors, since I hoped to avoid spending subsequent decades spelling them out to everyone. I shunned streets like Patchogue Road and towns like Aquebogue in favor of Mill Lane and Centerport. Doesn’t matter, though; my simply named place prompts plenty of spelling anyway.

Lucky us, we’re in health care, where far more has to be documented, and at both ends of the conversation. That means, for instance on a call to convey imaging results to a clinician, they need to spell our name, and we need to spell theirs. Also potentially the patient’s, and/or the patient’s medical record number.

Then, there’s the details. For instance, when you’re trying to call in an abnormal imaging study but wind up with a nurse running interference for the patient’s doc. The nurse has no idea what specific info the doc might want, so wants to get everything of possible relevance from you. S/he won’t necessarily understand everything you’ve got to say…and if you try to cut through it by saying, “Look, all the details are in my signed report which is already on the EMR,” you’re not fully “discussing” the case to justify your subsequent documentation that did so.

So you get to spell out things like what percentage you estimated the pneumothorax to have been, the current size of the abscess being followed, and medical terms that the nurse might not quite remember but feels the need to convey, like “glioblastoma” or “sternocleidomastoid.”

As if all that wasn’t enough, even the individual letters and numbers can come across as less-than-crisply on a typical phone connection, to say nothing of the recipient paying less than 100% attention. Or the recipient is in a busy ER, or has a TV on in the background. Was that a D or a B? Did you say 13 or 30?

Some clever monkey instituted a mandatory readback policy, whereby the recipient had to repeat the information back to prove it had been understood correctly. And, if the recipient didn’t do this of his own accord, the caller was in the uncomfortable position of asking for the readback, much as a schoolmarm might of a troublesome student to ensure instructions had been comprehended. (And then, if readback was imperfect, time to re-spell everything.)

To say nothing of the aggravation value in all of this, there’s a real cost in terms of people’s time. Thus, an impact on productivity. The hassle factor won’t result in any changes; if it doesn’t annoy high-level administrators or regulators, they won’t see it as a problem. Productivity, however, might just get their attention.

I live in hope that, before my career is at an end, something along the lines of a written instant messaging system achieves a level of acceptance in the medicolegal world on par with verbal communication. Speedy, spelled out in the digital record (no more he-said/she-said as to what was discussed)…and no longer with the logistical trouble of getting both parties on the phone and able to speak at the same time.