Dictatorship
Here is something weird that I have been doing lately: dictating. Everyday, I call up the hospital's dictation service, punch in a bunch of numbers, and speak aloud the progress note that I am to write each day on each patient. Then some nice middle aged lady somewhere in this hospital types out literally exactly what I say and posts it in the computerized medical record system for everyone to read.
This is strange for a number of reasons.
Reason #1: it is more difficult to speak out loud than write down what you want to say, especially when you factor in things like punctuation. It comes out like this: "The patient is a 67 year old male with chronic atrial fibrillation comma and chronic obstructive pulmonary disease comma with respiratory failure during an elective cardiac catheterization yesterday period."
Reason #2: I suck at dictating and it takes me forever. When I attempt to produce coherent medical verse, it actually sounds like this: "uhhhh the patient is a uh 67 year old male with..... ..... uh..... ..... chronic atrial ... fibrillation and ... uh..... sorry.... um, can we please go back to the part above when ..um... I say......." You get the idea. This is why it takes me 20-30 minutes for each daily progress note, when it takes my attending approximately 3 minutes. I am not in any way exaggerating. Half of the dictation time I spend rewinding and starting over, and then apologizing to the transcriptionists.
Reason #3: Tanscriptionists listen to me! There are people that are paid to listen to me bumble through in agony and decipher what I'm saying. I'm just picturing them, this group of middle-aged women in a windowless room in the hospital basement, calling eachother over to listen to my ridiculous dictation, making tallies on the wall of the number of "uhhh's" I utter in a row, placing wagers on how long my next dication will be. Oh, the eye-rolling that must occur when my name pops up in their cue. How I pray that I never run into them on the street. The infamous roving gang of angry medical transcriptionists.
Reason #4: Other people read what I say. My dictations immediately become a part of that patient's electronic medical record. This happened before when I put notes in paper charts, but somehow it seems so much more official when it is typed out all fancy. And sometimes I don't feel very official. This hit home the other day when, while standing outside a patient's room, I turned to the nearby computer to check on some labs. The window was open to my dictation from the day before, halfway scrolled down. The nurse had been reading it, to verify the plans of the CCU team. Fortunately, they had filtered all the "umm's" out.
One day, they say, dictating will be easier. One day, they say, it will fly off my tongue. I hope that day comes soon.
Speaking of dictatorships and public speaking... last night I watched the Steve Colbert address at the national press dinner. Oh my god. That man. Respect.
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I can't imagine being able to do that coherently. It's hard enough to form a thought, even with the assistance of Messrs. Jobs and Gates. I'm kind of surprised that they're still making people dictate—and into a phone! That seems extra hard. My father used to dictate all this stuff—papers, grants, I don't even know what. When I was small I would walk through the downstairs of our house (open parenthesis) he always did it in the dining room (close parenthesis) and I would hear his rhythmic speech, interlaced with "comma" and "colon," and punctuated by the click of his stop button. It seemed to me at the time as if he was composing these papers off the cuff, occasionally pausing to collect his thoughts or perfect a phrase, but just dictating right along. I don't know if that's what was actually going on; I should ask him. Anyway, I think that he only does that sort of thing on a word processor these days. In a way it seems a shame to stop doing it in what I think of as the Old Way, but it's got to be just unfathomably easier to actually write. So I wonder why they still make you suffer.
That was absolutely hilarious - especially about the uhhhh's and the apologies to the transcriptionists. I've certainly gotten better it, but there's a LOT of "Oh wait..go back up to Past Medical History because I forgot.." and so on.
It'll get better with time (I hope). :)
Hi Fiona. Thanks for keeping up the interesting blog. I am in Houston now. So I can see more cases and learn more vital path- of course. It's hot and muggy and the hours are longer than I remember in Portland. Still, I know this is going to be an awesome year and I will see so much material that I wouldn't have. I could go on, but I would sound like an ad. Besides the weather, I have some kind of cold/ allergy double threat going on that has me feeling like I am talking from inside a steamy bell jar. Take care. Misty.
Hi Fiona. Thanks for keeping up the interesting blog. I am in Houston now. So I can see more cases and learn more vital path- of course. It's hot and muggy and the hours are longer than I remember in Portland. Still, I know this is going to be an awesome year and I will see so much material that I wouldn't have. I could go on, but I would sound like an ad. Besides the weather, I have some kind of cold/ allergy double threat going on that has me feeling like I am talking from inside a steamy bell jar. Take care. Misty.
With Fyull Rspect for this prestigious field.. i m getting bored of boks books and bookss .. plz help sos sos sos...
I am a medical transcriptionist (part time only - if I had to do it full time, I would kill myself). Most of the dictators I transcribe for SUCK to the point of wanting to drive all the way to the state they are in and kill them. Yes, kill them. The ESLs (English second language) dictators try to talk so damn fast they trip over their words and keep in mind, these aren't regular, run of the mill words, these are MEDICAL TERMINOLOGY WORDS. And then of course we have the dictators born in the good ole USA who SUCK just as bad or worse. They too think they are in a race to the finish line and have to speak so fast that they are absolutely 100% NOT UNDERSTANDABLE. You'd think they'd realize these are LEGAL MEDICAL DOCUMENTS that the transcriptionist is doing her best to understand and you'd think they would slow down and speak concisely. I want to start a training school for these YAHOOS who have no idea how to dictate. Sorry. I feel better. I had to get that out. So Mr. Doctor, please,please practice your dictation and remember to speak SLOWLY, CONCISELY and respect your patients and the transcriptionist! Thank you.
There really is an "infamous roving gang of angry medical transcriptionists", but we are not angry at doctors. We are angry at HIM managers and MTSO executives who are paying us less and less to transcribe what even most doctors would have a hard time understanding. Our production requirement goes up, not down, as we get more and more ESL physicians, making it more and more difficult to earn a living wage. It takes longer to decipher what most ESL physicians are saying, so we may spend an hour doing a report that would normally take 10-15 minutes, and we are generally paid by the line or minutes of dictation. As the production requirement goes up, MTs are becoming more and more militant. Many experienced MTs are leaving permanently for other careers. As AHDI (Association for Healthcare Documentation Integrity) puts it, "Doctors don't generate revenue; documents do". Just as doctors and other medical professionals rely on transcribed reports being accurate, coders and billers also rely on the accuracy of our work. In other words, what we do ultimately affects the bottom line as well as patient safety. Until hospitals recognize this and pay us accordingly, there will be a critical shortage of experienced medical transcriptionists. Think about that the next time you see "peroneal rash" or "a vascular necrosis" in your medical reports.