Medicine

Pet Peeve: Surgeons Who Can’t Type

They bother me more than they should. Surgeons who can’t type.

I’ve seen surgeons who are some seriously bad typers. They’re hunt-and-peck type typers who manage maybe 30 words per minute (WPM. find out yours!). I watch them trying to log onto the electronic record system. They squint at the monitors, double click the icon, direct the cursor to the username field, click, look down at their hands, hunt-and-peck for their seven-character username, look back up, find their mouse cursor again, direct it to the password field, click, look down at their hands, hunt-and-peck for their ten-character capitalized password — using the numberpad for numbers — look back up, find their mouse cursor again, direct it to the Login button, and click. All the while, I’m seething with impatience, resisting the temptation to enlighten them about the magic of the Tab and Enter buttons, restraining the urge to scold them about inefficiency.

Well, I guess it’s up to them, right? The typing speed gap is more generational than anything, and older surgeons were swept up into an unexpectedly digital world of healthcare when they were already busy operating with difficult schedules. It’s a valid explanation and excuse.

But at the same time, arghhhh!! You spend so much of your professional lives typing! Don’t you know that investing 10-20 hours to learn proper typing technique would save you far more time than that in the future? Add to that the annoyance of others or your own sense of ineffectiveness. Sure, you can dictate your op reports (the funniest speed talking exercise ever) and you can hire medical scribes, but aren’t you all about self-reliance?

You can’t tell me you don’t care enough to optimize. Your life is built upon the principle of optimizing your manual dexterity. You spend half your working hours practicing your techniques  actively figuring out how to better approach, dissect, and suture as you operate. Does that mentality simply not extend to typing because it’s a far more plebian skill?

You also can’t tell me it’s because you’re too old to learn new tricks. What about all the fancy new operating technologies? Barbed or looped sutures or whatever. LigaSure cautery/shear things and fancy Endoshear staplers. You’ve weathered the advent of laparoscopic techniques, which means you’ve started operating with your hands in different orientations (laparoscopic instruments all have 60-degree elbows) and with an inverted movement scheme (you mirror and invert all hand movements to move the instrument against the abdominal wall port as a fulcrum) and with a different head orientation. So, you’re telling me that you learned how to operate using a screen without ever looking down at your surgical field. That sure sounds like touch typing to me…

 

Hmm, I sound bitter, don’t I? It’s because I am.

However, I’m not bitter because because I’m a typing snob (but I totally am a typing snob; I type on a custom Dvorak layout I designed in 2010). I’m bitter because I feel like I have to fight for my speed.

Most people just type fast because they’ve typed a lot. I remember watching my friend — who was much faster than me — type by toggling the Capslock to capitalize instead of holding Shift. Another acquaintance — also faster than me — only uses two left hand fingers. It just feels unfair. On Qwerty, I can’t surpass 80 WPM because I’m wildly inaccurate on the many strange sequences of positions that qwerty demands. Thus, I spent an agonizing summer dismantling my typing habits and relearning an entirely foreign layout so I could code marginally more efficiently. Even then I’m only 100 WPM on Dvorak, about average for my demographic.

The story repeats in most other dexterous endeavors I have. On piano, sure I can play advanced pieces, but those flurries of notes just hide my blunders. Listen to me still missing notes while playing an easy piece and I won’t sound like a musician with 10,000 hours behind him at all. An average speedcuber can manage sub-13 seconds with only 81 algorithms. I haven’t passed sub-15 despite already compensating with knowing 500+ algorithms. Members in the cubing community actually know me as the shaky one-handed dude who’s, like, weirdly slow.

When we started surgery last month, the senior residents held a review workshop for knot-tying techniques. One resident very patiently taught me the one-handed technique using the standard “gun and karate chop” instructions that everyone else imitates with reasonable ease. It took me much longer. I repeatedly bugged her to show me again and again. I tried to take note of everything, even the details her hands executed mindlessly that she couldn’t articulate: what fingers were used to grip the suture, on which finger segments the suture rested, the angle of each wrist during each motion, what instant to release some tension to let the cord slip. I feel like I must know. I have to be so thoroughly comfortable in practice so when they are presented in the OR with different angles and obscured by oozing blood and blocked by retractors, my hands will still be able to execute those key details. That’s why that day of watching Dr. Saldinger operate was invaluable for me because he dictated the particular details that most surgeons just take for granted.

So, a summary: surgeons who can’t type bother me because I see that discrepancy between their typing and operating skills as a tangible injustice, that they can “just do” when playing surgeon. Effortlessly, naturally, thoughtlessly.

Obviously that’s not true. Every teaching surgeon I’ve met has been able to articulate their reasoning behind each of their refined operating nuances. No, my peevish annoyance is just my infantile reaction to that particular discipline where my deficits feel so tangibly limiting. I know my hands well, their strengths and scars and shakes and most especially their illusory dexterity. My reaction is so revealing; I’m just a mediocre typist and jealous non-surgeon, fuming and idly wishing that surgery came naturally to me.

Well, now what?

 

This is Part 2 of 3 posts about my stance on surgery.