Terry’s parrot died: adventures in voice recognition

Voice recognition programs can create novel interpretations

At medical school, I was told that all the radioisotopes used in Australia came from leucocytes. This was the first medical homophone I encountered — the lecturer meant “Lucas Heights” — and I have enjoyed coming across them ever since. The use of voice recognition software when dictating clinical letters has furnished many fine examples, such as the one I use for my title: an ingenious rendition of “teriparatide”.

Consultants’ letters should be educational and written not so they can be understood, but so they cannot be misunderstood (to paraphrase Quintilian). My referring doctors were, or could have been, introduced to novel treatments for rheumatoid arthritis — the use of “deep mud therapy” (DMARD therapy), music therapy with “the Liverpool band” (adalimumab), joint lubrication (“deep grease” the medication, rather than decrease it) and even rejuvenation with intra-articular injections of “highly erotic acid” (hyaluronic acid). They could have been introduced to hitherto unrecognised, but plausible, conditions — “shopping” headache (shocking), “show-grounds” syndrome (Sjögren’s), “chat-rooms” arthritis (Jaccoud’s) and “football finals” syndrome (Klippel-Feil).

Those homophones that convey a wrong meaning are important to correct, such as “disgusted” with her (discussed it), treatment I “hardly” approve of (heartily), “an acceptable” diarrhoea (unacceptable) and “40 nightly” injections (fortnightly). Others do not matter so much. There is no danger of “Cairo” arthropathy (cheiro-) or “boloney” amputation (below knee) being misunderstood, and such phrases as “a new creation of the left thigh” (enucleation of the left eye) are obviously nonsense.

Law breaking seems to be a pet subject of my voice recognition program. The man with subacromial bursitis became a “cyber criminal but a scientist”. I have seen “parole clerks” (pleural plaques) on a chest x-ray, and withdrawn “only criminals” (only 3 mL) from a knee. I have asked one patient to stop the “blackmail” (Plaquenil) and accused another of homicide — she had been “on the run” since her husband’s death (on her own).

Sometimes the names of unknown contemporaries pop up in my letters: “Stewart Pini” (osteopenia) and “MP Gerald” (epidural), for example. Other names come from classical times, such as “son of Acme” (synovectomy), “Alex Rigidus” (hallux rigidus), and “ears and Ophelia” (eosinophilia). The monarchy, too, may be involved, with “Princess Anne” (prazocin), “Camilla ride” (amiloride) and the “cognitive Royal” (cod-liver oil). Was it he who experienced frequent attacks of “doubt” (gout)?

The voice recognition program can easily be trained never to make the same mistake again, but occasionally it is difficult. The only way I could get the machine to type “T-score” rather than “Peace Corps” was to remove the word “peace” from its vocabulary. Fortunately, or unfortunately, it is a word I seldom require in medical practice, although there is a hint of tranquillity in the use of a “fireside” diuretic (thiazide).

Stephen Fry1 recommended the use of voice recognition as a last resort for poets with writer’s block. I can vouch for its effectiveness: reference to meningomyelocoele conjured up the image of a swashbuckling sword fight (“ninja mild steel”), and the prosaic phrase “salbutamol and fluticasone” became the romantic “so beautiful and flew to Kosovo”.

The machine copes well when I have a cold and usually filters out extraneous noise. Once, when I was dictating at home, my Jack Russell terrier barked nearby and the machine typed “half bath”.

The homophones given here come from over a decade’s use of voice recognition. A colleague of mine has a disclaimer at the foot of his letterhead saying: “This letter has been created with a voice activated dictation program. There may be phrases that do not make logical sense …” While that may still happen to me from time to time if I am not vigilant, I would not dream of being without the help of voice recognition.