CONNECTING A SERIES OF INDEPENDENT CLAUSES:

You need to provide either a semicolon or a period to break these up. Medical dictation is very confusing as it is. Having lots of important clauses all connected together with only commas makes the medical document cumbersome (and the reader breathless). This is especially invaluable to the doctor who dictates the marathon sentence that can be five lines long. You need to provide clarity and distinction to such dictation. Remember, an independent clause contains both a subject and a verb.

EXAMPLE: The patient has abdominal distress, and he has pain in the right upper quadrant, and he also has a lot of epigastric distress, he finally sought medical attention after having had this pain for the last three days, and the pain became most intense yesterday.

SOLUTION: The patient has abdominal distress. He has pain in the right upper quadrant; he also has a lot of epigastric distress. He finally sought medical attention after having had this pain for the last three days. The pain became most intense yesterday.

CONNECTING SEPARATE ENTITIES:

Too many items are often run together. Separate symptoms, as well as areas of the body, need to have clarification and require a comma to break them up.

EXAMPLE: The patient has bloating belching gaseous distention dysphagia but has no evidence of an elevated temperature hollow feelings in his stomach vomiting nausea tenderness.

SOLUTION: The patient has bloating, belching, gaseous distention and dysphagia. He has had no evidence of an elevated temperature, hollow feelings in his stomach, vomiting, nausea or tenderness.

TWO- AND THREE-WORD MODIFIERS REQUIRING HYPHENS

When using two- and three-word modifiers for a noun, you need to supply a hyphen (if that modifier precedes the noun). A two-word modifier cannot stand on its own but needs to be a unit with connection. Common words joined together contain high-, low-, etc.

EXAMPLE: The patient is well developed, well nourished white male in no acute distress. He has a three day history of acute abdominal pain. For this, he was told to adhere to a low fat diet. He is to avoid spicy food, follow a 1200 calorie diet and return to the office for a follow up appointment in seven days.

SOLUTION: The patient is well-developed, well-nourished white male in no acute distress. He has a three-day history of acute abdominal pain. For this, he was told to adhere to a low-fat diet. He is to avoid spicy food, follow a 1200-calorie diet and return to the office for a follow-up appointment in seven days.