Cabbage and the Antichrist

I’ve been giving the Antichrist, specifically the car accident variety, a lot of thought today.

On a report one of my coworkers edited today, our speech recognition program had translated a patient’s chief complaint of “I was in a car accident,” as “I was in a car antichrist.”

First question that springs to mind, of course, is “why would a medical program even KNOW the word ‘antichrist?’” I understand that thousands of words were programmed into these systems, and obviously that each individual word could be looked at critically to judge whether it deserved to take up space in the program’s vocabulary--how likely would it be for the word to appear in a medical report? So there will be a lot of superfluous words, words the system “knows” but will never likely use, in its vocabulary, as is true for most of us speakers of a language.

Still . . . . My computer desktop occasionally tells me that there are unused icons on my desktop, do I wish to dispose of them? I would think that, given what I understand to be the fact that speech recognition programs depend on complex mathematical probability models and so forth to make its decisions concerning “le mot juste” in any given context, after producing thousands of documents I would think the program would begin periodically purging itself of the clutter of thousands of words it never, ever uses, or so very rarely that it’s not worth holding onto, if only to avoid embarrassments like calling an accident an antichrist.

We are told that these speech rec systems “learn,” and it’s true, to some degree. But we are also supposedly able to “teach” them. One of my favorites from the medical world is CABG, the acronym for “coronary artery bypass graft.” That particular acronym appears in a significant percentage of reports I transcribe. Speech rec invariably (so far) reproduces it as “cabbage.” The way the system’s “learning” theoretically operates, if “cabbage” gets edited to “CABG” three consecutive times, the system will forget all about cabbage and stick strictly with the bypass. Unless there are a lot of medical transcriptionists out there who REALLY think the heart surgeon is talking about a coleslaw ingredient, the system just cannot grasp acronyms pronounced as words (CABG is pronounced cabbage. Nobody ever says C A B G--if they did, the system doubtlessly would get it).

But I still halfway expect to see, come March 17, a flurry of speech rec produced reports of ER visits all over the country concerning some poor wretch, maybe even the Antichrist, who choked on his “corned beef and CABG.”

Similarly, the same system that invariably spells “Advair Diskus” as “Advair Discus,” come track season or the Summer Olympics, start reproducing lines like, “The spectator unfortunately was hit by a flying Diskus.” “Discus” probably appears in medical reports with approximately the same frequency as “cabbage,” after all.

Getting back to the Antichrist, maybe it’s only that speech rec is developing an ego and wants to autograph its work once in a while.

Winchester Legs

Those of us involved in the brave new world of medical transcription, that is, editing of reports produced by speech recognition programs, probably should take some solace in the face of ever-diminishing income by the fact that we at least have our "no time to be anything but a machine" days lightened by the stream of what may loosely be termed "malapropisms" spewed out by the ever-creative speech rec.

Today was relatively boring on that front, I suppose, but I must admit that I chuckled at "Winchester legs" when I saw the term a line or two ahead of where I was in the audio (we're told by the geniuses who designed the programs that we should always be reading ahead of the audio, although they never present anything but vague reasons for that).  Sometimes I try to think ahead of the audio, try to guess in advance what speech rec "transcribes" actually might be.  For instance, if I see "at a band" or "had a van" in a list of medications, I'll know even before I hear the dictator say it that the drug in question is Ativan.  Speech rec NEVER gets Ativan.  I hesitate to say that the program has a personal problem with the medication, but sometimes I wonder.

It also never gets GERD, which seemingly just about every patient gets at one time or another.  If I see a blank in a list of diagnoses produced by speech rec, and if I were a gambling man, and if Las Vegas somehow offered odds, over the long term I would make a ton of money just by plugging "GERD" into the blank spaces.

It is almost unfair even to mention cabbage/CABG.  First thing we were all told is that speech rec "learns," that if it "hears" and mis-reproduces something 3 consecutive times and we correct it three consecutive times to the "right" word, the program will pick up on it and "learn."  Now, I type "CABG" (coronary artery bypass graft) probably 12,587 times, any given year; I doubt that I have EVER typed the word "cabbage" in a medical report--it's just not one of those things that ever comes up.  Nevertheless, despite all my teaching, speech rec persists in referring to an open heart surgery as a vegetable--and not even a particularly tasty vegetable.

It is EASY to make fun of some of what speech rec comes up with.  (I won't touch too much on "prepped and draped"--a phrase in almost every operative report ever dictated--coming up as "prepped and raped").  Sad thing is, though, back when I trained medical transcriptionists, some actual human beings, with actual brains and actual life experience and so on, would commit the same kinds of malapropisms.

Sometimes maybe we just let our "critical thinking" go to sleep or take the day off.

Oh, about those Winchester legs?  Don't count on taking them deer-hunting this year.  What the doc actually said was, "when I touched her legs" (nothing pornographic--the lady was just being seen for pain in her legs).

(And about the quote way up there, about "no time to be anything but a machine"?  That's from "Walden," H. D. Thoreau.  Credit where credit is due.)