3. Texting 101 - so little to learn yet much to gain!

If the pen is mightier than the sword... the keyboard is a machine gun!

For a doctor, the computer is for the most part a tool to put information into text format. You are not drawing pictures of your patients and you're not creating 3D models with CAD. You are writing requests, letters, notes etc.

Remember, 50% of doctors' time is spent at the computer and so the one most important investment you can do for increased productivity is to master your texting skills. The faster you write the more productive you are and thus effective in patient work and administration. I have devoted a special post about why I think doctors, especially emergency physicians, should stop dictating text via secretaries and write notes themselves - there's more to it than meets the eye.

Not only will your medical work be easier but also many of your everyday tasks, these are a few examples:
  • Being able to quickly write notes is a lucrative skill. For example you can instantly write down ideas, thoughts or learning points, sometimes called 'brain emptying'.
  • Handling email is so much easier if one can write quickly, correspondence is immediate and thus the inbox isn't cluttered, full of unattended mail. Communications are done instantly instead of being procrastinated.
  • Instead of going home frustrated after last night shift, more chaotic than ever before, you can in a few minutes write a brief report to your chief and hope that it will lead to changes.
Learning to be a 'fast texter' will open a whole dimension of new opportunities for you.

It is a common misunderstanding that only some can learn to write fast. That is simply not true - if you just learn the basics and train some, you'll be fast and furious after only 2-3 days of training!

I've said this before but it's too important to say only once... the idea is not only to write fast but to let your mind flow without interruptions, in the case of writing to keep your eyes focused on the screen and fingers fixed on the keyboard. Undistracted,  your train of thoughts will be much easier to catch and put into words.


Touch typing

Let's say you're an average Joe, writing at a speed of 19 words per minute (see below), and that notes, medical letters etc. require you to write 2.500 words in an 8 hour shift.

19wpm means 132 minutes spent just writing, that's 28% of your 8h shift. Add to that the before mentioned clutter of moving the mouse pointer, picking, selecting and moving around windows and you're up to at least 3 hours, 37.5% of your working hours. Madness!

Then let's say you've trained your writing skills to reach 65wpm, now you're down to 38 minutes - 8% of your shift, a difference of 94 minutes - now that's a lot of coffee breaks, time with your patients or glimpsing the literature for more efficient patient care. I will not go into a cost analysis of this shocking reality for world wide health care...

Typing speed for various scenarios, words per minute (wpm)
  • Stephen Hawkins 15
  • Average computer user 19
  • Moderate training (touch typing) 40
  • Professional typist 80-120
  • My personal record 95
  • Audiobook read out 150-160
  • World record 216
There are many factors to account for while measuring typing speeds such as ergonomics (eg. sitting upright), keyboard quality and type (QWERTY, DVORAK), language, composition vs. transcription etc. The numbers above do not account for error rates which obviously are equally important.

TypeRacer What stands out is that learning touch typing is the best way to improve your writing speed. It is a technique every doctor should be trained to master. Fortunately the younger generation has learned it at school but there are still millions out there picking the keyboard with two fingers. With touch typing you have your eyes on the screen all the time and thus not only type faster but also correct errors instantly. Touch typing can be learned with some training in only 2-3days and nowadays is easily learned with online websites providing tutorials and free training (see links below).

Touch typing can easily be learned and trained in just a few days. TypeRacer, is an excellent starting point for you to try out your writing skills, I was very happy with my 81wpm until I saw I was being  slaughtered by keyboard ninjas on steroids, that SMS generation is hard to beat!

After-effects

TypeRacer While typing you will change your mind more often than you like to think. Words and even whole sentences need to be moved or corrected. We're human after all.

All this should be done without the mouse so that you don't waste your time and interrupt the creativity of your right brain. Hands on keyboard all the time! For that you'll need to learn more shortcuts for editing text.

To summarize:
  • ctrl+x: cut
  • ctrl+c: copy
  • ctrl+v: paste
  • ctrl+z: undo
  • ctrl+y: redo
  • ctrl+arrows to move cursor between words or sentences
  • ctrl+end/home to move cursor towards end/home of document
  • shift - while moving cursor to select text
  • ctrl+a: select all text
  • ctrl+b: bold
  • ctrl+i: italic
  • ctrl+u: underline

For Mac users, most of these shortcuts will work if you just swap Ctrl with command (Cmd). Congratulations, you're a keyboard Jedi!

Dictating and transcribing text

As mentioned above we speak out ca. 150 words per minute, considerably faster than writing. Dictating text is thus very favorable for busy doctors and maybe explains why so many are reluctant to writing their own notes. Until now, transcribing dictated text in real-time, on the computer screen, hasn't been an option but speech recognition (SR) technology is changing very fast.

The Chrome browser has supported SR since 2011 and is supported by HTML5 (the DNA of the web) - yet another reason to have an Android instead of Apple. Thus we should expect to see VR as a standard input choice in the very near future. The current choices available make use of Chrome's built in VR engine and do this flawlessly.

TalkTyper

http://talktyper.com
This awesome website is exactly what it's name says: you talk to it and it types your text. You can select your input language - unfortunately it lacks support for mine, Icelandic and Swedish... but all major languages are supported. Now that Android supports even the smaller languages I'd expect these to come to browser level very soon.

TalkTyper is smart, if it doesn't transcribe correctly you can easily choose alternate, similar transcriptions with a button.

As you speak along a text box is filled and you can easily move it to a bigger box for convenience and with one button click copy that text to clipboard, to paste it somewhere else, e.g. your email.

I keep TalkTyper in my bookmarks to be always at hand.

Chrome plugin

As said earlier, VR is built into Chrome but is not activated by default. This plugin will do that for you in all smaller text input fields so that you can use VR wherever you are typing text.

There is unfortunately a major flaw with VR in Chrome - it is not allowed (yet?!) for bigger text boxes. I haven't found any good explanation for this but I guess Google has decided that VR is not ready for prime time - they're known for having a looooong beta period for their apps.

Dictating bedside - the future for doctors?

VR has become an option on all of today's smartphones whether it's iPhone, Android or Windows Mobile but despite it's potential it hasn't caught so much attention. Everyone knows Siri the human robot but fewer know that text can nowadays be entered easily anywhere by VR. Extremely handy for writing emails or short messages on the run.

Accuracy, language support and personal learning are being improvised for each OS release. My Android has a microphone button in the keyboard panel so that wherever I'm typin that with time learns tog text I have the option to dictate it instead.

There are also 3rd party apps to do the same work, even better than the built-in ones. There is some difference in quality so if you're serious about using VR you should review the apps available. The Dragon Dictation app is commonly mentioned as a high quality app.

Dictation can be done without a keyboard and is thus a great option for those 'on the run' or with hands-free. Or... you can create text while standing besides the patient, a technique I'm evolving personally - it saves me time as the patient hears me review their story and can correct me instantly if I've misunderstood some part of the history.

Optical character recognition (OCR)

I once had an elderly patient from Serbia coming in the middle of the night to the ED and he didn't speak the native language. He had a saturation of 90% and his whole family with him and the situation was a little tense as nobody spoke my language... Things didn't get much better when they showed me some 5 pages of medical letters from his docs in Serbia - to me it was just more of alien information. Until I had an idea and typed the text into Google Translate (this was 2010, Translate was then pretty new stuff!). With a somewhat blurred translation I found out he had right heart- and kidney failure and that made the situation a little easier to manage.

Today, instead of typing the foreign text I use my phone camera and take a photo one page at a time and then run that image through an online OCR tool to get the text in digital format to enter into Google Translate.

Remember OCR when you have text on paper which you want to have in digital format, it will save you lots of time. Another clinical scenario - when your institution has disabled the copy & paste function and you need to grab a document's text...

See also