Arthritis from typing

[Redpancreas]

I have been told I type loudly and now that I'm typing so many notes as an IM resident I notice at the end of the day my DP joints feel sore and I'm worried I may be developing early arthritis when I'm still in my 20s and this shouldn't be happening. Anyone else have this?

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[chessknt]

In b4 dictate

 

[rokshana]

I have been told I type loudly and now that I'm typing so many notes as an IM resident I notice at the end of the day my DP joints feel sore and I'm worried I may be developing early arthritis when I'm still in my 20s and this shouldn't be happening. Anyone else have this?

Why are you typing? Do you not have dragon?

 

[Redpancreas]

Why are you typing? Do you not have dragon?

I've never seen myself as a dictator. I feel like the work it would take speak correctly the first time would be enormous enough on top of going in and typing in the mistakes anyways. Attendings can do it because I feel their notes don't have to say as much if they have fellows/residents writing the major components.

 

[ortnakas]

Don’t press as hard on the keys?

 

[chessknt]

I've never seen myself as a dictator. I feel like the work it would take speak correctly the first time would be enormous enough on top of going in and typing in the mistakes anyways. Attendings can do it because I feel their notes don't have to say as much if they have fellows/residents writing the major components.

It is a skill that takes time to learn, might as well start now.

If I am totally honest though I still type vast majority of my notes. I will dictate some things (procedure notes if I dont have a usable template for whatever reason) and went through a dictating phase but still find I prefer typing my notes because of the way it helps me lay out problems. I dont have joint pain when I type however which would probably prompt me to switch over.

 

[Gastrapathy]

So…first of all…no one reads your notes, except maybe the ID fellow and she won’t trust you anyway. The only part that matters is the A&P. If you’re on epic, get better smart phrases and use the autocorrect effectively. You should be more stenographer than typist. And…just write less

 

[chessknt]

So…first of all…no one reads your notes, except maybe the ID fellow and she won’t trust you anyway. The only part that matters is the A&P. If you’re on epic, get better smart phrases and use the autocorrect effectively. You should be more stenographer than typist. And…just write less

The plaintiff's medical expert witness will also read your notes....

 

[rokshana]

So…first of all…no one reads your notes, except maybe the ID fellow and she won’t trust you anyway. The only part that matters is the A&P. If you’re on epic, get better smart phrases and use the autocorrect effectively. You should be more stenographer than typist. And…just write less

He is an intern…other than the Med student, his should be the longest note.

trust me, learn now how to use dragon because this will be the time you have the least number of notes to do…

dragon is talk to text so you can see what you are saying… I’m terrible at dictating the old way… ramble when I can’t see what I’m saying… dragon 🐉 is the only way you will eventually be able to do 20-30 notes a day as a pcp or hospitalist

 

[Animalcules]

I doubt that you are developing arthritis from typing. You may be developing arthritis and it is aggravated by typing. Go see a rheumatologist.

 

[chessknt]

I doubt that you are developing arthritis from typing. You may be developing arthritis and it is aggravated by typing. Go see a rheumatologist.

Don't do this until you get a personal disability policy--if they discover a real disease youll be totally screwed.

 

[Crayola227]

Don't do this until you get a personal disability policy--if they discover a real disease youll be totally screwed.

110% this. Get a good own occupation policy. Unfortunately what you can get as a resident almost isn't worth it. Much better as an attending.

 

[Crayola227]

Even with the pain, highly doubtful to be osteoarthritis if that's what you mean. The cartilage and all that jazz in there is probably still fine.

That said, overuse injuries of all kinds can pop up just about anytime, quickly, and be next to impossible to get better without a total break from the inciting activity (and even then, maybe never).

Not as medical advice, but I highly advise all physicians but especially med students and residents (before having excellent own occupation disability insurance) to essentially drop everything and pull out all the stops the minute something like it rears it head. Something like this getting out of control in med school or residency can easily end your career before it even starts. Don't think it can't.

Start taking steps to get this under control. If that means more time to start mastering Dragon or even paying out of pocket for it, do it. Look into getting a more friendly keyboard, and lug it around and plug it in as you need to for whatever you're gonna have to do on a keyboard anyway.

Don't ever do less than the minimum required of your notes by your program or from a medicolegal perspective, that said, learn what is and work toward that absolute bare minimum.

Ditto making love to your EHR system and learn it inside and out, improve your templates and dotphrases. If it takes you time after work, do it. If you have to go in on your day off to an appt with one of the technicians to get your templates and dot phrases even better, do it.

I can't give you medical advice or tell you not to see a doc about this. I personally would start reading everything I can online about this problem and trying solutions. I would self treat with ice and perhaps NSAIDs in addition to looking for PT type solutions online.

Your hands may just toughen up with time, or you could just develop some sort of poorly understood chronic pain condition and lose not only your livelihood, end up in poverty, but also the ability to write more than a paragraph at a time or braid your child's hair or make your baby the baby blanket you always dreamed of, or even to masturbate. Do what you can now if there is any way to prevent any of the latter. Trust me on this.

 

[VA Hopeful Dr]

He is an intern…other than the Med student, his should be the longest note.

trust me, learn now how to use dragon because this will be the time you have the least number of notes to do…

dragon is talk to text so you can see what you are saying… I’m terrible at dictating the old way… ramble when I can’t see what I’m saying… dragon 🐉 is the only way you will eventually be able to do 20-30 notes a day as a pcp or hospitalist

Nonsense. I type 100% of my notes as a PCP seeing 25+.

Trick is, as was previously mentioned, learn to use the EMR better. We have epic and I have tons of dot phrases, macros, plus my notes are fairly succinct.

 

[NITRAS]

He is an intern…other than the Med student, his should be the longest note.

trust me, learn now how to use dragon because this will be the time you have the least number of notes to do…

dragon is talk to text so you can see what you are saying… I’m terrible at dictating the old way… ramble when I can’t see what I’m saying… dragon 🐉 is the only way you will eventually be able to do 20-30 notes a day as a pcp or hospitalist

I would kill for a real transcriptionist. But it is a thing of the past. Way easier and faster if the person on the other line has a brain. Sure I’ve apologized to the person on the other end of the recording and probably made them laugh.

My mmodal wasn’t working yesterday. . . . . I just was unhappy.

 

[Gastrapathy]

@rokshana I think we’re teaching the wrong message here. Quality over quantity. Intern notes that sound like a kindergartner telling a story (and then and then and then) are useless. We need to teach how to be succinct and communicate the relevant information. Length is a crutch for not knowing what matters.

 

[Gastrapathy]

The plaintiff's medical expert witness will also read your notes....

If that’s how you want to practice, so be it. I don’t think there’s any RCT showing long notes prevent lawsuits. The more you write, the more there is to pick apart.

 

[chessknt]

If that’s how you want to practice, so be it. I don’t think there’s any RCT showing long notes prevent lawsuits. The more you write, the more there is to pick apart.

It’s more that notes that are too short provide no defense. One dudette in my practice writes about 100 word total a/p for a critically ill patient and I wouldn’t want to have that as my sole defense in court. I always wrote out my reasoning, Ddx and sometimes reasons why I didn’t do things. It helps insurance not deny the bill too. But I dont write intern paragraphs

 

[Gastrapathy]

^exactly. You don’t read them either I bet

 

[rokshana]

@rokshana I think we’re teaching the wrong message here. Quality over quantity. Intern notes that sound like a kindergartner telling a story (and then and then and then) are useless. We need to teach how to be succinct and communicate the relevant information. Length is a crutch for not knowing what matters.

No that’s true! I was taught ( written notes!) that my H&P should be no longer than 1 pg back and front.
However I have seen some resident notes lately that are crap… cut and paste with none of their own thoughts.
An intern in July is just learning to write the appropriate note… if this was May, my expectations would be different.

 

[DrMetal]

I care more about my SDN posts than my notes. I'm likely to get arthritis from posting here.

 

[Redpancreas]

@rokshana I think we’re teaching the wrong message here. Quality over quantity. Intern notes that sound like a kindergartner telling a story (and then and then and then) are useless. We need to teach how to be succinct and communicate the relevant information. Length is a crutch for not knowing what matters.

This couldn't be more true. The quicker you learn to synthesize instead of report, the better off you are.

 

[rokshana]

This couldn't be more true. The quicker you learn to synthesize instead of report, the better off you are.

However, you can’t appropriately synthesized if you don’t know what you can omit ….have to learn the basics first… the fact that people want to leapfrog over things instead of learning from scratch is probably why there are such crappy notes that do nothing to inform other physicians are so prevalent… as a consultant that slugs through said crappy notes, it’s an issue…some are no better that the nursing notes…heck sometimes the nursing notes give me more information…

 

[Chads2]

I've never seen myself as a dictator.

But you’re a physician. Don’t others see you that way? 🙂

 

[Chads2]

@rokshana I think we’re teaching the wrong message here. Quality over quantity. Intern notes that sound like a kindergartner telling a story (and then and then and then) are useless.

I apologize for being the Attending king of snark, but I tell students and residents that the purpose of an H&P is to convince me that they are correct. It should be a leading story into your assessment and plan.

 

[Clean7795]

Dictating is a lot faster than typing unless you're able to type while you are seeing the patient in the room (which doesn't happen outside of outpatient settings). I'm not a slow typist either, I hit 100+ WPM but would prefer to dictate any day of the week.

There's a reason why radiologists and pathologists (whose pay partially depends on the speed of their report) all dictate and in the past used transcriptionists.

 

[CopaceticOne]

Dictating is a lot faster than typing unless you're able to type while you are seeing the patient in the room (which doesn't happen outside of outpatient settings). I'm not a slow typist either, I hit 100+ WPM but would prefer to dictate any day of the week.

There's a reason why radiologists and pathologists (whose pay partially depends on the speed of their report) all dictate and in the past used transcriptionists.

And when you get those lovely paper records only from your OSH trainwreck transfer, dictation is the only way to go.

 

[end stage fibro]

I've never seen myself as a dictator.

Did you see yourself getting arthritis in your 20s? L2dictate. It is by far the fastest for blocks of text

For a/p, you should have auto text for maybe 90% of what you're putting in there

I've heard of people with RSI using sweaters and gloves to keep their arms and hands warm. Makes sense to me but ymmv.

Also buy a bad ass keyboard like this:

ZSA Moonlander: Next-gen Ergonomics

An open-source keyboard for serious developers, creative professionals, and people who care deeply about their craft.

www.zsa.io