Dictation Therapy For Doctors

Why Should I Make A Donation?

noreply@blogger.com (Unknown) — Mon, 29 Oct 2007 19:26:00 +0000

Let’s not kid ourselves. Textbooks cost money.

In recent years, rising costs of paper, ink, and delivery have narrowed – if not totally destroyed – the profit margin on books which fail to become bestsellers. The amount of time and energy needed to get a book into the hands of its readers means that many works become obsolete by their date of publication.

That all changes with electronic publishing. Not only can bloggers retain complete artistic control over their intellectual product, bloggers quickly bypass some of the traditional obstacles encountered when publishing a text in hard copy:

Cost considerations:

Bloggers are not held hostage by variations in the prices of ink, postage, and/or paper.

Bloggers don’t need to worry about physical restrictions imposed by page size, book size, shipping weight and/or availability of shelf space.

Bloggers face no extra cost to add color to their presentations.

Bloggers don’t need to worry about the high price of binding a book – or publishing a book whose binding eventually falls apart.

Bloggers don’t need to budget for a sales/marketing campaign or particular size of print run.

Bloggers don’t need to pay the costs of warehousing inventory which might end up being remaindered.

Strategic risks:

Bloggers don’t need to compete against other titles in a publishing house's line of books.

Bloggers don’t need to negotiate with publishers through agents.

Bloggers don’t need to battle ridiculously outdated publishing concepts such as claims that "You can't have a murder mystery that's more than 225 pages....."

On the flip side, however, are the creative advantages:

Bloggers can update their work at any time.

By taking advantage of the hypertext links, bloggers can insert value-added reference links to intellectual content which is available to anyone on the Internet without any violation of copyright law.

Bloggers can get direct feedback from their readers.

One of my favorite quotes comes from the final scene of Hello, Dolly! at the moment when most of the principal characters have gone upstairs to get their money out of Horace’s safe. Left alone in Vandergelder’s Hay & Feed Store, Dolly Levi lovingly wraps her arms around the cash register, turns to the audience, and utters Thornton Wilder’s famous words:

“Money, money, money, money, money -- it’s like the sun we walk under -- it can kill and it can cure. Horace Vandergelder never tires of saying that 99% of the people in this world are fools and, in a way, I suppose he’s right. We’re all fools. Himself, Irene, Cornelius, myself. We’re all fools – and we’re all in grave danger of destroying the world in our folly. Yet the surest way to keep us safe from harm is to give us those few things in life which will make us happy – and that takes a little bit of money!

“Now, the difference between a little bit of money and no money at all is enormous – and it can shatter the world. And the difference between a little bit of money and an enormous amount of money is very slight. But that, too, can shatter the world. It’s all a question of how it’s used. As my late husband, Ephraim Levi, always used to say: Money -- you should pardon the expression -- is a little like manure. It doesn’t do anyone a bit of good unless it’s spread all around, encouraging young things to grow.”

A lot of hard work went into creating Dictation Therapy For Doctors. If this blog has been of value to you and you would like to make a donation to its author, please feel free to use one of the following options (the amount you donate is entirely your choice).

Online: You can make a donation via PayPal, credit card, or e-check, by clicking on the link in the right-hand column of your screen.

Snail Mail: You can send a donation via check or money order to the following address:

George Heymont
584 Castro Street, #275
San Francisco, California 94114

Please make checks payable to "George Heymont."

Thank you for supporting and spreading the word about

Dictation Therapy For Doctors.

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Consciousness Raising Exercise #39

noreply@blogger.com (Unknown) — Fri, 26 Oct 2007 21:31:00 +0000

Recent studies have exposed how the extreme levels of stress placed on medical students during the long hours they must work while in training to become physicians have made sleep deprivation an occupational hazard. Most of us have experienced what it feels like to fall asleep while watching television or reading a book. However, the threat of increased somnolence at work can cause a major problem with medical documentation.

Unfortunately, many doctors and medical students are great procrastinators when it comes to dictating reports and correspondence. By the time they actually sit down to dictate, some can barely keep their eyes open. I personally have listened to doctors start snoring while in the middle of a report, followed by a grunt and a confused dictator mumbling, “Huh? Where was I?”

During such moments, focus and memory are hardly in peak form. As a result, it is all too easy to make a mistake that will subsequently metastasize throughout a patient’s medical record.

Falling asleep at your desk is such a minor and embarrassing event that most people just laugh it off. However, when you see someone with an active case of narcolepsy, you get a very different view of the dangers involved.

A friend of mine who is normally quite healthy, athletic, and fit suffers from a peculiar form of narcolepsy in which his nervous system seems to suddenly need rebooting. Thankfully, he now has a devoted service dog who keeps a close eye for symptoms of a crash. But he will happily recite the story of how he once fell asleep at the wheel and was lucky enough to wake up in time to avoid a motor vehicle accident.

It all sounds quite theatrical and fantastic until you see it happen right in front of your eyes. Once, while we were on an Alaskan cruise, I witnessed such an event. We had just started looking at our menus when Richard’s head collided with his dinner setting. His three cruise companions looked up from their menus to see him slumped over the table, out cold. For a minute we weren’t sure what to do, as we were all aware of his attacks but had never really witnessed one. Just as we were about to call for medical help, Richard sat bolt upright and asked “Okay, what are we going to eat?”

Anyone who has earned a driver’s license should have learned to pull over to the side of the road when he is too tired to drive safely. In 150 words or more, explain why dictating medical reports when you are exhausted raises a risk management issue with regard to quality of patient care.

Reference Tools

noreply@blogger.com (Unknown) — Fri, 26 Oct 2007 20:03:00 +0000

The following titles may be of value to you as reference books or for purposes of entertainment.

Creating A Documentation Assembly Line

noreply@blogger.com (Unknown) — Thu, 25 Oct 2007 23:58:00 +0000

Designing effective documents and learning how to produce them in an assembly-like pattern (so that they end up looking like customized letters and reports), involves a similar process to the one used by the chef who creates customized omelets for a Sunday hotel brunch. The basic parts of the documents to be created should be engineered in advance so that you can assemble data in a modular style and then add in the frills and embellishments necessary to customize each report you dictate.

The key to success is learning how to organize your thoughts. Most physicians are forced to dictate when they are tired, rushed, or stressed out. As a result, they find it difficult to concentrate while dictating.

Frequently, physicians will dial into a digital dictation system and then hang on the line while they try to find the information they are looking for. Often they will skip back and forth through a patient's chart while looking for pertinent details (and making no sense whatsoever).

You would be shocked to discover how many doctors, after dictating thousands of reports, still cannot think on their feet. Listening to them fumble through the same report they must dictate day after day is embarrassing.

When dictating, you must always remember that the person receiving information from you is only getting aural input. Although that person can see what is on the computer screen in front of him, he cannot read your mind. As a result, you have to act like a seeing-eye dog for the transcriptionist by delivering the proper vocal cues each and every time you transmit information.

Next: Practice Makes Perfect

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Acoustical Considerations

noreply@blogger.com (Unknown) — Wed, 24 Oct 2007 20:46:00 +0000

Think, for a minute, about how most people react to the sound of chalk scraping on a blackboard. Then try to imagine what that sounds like if amplified and delivered directly to your eardrums through a highly-sensitized microphone. With that image in mind, try to imagine how medical transcriptionists react to the following sounds, which are routinely heard when transcribing reports:

The physician who speaks with a whistling "S."
The physician who coughs directly into the telephone.
The physician who loudly sneezes into the telephone.
The physician whose beeper goes off next to the phone as he is dictating.
The physician who is very tired and keeps yawning while trying to speak.
The physician who only dictates when he is drunk and his speech is slurred.

A simple rule of thumb:

If you would have second thoughts about doing any of these things while talking on the phone with your mother, do not do them when dictating medical reports.

While digital dictation systems have gone a long way toward improving the quality of recorded sound, they cannot always filter out extraneous sound from the area in which a physician is dictating. Because such sounds are part of a familiar environment, the dictating physician may automatically tune them out of his mind. Nonetheless, they are being recorded with stunning accuracy by the digital dictation system into which he is dictating.

"I had a doc once who dictated on a handheld mini tape. May God strike me dead if I'm lying -- he actually took the tape into the bathroom with him and kept dictating while he did his thing," recalls one transcriptionist. "Thereafter, I could never look at him when he came into the office. I would sneak off to the lounge to giggle uncontrollably. I mean, I just never wanted to know the guy quite that well."

Next: Sound Distortion From Peripheral Noise

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Rave Review from "For The Record Magazine"

noreply@blogger.com (Unknown) — Tue, 23 Oct 2007 07:09:00 +0000

In his new electronic "textbook," Dictation Therapy for Doctors, George Heymont has a bone to pick, and he's not bashful about picking it publicly. Taking aim against what many consider an unassailable target, he fires off an audacious salvo: doctors are frequently "language-impaired," and they must be made accountable for the mistakes they make in medical documentation. It's not an original thought -- no doubt it's traceable to the advent of the tape recorder -- still few have dared to state it outright.

As a veteran journalist who's written for publications ranging from GQ to American Medical News, from Opera Monthly to the Journal of the American Association for Medical Transcription, Heymont has a clear love of language and a respect for its power. As a medical transcriptionist (MT), he's witnessed the misuse of language in medical documentation and laments the fact that a transcriptionist's product "is totally dependent on the quality of dictation which reaches his ears."

Heymont tallies the enormous, yet often unacknowledged, cost of such dictating sins as mumbling, misspellings, misplaced modifiers, and malapropisms, and illustrates the consequences of these errors -- consequences that affect not only healthcare organizations and their patients, but also the physicians who make these mistakes and the professional medical transcriptionists who must make sense of them.

But Dictation Therapy for Doctors is no mere diatribe against the dictation-challenged. Heymont, cofounder of Alert & Oriented Medical Transcription Services, creator of the Internet's KAMT-LIST (Keeping Abreast of Medical Transcription) mailing list for MTs, and past president of the Golden Gate Chapter of the American Association for Medical Transcription (GGC-AAMT), doesn't simply diagnose the dictation disorders suffered by doctors. He offers treatment as well -- "preventive medicine" for dictating doctors. First, Heymont clearly explains the role of the medical transcriptionist in documentation and the MT's place in the healthcare organization's hierarchy. He offers doctors an understanding of the tools, techniques, and technology used by MTs, including digital dictation systems, word expanders, voice recognition technology, standard references, and word processing programs.

With both bite and humor, he illustrates the ways in which physicians create barriers to clear communication and discusses the ways in which they can prevent such obstacles. On the flip side, he offers MTs a road map to the common errors made by dictators and helps them avoid the pitfalls.

Heymont offers clear guidance on dictation techniques, addressing, for example, abbreviations, units of measure, standardized templates, enunciation, spelling, grammar, consistency, and special formatting.

Dictation Therapy for Doctors uses a hypertext system of inter-linked HTML files to provide a new form of continuing medical education -- an interactive teaching tool. The interactive format allows users to move in whatever fashion they wish between text, language skills worksheets, and consciousness raising exercises, or to sample the wry humor of Gerard Donelan's cartoons. The book also offers internal and external links to sources of additional information. Internal links take the user to files prepared specifically for Dictation Therapy for Doctors. External links offer side-trips to various home pages on the World Wide Web that offer resources for medical transcriptionists, general resources on healthcare, and sites concerning social issues that affect healthcare. Other external links may lead the readers to subjects as seemingly distant from medical records as politics, sex, drugs, and rock 'n roll. You may find links, for example, to information about Gilbert and Sullivan operettas or "The X-Files." Not standard fare for a transcription text, but navigating the twists and turns promises an unorthodox and interesting journey.

This dynamic teaching tool is not just remedial reading for doctors -- it's a must for anyone concerned with the integrity of the medical record, particularly medical records managers, transcription department managers, hospital administrators, and risk managers -- and anyone interested in improving communication between medical record personnel and physicians. It should be required reading as well for students, allied health professionals, nurses, physician assistants, and other members of the healthcare team. For medical transcriptionists, it's a primer on the profession and a tool to help them better decipher the "medical mush that emanates from the mouths of dictating physicians."

Kate Jackson, Editor
May 4, 1998 issue of For The Record Magazine

Next: Start

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Creating A Documentation Assembly Line

noreply@blogger.com (Unknown) — Sun, 30 Sep 2007 19:53:00 +0000

Designing effective documents and learning how to produce them in an assembly-like pattern (so that they end up looking like customized letters and reports), involves a similar process to the one used by the chef who creates customized omelets for a Sunday hotel brunch. The basic parts of the documents to be created should be engineered in advance so that you can assemble data in a modular style and then add in the frills and embellishments necessary to customize each report you dictate.

The key to success is learning how to organize your thoughts. Most physicians are forced to dictate when they are tired, rushed, or stressed out. As a result, they find it difficult to concentrate while dictating.

Frequently, physicians will dial into a digital dictation system and then hang on the line while they try to find the information they are looking for. Often they will skip back and forth through a patient's chart while looking for pertinent details (and making no sense whatsoever).

You would be shocked to discover how many doctors, after dictating thousands of reports, still cannot think on their feet. Listening to them fumble through the same report they must dictate day after day is embarrassing.

When dictating, you must always remember that the person receiving information from you is only getting aural input. Although that person can see what is on the computer screen in front of him, he cannot read your mind. As a result, you have to act like a seeing-eye dog for the transcriptionist by delivering the proper vocal cues each and every time you transmit information.

Next: Practice Makes Perfect

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Changing Work Styles

noreply@blogger.com (Unknown) — Sun, 30 Sep 2007 18:38:00 +0000

In the old days, a physician might dictate some reports and leave the patients' charts on the transcriptionist's desk with instructions to glean any additional information from the chart and put it in its proper place in the report.

If a transcriptionist mentioned that the physician had dictated a laboratory value which was obviously incorrect, the physician might wave his hand and casually say "Well, just go ahead and fix it" on the assumption that the transcriptionist had the time, the ability, or the authority to search for a patient's chart, find the appropriate information, and make the necessary correction.

In today's world, this is impractical, inefficient, and more often than not, physically impossible. Because transcriptionists are not necessarily working on-site, they rarely have access to a patient's chart. And, since some transcriptionists work during the evening and on weekends (when a Medical Record Department or physician's office might be closed), they cannot always ask someone to access a patient's chart for them.

Medical transcriptionists are no longer paid to bring productivity to a grinding halt in order to embark on an informational "wild goose chase" in the hope of finding a patient's medical record number -- or the proper mailing address of someone who is supposed to receive a copy of a dictated report.

That's no longer their job.

With computers having changed so much of the work process, let's take a close look at who is responsible for each part of the information chain

Next: Dictating Physician
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Dedication

noreply@blogger.com (Unknown) — Sun, 30 Sep 2007 17:36:00 +0000

If a person is genuinely lucky during the course of his life, he will encounter one or two people who help him to believe in himself and inspire him to keep working at whatever he has chosen to do. I was extremely fortunate to cross paths with three remarkable women at crucial turning points in my life.

During the late 1960s, while she was starring on Broadway in the hit musical Mame, I made the acquaintance of Angela Lansbury. Watching her perform the title role many, many times in Broadway's Winter Garden Theater (while managing to keep her performance fresh for each new audience) showed me what it meant to set high standards of professionalism and stick to them.

Offstage, Lansbury demonstrated to all who worked with her what it meant to be a good colleague and a hard worker. Angela and I began to correspond and, shortly after moving to San Francisco, I received a letter in which she wrote "With your talent, I have no doubt you will land on your feet."

Because her letter arrived at a particularly stressful time in my life, I remember being flabbergasted that a "big star" like Angela Lansbury could be generous enough to reach out and give a few simple words of encouragement to someone living in a world which must have been light years away from her daily reality. Her words bolstered my spirits during many emotionally tough moments and Angela has always been an inspiration to me: as a performer, as a professional, and as a human being. Here are two clips of Angela and George Hearn performing Stephen Sondheim's tongue-twisting lyrics from Sweeney Todd: The Demon Barber of Fleet Street.

During my career as a freelance writer I gained a reputation as the only music critic to give serious attention to the growth of regional opera throughout the United States. One of my most stalwart supporters in this endeavor was Ava Jean Mears, who was then Public Relations Director and Archivist for the Houston Grand Opera. A woman with an incredible memory, Ava Jean is a writer's strongest ally (a colleague once opined that if he ever needed to find a one-legged albino dwarf who could swing upside down from a tree limb while singing all four parts of some obscure operatic ensemble in Swahili, that person probably went to school with Ava Jean).

The dozens of professional arts publicists who matured under Ava Jean's guidance learned how to be solicitous without being pushy, how to be concerned without being territorial and, above all, how to be fair when dealing with the press. When I became National Editor of Opera Monthly magazine and needed an additional pseudonym for my writing, Ava Jean's devoted golden retriever, B.J., was hauled into service. Numerous young American opera singers were subsequently interviewed by "B. J. Mears" and were grateful for the opportunity.

In January 1991, after 15 years as a freelance journalist and opera critic, a combination of decidedly unpleasant events knocked the wind out of my sails. Forced to abandon my career as a writer and get a "real job," I was lucky enough to fall back on a skill I had completely forgotten I once had: medical transcription.

Although I had not transcribed for more than a decade, Janet Photinos, who believed in my talent, gave me a chance to sharpen my skills and start transcribing again. Had she not done so, I might have become homeless. A tough-minded, stubborn woman, Janet set extremely high standards for herself and everyone she hired. She believed in fighting for both the patient and the dignity of the English language. Unlike many other transcriptionists, Janet did not hesitate to criticize doctors for their sloppy dictation habits. As a result of her prodding, I eventually joined the American Association for Medical Transcription. AAMT's invitation to speak at its second annual managers and supervisors conference in Las Vegas triggered a curious chain of events, which led to the creation of this blog.

To Angela, Ava Jean, and Janet, my heartfelt thanks for your generosity, inspiration, and encouragement.

Consciousness Raising Exercise #3

noreply@blogger.com (Unknown) — Sat, 29 Sep 2007 22:06:00 +0000

One of the most frequent ploys used by physicians to intimidate fellow members of the patient care team is to accuse others of being jealous that the physician received a better education and that he makes more money than they do. Another tactic is to suggest that a doctor, by definition, is a professional and that anyone who lacks a license to practice medicine is not.

When a doctor haughtily suggests that a medical transcriptionist is jealous because the MT's education was inferior to the physician's, the medical transcriptionist is primed and ready to ask the learned doctor this question:

"Would you please tell me why, if my education was so inferior to yours, it has become my professional responsibility to identify and correct the documentation mistakes in your work that endanger a patient's care and make both you and this hospital vulnerable to a medical malpractice lawsuit? I'm really eager to understand this, especially since these are mistakes that you (as a doctor with such a superior education) should not be making!"

In recent years, the health information management industry has insisted on maintaining the highest professional standards of quality assurance with regard to accuracy in patient documentation. Coders, abstracters, and medical transcriptionists must all be held accountable for the accuracy of their work. And yet the accuracy of their work is totally dependent on the accuracy of the data they receive from doctors.

List ten reasons why dictating physicians should strive to meet the same standards of accuracy imposed on the health information management industry's knowledge workers.

1.____________________________

2.____________________________

3.____________________________

4.____________________________

5.____________________________

6.____________________________

7.____________________________

8.____________________________

9.____________________________

10.___________________________

Consciousness Raising Exercise #21

noreply@blogger.com (Unknown) — Sat, 29 Sep 2007 22:04:00 +0000

In an effort to save on transcription expenses, a consortium of hospitals decided to pool their bargaining power. Working with a medical practice management consultant, they entertained bids from the largest transcription agencies in the area. The agency that came in with the lowest bid got the contract for several large and lucrative hospital accounts.

Although Agency A's management bid successfully on the contract, Agency A did not have sufficient transcribing talent to meet its obligations. As a result, dictation which should have been transcribed within 24 hours was frequently five days late.

The head of the liver transplant service at one of the hospitals was appalled to discover that a two-page report contained 50 mistakes. When he protested to the hospital administrator about the poor quality of transcription, he was told that the hospital had locked itself into a contract for that price and it didn't matter how bad the reports were -- the hospital was bound to honor its contract with Agency A.

From the hospital administrator's standpoint, the lowest price per line was the driving factor behind the contract. Yet the hospital's risk management advisors might have felt otherwise -- had they understood how vulnerable the administrator's cost-cutting decision would leave them to medical malpractice lawsuits.

In an essay of 250 words or less, explain why the lowest possible rate can also guarantee a higher percentage of errors when outsourcing transcription services:

Consciousness Raising Exercise #37

noreply@blogger.com (Unknown) — Sat, 29 Sep 2007 21:58:00 +0000

One of the critical failings of voice recognition is its inability to spot contextual errors. Despite industry claims that artificial intelligence will soon take care of these minor "glitches," artificial intelligence is exactly what it claims to be.

The following headlines are notable for their sexual innuendo and/or typographical mistakes. Whether or not the meanings were intentional, these headlines are reputed to have appeared in the newspapers listed below them.

GATORS TO FACE SEMINOLES WITH PETERS OUT
The Tallahassee Bugle

MESSIAH CLIMAXES IN CHORUS OF HALLELUJAHS
The Anchorage Alaska Times

GOVERNOR'S PENIS BUSY (should have been "Pen Is Busy")
The New Haven Connecticut Register

THANKS TO PRESIDENT CLINTON, STAFF SGT. FRUER NOW HAS A SON
The Arkansas Plainsman

CLINTON PLACES DICKEY IN GORE'S HANDS
Bangor Maine News

STARR AGHAST AT FIRST LADY SEX POSITION
The Washington Times

CLINTON STIFF ON WITHDRAWAL
The Bosnia Bugle

LONG ISLAND STIFFENS FOR LILI'S BLOW
Newsday

ORGAN FESTIVAL ENDS IN SMASHING CLIMAX
San Antonio Rose

PETROLEUM JELLY KEEPS IDLE TOOLS RUST-FREE
Chicago Daily News

TEXTRON INC. MAKES OFFER TO SCREW COMPANY STOCKHOLDERS
The Miami Herald

MARRIED PRIESTS IN CATHOLIC CHURCH A LONG TIME COMING
The New Haven Connecticut Register

GOVERNOR CHILES OFFERS RARE OPPORTUNITY TO GOOSE HUNTERS
The Tallahassee Democrat

WOULD SHE CLIMB TO THE TOP OF MR. EVEREST AGAIN? ABSOLUTELY!
The Houston Chronicle

MONDALE GETS WARM RESPONSE FROM FRENCH HEAD
Champaign-Urbana Gazette (ca. 1978)

In 150 words or less, explain what can go wrong if a medical language specialist is not editing a doctor's dictation during the transcrpition process.

The Currency Of Language

noreply@blogger.com (Unknown) — Sat, 29 Sep 2007 05:06:00 +0000

Throughout the history of civilization, human beings have used a variety of means to communicate thoughts and images. Primitive societies depended on gestures, drawings, rhythm, sound, and an early form of telecommunications known as smoke signals. More advanced civilizations developed motion into dance, drawings into art, rhythm into music, and sound into language. Over the years, telecommunications have evolved from smoke signals to semaphore, from wireless to satellite technology.

Many people are drawn to medicine because it promises an exciting career. But what makes medicine so exciting is not just the challenge of helping people manage their health. There is also the element of change. Medicine does not change simply because of new diseases. Nor are changes in the language used by medical practitioners merely influenced by the release of new drugs into the marketplace. New words -- and new uses for old words -- reflect how language is being used in society at large. For example: Since 1970, two new uses for the word waste have entered our vernacular.

1. To get wasted (on drugs or alcohol).
2. To waste (kill) someone.

Quite frequently, new terms and phrases make their way into the vernacular from a variety of subcultural sources. Terms like “hip-hop,” “frug,” “rave,” “scat,” and “reggae” emerged from the music and dance worlds and were popularized through radio. Rock bands like the Dead Kennedys or Butthole Surfers chose their names for shock value and/or marketing purposes. Current events often lead to the coining of peculiar phrases to describe the news of the day. For example: A series of fatal incidents led to the terms “disgruntled postal worker syndrome” and “going postal.”

Slang most frequently originates among teenagers whose sense of alienation from older generations inspires them to concoct words of their own. The ultimate irony is that the words once thought to belong to the cutting edge soon become a mark of how dated a person’s references might be. Terms like “disco bunny,” “feminazi,” “Trekkie,” “shrimper,” “far out,” “Deadhead,” “dudette,” and “Beemer” can pinpoint a person’s age, interests, and sensitivities (or lack thereof) with cruel precision.

A society’s language changes as that language must continue to reflect the population it serves. The more diverse and multicultural a society becomes, the more diverse the language of medicine becomes. With each change in the practice of medicine (as with any changes in our society), words must be created or chosen to define what is happening and to communicate new thoughts. In order to produce a coherent patient record, these words must be clearly articulated by the dictating physician and understood with the same clarity by the medical transcriptionist.

If any profession is filled with people who love words, it would have to be medical transcription. Perhaps even more than in publishing and editorial endeavors, medical transcriptionists form a nationwide army of wordsmiths. People who enjoy seeing how words are put together. People who enjoy seeing how words relate to each other. People who enjoy seeing a word used in its proper context. People who can find the same kind of joy and excitement in the discovery of a new word that they experience upon biting into a chocolate truffle and -- as the soft, creamy filling titillates their taste buds -- savoring the exotic flavor within.

If one were to examine common traits found in medical transcriptionists, they might include:

Curiosity

Strong reading skills

A passion for crossword puzzles and anagrams

A genuine love of language.

So why not let these people have some fun with their work? During the past 25 years, the words contained in Group A have become assimilated into our common language. Some are medical terms, some are terms from the vernacular:

Group A

ATM machine

gridlock

salsa

AZT

infomercial

satellite dish

BBS

Internet

shrink wrap

compact disk

kiwi

sound bite

condom

megalopolis

spin doctor

cyberspace

microwaveable

sushi

cyclamates

modem

sysop

dissing

nose ring

target marketing

downsizing

on-line service

televangelist

freebasing

outplacement counseling

tofu

freeze dried

outsourcing

upscale

frequent flyer miles

politically incorrect

Wassup

gentrification

relational database

Walkman

global economy

salad bar

wok

Suppose you try an interesting exercise: Spend some time with a physician who is 25 years older or younger than yourself. Analyze these terms by asking each other the following questions:

What does this term mean to me?

How does the proper use of this term reflect changes in the world in which I live?

How does the proper use of this term affect me from a personal standpoint?

How does the proper use of this term affect me from a professional standpoint?

If this term did not exist, how would I describe the phenomenon it identifies?

If this phenomenon did not exist, how would my life be different?

While you have your colleague’s attention, tell him you need his help in understanding some words from the following scenario:

“An ‘urban aboriginal’ patient who has been shooting speed comes to the Emergency Room complaining of burning on urination. As the patient is examined, the physician notices a variety of tattoos and body piercings, including a stainless steel stud piercing the tongue, a pair of nipple rings, a gold navel ring, a Prince Albert, and a guiche. In addition to the patient's urinary tract symptoms, there is concern about the possibility of the patient developing an abscess or infection.”

Look the physician straight in the eye and ask him to explain the terms “Prince Albert” and “guiche” to you. Ask him to draw you a diagram, if necessary, and articulate how he would describe any other body ornaments while dictating this patient’s physical exam.

What’s the point? Why bother?

It’s easy to throw words around just to make noise and try to impress people. It’s much more difficult to use words properly. Whether someone is wealthy, self important, or a figure of authority, a critical weakness in language skills can have serious repercussions in the workplace.

One of the main characters in the film The Opposite of Sex is a high school English teacher who has been having an affair with a much younger man. No matter how much emotional pain he is subjected to by his lover’s selfishness and thoughtlessness, the teacher cannot stop himself from correcting the young man’s sloppy grammar. Each time this occurs, there is a peculiar poignancy attached to the teacher’s unwillingness to let the language he loves be abused with such recklessness.

I remember how, when re-entering the field of medical transcription after a 15-year career as a freelance writer, the woman who was mentoring me warned “This is about working on a production basis. If you’re having trouble hearing what a doctor says, listen to it three times and then leave a blank. Move on to the next sentence. This is not about creating art.”

Yet any teacher can tell you that there is a stunning difference between math, science and language arts. One of the most interesting reality checks being delivered to today’s new generation of “knowledge workers” has to do with the use of search engines on the Internet. It’s all well and fine to want to search for information. But if you don’t know what you’re looking for – and don’t know how to define the parameters of your search – you might not get good results.

More to the point: if the word you type into a search engine’s data entry field is misspelled, the results of its search will be meaningless.

This can be a real “bummer” for people who are functionally illiterate and/or driven by a need for instant gratification. But them’s the rules, folks. You have to spell the word correctly if the search engine is going to function properly. If you don’t use a word to communicate its proper meaning, you are failing to communicate. With that thought in mind, let’s examine the terms in Group B that have become part of our popular vocabulary:

GROUP B

African-American

fax

Neptune Society

Amerasian

fiberoptics

PMS

angioplasty

gene splicing

Prolene

artificial intelligence

Gore-Tex

significant other

bionics

Hemlock Society

sky pager

biofeedback

hospice

surrogate mother

CAT scan

intraocular lens

telecommute

cochlear implant

in vitro fertilization

trabeculoplasty

crack head

laparoscopy

ultrasound

cryotherapy

liposuction

uplink

digital sound

Marlex

VCR

Ebonics

MRI scan

virtual reality

extended family

needle exchange

WYSIWIG

Once again, try to spend some time with a physician who is 25 years older or younger than yourself. Analyze these terms by asking each other the following questions:

What does this term mean?

Was this term commonly used when I was in medical school?

How did this term come into existence?

How did this term become popularized in our culture?

How does the proper use of this term affect me from a personal standpoint?

What you will soon discover is the power of words to help or hinder communication. The lesson to be learned is that unless we understand the words we are using – and how those words may be interpreted by the person who hears us use them – we may easily fail to communicate with each other.

Compared to how medicine was practiced at the beginning of the century, the technology at our disposal is quite remarkable. Syphilis and polio are no longer major diseases. Organ transplants have become routine procedures. Laser keratotomies can be done in the office. Laparoscopic techniques have had a dramatic impact on the surgical suite.

Despite our technological sophistication, new diseases keep surfacing. Among those identified in the past 25 years have been Legionnaire’s disease, carpal tunnel syndrome, AIDS, chronic fatigue syndrome, and toxic shock syndrome. Although a cure has yet to be found, there is a much more sophisticated understanding of Alzheimer’s disease. Drugs such as Sustiva, Celebrex, Aricept and Viagra have entered the marketplace while many more are undergoing clinical trials.

Accompanying all of these medical breakthroughs are new words -- and new uses of old words -- to describe and enhance the practice of medicine. My suspicion is that if physicians, risk managers and hospital administrators were more impressed with the power of language -- and the love medical transcriptionists share for words (which, after all, are the basic building blocks of language) – then medical transcription itself might be regarded very differently by the powers that be.

First Walk A Mile In My Shoes

noreply@blogger.com (Unknown) — Sat, 29 Sep 2007 04:44:00 +0000

In the 1995 film entitled Swimming With Sharks, Kevin Spacey delivers a bravura performance as Buddy Ackerman, a spoiled, brutally selfish Hollywood executive who takes great delight in making his underlings miserable. Anyone who has worked as a legal secretary, medical transcriptionist or administrative assistant for a megalomaniacal monster like Ackerman will recognize each sadistic bit of needless humiliation, power tripping and job-related abuse. Viewers may swallow their horror long enough to cheer when Ackerman’s assistant Guy (played by Frank Whaley) turns the tables on his boss and proves how sweetly detailed revenge can be.

Those who have never worked for such prima donna personalities can’t believe that people actually behave that way in the workplace. However, the poor souls who have hung onto their jobs through thick and thin – suffering constant streams of invective mixed with daily doses of humiliation -- often find it difficult to describe the personal hell they have endured.

Medical transcriptionists often find themselves in a similar situation. And there is little solace in knowing that only people who transcribe on a regular basis truly understand what they are subjected to while trying to do their work. It’s the folks who are in the trenches day in and day out – listening to some muckmouth doctor’s mumbling, screaming, or other distorted attempts at dictation -- who know what professional MTs must listen to in order to produce a finished report.

It doesn’t matter whether doctors are dictating onto cassette tapes, using a cell phone (which broadcasts their dictation over radio frequencies and thereby compromises patient confidentiality), or dictating over a secure phone line. Their constant lack of attention to the acoustics of the environment in which they are dictating causes severe problems for medical transcriptionists which can impede productivity and dramatically increase job stress.

Here are some real life examples (taken from my own experiences as well as from colleagues in the industry) of what MTs are forced to listen to as they attempt to work:

The doctor who insists on dictating next to ringing phones, high-impact printers, beeping cardiac monitors, vacuum cleaners, or simply prefers to hold his pager next to the telephone as he dictates reports. This has the same effect as someone holding a highly sensitized microphone next to chalk that is repeatedly being scraped against a blackboard.

The physician who dictates reports while sitting in his jacuzzi.

The physician who dictates reports over his cell phone from an airport lounge or from the first class cabin of his plane (either while in flight or on the ground) knowing full well that his voice is in direct competition with the public address system, the noise from the plane’s engines and the general hubbub in the cabin.

The physician who tries to dictate over a cell phone while driving to work and can’t understand why transcriptionists are unable to hear every word of dictation while the doctor is driving through a tunnel.

The physician who tries to dictate in English while holding a conversation in Mandarin with someone else in the office.

The physician who tries to make the most of his time by dictating while he eats his lunch.

The physician who loudly sneezes, belches, coughs and burps throughout his dictation.

The physician who dictates while seated next to his pet parrot (who has a nasty habit of making loud – and lewd – comments which drown out the doctor’s dictation).

The physician who, not wanting to waste a moment of time, carries his microcassette recorder into the bathroom and continues to dictate while urinating, defecating, wiping himself and flushing the toilet.

The physician who watches The Late Show With David Letterman while trying to dictate reports.

The physician who attempts to cook dinner, feed her infant and dictate reports while her two other children scream at each other and watch television in the background.

The physician who is too busy comparing dating techniques with her fellow residents to pay attention to the report she is dictating and thus keeps mixing up all of the information about the patient’s surgery.

The physician who is trying to dictate on an office phone, talk to her boyfriend on a cell phone and hold a conversation with someone in the hallway at the same time.

If you talk to other transcriptionists about how such problems affect their work, they knowingly shake their heads and start to share their war stories with you. However, when you talk to managers who don’t transcribe – and don’t have a clue about how seriously bad acoustics on the dictator’s end of the conversation can affect the quality assurance of transcribed reports – it becomes obvious that most transcriptionists’ complaints and criticisms fall on deaf ears.

Management typically thinks that transcriptionists make up these little stories because they have nothing else to complain about. Or because they’re unhappy. Or because they think these stories are funny. A standard clueless reaction recently came to me from a HIM manager who contacted me by e-mail. The fact that this person would not even sign her name to her correspondence told me that she had some problems with cowardice and insecurity. Here are some excerpts from her e-mail:

“I am an RHIA and manage a middle-sized hospital department, including 4.5 Transcriptionists. I have never typed a report outside a classroom (okay, I tried it once). However, I do not believe this makes me any less of a good manager.”

“Just as my boss has enough Health Information Management knowledge to make him dangerous, direct work experience is not always necessary to get the job done.”

“You are very knowledgeable in your area of expertise & I feel that the Transcriptionists who work in my department would find your articles a good resource for information. However, due to the constant unfounded negative comments & suggestions towards administration and management, I feel that more harm than good would be done to the self-esteem and self-worth of the Transcriptionists.”

Her comments would be laughable if they were not so pathetic. By taking on the role of the superprotective schoolmarm, this RHIA insults the intelligence of her medical transcriptionists as a means of covering up for the fact that other people know more about their work process than she does. Not only does this RHIA exhibit serious control issues, she obviously does not trust her transcriptionists enough to allow them to read and digest information about their work (what they do every day) without her censoring their reading material.

This is the kind of manager who does not know how much she does not know. And certainly doesn’t want anyone pointing out that the Empress is wearing no clothes. But what about some of the real problems facing her transcriptionists? Who can they seek help from when confronted with such an ignorant and unsympathetic supervisor? Who can they turn to who will challenge the doctors at this facility to improve the quality of their dictation?

Often, when medical transcriptionists complain to management, no one seems to care or want to ruffle the feathers of “the poor doctors.” Unfortunately, many doctors have reached a level of success where they are no longer interested in learning how to do something better. The chances of making them change their dictation habits are really very slight.

How can the problem be fixed when the people who are capable of initiating change are in such a strong state of denial that they refuse to admit a problem even exists? In situations where a transcriptionist or MTSO has a casual, personal relationship with a doctor, progress can often be made over drinks or dinner as part of “continuing medical education.” If you are a doctor’s patient, a fail-safe technique is to grab his attention in the examining room when you can lock eyes with him.

For those who lack such options, let me offer a fantasy scenario akin to the treatment Buddy Ackerman receives from his vengeful assistant in Swimming With Sharks. Some might call it “Paybacks Are A Bitch.” I prefer to think of it as a consciousness-raising exercise that should earn credits for continuing medical education. Here’s how it works:

Insist that your doctor make a deal with a male teenager who is not a member of the physician’s immediate family. The doctor must give the teenager an apple, a can of warm soda, a copy of the daily newspaper's sports section and promise to pay the teenager with a $100 bill as soon as he acts out the following script.

The teenager goes home and gets ready to place a phone call to the doctor. Before he dials the physician’s number, he makes sure that a radio or television can clearly be heard in the background. He then drinks the can of warm soda as quickly as possible.

The teenager then calls the doctor on the phone. As soon as the doctor answers, the teenager says "Testing, testing," and spits into the mouthpiece three times. The teenager then starts to eat the apple as he reads the sports page aloud.

After reading the first paragraph, the teenager taps the phone's mouthpiece five times with a pen.

After reading the second paragraph, the teenager belches as loudly as possible into the mouthpiece. Once he has finished belching, the teenager positions the mouthpiece near his forehead and mumbles a set of game scores as quickly as he can while finishing off the apple.

When he has finished, the teenager slams the phone down without any warning and quickly returns to the physician’s house. Upon storming into the physician’s home, he grabs the $100 bill from the physician’s hand and screams: "Whaddaya mean you couldn’t understand my dictation and had to leave blanks? How dare you criticize a teenager! You've got a lot of nerve, biting the hand that feeds you. Why, if it weren't for us teenagers, you wouldn't have a job!"

At this point, the physician must apologize profusely to the teenager, tell him how sorry he is to have upset him, and promise never, ever, to upset him again.

Managers like the RHIA who wrote to me may not understand this. They may think it is a horrifically rude and petulant assault on physicians. So would anyone who lacked real life experience working as a medical transcriptionist. However, the medical transcriptionists reading this article will know exactly what I’m talking about.

Fools Rush In

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 23:15:00 +0000

There’s an old joke about the businessman who became a multimillionaire and, with his newfound wealth, purchased a large and very impressive yacht. Bursting with self-importance, he flew his little old Jewish mother out to visit him and arranged to have her met at the airport by a stretch limousine. When the chauffeur delivered the old woman to the dock, she saw her son proudly standing by the gangplank in front of his yacht, decked out in the flashiest maritime uniform he could find. “Look, Ma. I’m a captain!” he boasted.

His mother (who was no fool) instantly sized up the situation. Taking her son’s hand reassuringly, she leaned over, kissed him on the cheek and whispered to him: “Darling.......By me, you’re a captain. And by you, you’re a captain. But, trust me on this one. By a captain? You’re no captain!”

In a professional world that has been flooded with inflated resumes transforming waiters into“beverage service managers” and fast food outlet counterboys into “nutritional counselors,” it has become increasingly difficult to identify and hire “the real thing.” Many job applicants, consultants and entrepreneurs feel confident that, by inflating their resumes, they can make their achievements sound more impressive and, as a result, ace out the competition. The cynics and fact checkers who know how to read between the lines no longer find much humor in such pathetic exercises in self-aggrandizement.

Recently, a friend with 14 years of experience handling affirmative action complaints for a state university described how, as part of yet another bureaucratic reorganization, the people in her department had been demoted and forced to report to a 26-year-old woman with no experience in affirmative action (who came to the job following six months as the marketing director for a winery). “The terrible thing about this situation is that she doesn’t even know what she doesn’t know! Unfortunately, the rest of us do!”

Another colleague (who has enjoyed a 20-year international career as a leading coloratura soprano) recently transitioned to teaching voice at the university level. A competitive professional singer who always learned her music and arrived prepared for any job, she is appalled by the lack of initiative and professionalism she encounters in her students. “They don’t learn their languages and they’re not musically prepared. To make matters worse, they seem to think that all they have to do is just show up and get a grade so they can then magically move on to a big money career,” she groans. “You know what makes this whole thing so pathetic? These students are suffering from delusions of adequacy!”

That term – delusions of adequacy – keeps coming to mind each time I receive a new -- and utterly ridiculous – e-mail from some Third World entrepreneur trying to convince me to subcontract work to a firm that has no experience in medical transcription. Because you have to see some of these messages to believe them, here’s a tasty little sampler of what many MTSOs have been receiving:

“Let me introduce myself,i am jayakeerthi,an engineer.,working with my father in interior decoration firm, I am setting up medical transcription service in india very soon, i am looking for orders from usa countries for mts We have dedicated people,having training in good medical transcription school, We will assure you of 98.5% accuracy min all the time,with 24hrs to 48hrs turnaround tim,with well documented with 5 cents per line. looking forward for your positive reply from u”

"Dear Sir, I have man & mechinary & big basement to start Medical transction work. Please give me all guidence.”

"well , i am on my way toset up a MT unit in Delhi which i have already mentioned in my last mail now i am facing couple of problems regarding the information technologies requirements. I am not much aware of the the software requirements in this field. it would be a kind enough jesture if u can let me know bout this aspect."

“I'm a Graduate from Pakistan. For the last week I was searching transcription companies and have found you. I'm willing to work for you, I have heard a lot about you on the internet. Although I have got no experience in the past but have good typing skills and can very well understand the American English accent. I'm sure I'll be able to this job.

“Today, I was browsing about the [web site]. I m very much intrested in becoming a quality transcriptionist. could please help me about voice recognition and other important features in becoming a competitive transcripitonist. And i m intrested work in u.s.a, how about the posibality? can I make it. Please help me by sending to my e-mail adress. I hope, I get some positive replay.”

“We would like to introduce ourselves as Exporter of Marine Products mainly to Japan with an annual turnover of approximately INR 150 milion. Now we are interested in starting Medical Transcription Business through you from India with 10 pc's. As we have to start from scratch, we need total guidance as to how to go about it including the requirement of Hardware & Software.”

When I looked at this last person’s website, I discovered that he was actually a shrimp farmer. But, what the hell! India is rapidly becoming known as the virtual back office to the world. Airlines, banks and other businesses are using Indians for data entry and customer service support calls. The logical assumption would be that, as long as you have a computer, who says you can’t do medical transcription for Americans?

Maybe some people who know what they’re talking about?

Perhaps those professional MTs who have been doing this for a living?

I am deeply indebted to Renee M. Priest, CMT, and Carole J. Gilbert, ART, for their willingness to offer proof to America’s health information management industry of the ludicrous sales pitches and piss-poor quality of work they encountered when trying to deal with offshore subcontractors. I urge every person who reads this article to point their web browsers to www.optitron.com/offshore/ to see just how outrageous the situation has become. Once you’ve finished reading the sales pitches, do be sure to click on the “Discussion” link to view the proofreading log!

Why did Priest & Gilbert feel a need to post this information on the web? “We see endless posts online assuring people that offshore services are not as bad as the massive volume of badly worded e-mail letters we all receive each day––the e-mails that are touting how much more cheaply and accurately offshore transcription can be provided. It is our hope that by sharing these files with you, you will realize that there is a great deal of important information being left unsaid about the pitfalls of utilizing an offshore company, or any company for that matter, whose sole purpose is using our profession as the latest get-rich-quick scheme for global entrepreneurs.”

Rest assured that the same problem exists in America. Throughout the past decade, business magazines have consistently touted medical transcription as a major growth industry, luring many unqualified people to the field. A client who is an attorney sent me a postcard he recently received announcing an upcoming seminar at the Learning Annex. The pitch was short and sweet. “If you know how to type and like the thought of starting a business without much hassle, medical transcription may be the business for you!......If you want to have a business at home, find employment easily, and make a living on your own, this class will get you started!”

Whether aimed at American or Third World entrepreneurs, these types of solicitations give people the false impression that all they need to do is purchase a computer and the rest will happen by magic. Having bought into the fantasy, these MTSO wannabes further assume that doctors, hospitals, clinics and experienced professional MTs will automatically want to give them tons of work (regardless of whether they are the slightest bit qualified to perform the services required). Nor do they seem to be concerned that so many similar start-up ventures have crashed and burned with astonishing rapidity.

Several years ago, an aspiring MBA who was planning to start a medical transcription business sought my counsel. She had crunched all the numbers and figured out how to make it work. She was sure of it. Besides, she was great at selling and knew how to get new clients. The fact that she had no experience transcribing didn’t seem to matter to her because, as she proudly told me, a friend of hers could do some part-time editing and she was confident that would take care of any and all problems.

How did she plan to manage her subcontractors? “Well, if a doctor wants his documents in MSWord, I’ll tell the transcriptionists to type it in Word. And if he wants it in WordPerfect, then I’ll tell them to type it in WordPerfect.”

She was supremely confident, very sure of herself and, without a doubt, dressed for success. Guess what? Six months later she called to inform me that things had not quite worked out and, since her return on investment didn’t materialize fast enough (and she was getting married), she had decided not to continue in the field of medical transcription.

Her future business plans? Spending six months honeymooning in Europe.

And what did she expect her clients to do? “Whatever!”

I mention this incident to counter some accusations of racism that have come my way as a result of my having taken such a vehement stand against offshore transcription. There are certain human traits which transcend racial and/or national boundaries. These include (but are certainly not limited to):

Greed

Arrogance

Incompetence

Ignorance

Stupidity

Deceit

Failure to produce

Lack of responsibility

Lack of professionalism

Doctors have been known to display these qualities with startling regularity. With industry analysts now estimating that one in every five doctors practicing in America is an Indian import (and managed care putting the squeeze on every doctor’s earnings), some physicians have decided to invest their money in the healthcare information management industry as a means of developing a secondary revenue stream.

More than one Medical Records Director has already complained about Indian physicians on staff who are constantly pressuring their hospital administrator to award transcription contracts to companies that are owned by themselves, their friends or their relatives.

This is definitely not a means that justifies the end.

Several years, ago, it was determined that potential conflicts of interest should prevent doctors from owning their own medical laboratories. With news items constantly surfacing about doctors who have been indicted for double-dipping on travel expenses -- or fraudulently overbilling Medicare – the concept of allowing doctors to be involved in the ownership of medical transcription services makes as much sense to me as permitting drug dealers to set up rehabilitation programs.

Forgive me for asking such a simple question. But exactly who is America’s healthcare system supposed to be taking care of? The patient? Or some staff physician’s relatives overseas?

San Diego MT Discovers Missing Link

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 22:44:00 +0000

In 1962, when Who’s Afraid of Virginia Woolf? premiered on Broadway, playwright Edward Albee used new dramatic techniques to bore a hole into the American psyche. Unlike classic Greek dramatists who favored the use of a “deus ex machina” -- or mystery writers who thrived on revealing hidden pieces of evidence – Albee shattered the illusions of an alcoholic couple trapped in a miserable marriage by allowing one partner to call the other’s bluff with devastating accuracy. As an evening of drunken debauchery and dysfunctional party games (Humiliate the Host, Get the Guests, Hump the Hostess, Bringing Up Baby) wound down, Albee’s shrewd and shrewish Martha sighed “Truth or illusion, George. Doesn’t it matter to you...... at all?”

A pertinent question, indeed! In April, the Medical Transcription Industry Alliance held its annual conference in Seattle, a city that had recently been rocked by a sizable earthquake. Over at Seattle’s Pacific Science Center, “Titanic: The Artifact Exhibit” invited visitors to touch a wall of ice upon which a series of hand prints had been fashioned. The bone-chilling sensation made it shockingly clear that, instead of drowning, most of the 1,509 people who perished in history’s greatest maritime disaster succumbed to hypothermia after being exposed to the icy waters of the North Atlantic. As the MTIA conference got underway, an unsettling theme started to emerge through a pattern of acutely painful reality checks. Like Albee’s searing drama, the conference forced participants to confront some appalling truths and/or prepare to dump a bunch of tired illusions that have haunted the transcription industry.

After 18 years as the driving force behind the American Association for Medical Transcription, news of Executive Director/CEO Claudia Tessier’s sudden resignation provoked emotional outbursts ranging from deep concern about AAMT’s future to ecstatic war whoops (a former AAMT President was seen clicking her heels in the air to express her delight). However, finding someone who can replace Tessier and breathe new life into AAMT will be a daunting task. What will the future bring for AAMT? Truth or illusion?

News spread quickly that, as a result of acquiring an ASP company named Speech Machines, industry giant Medquist had gained access to competitors’ client information which had been resting on the Speech Machines servers. As Medquist tries to redefine itself as a technology company, many MTIA members wonder how soon that company’s definition of “free market competition” will start to resemble Microsoft’s monopolistic arrogance. Will MTIA’s Board of Directors take action with regard to the predatory practices of the industry’s largest medical transcription service? Truth or illusion?

In yet another demonstration of the supposed wonders of speech recognition technology, a representative from Dictaphone/Lernout & Hauspie went through the text she had dictated three times without catching a simple grammatical error. When asked why she had not fixed this error, she stated that she had seen it and should have corrected it, but was in a rush to finish her presentation. Truth or illusion? MTs don’t have that luxury. For a real eye-opener on the continued woes of Lernout & Hauspie and the future of speech recognition, read about Lernout & Hauspie's Continued Woes.

Joe Weber’s article entitled “Speech Recognition: Is It Ready for Docs?” raised an important question: Can users of speech recognition safely rely upon statistical analysis of performance if SR fails to understand context? Editing SR-generated documents can easily cause a lazy eye syndrome among editors which leads to easy distraction and diminished concentration. If mistakes such as the one missed in the above-mentioned demonstration keep getting missed, will more serious mistakes metastasize throughout a patient’s medical record? Truth or illusion? If such mistakes are not caught in the process of editing SR-generated documents, could patients be harmed – or die -- from the use of speech recognition technology?

After more than three decades of the women’s rights movement, and AAMT’s never-ending struggle to gain professional respect for medical transcriptionists, there are still female MTSOs who refer to their transcriptionists as “my girls.” Truth or illusion? Are service owners (instead of doctors) the real reason why MTs can’t get no respect?

A particularly hot topic was whether companies should look toward combining coding and transcription services as a way to broaden profits (the assumption being that medical transcriptionists already know enough to do coding). Truth or illusion? Unlike medical transcriptionists, coders have to pass a variety of exams and continuing education courses in order to maintain their licenses. Medical transcriptionists might not wish to embark on another learning curve with no guarantee of being financially rewarded for their efforts. There might also be strong resistance from the folks in AHIMA and other parts of the coding industry.

In one of the keynote sessions, William Young (President of Market Trends, Inc.) explained how the market assessment commissioned by MTIA to determine the size and scope of the medical transcription industry had tried to evaluate the different types of medical transcription services and the relationships they held with their clients. Estimating that the current market ranges up to $25 billion -- with an estimated 30% increase in volume predicted over the next two years -- Young tried to demonstrate how questions of satisfaction with regard to accuracy, quality, responsiveness, turnaround time, and cost often determine whether a national, local, or independent MTSO will offer the best match of services for a particular client. Young’s presentation left MTIA’s membership struggling to decide whether, once again, they were dealing with truth or illusion.

In examining overall satisfaction with outsourced transcription, the sample size of Young’s market analysis found the impact of offshore transcription firms too small to allow for any future projections. Truth or illusion? Nearly 10% of MTIA’s membership now consists of offshore firms aggressively marketing their services to American hospitals and MTSOs while seeking positions on MTIA’s Board of Directors.

If the rate at which companies represented on MTIA’s Board of Directors keep disappearing into Medquist’s hungry maw continues unabated, MTIA’s board will have a tough struggle to stay true to the organization’s rank-and-file membership. Truth or illusion? Now that Medquist has swallowed most of MTIA’s large members, small to medium-sized companies may have trouble finding the time and/or funds to participate at the board level. MTIA may soon face an identity crisis.

Despite exhortations that the medical transcription industry must catch up to other industries which have quickly and easily surpassed us in embracing new technology, MTIA’s conference demonstrated with truly appalling visuals that an industry which stresses accuracy in healthcare documentation is doing a very poor job of proofreading its own materials. MTIA’s conference binder was filled with numerous mistakes and outdated information about its membership. Slide presentations and placards outside the conference rooms contained typos which should have been caught. Do we practice what we preach? Truth or illusion?

An article by MTIA Board member Joe Weber which appeared in the conference binder included the statement “We wanna get the draft text as accurate as possible, so that minimal editing is required.” Truth or illusion? Any MT who submitted that text in a report would probably be fired. That kind of grammar causes MTSOs to lose credibility and lose accounts.

Outgoing MTIA President Steve Dunkle’s presentation on the opportunities technology might bring us in the future resembled the Pentagon’s approach to spending billions on an unproven missile shield program. Is this the future MTSOs should embrace? Most of the people in the room represented small to medium-sized MTSOs that would be bankrupted by attempting even one small portion of Dunkle’s Star Wars vision. Truth or illusion? When push came to shove, Dunkle confessed that only one or two big hospital chains were thinking about this approach and that his presentation was mostly hypothetical.

In what may well have been her farewell appearance before the MTIA membership, Claudia Tessier (speaking with an adrenaline-induced fervor bordering on a Florentine frenzy) outlined the work being done by ASTM’s transcription committee and the relationships spawned with other organizations that impact the future of healthcare information management. The most eagerly awaited session, however, was Kathy Rockel’s superb and concise presentation about the new HIPAA regulations that had just gone into effect a week prior to the MTIA conference. Discussing the political process which brought HIPAA to its current state and HIPAA’s specific impact on the transcription industry, Rockel outlined key issues confronting MTSOs:

Criteria for determining HIPAA compliance include low development and implementation costs relative to the benefits of using the HIPAA standard.

The question of whether an MTSO is considered a business partner or a clearing house might have a huge impact in determining the size of penalties for failure to comply with the HIPAA regulations.

The issue of claims attachments and how they are dealt with under the HIPAA rules and regulations will have a major impact in focusing attention on transcription’s role in profitability and reimbursement. Within two years there may be no more handwritten notes in patients’ charts with the possible exception of nursing entries and vital signs.

In order for MTSOs to protect themselves and their transcriptionists from having patients knocking on their doors and insisting on their right to make changes in their medical records, revised contracts must stress that the MTSO and/or transcriptionist does not hold the final record.

The financial impact of HIPAA compliance for MTSOs is expected to be 1-3 times the costs of preparing for Y2K. Most transcription services will find themselves needing to draft written policies and making changes in some operational procedures. One of the most pressing issues involves developing policies and practices for those who work at home.

Compliance with the new HIPAA regulations will be enforced by the Office of Civil Rights. Truth or illusion? Since the Bush Administration has yet to allocate any extra funding to this office, the actual enforcement of the HIPAA regulations may result in nothing more than a photo opportunity for political purposes.

A bill has subsequently been introduced to say that no rules are final until all of the final rules have been published except for the individual identifier rule or until 2004 (whichever is sooner). Truth or illusion? “It will be interesting to watch Congress respond to the cries from business about the cost of HIPAA and see where this one goes,” says Rockel. To stay abreast of further developments, she advises subscribing to a mailing list that can be found at HIPAA listserv.

A panel designed to demonstrate how educating MTs can increase the bottom line for hospitals and service owners was aided tremendously by the hard data provided by Elaine Olson of Stat Enterprises, Inc. This may have been the first time that anyone has actually tracked productivity in a work environment based on the impact of continuing education of MTs. Using her experience consulting with a regional hospital, Olson described the transformation of an in-house transcription team from a group of lethargic, unmotivated, underachieving MTs with a bad attitude to people who had more respect for themselves, were taking more interest in their work, and whose productivity had jumped as much as 80%! While the results of her presentation were inspiring, the question still remains: How long will the learning curve take to accomplish such results?

The answer was found in a small booth in the exhibit area where I came across a product that justified my trip to Seattle. In the process of touring vendor exhibits, one becomes a little numb to the strutting and hype coming from sales teams that make great promises but don’t always deliver the goods. When you come across the real thing, the blunt truth behind the product is so daring and refreshing that you sit up and pay close attention.

I don’t usually flip out over new software, but I think that Chad Francisco, the creator of Keymaster, should be given an industry award for the most innovative and thoughtful use of technology to help medical transcriptionists. I would urge everyone reading this article to visit the Keymasters website and order his demo CD. After viewing the intelligently designed and coherently scripted multimedia presentations on the demo CD, you will understand why Keymaster – a product designed by an MT who has an acute appreciation for how an MT works – truly represents this industry’s “missing link.”

Keymaster goes far beyond most word expanders. Its owner did a spectacular job of putting together the pieces of an MT’s work process puzzle and understanding the big picture. A Windows-based word expander that will work with any Windows application (it does not need to be linked to your word processor in order to function), Keymaster combines the use of established shorthand techniques for building short forms with a database of more than 450,000 transcription words and phrases which it calls the MEDb or MED Brain. Owners of MEDb receive daily electronic updates containing new drug names and other emerging medical terminology which can be added into the database with several keystrokes. Drugs appear with standard dosages; definitions are accessible from your keyboard.

Whereas traditional publishers of medical transcription reference materials have dragged their feet and been reluctant to publish their word list books in electronic format, Keymaster incorporates the vocabulary and definitions into a huge database that matches your keystrokes. Its suite of products shows people how to systematically create and use short forms so that they can earn as they learn.

I can’t speak highly enough of this product. But what excites me even more is what it can do for this industry.

If incorporated into the curricula of medical transcription courses, Keymaster can probably do a faster job of training more people to become medical transcriptionists so that they are able to enter the workplace ready to perform at decent levels of productivity.

Medical transcriptionists who are individual contractors will find this product boosting their productivity while saving them time researching new drugs and medical terms on the Internet.

MTSOs and Transcription Departments that train their employees on this software will be able to process larger volumes of work with greater accuracy. If their employees have an incentive program, they will earn more money. Happier, more loyal employees build better team morale. Get it? Got it? Good!

Quality assurance people will find their work at lot easier to perform; clients may also get greater accuracy in their documentation.

As more and more productive MTs enter the American labor market, there will be less need to send transcription offshore.

In short, Keymaster offers a cost-effective, easily affordable, win/win solution for many of the problems facing America’s medical transcription community. In terms of earning a return on your investment, I would suggest budgeting for this product before anyone budgets for the cost of an AAMT membership. Why? Because embracing Keymaster’s technology will give MTSOs and medical transcriptionists the tools with which to quickly generate sufficient revenue to pay for AAMT memberships.

Truth or illusion? Don’t take my word for it. Check out this product yourself.

Till There Is A Cure

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 22:24:00 +0000

We’ve all heard of PMS. Will someone please tell me why no one wants to talk about PJJ syndrome? PJJ occurs on a regular basis in hospitals throughout America. Most medical records personnel anticipate the onset of PJJ months in advance. The pre-JCAHO jitters can have a devastating impact on workplace stress, staff morale, employee health, and productivity. But no one has found a way to tame this bizarre form of administrative seizure activity which precedes an audit by the Joint Commission for the Accreditation of Healthcare Organizations.

While the folks in IT and other departments have no trouble understanding the classic GIGO formula (garbage in, garbage out), risk managers, Chiefs of Staff and physicians on the Medical Records Committee seem to suffer from an occupational blind spot. If nurses and medical transcriptionists can easily identify the chronic conditions which provoke PJJ, why can’t those with medical licenses diagnose the problem? As Bill Maher (the host of TV’s Politically Incorrect) would say, it’s like watching people trying to ignore a 500-pound pile of elephant dung located smack in the middle of their living room!

If a patient required treatment with antibiotics, anti-inflammatories, antacids or a change of diet, everyone would know what to do and the problem would quickly be solved. So let’s not kid ourselves. The “garbage in” factor can often be traced to known sources. The culprits can often be quickly identified.

Why can’t the pre-JACHO jitters be avoided? To answer the question, let’s look at certain news stories which are guaranteed to appear every year. Will there be stress at the nation’s airports over Thanksgiving weekend? You’d better believe it. Will the first baby born in the New Year make it onto the local news? Without a doubt. Will everyone wonder if Punxsutawney Phil sees his shadow on Groundhog Day? Easy story to cover.

Come April 15th, will the news media have their cameras out as taxpayers rush to the post office to file their returns before the midnight deadline? You can bet money on it. Planning a story about people who wait until the last minute to do their taxes is a no-brainer for news editors. It makes for good copy and touches a universal fear button. The story is a sure shot for the 11 o’clock news because there’s always some poor schmuck who will wait until the last minute to file his tax returns.

But what about the story that does not get written? What about the millions of people who file their tax returns on time because they were doing what they should have done all along? I’m not just talking about people who are employees, but also about those freelancers and business owners who maintain the financial discipline necessary to track their income and expenses using programs like Quicken and/or Quickbooks.

These people dutifully log all transactions, balance their checkbooks, and deliver reliable financial data to their accountants in plenty of time to meet each year’s April 15th deadline. Whether running a hospital or a restaurant, they pay their employer’s taxes on time. Their W-2 forms are delivered to employees and their 1099 forms appear in contractor’s mailboxes on time.

Not only do these people understand the responsibility to store and maintain data so that they are ready to print W-2 and 1099 forms by mid-January, they also know that other people are expecting these forms to arrive on time in order to prepare their taxes and avoid any penalties for late filings.

That seems pretty straightforward, doesn’t it? It’s the kind of process that someone with a medical degree should be able to understand. And yet, when it comes to creating valid clinical documentation, too many physicians think that their patient’s right to a clear and concise medical record has nothing whatsoever to do with the timeliness and quality of a physician’s dictation.

Suppose we compare maintaining a patient’s medical record to handling a company’s accounting functions. In the financial world, data has to be clean. If you make the kind of mistake that moves a decimal point three digits to the right, it can have stunning economic repercussions. If, for some bizarre reason, you decide not to record any transactions that occur on Fridays, how can you know how much money you have in the bank? How can you plan a budget without sufficiently solid data to forecast income and expenses? How many people in your accounts payable department are allowed to issue blank checks?

No one in the business world can tolerate that kind of ineptitude when profit margins are tight and management needs to maintain a desperate grasp on reality. But look at what we tolerate in the world of medical transcription. There isn’t a hospital in this country that doesn’t have at least one doctor whose dictated reports contain enough blanks to look like a piece of Swiss cheese. Or a handful of physicians who are notorious procrastinators. Not to mention the doctors who don’t bother to read their transcribed reports in order to check for errors and/or make corrections.

When people don’t know how much of a mess has been made – or don’t care – there’s good reason for the person in the hot seat (usually the Medical Records Director) to get a bad case of the pre-JCAHO jitters. Suddenly, there is a heightened awareness of the need for quality control in transcription. Like a bolt out of the blue, there is a demand for perfect transcription with no blanks in any reports. Extra employee hours must be devoted to making sure that past records are complete and can withstand the scrutiny of the JCAHO’s auditors. As the pressure starts to build and employees are asked to work longer hours, management’s expectations become more and more unreasonable.

Like someone who has “found” religion, a clinic or hospital that once wasn’t very concerned about quality assurance suddenly executes a 180-degree turnaround in policy and procedures. With a JCAHO audit looming on the horizon, there is a newfound urgency for all charts to look pristine and complete. Is this any more of a joke than the stereotype of the stewardess who, on April 14th, shoves a box full of receipts at her accountant and says “I don’t know what these are for, but I saved all of my receipts this year. Just make sure you get my taxes done on time, Buster.”

While working in the arts, my friends and I used to compare the long-term health of large dysfunctional nonprofit institutions to that of problem drinkers. In many cases, the management and staff of these institutions resembled adult children of alcoholics who desperately kept trying to “make their parents get better” without being able to face the horrid fact that their parents didn’t want to get better. Is there a corollary between a hospital’s pre-JCAHO jitters and an alcoholic’s delirium tremens? You tell me.

The people at the bottom of the ladder are not fools. Nurses know which doctors make sloppy, illegible entries into patients’ charts. Medical transcriptionists know which doctors are continually contradicting themselves while dictating because they’re lost in space, dictating so fast that they can’t help but make errors, or are simply too pooped to pay attention to what they’re doing. Accountants know who’s been doing a responsible job of tracking expenses. Even Santa Claus knows who’s been naughty or nice.

But in the medical field, everyone keeps dancing around the truth about doctors like a bunch of co-alcoholics who are terrified to perform an intervention. God forbid someone should nail a physician to the wall, tell him he has sloppy work habits and force him to sober up and learn the proper techniques for creating a coherent medical record. That might require people to risk losing their jobs by accusing a doctor/alcoholic figure of not doing his work properly and being a hazard to those around him. Even worse, it might mean that in a medical peer review, doctors might actually have to accuse their colleagues of being incompetent slobs whose poor work habits continually jeopardize the accuracy of their patients’ medical records.

So what happens? Each year, we see the same news stories on television and witness the same song and dance in the HIM industry. The variations are easy to spot from one year to another. In one instance, a hospital installs a new piece of software which is supposed to guarantee that physicians follow certain procedures for templating their reports. In another, hospital administrators decide that by outsourcing transcription to India they can get faster turnaround with a lower price per line. With new advances in Internet technology, ASP entrepreneurs trumpet claims that they have solved all the problems of creating and maintaining an electronic medical record.

Larry Abernathy, the President of Digital Voice, Incorporated, claims that “Philips speech recognition technology is being married to our dictation system, to give birth to DVI SpeechPower. Without changing physicians’ dictation behavior, we can run their DVI VoicePower dictations through the speech engine, produce a draft text report, and then provide this text – along with a synchronized voice playback – to a ‘medical editor.’ We anticipate dramatic improvements in productivity since correcting a small number of mistakes will be considerably faster for your transcriptionists than transcribing the entire document. And it also expands the pool of personnel from which you can recruit, since fast keystroking is no longer a required skill.”

Abernathy’s statement blithely ignores the fact that fast keystroking is not the issue which keeps bringing medical transcriptionists to their knees. The problem is the incoherent garbage spewing forth from the mouths of physicians with absolutely no intention of improving the quality of their dictation.

In its mission statement, the American Society of Tests & Measurements (ASTM) claims to be the foremost developer and provider of voluntary consensus standards, related technical information, and services having internationally recognized quality and applicability that:

"promote public health and safety, and the overall quality of life; contribute to the reliability of materials, products, systems and services; and facilitate national, regional, and international commerce."

In recent years, an ASTM committee supervised by AAMT’s Claudia Tessier has been hard at work developing new standards for medical transcriptionists to follow. Although doctors initially said they wanted to be told how to dictate, it soon became obvious that the transcriptionists would have to make all the adjustments in their work habits.

It’s interesting to note that some 85 years after the Titanic disaster, analysis of the wreckage retrieved from the ocean floor helped scientists determine that the use of a cheaper grade of steel (which became brittle at low temperatures) was a major factor in causing the ship’s hull to buckle when the Titanic collided with an iceberg. Will ASTM, which supposedly sets standards for raw materials used in the manufacturing process, insist that doctors deliver a higher quality of dictation (the basic raw material that transcriptionists must process in order to create a coherent patient record)?

The reason it will be a cold day in hell when that happens is best articulated by Robert I. Field, the director of the graduate program on health policy at the University of the Sciences in Philadelphia. In his comments about the challenges faced when two or more hospitals try to merge, Field notes that basically “you have a large number of prima donnas who are used to taking orders from no one."

In her superb essay in the New York Times entitled Teaching Old Dogs New Medicine Can Be Some Trick, Dr. Abigail Zuger explains that the wealth of important new information offered to doctors during continuing medical education sessions is often forgotten soon after physicians settle back into their professional routines. And so the dance of denial continues. It doesn’t matter that the good doctor drools, has two left feet, and keeps stepping on his partner’s toes. He’s not going to change.

Which means that you’ll just have to keep dancing with the folks what brung you (and try to avoid stepping in that 500-pound pile of elephant dung in the middle of the dance floor). Think about that the next time you attend a conference sponsored by AHIMA, AAMT, HIMSS, MTIA, or any other healthcare information management-related organization. Because once you go back to work, you’re going to face the same old problem.

Garbage in, garbage out.

What's In A Name?

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 22:06:00 +0000

A favorite cartoon shows a physician’s tombstone with the epitaph “He never spelled the patient’s name.” Many transcriptionists have experienced the nightmare of listening to a doctor dictate “This is a report on John Kryzmanowski. That’s J-O-H-N.”

Have you ever listened to a Russian physician with an accent thicker than mud dictate that “The patient is having trouble pronouncing names.” Or a Chinese doctor try to pronounce and spell a Russian patient’s name? What about the Chinese physician who dictates a letter to Dr. Tse but refers to him as “Dr. Cho”?

Amusing is not the word that comes to mind.

Late one night, about a year after I had entered the field of medical transcription, I found myself pacing back and forth in the medical records department of a local hospital. A word was bothering me (a phenomenon well known to medical transcriptionists). What bothered me about this word was that I could not find it in a medical dictionary. Or any other available medical reference book, for that matter. I knew I had heard that word before. I was almost sure I had typed it that week. But for the life of me, I couldn’t remember what it meant. And I was mad at myself for not being able to remember.

There wasn’t much help at hand. By that time, only the swing shift crew was present in our department. Ken, a very polite African American file clerk, didn’t mind when people “axed him questions,” but didn’t have too many answers. Lillian was an elderly transcriptionist who was legally blind and smoked like a house on fire. Caroline was the image of an aging cheerleader who was rumored to be screwing one of the OBGYN surgeons. And Maryann, bless her soul, was a prim and proper librarian type (a superb transcriptionist who worked a second job to pay for her mother’s medical bills) who pretty much minded her own business. I couldn’t get any answers from them.

The word that was driving me nuts was “Ochoa.” But it wasn’t until two weeks went by -- and another patient named Ochoa got admitted to the hospital -- that I realized I had been obsessing over a patient’s name rather than an item of medical terminology.

That was back in 1974. Although the hospital where I worked had a large number of Filipino and Hispanic employees, it had never dawned on me that Ochoa might have been a patient’s name. I never would have guessed that my answer could have been found in a telephone directory because I was only thinking in terms of medical and pharmaceutical terminology.

Doctors often like to think that, without their godly presence, people like medical transcriptionists wouldn’t have jobs. But the truth is that without patients there would be no practice of medicine, no health information management industry, and a major dent in the world’s economy. Since 2000 is a census year, it’s important to understand how changes in America’s demographics affect the knowledge base of a professional medical transcriptionist.

When I was a child, it was a pretty fair assumption that the doctor who treated you would be a Caucasian male. It has taken many years for the demographics of physicians and medical transcriptionists to catch up with the demographics of the population at large. But the times, they are a-changing! A sure indicator of the altered face of medical care in America is to examine the names of the patients who are being treated and the healthcare providers to whom they turn for their care.

Most medical transcriptionists wouldn’t be expected to know the names of the Native Americans who welcomed the first wave of immigrants. Some patients are indeed named Pocahontas and Hiawatha. Many towns in New England (Matunuck, Pawtucket, Narragansett, Chepachet), were named after local Indian tribes. Street signs and business names in the American Southwest often include tribal names like Pima, Osage and Navajo. But few transcription courses offer clear instructions on the proper hyphenation of a patient’s name when that name is “Benjamin Brings-Plenty.” I doubt there are any medical transcription courses which teach that a contaminated quahog could be a source of food poisoning. Yet these words are part of the language which forms our American heritage.

Recent years have seen huge numbers of immigrants arriving in the United States to seek a better life. Whether they came from Europe, Mexico, Central America, or countries along the Pacific Rim, these people have had a tremendous impact on America’s healthcare services. Be honest: Until the Elian Gonzalez story hit the news, how many women named Marisleysis were a part of your daily life?

Whether recent immigrants have been Haitian boat people attempting to enter the country illegally or relatives being brought to the United States by naturalized Filipino-American citizens -- whether they were newly-free Russians or families that fled Hong Kong before it came under Communist rule -- they all brought their past medical histories, healthcare needs, and ethnic vocabularies with them. Some have created a need for physicians who speak a foreign dialect. Others have created a growing market for interpreters.

Many cities now have large ethnic populations. And, for many minorities, the desire to keep the money flowing “within the community” is matched by a distrust of people from other backgrounds. For these reasons, a Hispanic physician is likely to attract a Latino-identified patient base the same way that a black physician might attract a largely African-American patient base.

However, searching a database for a patient named “Chan” in San Francisco, “Hernandez” in Los Angeles, or “Schwartz” in New York might reveal hundreds of patients with the same last name. A medical record number may be the only way of finding the correct “Carlos Hernandez,” “John Chan,” or “Paul Schwartz.” Other, more subtle variations, must also be recognized. In many ways these reflect the language of a subculture and, to a certain extent, the musical rhythms with which that language is spoken.

Is the proper spelling of a patient’s last name Gonzalez or Gonzales? Does that change in spelling indicate a different heritage or country of birth?

Should a Hispanic woman’s first name be spelled Ofelia or be spelled the same way as Shakespeare’s Ophelia?

Should another patient’s name be spelled Mohammed? Muhammed? Or Mohamet?

The further one delves into the spelling of family names within ethnic subcultures, the more difficult it is to be sure that a medical record is referring to the proper person. Especially when doctors continue to dictate names without spelling them.

For example: San Francisco has a huge Asian population. With an increasingly large number of Asian patients in many cities, it is often difficult to identify which word represents the patient's first, middle, or last name. Names like Boon Hang Ling or Fang Nguyen can easily be transposed to read Ling Hang Boon or Nguyen Fang. Once again, a medical record number serves as a crucial identifying marker.

The term “Asian,” however, is no longer restricted to people from China and Japan. It also encompasses the Korean, Thai, Burmese, Vietnamese, Cambodian and Filipino subcultures. Under this huge umbrella of nationalities stand endless numbers of patients whose names sound alike but may be spelled very differently.

Is the patient’s last name Wu or Woo?

Li or Lee?

Low, Lo or Lowe?

Young, Yang or Yong?

Chen, Chan, Tsang or Tsiang?

Leung, Leong or Liang?

What about the Chinese physician who pronounce things very differently than a transcriptionist might expect? Suppose he is dictating a letter to a physician named Dr. Kwok? Could he really mean to dictate a letter to Dr. Quock (whose office is in the same building as Dr. Kwok’s)? What about the physician who sends referral letters to both colleagues but pronounces their names “Dr. Kwa”? Or refers to Dr. Hsu as Dr. Shoe? How is speech recognition going to make these distinctions when the medical transcriptionists who are familiar with this doctor’s work can barely figure out what he is trying to say? Should we be demanding equal rights for homophones?

There can be no doubt that the medical transcriptionist who works on an account with a high percentage of patients and physicians from any ethnic background must tune his ears to the finer shadings of words which will never be found in medical reference books. These words reflect the community served by the hospital as well as the subset of physicians from the same ethnic background.

However, there are times when not even a knowledge of a community’s ethnography can prepare a medical transcriptionist for coping with the kind of name recognition that accompanies fundraising for nonprofit organizations. In certain healthcare facilities there are rooms, wards, and entire wings that have been named in honor of philanthropic donors. Building-specific names like the “Krietzler Ward,” “Magrob Unit,” or “DeSantis Wing” would never be found in medical reference books. How does an MT properly enter “The Artist Formerly Known as Prince” into an electronic field limited to a specific number of digits?

The Hippie era witnessed the birth of children with names like Unicorn, Atom and Chastity. We now have performers who have adopted single-word names like Cher, Carrottop and visual artists named Stephan and Pumpkin. A transcriptionist in the Midwest once told me of a new (and rather illiterate) mother who, when presented with birth certificates that read “Twin A” and “Twin B,” was utterly relieved and profusely thanked the confused hospital staff for saving her from having to decide what to name her children.

The piece de resistance, however, is a story once told to me by a woman who transcribed for a hospital near Detroit. “One family was extremely well known to the medical records staff because we could never figure out how or why the mother gave her children their names,” my friend chuckled. “Her kids were named Park, Drive, Second and Neutral. My theory has always been that each child was named after the gear the car was in at the moment of conception!”

Who Would I Work For?

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 21:54:00 +0000

Anyone who studies gambling learns a quick lesson: The odds are on the side of the house. So if you’re wise, you find a way to become the house. Things are pretty much the same in medical transcription. If you want to earn more money and have greater control over your work process, you start your own service and take the responsibility for making things happen the way you want them to happen.

Alas, not everyone is in a position to make that move. The majority of medical transcriptionists are women. Some are single mothers and, as the sole wage earners in their household, are doing everything they can to keep their heads above water. Others may be raising children with the luxury of a second income in the family. Others may simply be single (male or female).

Whatever the domestic situation, not everyone is cut out to run a business. Some MTs are at their best simply transcribing. That’s what they do. They do it well, they do it efficiently, and they enjoy doing it. Unless, of course, people are trying to make their professional lives miserable (a wealth of dysfunctional behavior can be found in the field of medicine).

With the industry facing a critical shortage of qualified medical transcriptionists – and the Internet making it easier for MTs to check out a wide variety of job opportunities – it has truly become a seller’s market for talented medical transcriptionists. With one qualifier: Technology is what is driving change. Thanks to technology, MTs no longer have to go where the work is. Instead, the work can come to them. Although medical transcription cannot be done without the human resources necessary to do the job properly, too many entrepreneurs, MBAs and venture capitalists have been seduced into thinking that the professional MT has become a vestigial part of the process.

Having gone through various stages of working as a medical transcriptionist (hospital employee, independent contractor, and owner of a medical transcription service), I think it would be wise to examine the financial, professional, ethical and practical ingredients of an employment package which are going to make a seasoned medical transcriptionist want to work for any employer.

Compensation:

With competition from offshore transcription firms increasing the pressure to lower the cost of transcription, it’s difficult to find qualified MTs who are willing to work for peanuts. Why should they? No matter what formula or unit of measurement is used to determine earnings, experienced transcriptionists have been doing this kind of work long enough to know when they’re getting screwed. Thanks to the Internet, it is now much easier to shop around for transcription services that might place more value on their skills and experience. In an age where corporate loyalty has become a joke (sometimes the corporation is no longer in existence by the end of the year), there is no reason for experienced MTs to take any job unless it is worth their while.

Corporate culture:

Is this company run by people who have experience transcribing and will understand the professional and ethical values of a medical transcriptionist? Or is it being run by a bunch of cowboys and jocks with MBAs who want to pay transcriptionists as little as possible? Does this company believe in protecting the confidentiality of a patient’s medical records? Or is it sending work overseas to offshore transcription firms in an effort to make a quick buck? Will I feel I can be proud of the work I do for this company? Or will I be ashamed to admit that I work for this company?

Employee versus independent contractor status:

MTs who choose to work as independent contractors take on certain responsibilities for which they get certain tax breaks. Unfortunately, some MTSOs want all the advantages of treating an MT like an employee but don’t want to pay the taxes that come with having so much control over someone’s work situation. If being a “statutory employee” means I must sacrifice all the benefits of being an independent contractor in return for a big fat nothing, why would I want to work for your company?

Formats:

Do your documents follow a standard format? If not, how many different formats must I work with? How often am I going to be asked to switch from one format to another? How many different accounts am I going to be working on?

Hardware:

Will I have to perform all work for your company on a separate computer? If so, will you furnish the computer at no cost to me? If not, how much is my investment? How much of that investment can I salvage if we part company?

Leaving blanks:

Does the management of your firm understand why medical transcriptionists leave blanks? Or are they trying to deliver “cosmetically appealing” documents to their clients – regardless of the risk of compromising patient care?

Lost Time=Lost Money:

I’m willing to work on a production basis assuming that a steady flow of work is available. But what about when the work dries up? What kind of compensation can I expect if your servers are down and I can’t receive any work?

Manuals:

Will I receive a manual which clearly outlines procedures and responsibilities? Has this manual also been written in HTML format so that I can access it from my desktop? When was the last time this material was updated by someone who really knew what was going on?

Medical Benefits:

More than line rate or salary, one of the most crucial issues for information workers is medical benefits. Some transcriptionists have hopped from job to job without being able to maintain coverage; others have a spouse whose employee benefits cover the entire family. But for those who are single – or single parents – medical benefits can make or break an employment offer. Sometimes the benefits package offered by an employer isn’t as sweet as it sounds. My prediction for the future is that information workers will shoulder the costs of their own health plans as they take on work from more than one source. In the end, “bennies” will no longer be the golden handcuffs that can keep employees in place.

Prompt payment:

Will my check arrive on time? That’s not as funny as it sounds. If you – or one of your partners – is an alcoholic (or snorting cocaine), I can’t afford to let it affect my ability to pay my bills. I don’t want to hear lame excuses about a client being late with payment or be forced to listen to any long, sad tales of woe about the problems you’re having with cash flow. If you expect me to work tight deadlines and deliver for you, then I expect you to deliver a check to me. On time. Every time.

Quality assurance:

Medical transcription is very difficult work which requires lots of judgment calls (always remember that the quality of an MT’s transcription is directly related to the quality of any doctor’s dictation). If I have to leave blanks because some bozo can’t -- or won’t -- speak clearly, I need to be assured that my professional expertise will be respected. If I am not hearing things correctly, I don’t want to be reprimanded like a child. And if the folks doing quality control are prone to retaliatory strikes against MTs because of personality conflicts, unhappiness with their own failed careers (or perhaps some particularly evil bouts of premenstrual syndrome), I want to be told about this situation before I sign on to work for your company.

Respecting boundaries:

We’ve all heard horror stories about MTSOs who call transcriptionists at 6:00 a.m. and scream “Get out of bed and start typing -- there’s too much dictation on the system.” I still remember the transcription manager who told me I was not allowed to leave my own home without her permission. Medical transcription is a profession, not a religious cult. If I say that I’m unavailable between certain hours, don’t call me. If I say that I’m going on vacation for several days, don’t call me. Never forget that lack of planning on your part does not constitute an emergency on mine.

Software:

How much training is required to understand your software and get up to speed on it? Will off-the-shelf applications like word expanders, drug indexes, and medical dictionaries work with your software? Do you furnish those to your transcriptionists?

Technical support:

With more and more proprietary software systems in use, a common complaint is that “the software is great – when the servers are working.” If I have to rely on your software, are you going to have tech support people available during all of the hours that I’m scheduled to work? Because if you want me to work evenings, graveyards or weekends, I need to know that there’s someone I can call when things go wrong.

Toxic work environment:

I’ve got enough drama in my life without unnecessary egomaniacal tantrums and unprofessional nuclear meltdowns getting in the way of my work. If your managerial staff is prone to screaming at each other, having fights in the hallways, or laying the blame for management’s stupidity on the transcriptionists who work hard to earn the administrative staff their salaries, then I don’t want to work for you. Is that clear?

When confronted with voice recognition technology and constant pressure to decrease the earnings of medical transcriptionists in order to pay for expensive technology, there is a lot to be said for MTs having a solid sense of self worth -- and knowing that every job offer they receive will not necessarily be their last. Any experienced medical transcriptionist worth his/her salt has put a lot of effort into developing the skills and vocabulary necessary to do this kind of work.

In a thriving economy, the smartest employers will treat their transcribing talent well because happy workers are more productive workers. Stupid, selfish and uncaring employers will quickly learn that unhappy workers can vote with their feet and warn others about their experiences in an unhappy work environment.

A Funny Thing Happened On The Way To The Forearm

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 19:45:00 +0000

Like many mouse potatoes, medical transcriptionists are not always driven to exercise. Because their work requires them to be sedentary for prolonged periods of time while focusing their attention on computer monitors, many develop the kinds of aches and pains which can have a severe impact on their productivity. Such ailments come from repetitive stress injuries -- things we assume are supposed to happen to everyone else. But certainly not to us (after all, we’re only typing).

None of the printed material you read about ergonomics in the workplace will have deep meaning for you until you have suffered enough pain and discomfort to know that you can’t continue to work the way you used to. I say this from experience.

About 20 years ago, when I was new to the concept of working on a productivity basis, I injured myself in a very stupid way. At the time I was transcribing for court reporters who frequently needed a fast turnaround on depositions for cases that were going to trial. Faced with some tight deadlines, I kept working long hours without taking any breaks. I had a less-than-ideal secretarial chair and, as I strained to keep working late into the night to stay on top of deadlines, the muscles in my neck and back kept getting tighter and tighter.

Until that fateful morning when I awoke in so much pain that I couldn’t hold my head up, the closest thing I had ever known to an exercise program consisted of “calzone curls” (lifting Italian food from the plate to my mouth) or waddling over to Mrs. Fields for a high-calorie reward. But that morning, getting out of bed was an exercise in strategic planning. Standing under a hot shower only offered temporary relief. A friend graciously referred me to a chiropractor whose adjustments helped get my back into alignment. He also made me understand that my head weighs as much as a bowling ball and that, without proper support from my neck and shoulders, my earnings were headed for the gutter.

I was younger then, more resilient, and able to make a slow and steady recovery. Thankfully, I was not stupid. Even though I have always been loathe to exercise, I learned that simple things -- like getting up and stretching -- can alleviate tension in the body. Bizarre head-rolling exercises that can make you look really stupid can also reduce the stress accumulating in your neck. Perhaps the hardest lesson to learn was to walk away from my work station and do something which, in the short run, might seem to ruin my productivity but -- in the long run -- might save me from great pain.

This is a very hard lesson for transcriptionists to learn, especially when they are under constant pressure to increase their productivity. Or have been socialized to put the hospital’s, doctor’s or employer’s needs above all else.

About a year ago, someone complained to me about a hospital administrator who had unilaterally decided that medical transcriptionists could and should be expected to increase their productivity by 15% every six months!

Corporate bean counters who have never transcribed do not understand the burning pain that can build up between one’s shoulder blades after 30 minutes of listening to an ESL doctor butcher the English language. They do not know how our work’s intense concentration and ongoing frustrations can affect body language. They do not know how much pain you can experience when your back muscles lock up. They do not know what it’s like to visit a chiropractor or massage therapist (whose services are not cheap) and leave the session still hurting. Nor do they know what it’s like to have to stop working because the muscle relaxant you’ve swallowed has made you too woozy to transcribe. Instead, they think that medical transcriptionists -- like Greyhound bus drivers -- should be able to sit in their chairs without taking a break for three hours of nonstop work.

Survival of the fittest is an important factor for all information workers who, like MTs, are paid on a productivity basis. While knowledge and experience are valuable, there will always be someone younger and peppier who is all too eager to prove himself. How does one transition from being a sprinting newbie into a seasoned, cross-country medical transcriptionist? By taking care of one’s body.

In the 15 years that I spent as a frequent flyer, I did mind-numbing laps around more airport lounges than you ever want to imagine. The important thing to remember is that anything you can do which will keep oxygen going through your body and brain will help to keep you alert and make you more productive.

I’m no fitness expert. And given the slightest opportunity, I have a severe tendency toward sloth. But I’ve learned how to include a certain amount of motion in my computer routine to lessen the amount of daily neck and back strain. When a friend recently opened up a yoga studio, I went there for some introductory sessions. I won’t hesitate to tell you that hanging upside down in an “inversion” exercise did more to loosen my back and neck muscles than any combination of chiropractors and massage therapists ever accomplished.

Here are some simple suggestions for things you can do to keep your body loose and flexible in the workplace:

Start by examining how you sleep. If you experience problems with a stiff neck or muscle spasms in your back and shoulders, I heartily recommend the use of a buckwheat or soba pillow. These can be found in most drugstores for about $20 and are worth their weight in gold. I was first introduced to these pillows during a massage and instantly noticed a difference in support for my neck. I’m getting a better night’s sleep as a result of using this type of pillow.

Look at your office telephone and decide whether you want it to be your friend or your foe. If you treat the phone as a friend, you will learn to get up out of your chair and move around whenever you have to talk on the phone (a headset is highly recommended). If you keep the phone crooked between your ear and neck while trying to work on the computer (or look through a bunch of files), the phone will become one of your worst enemies.

Examine the frame around the door to your office. Get to know it intimately. Stand in the doorway with your palms facing forward against the door frame and slowly lean forward as far as you can go. This is a very safe and vertical variation on doing a pushup which will help to stretch your back muscles. You don’t have to be physically fit to do it and you don’t have to get your clothes dirty. Just lean forward and feel the stretch.

While sitting at your desk, use your hands to grip the sides of your chair seat. Then quietly lift your legs straight out in front of you underneath the desk and slowly work them like a pair of scissors, moving them together and apart while keeping them parallel to the floor. You’ll feel a stretching sensation in your thighs that will only make you want to move some more.

Think of that old folk song: “Gotta jump down, spin around and pick a bale of cotton, gotta jump down, spin around and pick a bale of hay!” Get some movement into your work pattern.

Keep a dish towel in your deskdrawer. Whenever you can, take a two-minute stretch break and do the following exercise. While seated, grasp the dish towel with your two hands behind your back. With your arms held straight, slowly raise your arms as far up behind you as possible. You will feel the stretch this provokes in your upper back and arms and welcome the sensation each time you perform this exercise.

Keep a broomstick in your office. This should not be used to suggest an alternate mode of transportation for your supervisor. Instead, when you have a spare moment (and preferably if no one is looking) place the broomstick on your shoulders and use it to help you do trunk twists and lateral stretches.

While consultants will occasionally check the ergonomic settings of your work space, they are not responsible for making sure that your body remains limber and flexible. Only you can do that. And if you make an effort to include a little exercise in your work routine, you might even become a happier person.

Word Games

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 18:34:00 +0000

Are people attracted to medical transcription simply because they like working with words? As I type this thought, I feel like Sex and the City’s Carrie Bradshaw as she tries to wrap a column around an idea that has popped into her brain. But when I stop to think about the kinds of people who become my friends, I realize that most are facile communicators – people who use language well and enjoy doing crossword puzzles. People who love to solve the “Jumbles,” folks who crave a good game of Scrabble. People who like to press the “scramble” button in their minds to see what other words could possibly make their writing stronger, their criticism sharper, their wit keener, or their game quicker.

In short, people who like to have fun with words. The kinds of folk who would be intrigued by a game of 52-Pickup that used words instead of playing cards. The nerdy-wordy types who relish a good pun. As an example, one of my friends likes to take a common word and see how deliciously it can be bastardized by combining it with inappropriate prefixes and suffixes. This party game produces catchy new terms like “procrastinaceous,” “victorimonious,” and "snortalicious .” Paronomastics who would like to subscribe to Stan Kegel’s “Puns of the Day” users group should point their browsers to Puns-of-the-day Readers who get a kick out of Internet word sites might want to check out Wordorigins.org and Unwords.com.

In recent months, the comedy writers at The Daily Show With Jon Stewart have had great fun creating skits in which reporters murder the English language with even greater clumsiness than President George W. Bush by wildly inventing meaningless words with a self importance that few dictating doctors could ever hope to match. An equally ferocious attack on the English vocabulary runs rampant throughout Word Freak, a fascinating expose of the world of competitive Scrabble players as told by sports writer Stefan Fatsis.

As he relates the history of Scrabble’s creation, Fatsis provides the reader with stunning portraits of some of the game’s most successful – and dysfunctional – players. Two skills quickly emerge as critical to anyone aspiring to play championship Scrabble. First is the ability to memorize valuable words -- whether they be two-letter, three-letter, or the highly-prized seven-letter “bingo” words. Second is the ability to quickly solve anagrams in order to find as many permutations as possible resting within a rack of tiles.

Fatsis is quick to point out that, despite having memorized thousands of words, many English and American players do not know the meanings of the very words they have memorized. Competition players from foreign countries are sometimes barely able to converse in English and yet, according to Romanian player Laurentiu Sandu, “You don’t have to know how to speak.”

As a rule, medical transcriptionists rely on the prefix-root-suffix theory of building words. But when a new medication hits the market, their professional curiosity may extend far beyond what the drug can do. Like a good wine, a new drug name should be savored; its sound rolled around on the tongue to see how it fits into the lexicon of other pharmaceuticals. Once the initial sampling has transpired, a medical transcriptionist can then begin to explore how the new name relates to other words found in medical terminology.

But, as the King of Siam exclaims in a favorite Rodgers & Hammerstein musical, “Is a puzzlement!” On one end of the spectrum are the MTs who have gone through years of formal training and continuing education in order to excel at their work. On the other end are today’s speech recognition engines which, having built databases of medical words, are now attempting to outperform the formally-educated MTs. Caught between the two extremes is a much larger population of medical transcriptionists who have learned a great deal of terminology on the job. Some of these medical language specialists have learned how to spell many words without taking the time to learn what they mean or how they relate to other medical terminology. One MT used to sign Internet posts “I may not be a doctor, but I sure can talk like one.”

Although such MTs may horrify the purists, by and large they are working very well with the support of medical spell checkers, word expanders, macros, and other productivity tools designed to help them pump out a larger volume of work. Often, their strongest point is knowing when they need to look something up -- or their ability to try to find the word a dictator is actually trying to say in order to ensure that the correct term is used in its proper context.

Much as the marketers of speech recognition technology would like us to believe their hype, such word skills are not necessarily built into speech recognition engines. During MTIA’s most recent technology seminar, I watched a demonstration of Dictaphone’s latest speech recognition engine, which is designed for use as back-end support which can handle dictation from any telephone. This time, I wasn’t the only skeptic in the crowd. The fact that Dictaphone’s new technology can recognize and eliminate such stuttering utterances as “ums,” “ers,”and “arghs” from a stream of dictation does indeed lead to a more cleanly spaced flow of words. However, this latest edition does nothing to account for the numerous times doctors contradict themselves within one report. Nor should the fact that barely 50-60% of dictating doctors qualify as likely users of this technology inspire great confidence in MTSOs.

Understanding how our minds work – and how words become a key factor in building relationships – is the theme of David Weinberger’s fascinating new book, Small Pieces Loosely Joined – A Unified Theory of The Web. In his book (which I cannot recommend highly enough), Weinberger explains how words form the glue between thoughts that build a connectivity across the Internet in ways that defy all of our previous models for communication. Using easily recognizable samples of Internet-based behavior, he explains how the business world has completely misconstrued the potential of the Internet largely because it has failed to understand how the web allows humans to interact with each other.

How we respond to each other’s thoughts – in real or perceived time frames – is rapidly changing the way we work and function as a species. Unfortunately, word skills and ntelligence are not for everyone. Ron Ritchhart, a research associate with the Harvard Graduate School of Education's ProjectZero, claims that intelligence is not ability centered, but is instead built around a set of dispositions. In his new book, Intellectual Character: What It Is, Why It Matters, and How to Get It, Ritchhart (who received the 1993 Presidential Award for Excellence in Teaching Mathematics) identifies the six traits that people need for intelligence as follows: “They must be curious, open-minded, reflective, strategic, skeptical, and willing to search for truth and understanding.”

Ritchhart’s theory came to mind when I attended a recent performance by a brilliant monologuist named Reno. Rebel without A Pause covers a lot of political and social territory as Reno describes what it was like to live near the st1:place>World Trade Center (in what she now calls “TriBeCaStan”) and how the events of 9/11 have changed her perspective on life. A tough New Yorker with attention deficit disorder whose jaw-dropping political rants can rattle anyone’s cage, Reno doesn’t pull any punches when skewering Creationism or exposing political hypocrisy. A performer who thrives in dangerous territory, Reno doesn’t hesitate to explain why, if you are the most powerful man in the world, it is important to know the difference between words like “democracy” and “demagoguery.”

My reason for directing readers of this column to Reno’s website at Citizenreno.com (where you can hear samples of her rants) is not because of her politics, her art, or the fact that Lily Tomlin is one of her biggest fans. It is because, as part of her act, Reno stresses that words really do matter. And that, when used inappropriately, words can have disastrous repercussions. With a fierce determination that quality assurance workers in the medical transcription industry could never hope to match, this woman battles to build an audience’s awareness of the importance of using words in their proper context. We need more people like Reno defending the proper use of the English language.

When You Wish Upon A Star

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 18:10:00 +0000

If indeed a picture is worth a thousand words, then I can’t help but wonder if medical transcriptionists have become the poster children for the electronic sweatshop. It doesn’t matter whether you examine ads selling training courses in how to become a medical transcriptionist -- or the display advertising used by large national transcription companies seeking to hire qualified MTs – the images seem oddly disconnected from reality. The clip art used in many of these sales pitches shows trim, perky women wearing business suits or soft white blouses. Whether or not the woman is wearing earphones, she sits in front of her computer smiling inanely -- like a Stepford wife who has just taken another hit of Ecstasy!

This image makes no sense -- especially when the reality of a medical transcriptionist’s lifestyle is so shockingly different. Why don’t these ads show women tearing their hair out as they try to decipher an ESL doctor’s incoherent ramblings? Why don’t these ads show worn and used reference books scattered across a transcriptionist’s desk? Why don’t these ads -- ostensibly marketed to people who want to work at home -- show a cat sitting on top of the monitor and a brat playing in the background? I’ll tell you why. It’s because these ads are about as fanciful as children dressing up and pretending to be adults.

With so many MTs transcribing in home offices while trying to manage a busy household and make sure that their children don’t kill each other, the packaging of the professional medical transcriptionist’s image strikes those trying to make a living from MT as a joke. Despite the glorified images seen in display ads produced by and for the medical records industry, many MTs are fully-figured women working in T-shirts, sweat pants and sneakers. Faced with long hours in front of a keyboard, few transcriptionists are dressing for success. If anything, they are dressing for comfort. Medical transcription is not about wearing high heels and tight girdles (you’ll never see an MT wearing a Madonna-type bustier in the hopes that it will help her transcribe a difficult operative note).

Like Rodney Dangerfield, MTs frequently complain that they “can’t get no respect.” Trust me on this one. It’s not because of how they look. It’s because MTs are usually kept out of sight – invisible data entry people who work from remote locations. And when you are out of sight (and out of mind) it’s easy to fall victim to corporate spreadsheets and bean counters. In the past five years many transcriptionists have had their line counts redefined (resulting in less earned income), their benefits shortened, their productivity challenged, and their intelligence insulted. Some have been harassed by employers and business owners who use guilt-trips as a way of getting MTs to sacrifice their days off and personal time because “there’s a stat that needs to be done.” Others have seen the education they struggled to achieve mocked by people who know absolutely nothing about transcription; people who tell them to transcribe verbatim or “just give the doctor what he wants.”

“Three years ago I joined a national organization because I was tired of office politics and wanted to work from home. But, along with my fellow MTs, we continue to have our benefits stealthily plucked out from under us. Everything (from a cut in pay and a cessation of our longevity bonus to PTO paid at minimum wage and a decrease in 401K benefits) has been snatched away from the home MT. Benefits are now‘adjusted’ every year,” writes Donna Gordon. “Iam saddened and disillusioned by what I see happening to what I once regarded as a highly prestigious and worthy occupation of which I was proud to be a member. I now feel that the MT has been reduced to little more than a cog in the big national machine that is steadily grinding away to fill the deep pockets of CEOs and other corporate VIPs that remain nameless and faceless.”

“If you are an independent contractor, there ain't no such thing as sick days, vacations, or anything like that unless you are lucky enough to have coverage and pay it out of your own pocket,” warns Marsha Macchi, a blind transcriptionist in San Francisco. “When I went to Pilot Dogs to get my fifth guide dog, there was no such thing as coverage while I was gone. I took one heck of a loss – even though I knew that it was just the price of doing business.”

Several postings on MTDesk.com's Hot Zone this spring made it crystal clear that – regardless of the official talking points from AAMT and MTIA – all is not well in MT-Land.

“Here it is Thursday night and guess what I got from MedQuist? Nothing. Nada. Zilch. Not even a Happy MT week,” groused one transcriptionist. “Nothing last year either. Sure makes a person feel appreciated.”

“Guess what EDIX is giving for MT week as a show of appreciation? A cheap, tacky, plastic container filled with stale candy. That’s what they give you for 10 years experience!” complained another. “Could they be more insulting? Getting nothing would have been less insulting than that garbage. I threw it in the trash.”

E-mails on the KAMT-list from members upset with AAMT’s hike in membership dues indicate that the natives are restless:

“After having been a medical transcriptionist for 25+ years and having the reputation I have for turning out quality work, I do not see any reason for being certified, especially as I could find no real benefit to anyone but AAMT,” writes Linda Taylor.

“Can any of you erudite MTs give me a reason that I should pay $195 this year to show my support for the organization, when about the only goody I get is the ‘$40' quarterly magazine and the opportunity to buy the BOS at a $10 discount?” asks Valeria D. Truitt.

“The profession has been demoted rather than promoted; it has little respect from other health professionals who still don't have a clue about what it takes to do this, which may be why wages are still so horrible and often tied to productivity -- all things AAMT was supposed to help but obviously has not,” stresses screen name Bibliomania.

“I find it interesting that they have the nerve to say they protect your interest, when they have helped train and certify transcriptionists in India. They have done nothing to fight the amount of work going overseas. Many large services say they cannot find experienced transcriptionists. The truth is they can, they just don't want to pay them. We don't need terrorists to take down the US when our own companies are selling us out for cheap offshore labor,” writes Susan Mitchell.

With so much unhappiness rampant throughout the medical transcription community, with our economy headed toward a recession, and with MTs feeling waves of depression, frustration, and anger in the wake of September’s terrorist attacks, I’d like to recommend a book which can inspire each and every MT to pick up the reins and assume more control over her life. While Susan Jane Gilman’s Kiss My Tiara is filled with plenty of good laughs, it also gives anyone who has battled office politics, endured bad supervisors, wrestled with a weight problem, or suffered from low self-esteem a whole new outlook on life. I cannot recommend it highly enough.

In the meantime, I’m going to tell you a story (storytelling is, after all, an age-old device used to calm people and give them hope). Not only is this story based on real life, in many ways it resembles a medical transcriptionist’s version of the Cinderella legend. As most readers know, the Cinderella legend (a/k/a The Glass Slipper) has appeared in various formats in cultures around the world. In recent years, author Gregory Maguire has done a stunning job of re-examining the classic fairy tale in his novel Confessions of an Ugly Stepsister. Music critic Manuela Holterhoff entitled her book about two years in the life of famed mezzo-soprano Cecilia Bartoli Cinderella and Company.

This rags to riches story has been immortalized in opera (Rossini’s La Cenerentola, and Massenet’s Cendrillon) as well as ballet (Prokofiev’s Cinderella). Ever since Walt Disney’s animated cartoon introduced us to the magic of“Bibbity Bobbity Boo,” audiences have flocked to see Jerry Lewis in Cinderfella, Drew Barrymore in Ever After, and numerous other films with titles like If The Shoe Fits. Popular musicals include Rodgers & Hammerstein’s Cinderella (originally starring Julie Andrews and now with pop singer Brandy in the title role), Bock & Harnick’s Passionella, Larry Hart’s rhythm & blues treatment (Sisterella) and Stephen Sondheim’s Into The Woods. So sit back and make yourselves comfortable while I tell you the medical transcription version.

Once upon a time and not so very long ago, I was contacted by a medical transcriptionist who had been referred to me by a member of the KAMT-list. Although curious about working with me, Carla was extremely cautious – almost to the point of being paranoid. Always on the lookout for qualified local talent, I suggested that we meet for an informational session during which we could talk in detail about how my company operates and see if we might want to work together.

Upon her arrival, it became obvious that I was talking to a very attractive, personable, conscientious, and intelligent CMT who, although she was an extremely hard worker, was also a battered medical transcriptionist. The battering had nothing to do with her recent divorce. In the 15 years that she had been working as a transcriptionist her self-esteem had been pummeled to bits by overbearing hospital supervisors and MTSOs who knew how to manipulate Carla’s emotions in order to make her work longer hours and cover for other MTs. Carla’s way of avoiding office politics – and harassing phone calls– was to put on her earphones and keep transcribing (often to the point of exhaustion). Although she had diligently earned her CMT, she did not enjoy socializing with “the girls” at AAMT meetings and preferred to spend her spare time at the gym, running, or playing a musical instrument.

By the time we met, Carla had been threatened with (and survived) so many guilt trips that she was terrified of the future, fearful of retribution, and desperate to make changes in her professional life. Although she had worked for many years as an independent contractor, she still thought like an employee. Feeling powerless against the constant demands placed on her, Carla’s only solution had been to work herself to the bone because (a) she needed the money to pay her mortgage, and (b) she didn’t know how to say no. There was so little sense of self left that there were times when she felt as if she had become a transcribing automaton.

Although Carla was used to working long hours, she didn’t always have a clear idea of how much money she was earning. She never questioned her line counts because her productivity and income seemed far less important than not being yelled at. She was tired of being told that because no one else could understand a difficult doctor’s dictation, she would have to work on his account. Or that because other people had to take care of their children, she’d have to transcribe work that was already late and kept piling up. In far too many ways the drudgery of her professional life resembled the downtrodden existence Cinderella suffered at the hands of her stepmother and ugly stepsisters.

That afternoon Carla and I spent a lot of time talking about the kind of person she was, what her goals were, the changes she wanted to make in her life, and how she might be able to work with Alert & Oriented. We discussed the relative merits of earning money simply for the sake of a paycheck versus working in an environment where you are treated with respect, people don’t insult your intelligence, you are thanked for your contributions, and you’re entitled -- if not expected -- to have a life.

While covering the differences between an employer/employee relationship and the relationship between a business owner and independent contractor, we reviewed how the issue of “control” affects the definition of a business relationship in the eyes of the IRS. I assured Carla we would not harass her and stressed that, in an entrepreneur/independent contractor relationship we were legally obligated to respect her boundaries. I emphasized that I was not afraid to receive bad news if she had a problem or personal need that was a higher priority than transcribing and stressed that establishing clear and easily understandable channels of communication was the key to a successful working relationship.

That part was the simple stuff. The tougher nut to crack was helping Carla understand that if she had a better work situation, she could lead a happier, healthier life. To help paint a picture of what her future could be like, I tried to depict a lifestyle in which she did not dread hearing the phone ring. In which she no longer transcribed until all hours of the night (only to get up at dawn and start back in at work). A lifestyle in which she was nice to herself, earned enough money for her needs, and didn’t drain her emotional and spiritual reserves to the point where she was always running on empty.

Carla looked at me as if I had described life in another galaxy. But, by mid December, she had gotten up the courage to sever her abusive business relationship and start working with us. Having spent so many years working in WordPerfect 5.1 for DOS, she was eager to see what transcribing in a Windows environment would be like. Much to my delight, her work proved to be excellent. She was computer literate, extremely reliable, and turned over an impressive volume of dictation.

As Carla eased into working with an MT-friendly MTSO she began to experience some fascinating changes in her life. Not only did she enjoy working in a Windows word processor with true WYSIWYG features, but without the constant dread of the phone bringing bad news she was beginning to enjoy her work. Not just enjoy it – Carla was falling in love with transcribing all over again (she had always loved to transcribe but had been so miserable that she had completely forgotten how much she truly loved her work). With a cloud of doom no longer hanging over her daily life, she began to smile more and be open to all kinds of possibilities.

One afternoon, she stopped to look at a neighboring house that had been placed on the market. As Carla toured the property, she recognized the realtor and started chatting with him. They quickly discovered that they had seen each other on numerous occasions but each had been too shy to approach the other. As Carla and Ted laughed about the strange way fate had intervened, they realized they were sparking on each other’s company and agreed to meet for dinner the following week. Not only did Ted turn out to be a fellow vegetarian, “We stayed up all night long just talking and laughing,” Carla told me. “Do you know how long it’s been since I’ve experienced anything like that?”

As Carla became more confident, the flowers of spring weren’t the only things to blossom. So did a new romance. Because the two lovers had experienced difficult divorces in the past, each was wary of the future – waiting for the proverbial other shoe to drop. As you recall, after Cinderella left her glass slipper at the Prince’s ball it was only by searching the kingdom for her matching slipper that Prince Charming was able to find his true love. In Carla’s case, each lover took an old shoe from the closet. One sunny afternoon they walked out onto a nearby bridge and symbolically tossed the “other shoe” into the water far below.

In March, Carla called to inform me that she and Ted were planning a trip to Hawaii and that she wanted to request time off for a vacation. I reminded her that she was not an employee and that it was up to her to tell us when she would be unavailable for work. Pinching herself to make sure that she wasn’t dreaming, Carla agreed to get back to me with full details of her trip. A few months later I received a postcard from a beach resort telling me that everything was going well, that she hadn’t really thought about transcription at all, and that she was enjoying the most relaxed vacation of her life.

A subsequent trip to meet Ted’s family over the Labor Day weekend went smoothly and the happy couple recently celebrated the six-month anniversary of their meeting. Carla has set up a second work station in Ted’s house and often stops transcribing in late afternoon. She tells me that she is happier than she has been in years and often has trouble believing that this has really happened.

Will Carla and Ted live happily ever after? Time alone will tell. My point in telling this story is not to position myself for a new career as a fairy godmother. It is to remind medical transcriptionists who feel “hopeless and helpless” that long hours of transcription need not take place on a dark and stormy night. Fairy tales can come true.

It could happen to you.

Whose Work Is This, Anyway?

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 18:00:00 +0000

When George Bernard Shaw wrote Pygmalion in 1913, he set out to prove that the proper or improper use of the English language could transform a flower girl into a duchess and, conversely, a duchess into a flower girl. A highly successful playwright who felt that his main purpose was to shock people out of conventional ways of thinking, Shaw described his stage works as unpleasant because "their dramatic power is used to force the spectator to face unpleasant facts."

Because language is not well respected in today's society, words get thrown around the medical profession in a very casual and careless manner. Even though they may be charged with creating a medical record, doctors are human beings. When they dictate, they speak the same language they use when off duty. What comes out of their mouths may not sound very professional. It often clashes with the romantic ideas some people have about how a physician should sound.

Because words and numbers form the currency of patient documentation, medical transcriptionists are acutely aware of how words and numbers are used -- and mis-used -- in the creation of medical records. We hear things that other members of the health information management industry do not. Part of our job is to clean up the mess created by a dictating physician before it gets into the medical record.

Why is “mess” the operative word here? Because medicine is a messy practice. Those who do billing, coding and manage charts keep their dainty hands free of bed pans, blood, boogers and bile. Their fingers rarely come in contact with vaginas, vomit, vulvas or varicose veins. As a result, it’s interesting to note their reactions when confronted with the sexual language and/or “curse words” that medical transcriptionists listen to day in and day out.

Although these words are spoken by most people on a casual basis, some feel that such language is inappropriate or unprofessional in a medical situation. They obviously haven’t listened to a surgeon throw a major temper tantrum. Or been on the floor when the clinical staff at a major cancer center voted “Mr. Stinky” as its favorite term for a particular patient’s feces.

It’s no big secret that our society is rooted in denial. Too many Americans rely on euphemisms as a way to avoid confronting difficult issues. That’s why I’m always amused that whenever someone objects to the use of sexual language in articles I’ve written about transcription (in this and other publications), the objection invariably comes from an ART rather than a medical transcriptionist.

I’m certainly not surprised. It’s easy to be a back-seat driver. But, as anyone with a driver’s license knows, things look and sound very different when you’re behind the steering wheel. Medical transcriptionists are used to hearing a doctor mumble “Oh, shit!” as he thumbs through a chart. We’ve even heard them say things like “Jesus Christ, where’s that goddamn lab report?”

The role of the medical transcriptionist is to interpret -- not to diagnose or sit in judgment. Thus, when a physician uses words like “Mom” and “Dad” instead of “Mother” and “Father,” we type what the physician said. When a doctor working at a clinic which services a low-income population dictates “The patient is having trouble peeing,” it is not the editorial prerogative of the transcriptionist to change what the doctor said so that it will fall gently on the ears of others.

There are even times when crude language must be included in a medical record. The doctor who dictates “The patient then became extremely abusive to the staff -- telling this physician that he could personally go fuck himself -- and was eventually escorted from the area by the security guard,” may be using such language in his dictated report for his own legal protection.

With so much violence in our daily lives, it should come as no surprise that the violent language which accompanies so many violent acts has become a part of our society’s cultural landscape. As the language of our culture changes it is reflected in every form of media we encounter.

A poster from the popular cartoon South Park has the caption “Please excuse me, I have explosive diarrhea.”

Tune into the Ricki Lake or Jerry Springer show and you’ll notice a steady stream of invective that has been bleeped out of the broadcast.

“Shock jock” Howard Stern has become an idol to millions who listen to his radio show.

Filmmaker Todd Solendz (Welcome to The Dollhouse, Happiness) refers to 1998's Hollywood film crop as “the year of the semen shot.”

Last year, Americans watched media icons like Dan Rather and Barbara Walters fumble for words as they were forced to discuss oral sex before the camera.

Some words offend people by conjuring up frightening thoughts. But they are merely words. Their power over the reader is only as great as the reader’s deepest fears and darkest secrets. If a physician can feel comfortable sticking his hand inside a patient's rib cage and holding a person's beating heart between his fingers, then words should never threaten him.

However, if the power of language rattles someone’s nerves so severely that s/he cannot manage to use words properly, then that person has no business dictating or transcribing medical reports. Blunt and crude language comes with the territory. Listening to that language is part of our work.

If the sight of blood makes you squeamish, you probably shouldn’t become a doctor. If you don’t like snakes, you’d be well advised to avoid a career in zoology.

My message to the ARTs who are affronted by the use of language they consider to be inappropriate or unprofessional is simple. One of the best ways to understand someone else’s work process is to spend some time doing it. Or, as the popular saying goes, walk a hundred miles in their shoes.

Asleep At The Wheal

noreply@blogger.com (Unknown) — Fri, 28 Sep 2007 02:38:00 +0000

These days it’s hard to tell which is more fascinating: the business of culture or the culture of business. As the Internet and other forms of digital media have made it possible for people around the world to experience each other’s cultures (which can result in greater understanding or increased religious hatred), the business of importing and exporting culture has grown by leaps and bounds. In June, the San Francisco Gay & Lesbian Film Festival had nearly 300 offerings, with a preponderance of films coming from Asia. Documentaries covering the two-spirit people of Hawaii’s fading culture Ke Kulana He Mahu, the spirit mediums of Burma who, defying military rule and the official religion of Buddhism, continue to make a living by communicating with popular Burmese household gods Friends In High Places, and a magnificently imaginative dance short from France Ere Mela Mela, showcased the creativity of filmmakers working in other cultures. American filmmakers countered handsomely with HIV Basics for Corrections Officers as well as documentaries about the tragedy of homeless teens Out in the Cold, the popularity of certain hairstyles, American Mullett and F**K The Disabled (the story of a gay standup comic with cerebral palsy who lives in Harlem).

Several weeks later, the San Francisco Silent Film Festival showed a beautifully restored copy of Harold Lloyd's Girl Shy (1924) with live accompaniment on the Castro Theater’s Mighty Wurlitzer organ (Lloyd’s granddaughter announced that his entire collection of silent films will soon be released on DVD with both organ and orchestral accompaniments). India’s Shiraz (1928) was introduced by the Consulate General of India in San Francisco and accompanied on tabla and sarode by musicians from the Ali Akbar College of Music. Later in July, the San Francisco Jewish Film Festival featured programs about the role of the Jewish mother in cinema as well as a documentary about a cowboy who sings to his flocks in Yiddish. A fascinating smorgasbord of international cinema within eight short weeks!

Meanwhile, the business world was experiencing some white-knuckle thrills as the market reacted to massive corporate meltdowns at companies like Enron, Global Crossing, Worldcom, and Tyco. Cultural icon Martha Stewart got caught with her exquisitely floral patterned pants down and was accused of insider trading (definitely not “a good thing”). John Rigas (the devout Christian founder of Adelphia Communications) was arrested after looting the company of billions of dollars. James A.Traficant Jr. of Youngstown, Ohio was ousted from the House of Representatives following his conviction on bribery, fraud, and tax-evasion charges. Wal-Mart was sued for its system-wide efforts to avoid labor costs by insisting that employees continue to work after punching out. And Alan Greenspan bemoaned the shift from a financial atmosphere of “irrational exuberance” to one of “infectious greed.”

“Confidence in the equity markets is nearly non-existent. Analysts and stockbrokers have overtaken mechanics, lawyers, and politicians as the professional class most despised (and distrusted) by the American public,” notes financial planner Tom Swift of Financial Avengers. “Other than a brief foray into Enron, we have avoided companies with excess debt and we always will. We prefer companies that grow organically, rather than companies that grow through acquisition.”

The popular street question “Got any E?” might now have people wondering if one is trying to score a hit of Ecstasy or find a business with a sense of ethics. In July, I was asked by a medical transcriptionist which came first – my company or an MTSO in India that had obviously plagiarized several pages from Alert & Oriented’s website (a strongly-worded e-mail with a copy to the Indian Consulate promptly got the offending material removed from the Indian MTSO’s website). One MT vented her rage at listening to a resident who, while trying to simultaneously dictate reports and converse with a friend, could clearly be heard to say “I am making so many mistakes! This is so messed up. I'll just blame it on the transcriptionist.”

Whether it’s a dizzy doctor, the former CEO of Halliburton Industries, or the folks at Arthur Andersen, the people who are supposed to be taking the high road are doing a phenomenal job of screwing things up (don’t get me started on the Catholic church’s handling of pedophilic priests). The abrogation of responsibility in favor of defying laws and regulations has led to an American business culture in which the ends justify the means (no matter how sleazy they might be). Anyone who doubts this phenomenon should get their hands on David Brock’s new book, Blinded By The Right, to witness the evil some people embrace to justify their actions in the name of doing business.

If one applies Elizabeth Kubler-Ross’s four stages of grieving to the current crop of corporate corruption scandals, it won’t take long to realize that Americans are at the point in the process they handle best – affixing blame. In doing so, some remarkable parallels can be seen between the small investors and workers who have suffered as a result of losing their money in companies like Enron and Worldcom, and the culture of blame which has been institutionalized within the field of medical transcription. Never mind that medical transcriptionists must often work with dictation that is unintelligible and makes no sense whatsoever. While some of America’s largest medical transcription companies woo new recruits with sign-on bonuses and glowing descriptions of their incentive programs, others operate like miniature penal colonies in which each infraction incurred by a medical transcriptionist can lead to a reduction in earnings.

If you’re forced to leave a blank because you can’t understand what the dictating physician is saying, you can be penalized.

Suppose the good doctor goofs and dictates “Temperature 120/80, blood pressure 98.” If you automatically correct it to “Blood pressure 120/80, temperature 98" you could still get penalized because your transcribed work does not match the dictation verbatim.

If you get stuck with a bunch of dictations from doctors who speak English as a second language and have to hand in a series of documents containing blanks, guess what? You can get marked down and gather enough points against you that you fail to earn the higher line rate that was dangled in front of you as part of your MTSO’s so-called incentive program.

Last, but not least, once you’ve uploaded your work, who is to say that it will be proofread with any consistency? Suppose one QA person grades your work with an entirely different set of standards from another?

While this is all done under the rubric of “quality assurance,” it is primarily a numbers game to boost profit margins while decreasing labor costs. Most often, it leaves medical transcriptionists feeling as if they are standing on a vibrating platform in a video arcade and attempting to shoot at targets that keep popping up at random while their supervisors toss water balloons at them and throw sand on their keyboards.

Anyone who has tried to transcribe while angry knows that they are prone to make more mistakes and will likely experience a decrease in productivity. The more mistakes in one’s work, the more one gets penalized. The more one gets penalized, the less one earns. The more institutionalized the system of penal enhancements, the easier it is for transcriptionists to be demoralized by their work and lose concentration. But because some MTSOs have instituted quality assurance programs that dwarf the dictation/transcription process, these business owners spend more time and energy intimidating transcriptionists with penalties than supporting them and helping them to perform their craft.

“The way they have figured and refigured lines and how to scam (I mean pay) you – I work three times the hours for not even close to the pay I used to make. I made $17,000 dollars less last year than the year before. Do you think I worked less hours?” asks a subscriber to the KAMT-list. “I find this ‘new’ (or at least new to me) trend of docking wages for mistakes incredible. Where are the bonuses for saving these dumbass illiterate doctors’ asses when they screw up their dictation? Where is the reward there?”

When MTSOs wonder why they have such a large turnover in personnel (and assume that it is because of the shortage of good transcriptionists), these people often fail to understand that they have created a corporate culture which so severely alienates and punishes medical transcriptionists that only the most desperate and masochistic MTs remain on board. Many medical transcriptionists have noticed a strong parallel between their feelings of hopelessness and helplessness and the emotions of the hundreds of thousands of workers who recently lost their jobs while corporate executives were awarded million dollar bonus packages. Even if their skills are excellent, some medical transcriptionists are forced to vote with their feet in order to find a situation that will not cripple their earnings with penalties.

The steady erosion of ethics in the health information management community has been a continuing cause for concern. Watching Laura Dern’s poignant portrayal of Dr. Linda Peeno inS howtime’s Damaged Care (the story of the physician who blew the whistle on Humana’s scurrilous methods of denying health coverage in order to contain costs) offered little comfort to those who document patient care. Managers and MTSOs may not be sensitive to how deeply punitive values have become entrenched within the culture of the medical transcription industry. But if they have any doubts about how the fear of being penalized can affect the accuracy, productivity, and profitability of their operations, they need only refer to the letter FBI agent Coleen Rowley sent to Director Robert Mueller describing the culture of risk aversion which may have contributed to the agency’s tragic internal failures in the months prior to 9/11.

It Takes A Virtual Village

noreply@blogger.com (Unknown) — Thu, 27 Sep 2007 23:46:00 +0000

Every now and then a message appears on one of the Internet MT boards in which some newbie complains about “those old fart MTs who think they know everything but won’t give anyone else a chance.” Age and life experience are remarkable benchmarks for measuring one’s professional standing. Maturity and craft are not measured in years so much as by accumulated wisdom.

Many newbies haven’t a clue about what it was like to perform corrections on seven carbon copies of a report with only chalk and razor blades at your disposal. As a teenager, I remember the thrill of visiting the IBM pavilion at the 1963-1964 World’s Fair and testing those newfangled Selectric typewriters where the carriage did not move. I even remember what medical transcription was like before digital dictation systems, medical and pharmaceutical spellcheckers, drug databases and e-mail. It wasn’t so very long ago that certain electronic tools (which we now take for granted) didn’t exist.

Because we live in an age dominated by rapidly-accelerating advances in electronic technology, new inventions bombard us so quickly that last year’s breakthroughs are easily forgotten. “The further and faster the human race goes, the more difficult it becomes to remember its receding and ever-expanding past,” claimed William Clay Ford. “To neglect that heritage is to risk a future in which young people find themselves without a means of building on the firm and reassuring foundation of the past.”

Had it not been for the zeal with which Ford’s grandfather, Henry Ford, collected traces of America’s Industrial Revolution, there might be little left to remind us of our not too distant history. Their pattern of display at the Henry Ford Museum in Dearborn, Michigan is vastly different from that seen in most other science museums. In Dearborn, visitors can observe minute changes in technology and design. The evolution of dictating equipment proves fascinating when compared to the technology of today’s electronic office.

An indicator of the breadth of Henry Ford’s collection is to note that during the first few years of the museum’s life perhaps 80% of its visitors could recognize and identify most of the objects on display from their personal experience. At best, no more than 5% of today’s visitors can readily identify the same objects.

The society in which we live is a far cry from the society that existed when the senior physicians on staff at most hospitals entered medical school. Sweeping changes due to technology, politics and healthcare reform have altered the way we think and work. Just as new technology has brought about some dramatic changes in the surgical suite, technology is forcing changes in how we dictate and transcribe medical reports. In order to understand where we are headed in the era of Internet access, we need to stop, take some time to reflect on recent changes in our culture, and try to understand how our work has been affected by changes in the society in which we live.

Now celebrating its 21st anniversary, the American Association for Medical Transcription (AAMT) has over 130 local AAMT chapters and state/regional associations. AAMT established the Medical Transcription Certification Program (MTCP), publishes the bi-monthly Journal of the American Association for MedicalTranscription (JAAMT), and boasts a strong calendar of lectures and programs which allow MTs to earn continuing education credits. But the long, hard years of building AAMT’s membership toward the 10,000 mark were based on a power structure rooted in a local/state/national hierarchy.

Legend has it that when King Arthur was a youngster, Merlin transformed him into a bird so that he could soar over the land and learn that national and political boundaries are meaningless. Today, anyone with Internet access has the ability to research information pertinent to medical transcription on the World Wide Web. There is no need to drive 60 miles to a meeting. One need not wait another month for the next opportunity to network with MTs. The only secret handshake is made by modems screeching at each other to establish an on-line connection.

How did it become so easy? The quantum leap occurred about five years ago, when Compuserve and Prodigy were major players in the on-line services industry and America OnLine was a rude little upstart with a tiny portion of market share. Back then, the forums maintained by major on-line services were only accessible to those who paid for the service which maintained a specific forum. Thus, someone with a full-service Internet account who did not belong to a major on-line service like Compuserve or America OnLine could not access the forums for medical transcriptionists maintained by those on-line services.

Because staying on-line to read and post messages on such forums once produced an exorbitant bill, I decided to reverse the process through the use of an electronic mailing list or listserv device. Instead of users having to find their way to each forum and access messages that had been posted on that forum, I set things up so that messages posted by subscribers to the KAMT-LIST mailing list would automatically be distributed to all subscribers. Whenever a subscriber logged on to gather e-mail, any messages which had been posted to the list were waiting in the subscriber’s mailbox.

Because my sister is very active on the LM-NET mailing list for professional librarians, Alice and I often compare what is happening with subscribers on both of these lists. What continues to amaze us is the newfound ability of MTs and librarians to reach out and share their knowledge, wisdom and opinions with newbies, oldies, and those who are just curious.

I can certainly tell you that my investment in creating the KAMT-list has paid off in spades. Thanks to the KAMT-list I have been able to find some wonderful local subcontractors through word of mouth without ever paying a cent for advertising. I have been able to start writing a column again (I was an opera critic for 15 years) and have my professional voice heard through this magazine. I have been delighted to get feedback from readers after each article comes out.

The brave new world of electronic mentoring is an incredibly exciting phenomenon. I'm particularly gratified that subscribers to the KAMT-list (and a variety of other MT message boards) have been able to give sound business advice to MTs who were not sure whether they should:

Enter a new job situation.

Take on a new contract.

Confront an abusive physician/supervisor/client.

Go to work for a particular service bureau.

Tell someone to take a flying leap.

Previously, free professional advice from people in every state was not only unavailable, it was highly restricted by association guidelines and old- fashioned employer/employee taboos. When I started the KAMT-list back in October of 1995, the use of the Internet by professional groups was a relatively new phenomenon. The sci.med.transcriptionnews group was still in its infancy. My own company (Alert & Oriented) was the first medical transcription service to have a web site on the Internet.

As millions more have acquired Internet access -- and as new software keeps evolving -- we have witnessed a formidable growth in on-line networking. There are now MT chat rooms, message boards, and web sites filled with information on pharmaceuticals, employment opportunities, you name it! If the Internet has helped to break down some of the old communication barriers, then all hail the Internet and the people who make use of this exciting technology.

While e-mail has had a tremendous effect on our lives (uploading transcribed reports, communicating with colleagues all over the world, and contacting people about employment opportunities) the World Wide Web has had a profound impact on the world of medical transcription. The freedom of expression available on the Internet gave rise to a wealth of websites, message boards, and mailing lists devoted to serving medical transcriptionists and, most importantly, offering them valuable information for free.

Perhaps we should all stop for a minute and think about how being able to communicate with each other electronically -- at almost no cost -- has helped us to:

Gain strength and confidence as professionals.

Take a break from struggling to understand muckmouth dictators.

Enjoy a few raunchy laughs around the electronic water cooler.

Ask and answer reference questions at all hours.

Ease the loneliness many of us feel while working at home.

Stay in touch with our professional peers without having to pay annual dues to an association or travel to a meeting.

Ironically, it was the freedom of speech available on the Internet that broke AAMT’s stranglehold on the microphone in this profession. For whatever reasons, AAMT’s leadership had refused to participate in any of the on-line forums. When the AAMT Track column decried the Internet as a “passing fad equivalent to the pet rock,” it became obvious that certain people had their heads buried in the sand. Had AAMTused the Internet shrewdly, the organization could have been a potent force in the online community. But alas, one of AAMT’s most tragic blunders was the trepidation and downright timidity with which it approached the new world of interactivity and electronic communication.

Franco Zeffirelli’s film Tea With Mussolini depicts the poignant situation of a bastard child whose father can’t find the time or desire to raise him as his own son. The boy, Lucca, is saved from an orphanage and taken under the wing of the father’s very prim and proper English secretary, who doesn’t hesitate to tell Lucca’s father that “There are no illegitimate children, only illegitimate parents.”

What does this have to do with medical transcription? There are strong parallels between a small town’s condescension toward a bastard child and AAMT’s reluctance to establish a viable presence in the world of on-line networking. The rapidly growing on-line community of medical transcriptionists deserves special credit and an extra special vote of thanks for its generosity in encouraging newbies, sharing information about job opportunities and employers, offering technical tips, coming to the rescue with word help at all hours of the night, and building a priceless sense of professional camaraderie. That sense of community has never been defined by payment of one’s dues to a professional organization. Indeed, the only fees these people pay are to their ISPs or to on-line providers such as America OnLine.

If you ask the average medical transcriptionist to choose between spending $100 on a year’s individual membership in AAMT or $100 for five months of Internet access, the choice will pretty much be a no-brainer. It’s far too easy for most MTs to identify which item is a luxury and which has become a professional necessity.