Dictate the follow-up letter while the patient gets dressed and the injection note straight after the procedure. Without sending anything online, Dictadoc checks the joint terms it is unsure of and, if you turn it on, writes bloods and doses as numbers.
A rheumatology day mixes long consultations, ultrasound and procedures. Each one leaves a document, usually for the GP, sometimes for the surgeon or the physiotherapist.
The new patient letter
The pain history and its pattern through the day, the joint and spinal examination, bloods, imaging and the working diagnosis. It is the longest letter, and the GP who referred the patient is waiting for your reply.
The inflammatory arthritis follow-up letter
Tender and swollen joints, CRP, how the disease-modifying drug is tolerated, and the decision. It comes back at every appointment for years, with figures and doses that have to be right.
The joint injection or aspiration note
The joint, ultrasound guidance if used, what was injected, the appearance of the fluid and the aftercare advice. A few lines that ought to be written before the next patient walks in.
The musculoskeletal ultrasound report
Effusion, synovitis, Doppler signal, tendons and entheses, described joint by joint. It goes with a clinic letter, or on its own to the clinician who requested it.
Day to day
What slows down your rheumatology letters
Joint terms to correct
Today
Enthesopathy, trapeziometacarpal, adhesive capsulitis, sacroiliac: general speech recognition can garble all of these. Every letter gets read word by word, and the error that slips through ends up with the GP.
With Dictadoc
When the engine hesitates over a word, Dictadoc compares it with a medical vocabulary in which joints, spine and bone take up the most room: synovitis, spondyloarthritis, morning stiffness, osteoporosis. A word heard clearly is never changed.
Medical vocabulary check
CRP and doses that must be right
Today
Following rheumatoid arthritis or spondyloarthritis means a string of figures: CRP, ESR, steroid dose. Dictated, they come out in words or in digits depending on the tool, and a dose gets checked twice before the letter goes.
With Dictadoc
With "Numbers, units and dosages" on, "CRP twenty-four milligrams per litre" is written "CRP 24 mg/L" and "twenty milligrams once a week" becomes "20 mg once a week". A number with no unit stays in words, and Dictadoc checks no dose.
Numbers, units and dosages
The procedure note left until the end of clinic
Today
After an injection, you take off your gloves, reopen the record and type the joint, the drug and the aftercare advice. The next patient is waiting, so the note gets put off until the end of clinic.
With Dictadoc
Turn on the dictation key. With the record open, press it once, dictate the procedure and the advice, then press it again. The key responds even when Dictadoc sits behind your clinical software, and once Dictadoc is allowed to type into other applications, the text lands in the record where you had clicked.
Dictation key
Text typed into the field
Dictation example
A rheumatoid arthritis follow-up letter
Clinic review for a flare of rheumatoid arthritis.
What you say
Reviewed for a flare of her rheumatoid arthritis [full stop] hand pain waking her at night [comma] with prolonged morning stiffness [full stop][new paragraph] on examination [comma] synovitis of the left wrist and the second and third right metacarpophalangeal joints [full stop][new paragraph] CRP twenty-four milligrams per litre [comma] ESR forty millimetres per hour [full stop][new paragraph] impression [colon] active inflammatory disease despite methotrexate [full stop][new line] intramuscular methylprednisolone one hundred and twenty milligrams given today [full stop][new line] methotrexate increased to twenty milligrams once a week [full stop][new line] review in six weeks [open parenthesis] biologic therapy to be discussed if still active [close parenthesis][full stop]
What Dictadoc writes
Reviewed for a flare of her rheumatoid arthritis. Hand pain waking her at night, with prolonged morning stiffness.
On examination, synovitis of the left wrist and the second and third right metacarpophalangeal joints.
CRP 24 mg/L, ESR 40 mm/h.
Impression: active inflammatory disease despite methotrexate.
Intramuscular methylprednisolone 120 mg given today.
Methotrexate increased to 20 mg once a week.
Review in six weeks (biologic therapy to be discussed if still active).
The words in brackets are commands. Dictadoc replaces them with punctuation and line breaks.
With the "Numbers, units and dosages" setting turned on.
The settings list every command for your language.
Privacy
What you dictate stays on your computer
Transcribed on your computer
Your computer transcribes your voice itself. Nothing you dictate is sent over the internet.
Erased on quit, if you want
Choose to keep nothing, and reports and recordings are erased when you quit Dictadoc.
Encrypted on your disk
The reports you keep stay in an encrypted database whose key is held by your system keychain.
For a group practice
Dictadoc Server transcribes for every workstation in the practice from one computer. Workstations need neither a graphics card nor internet access.
Which rheumatology terms and drugs does Dictadoc know?
Its medical vocabulary holds about 250 terms, mostly joints, spine, bone and soft tissue: osteoarthritis, synovitis, enthesopathy, osteoporosis, carpal tunnel syndrome. Its rheumatology drug list, with COSENTYX or SIMPONI, works only when you dictate in French. In English, add the disease-modifying drugs and biologics you prescribe to your vocabulary. Disease activity scores are not covered.
Are dosing frequencies written as numbers?
In part. Once "Numbers, units and dosages" is on, "three times a day" becomes "3 times a day". "Once a week", on the other hand, stays in words, like a count of swollen joints. Dictadoc neither checks nor calculates a dose: it is not a medical device.
Can I dictate during an ultrasound with the probe in my hand?
You need one hand free. A press on your dictation key starts recording and another sends it, and Dictadoc does not start at the sound of your voice. From the floating panel, you can pause between two joints and carry on in the same report.
Can my colleagues read my reports in Dictadoc?
No. Dictadoc does not share reports between colleagues: each one stays on the computer where it was dictated, and a licence covers one computer. The text reaches the shared record when you copy it or have it written into your clinical software.
Do we need an internet connection in clinic?
Once, to activate the licence and download a transcription model. After that, everything happens on your computer: the dictation, its transcription and your corrections never leave it.
Install the app on Mac or Windows, buy a licence, then enter the key you receive by email in Dictadoc. The licence year starts on the day you activate it.
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