Intended for healthcare professionals

Views And Reviews Critical Thinking

Matt Morgan: The death of the dictaphone

BMJ 2022; 377 doi: (Published 17 May 2022) Cite this as: BMJ 2022;377:o1192
  1. Matt Morgan, consultant in intensive care medicine
  1. Western Australia
  1. mmorgan{at}
    Twitter: @dr_mattmorgan

The clicking of dictaphones starting, stopping, and rewinding used to echo around busy outpatient clinics. Tiny cassette tapes were scattered over the desks for medical secretaries to decipher and translate garbled sounds into organised words. These secretaries were the conductors of the hospital—coordinating, organising, typing, and supporting. They still are.

But, despite the key role that these skilled administrators play in the smooth running of the hospital, they’re being replaced with fewer people and more technology. Large A4 diaries with colourful inked entries have been replaced by the ping of Office 365 notifications. The sound of dictaphones clicking has been muted, replaced by automated speech-to-text software that autocorrects “acyclovir” to “a cycle of ear.”

There are many benefits to rolling out this new technology and empowering consultants to manage their own diaries and type their own letters. But reducing the medical administration workforce in response is an error. Instead, we should use this as an opportunity to harness the skills, knowledge, and communication of medical secretaries in new ways. Perhaps it’s time to reimagine the role that this workforce can play in helping to support patients and not just consultants.

The three most common complaints made to medical regulators are problems with investigations or treatment, communication, and a lack of patient respect. If medical secretaries were instead thought of as patient care and communication experts, we might realise that they can be the perfect intermediary between medicine and people. They could be advocates for patients as well as for consultants. They could direct worried families to education resources, help prioritise appointments in a stretched care system, and bring in other allied services to support patients in the community. This would allow better use of consultants’ time and ultimately better care for patients.

Medical secretaries already do much of this work, so it doesn’t represent a huge shift in thinking. But as the dictaphones are replaced perhaps this could become their main focus, with dedicated time and training to support them. And perhaps it would help us to realise that reducing the number of these experts as technology moves on misses their true worth. The value that they bring is not only in the administrative tasks they perform but in their knowledge of navigating the complexities of an ever changing healthcare system—one that’s not designed for the needs of patients.

We should respect this foundation that holds us all together. And we should continue to value the medical secretary as a conductor of care, even when the music changes and the tempo of technology ramps up.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an honorary senior research fellow at Cardiff University, UK, a consultant in intensive care medicine in Western Australia, and an editor of BMJ OnExamination.

View Abstract