I always loved to type. It started in high school with typing class. We were told that typing was critical for college term papers. I liked it so much that I took advanced typing. It was myself and 12 girls with Farrah Fawcett hair. Heaven.
Fast forward to 2011. My interface with the medical record is my fingers. Most of my communication flows through my hands. I complete the core of my documentation in the exam room. Fast documentation of information at the outset of an encounter allows for meaningful, eye-to-eye dialog during the latter part of the visit.
Those who can’t type have a different experience with their EHR. Sure there’s voice recognition but when pressed they wish they could make a sentence instantly flow onto the screen. Two colleagues this week, one from Barbados and another from the UK, shared difficulty with our American-centric voice recognition software. This technology will improve, however. But beyond EHR there’s email, manuscripts, this blog and the shortlist of real-time social applications that demand typing.
For now the keyboard is my gateway to the world. Typing is arguably the most important skill in how efficiently I work. Perhaps this should be a medical school prerequisite.
My high school graduation gift was a Smith Corona typewriter. My parents had no idea.
And check out this brilliant study by Dr. Wes which suggests that keyboarding skills among physicians are inversely related to age.
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I still remember my typing teacher, Mr. Clayton and memorizing the placement of our hands on the these keys – asdfjkl;. We repeated typing that sequence until our fingers were strong. Some forty (ahem!) years later the sounds of fingers flying across a keyboard is still wonderful. I hope that listening to words taking flight, in medicine, in science and in all things good, will always be a joyful noise.
Thanks for such a neat post!
Jody
(sharp clicking of ruler on desk) f-d-s-a j-k-l-semi
Then sharp clicking of the ruler on my hands when I was out of place. Those were the days.
Bryan, I’m nodding my head.
My parents forced me to take typing in high school. It was a huge fight (I wasn’t able to take drafting and I was all fired up). I have said many times that it was my most important class in high school. My mother’s intuition at work again.
When we introduced EPIC into our clinic nearly 5 years ago, my level (and area) of frustration while learning to thrive in an EMR were very different than my partner who was finger picking at the keyboard in our shared office. I think I was worried about higher level roadblocks. I was lucky. He has been in practice for 17 more years.
Thing is, we don’t have to teach typing in med school. Students entering training now are not digital natives, and certainly not keyboard natives. Growing up with email, Facebook, and a cell phone have provided med school prereq #1. Right?
Probably right if you look at Wes’ curve…but it sure makes a pressing point to suggest that typing should be required to be a doc.
Thank you so much, I am sharing this on my twitter as well!!
This is a great post that also touches on a subtle aspect of the generational resistance to new technologies (such as social media) within traditional medical settings – the gendering of the keyboard. It’s no surprise that you were the only guy in the room with the 12 Farrah Fawcett lookalikes, as those classes were historically for tracking girls to become secretaries. I’ve heard countless stories of older male doctors who refuse to email, instead hand-writing notes that they give to their female secretaries to type up and send. But this gendering is completely changing with the born-digitals, for whom being male or female has no bearing on whether or how well they use their keyboards. They are truly ‘born-digital’ in both senses of the word – intuitively attuned to digital media, and intuitively skilled at using their ‘digits’!
I have always said that typing was the most beneficial class I took in High School. I was lucky and there were no rulers in our classroom; we typed on manual typewriters in time with classical music.
I think good preparation is key to a positive experience. Many of the things that frustrate us are the things we aren’t prepared for or don’t understand. If typing skills were a given, might EHR meet with less resistance?
I would also add that it’s never too late to improve typing skills. I learned to touch type my numbers about three years ago when I stopped using a keyboard with a numeric keypad.
So true! As a woman of a certain age (cough), only girls took typing in high schools. Thus, my male colleagues (of a certain age) are greatly impaired by the EHR – probably younger ones who had their term papers typed for them also are the ones staying the latest.
Perhaps remedial typing should be offered as a pre-entry course for deficient students — similar to those who get accepted but are known to be at high academic risk and are required to take a few weeks of early courses. (Maybe those who have crappy interpersonal skills could be identified and likewise be remediated since we continue to admit them and release them on the world unchanged.)
I don’t have found memories of my high school typing class. During college I traded sunglasses, my parents owned a sunglass company, for typed term papers. Both those who typed and I found this to be mutually satisfying.
It was only when I began graduate school did I learn to type for myself.
Now that I have a keyboard attached to my hip, Dysgraphia, a learning challenge that impacts handwriting no longer impacts my life. The only downside is that I can’t do my Marcus Welby impression anymore.
There is hope for us old guys. Thank God I did learn how to type in high school even though the utility of this has just become apparent as our group has deployed an EHR. Of the 4 senior docs in our group, I am the only one who can type. My other 3 older partners are using Dragon, but we have already had a couple of our referring docs call to say that they don’t know what Dr. X, Y, and Z was talking about in the faxed, EHR generated consult letter. I don’t know. Technology continues to move at a lightning pace. I think one needs to type at least 40 words a minute without errors in order to effectively use an EHR. Thanks for the post.
I agree that typing is a very important skill that even old doctors should train themselves to be good at but I disagree with the implication that the lack of typing skills has much to do with the usability of EMRs. Most of the time lost in the documenting aspect of EMRs is not due to how fast I can type but the time spent switching between windows, clicking through Navigators (looking at you Epic and Nextgen), tabbing through option boxes, scrolling through drop-down menus, clicking check boxes etc. Many EMR don’t even have a single text field to type in, but have things broken up in to multiple sections and some even go so far as to want each complaint and diagnosis in a separate field. Even tabbing through these fields, if your EMR/VPN/PC combination even recognizes the tabbing, takes up much more time than just free typing in one field. This gives poorly designed EMRs another pass while incorrectly shifting the blame to “luddite” physicians.
Also, while being able to type fast is helpful, if that’s all you’re doing you should look into some force multipliers. For example, while I can free type at 80 wpm, with a text macro program, I can do several hundreds of words a minute in an actual in-front-of-the-patient clinical situation. While some look down on those who can’t type, I look down, gently, on those who only type. And I bet there are other tricks out there that I have yet to learn.
With regards to older physicians who have not learned to type, I don’t think we should waste much time on that issue. To paraphrase Steve Jobs, those who don’t know how to type will all die out eventually.