THE DREADED RUN- ON SENTENCE AND OTHER PUNCTUATION RULES THAT KEEP YOU UP AT NIGHT!!!!

Transcription

1 THE DREADED RUN- ON SENTENCE AND OTHER PUNCTUATION RULES THAT KEEP YOU UP AT NIGHT!!!!

2 Is punctuation giving you NIGHTMARES???

3 Does it give you a headache?

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5 When you think of punctuation, do you want to go running away?

6 Punctuation is supposed to bring order to our world, not chaos. Punctuation does make a difference. A misplaced punctuation mark can change the entire meaning of a phrase or sentence.

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8 Let s look at another reason why punctuation is so important.

9 Because of a displaced comma, a lawsuit was brought about by Oakhurst Dairy. Google it. It was a misplaced comma in a list. That misplaced comma changed the complete meaning of the rule, and it resulted in a $10 million lawsuit. It resulted in a $5 million settlement. This is all because of 1 misplaced comma.

10 Let s take a look at some examples where misplaced or no punctuation changes the complete meaning.

11 The patient has 2 children, a dog and a cat. The way this is punctuated makes it seem like the patient's children are a dog and a cat. This should be: The patient has 2 children, a dog, and a cat. This changes the meaning completely.

12 Another one: Let's cook and eat folks. Instead, it should be: Let's cook and eat, folks!

13 Another one: I love baking my kids and my pets. Should be: I love baking, my kids, and my pets.

14 Last one: I am sorry I love you. Should be: I am sorry. I love you. Huge difference. Seems silly, but punctuation matters!

15 Let s look at some examples in medical transcription.

16 Amoxicillin 250 mg daily aspirin 81 mg lisinopril 10 mg recently added hydrochlorothiazide. How you punctuate this changes the meaning and could jeopardize patient safety. Amoxicillin 250 mg daily, aspirin 81 mg, lisinopril 10 mg recently added, hydrochlorothiazide. Amoxicillin 250 mg, daily aspirin 81 mg, lisinopril 10 mg, recently added hydrochlorothiazide.

17 Inability to eat diarrhea. Of course, it should be: Inability to eat, diarrhea as a list of symptoms.

18 The patient was given ibuprofen 800 mg. Yesterday was given aspirin p.r.n. The patient was given ibuprofen 800 mg yesterday. Was given aspirin p.r.n.

19 Given NPH insulin, 10 mg lisinopril daily. Of course, you would look up the drug dosage, but it is very difficult sometimes. If you did not look this up, you could transcribe it this way: Given NPH insulin 10 mg, lisinopril daily.

20 Punctuation does make a difference and can change the meaning of a sentence.

21 Punctuation questions are probably the most frequent questions we get as instructors. It would be fantastic if punctuation was simple, that everything was black and white, and all the rules made sense.

22 Wouldn't it be great if dictators actually added in the punctuation and, more importantly, added it in correctly?

23 That universe does not exist.

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25 Moreover, while there is a set rules for punctuation, there are often acceptable variations of how sentences can be formatted. This leads to more confusion. Sentences can also demand more than 1 BOS rule for punctuation.

26 You can learn these rules! You can do it!

27 Let's get started!

28 Let's start with the basics.

29 To understand punctuation better, let s start first with the very basics. A sentence consists of a subject and a verb.

30 A complete sentence is a phrase with a subject and a verb that can stand on its own. It is not dependent on another sentence.

31 The patient is a 55- year-old female. Patient Subject Is Verb She comes in today for followup of her hypertension. She Subject Comes Verb COMPLETE SENTENCE COMPLETE SENTENCE

32 Subject: This is the main thing being talked about in a sentence. Verb: This is the action word. A word used to describe an action, state, or occurrence.

33 Let s not forget about helping verbs. Helping verbs are verbs that help the main verb express action or make a statement. Together with the action verb, they form a verb phrase. Common helping verbs are am, are, is, was, were, do, did, have, has, had, can, may, will be, will have, has been, can be, can have, could be, could have, will have been, might have, must, must have. The list is exhaustive.

34 To summarize, every complete sentence has a subject and a verb and is a complete thought. The subject basically is what the sentence is about, and the verb tells about the subect.

35 Some of the most common errors we see, as instructors, in transcribed reports are the runon sentences and/or the comma splices. This is what we see very often.

36 The patient was running a fever of he was given ibuprofen and Tylenol to bring his fever down. Run-on sentence.

37 The patient was running a fever of 103.5, he was given ibuprofen and Tylenol to bring his fever down. Comma Splice.

38 The only difference between a comma splice and a run-on sentence is that a comma is used for the comma splice. The patient is sick he is in the bed. The patient is sick, he is in the bed. Both are incorrect! The patient is sick. He is in the bed. The patient is sick; he is in the bed. Both are correct!

39 Let's do a quick exercise!

40 Identify the subject and verb in each sentence.

41 The patient came in today.

42 The patient came in today.

43 I referred the patient to Gastroenterology.

44 I referred the patient to Gastroenterology.

45 The patient, by the time he arrived to the ER, had a fever of degrees Fahrenheit.

46 The patient, by the time he arrived to the ER, had a fever of degrees Fahrenheit.

47 While being seen in the emergency room, the patient fainted.

48 While being seen in the emergency room, the patient fainted.

49 The patient came in today. I referred the patient to Gastroenterology. The patient, by the time he arrived to the ER, had a fever of degrees Fahrenheit. While being seen in the emergency room, the patient fainted.

50 Let's add on.

51 Complete sentences need a full stop. The period is punctuation for a full stop. The period is for termination of a thought. While in the ER this evening, the patient was running a fever of Full stop. He was given ibuprofen and Tylenol to bring his fever down. Full stop. Two complete sentences. Two full stops.

52 This is where we start getting into trouble - combining these 2 full thoughts without a conjunction or joining words without punctuation or with a comma.

53 There are 2 correct ways to punctuate 2 complete sentences without a conjunction or joining word. You can use a semicolon or a period. If the ideas are similar in these sentences, a semicolon can be used.

54 For example: The patient was running a fever of 103.5; he was given ibuprofen and Tylenol to bring his fever down. OR The patient was running a fever of He was given ibuprofen and Tylenol to bring his fever down.

55 We see the following error very, very often.

56 The patient was running a fever of 103.5, he was given ibuprofen and Tylenol to bring his fever down. You must use a period or a semicolon. Again, 2 independent clauses, without a conjunction, joined together with a comma create a comma splice.

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59 Don't let punctuation do this to you!

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61 Another way to look at it is that when there is no conjunction or connecting word between 2 independent clauses (with a subject and a verb), use a semicolon or period.

62 Connecting words or conjunctions include and, but, for, or, nor, so, or yet. There are others for sure.

63 Think of run-on sentences as fused sentences, 2 complete thoughts. Again, this is when 2 independent clauses are joined together with no connecting word or punctuation to separate the clauses.

64 Let s do a quick exercise.

65 Identify the following as either fragment, complete, comma splice, or run-on.

66 Having nausea, vomiting, and diarrhea.

67 The patient was sick.

68 I saw the patient on May 30, he was transferred to the hospital immediately.

69 Seen by a physician.

70 Having nausea, vomiting, and diarrhea. Fragment. No subject. The patient was sick. Complete. I saw the patient on May 30, he was transferred to the hospital immediately. Comma splice. Seen by a physician. Fragment.

71 His PCP referred the patient to me and also to the gastroenterologist.

72 Because the patient was not taking his medications.

73 As instructed by the pediatrician.

74 A cough with sinus drainage.

75 The patient had nausea and vomiting he was also having diarrhea.

76 His PCP referred the patient to me and also to the gastroenterologist. Complete. Because the patient was not taking his medications. Fragment. Dependent on another sentence. As instructed by the pediatrician. Fragment. A cough with sinus drainage. Fragment. The patient had nausea and vomiting, he was also having diarrhea. Run-on.

77 Use a semicolon to separate two independent clauses. While independent clauses are typically separated by periods, a semicolon can be used when the two clauses express closely linked or related concepts or ideas.

78 This can be separated with periods or semicolons. BP is 110/80. Pulse is 74. Respiratory rate is 18. Weight is 140 pounds. BP is 110/80; pulse is 74; respiratory rate is 18; weight is 140 pounds. All independent clauses with subjects and verbs. Commas cannot be used here to separate.

79 LET S TAKE A QUIZ!

80 MULTIPLE CHOICE CHOOSE THE CORRECT ANSWERS

81 A. When I last saw the patient, she was just getting back from vacation. She comes in now for a followup on her hypertension. B. When I last saw the patient, she was just getting back from vacation, she comes in now for a followup on her hypertension. C. When I last saw the patient, she was just getting back from vacation; she comes in now for a followup on her hypertension.

82 CORRECT ANSWERS A. When I last saw the patient, she was just getting back from vacation. She comes in now for a followup on her hypertension. C. When I last saw the patient, she was just getting back from vacation; she comes in now for a followup on her hypertension.

83 A. The patient states that she fell on Tuesday; 2 days later she developed pain in her right leg. B. The patient states that she fell on Tuesday. Two days later she developed pain in her right leg. C. The patient states that she fell on Tuesday, two days later she developed pain in her right leg.

84 CORRECT ANSWERS A. The patient states that she fell on Tuesday; 2 days later she developed pain in her right leg. B. The patient states that she fell on Tuesday. Two days later she developed pain in her right leg.

85 A. I had recommended that the patient be seen in the dermatology clinic, she comes in here instead. B. I had recommended that the patient be seen in the dermatology clinic. She comes in here instead. C. I had recommended that the patient be seen in the dermatology clinic; she comes in here instead.

86 CORRECT ANSWERS B. I had recommended that the patient be seen in the dermatology clinic. She comes in here instead. C. I had recommended that the patient be seen in the dermatology clinic; she comes in here instead.

87 A. I think that the patient's hypertension has improved on her medication. She is going to continue taking it. B. I think that the patient's hypertension has improved on her medication; she is going to continue taking it. C. I think that the patient's hypertension has improved on her medication, she is going to continue taking it.

88 CORRECT ANSWERS A. I think that the patient's hypertension has improved on her medication. She is going to continue taking it. B. I think that the patient's hypertension has improved on her medication; she is going to continue taking it.

89 A. The patient is on an aspirin a day, a multivitamin a day; and she is also on lisinopril for her hypertension. B. The patient is on an aspirin a day, a multivitamin a day, and she is also on lisinopril for her hypertension. C. The patient is on an aspirin a day, a multivitamin a day. And she is also on lisinopril for her hypertension.

90 CORRECT ANSWERS B. The patient is on an aspirin a day a multivitamin a day, and she is also on lisinopril for her hypertension. We will discuss this rule (BOS 6.2.3) in just a bit.

91 Note the change without the conjunction. The patient is on an aspirin a day a multivitamin a day. She is also on lisinopril for her hypertension. The patient is on an aspirin a day a multivitamin a day; she is also on lisinopril for her hypertension.

92 A. The patient has nausea, vomiting, and diarrhea that all started after after a high fever, and she also has a severe headache. B. The patient has nausea, vomiting, and diarrhea that all started after after a high fever; and she also has a severe headache. C. The patient has nausea, vomiting, and diarrhea that all started after after a high fever. She also has a severe headache.

93 CORRECT ANSWER A. The patient has nausea, vomiting, diarrhea that started after after a high fever, and she also has a severe headache.

94 Let s talk about a couple more BOS rules.

95 BOS 6.2.1: Use a comma to separate two or more adjectives modifying the same noun. Examples: The patient is a pleasant, elderly female. A well-developed, well-nourished, awake, alert, cooperative, healthy-appearing male. Nontender, nondistended abdomen. Pleasant, alert, cooperative female.

96 BOS 6.2.2: Use a comma to separate two or more items in a simple series, where none of the items contain internal commas.

97 EXAMPLES: The patient has nausea, vomiting, and diarrhea. The patient s symptoms included fever, sore throat, cough, body aches, and nausea. The patient has no fever, chills, or shortness of breath.

98 Do not use a comma if all the items are joined by and or or.

99 The wound has no redness or drainage. The patient has nausea and vomiting and diarrhea. The patient has no nausea or vomiting or diarrhea. The patient s symptoms include fever and cough and sore throat and a little bit of shortness of breath.

100 Always use a serial comma before the conjunction preceding the final item in your series (a, b, and c). It is still acceptable in some sources to omit the serial comma, but both AHDI and the AMA recommend inclusion of that comma for clarity.

101 Let s take a quick quiz!

102 CHOOSE THE CORRECTLY PUNCTUATED SENTENCES.

103 The patient was referred to Gastroenterology, ENT and Neurology.

104 The patient was referred to Gastroenteroloy, ENT, and Neurology.

105 I started the patient on vitamim D, calcium, and magnesium.

106 I started the patient on vitamim D, calcium, and magnesium.

107 The patient had a CT scan of the head and neck; an ultrasound of the abdominal region; an x-ray of the left hip; and a chest x-ray.

108 The patient had a CT scan of the head and neck, an ultrasound of the abdominal region, an x- ray of the left hip, and a chest x-ray.

109 The following labs were ordered: CMP, and CBC, and TSH.

110 The following labs were ordered: CMP and CBC and TSH.

111 A. The patient was referred to Gastroenteroloy, ENT, and Neurology. B. I started the patient on vitamim D, calcium, and magnesium. C. The patient had a CT scan of the head and neck, an ultrasound of the abdominal region, an x-ray of the left hip, and a chest x-ray. D. The following labs were ordered: CMP and CBC and TSH.

112 A. No redness, burning, itching, raised areas, or blisters. B. The patient had a normal BP, and weight, and pulse rate.

113 A. No redness, burning, itching, raised areas, or blisters. B. The patient had a normal BP and weight and pulse rate.

114 Let s go back to the first part of this rule. BOS says to use a comma to separate two or more items in a simple series, where none of the items contain internal commas. Let s take a look at that exception.

115 Vital signs included a blood pressure of 115/82, repeat of 118/88; pulse rate of 72, normal; respiratory rate of 22, elevated; weight of 185, normal.

116 Look how confusing it could be if the semicolons did not separate the following information. Vital signs included a blood pressure of 115/82, repeat of 118/88, pulse rate of 72, normal respiratory rate of 22, elevated weight of 185, normal.

117 The patient s medications include lisinopril, which was recently increased; an aspirin a day, 81 mg; vitamin D, recently increased to 5000; calcium 600 mg daily.

118 The patient s urinalysis showed positive white cells, markedly elevated; negative red blood cells; positive ketones, which is a new finding; negative protein.

119 CBC showed a WBC of 18.6, elevated; rbc of 4.0, normal; hemoglobin of 11.4, low; hematocrit of 33, low; platelet count of 121, low. These have to be separated for clarity.

120 Time for a quiz on what we have covered so far!

121 A. The patient is a 55-year-old female, she comes in today with a myriad of symptoms. B. I saw the patient. I am referring him to Dr. [Name]. C. The patient presents with nausea, vomiting, and diarrhea, she has had this for 3 days. D. The patient states that she has seen Dr. [Name] before she would like to see her again.

122 NOW ALL CORRECT A. The patient is a 55-year-old female. She comes in today with a myriad of symptoms. B. I saw the patient. I am referring him to Dr. [Name]. C. The patient presents with nausea, vomiting, and diarrhea. She has had this for 3 days. D. The patient states that she has seen Dr. [Name] before. She would like to see her again.

123 ALSO CORRECTLY PUNCTUATED The patient is a 55-year-old female; she comes in today with a myriad of symptoms. I saw the patient; I am referring him to Dr. [Name]. The patient presents with nausea, vomiting, and diarrhea; she has had this for 3 days. The patient states that she has seen Dr. [Name] before; she would like to see her again.

124 Is this correct? The patient seemed to understand this informed consent was obtained.

125 The patient seemed to understand this. Informed consent was obtained.

126 WHICH OF THE FOLLOWING PUNCTUATED IS CORRECTLY?

127 A. Vitals include a BP of 112/80, a pulse rate of 68, a temperature of 36.2; and his weight is 150 pounds. B. Vital include a BP of 112/80, a pulse rate of 68, a temperature of 36.2, and his weight is 150 pounds.

128 B. Vital include a BP of 112/80, a pulse rate of 68, a temperature of 36.2, and his weight is 150 pounds.

129 A. The patient's BP is 112/80 when seen by the nurse, it is 120/76 by me pulse 72. Weight is 150 pounds. B. The patient's BP is 112/80 when seen by the nurse; it is 120/76 by me. Pulse 72. Weight is 150 pounds.

130 B. The patient's BP is 112/80 when seen by the nurse; it is 120/76 by me. Pulse 72. Weight is 150 pounds.

131 A. Oropharynx was normal, it was not inflamed. B. Oropharynx was normal; it was not inflamed. C. Oropharynx was normal. It was not inflamed.

132 CORRECT B. Oropharynx was normal; it was not inflamed. C. Oropharynx was normal. It was not inflamed.

133 A. Eyes were clear; conjunctivae were nonicteric. B. Eyes were clear, conjunctivae were nonicteric. C. Eyes were clear. Conjunctivae were nonicteric.

134 A. Eyes were clear; conjunctivae were nonicteric. C. Eyes were clear. Conjunctivae were nonicteric.

135 MAKE SENSE?

136

137 Let s go over one more rule.

138 BOS 6.2.3: Use a comma to separate two independent clauses in a compound sentence that are joined by a conjunction (and, but, or, nor, or for).

139 We have talked about independent clauses before, so we are just adding on to what we have been talking about here today. Two independent clauses joined by a conjunction.

140 Examples: Conjunctivae are clear. Sclerae are clear. Two complete sentences. If dictated with a conjunction between, you add a comma before the conjunction. Conjunctivae are clear, and sclerae are clear.

141 The patient came to the ER, and labs were drawn. The patient s temperature was elevated, but the fever came down with medications. Hemoglobin is 13, and hematocrit is 38. The patient will follow up with me, or I will send him to Cardiology for further tests if needed. Vital signs were within normal limits, but the patient s BMI was elevated.

142 One last quiz!

143 A. Vitals include a BP of 112/80; a pulse rate of 68; a temperature of 36.2; and his weight is 150 pounds. B. Vitals include a BP of 112/80, a pulse rate of 68, a temperature of 36.2; and his weight is 150 pounds. C. Vitals include a BP of 112/80, a pulse rate of 68, a temperature of 36.2, and his weight is 150 pounds.

144 C. Vitals include a BP of 112/80, a pulse rate of 68, a temperature of 36.2, and his weight is 150 pounds.

145 A. Vitals: BP is 112/80; pulse rate is 68; respiratory rate is 16; weight is 150 pounds, and his temperature is B. Vitals: BP is 112/80; pulse rate is 68; respiratory rate is 16; weight is 150; and his temperature is C. Vitals: BP is 112/80. Pulse rate is 68. Respiratory rate is 16. Weight is 150, and his temperature is 36.2.

146 A. Vitals: BP is 112/80; pulse rate is 68; respiratory rate is 16; weight is 150 pounds, and his temperature is C. Vitals: BP is 112/80. Pulse rate is 68. Respiratory rate is 16. Weight is 150, and his temperature is 36.2.

147 A. The patient's BP is 112/80 when seen by the nurse; it is 120/76 by me. Pulse 72. Weight is 150 pounds. B. The patient's BP is 112/80 when seen by the nurse, it is 120/76 by me. Pulse 72. Weight is 150 pounds.

148 A. The patient's BP is 112/80 when seen by the nurse; it is 120/76 by me. Pulse 72. Weight is 150 pounds. B. The patient's BP is 112/80 when seen by the nurse, it is 120/76 by me. Pulse 72. Weight is 150 pounds.

149 A. The patient's BP is 112/80 when seen by the nurse; it is 120/76 by me. Pulse 72. Weight is 150 pounds.

150 A. Ears: TMs were inflamed. The ear canal was retracted on the right. B. Ears: TMs were inflamed; the ear canal was retracted on the right. C. Ears: TMs were inflamed, the ear canal was retracted on the right.

151 CORRECT ANSWERS A. Ears: TMs were inflamed. The ear canal was retracted on the right. B. Ears: TMs were inflamed; the ear canal was retracted on the right.

152 A. Extremities had normal pulses and good color. No edema was seen. B. Extremities had normal pulses and good color, no edema was seen. C. Extremities had normal pulses and good color; no edema was seen.

153 CORRECT ANSWERS A. Extremities had normal pulses and good color. No edema was seen. C. Extremities had normal pulses and good color; no edema was seen.

154 A. The heart had a regular rate and rhythm and I heard no murmurs. B. The heart had a regular rate and rhythm; and I heard no murmurs. C. The heart had a regular rate and rhythm, and I heard no murmurs.

155 CORRECT ANSWER C. The heart had a regular rate and rhythm, and I heard no murmurs.

156 You can do this!

157 In conclusion, a sentence is a complete thought with a subject and a verb. If you have a subject and a verb, there needs to be a full stop at the end of the thought. You cannot use a comma to connect these without a conjunction. If there is a conjunction joining these 2 complete thoughts, then you use a comma.

158 You can do this!

159 Thank you for attending today s webinar! Susan Anderson, CHDS