I am in training at a local health care facility. We have three computer systems. One handles all our clinics (16), outpatient ops, pain center, senior rehab. The second and third ones each handle about 4 hospitals; the ERs, Ops, H&Ps (with ROS etc.), Discharge Summaries, etc. I've completed my training on the clinics' server, and have started on one of the hospital servers.

Yesterday, I had an H&P that was impossible. The Dr was foreign, gave NO headings, mumbled, and talked incredibly fast. Even WITH the ability to see his prior reports, I wound up leaving about 50 blanks (no exaggeration). I'm not stupid, my technical ability is excellent, but I just couldn't understand what he was saying!

Of course, I'm a trainee and my supervisor just says, "Don't worry, that's how you learn." My reports are all corrected by her and I receive the reports back so I can see my errors. I can even relisten to the dictation so I can "rehear" what he said. Also, I'm paid hourly so time and production is not an issue while I'm training. Basically, I have an "ideal" situation for learning.

Sooooo..... For those who are starting at home, what do you do when you have that type of report? I can't imagine starting out at home on a production basis and being confronted with a 67-line report that takes 3 hours and still has 50 blanks.

What do you do ??

To begin with, an MT is never going to know EVERYTHING about every specialty, especially with the constant addition of research, new procedures, new equipment, new imaging techniques, new chemotherapy protocols.

I recently took a test in a large hospital for a part-time radiology transcription position. That position would have actually been "IN-HOUSE," i.e., in a hospital office, albeit on weekends with NOBODY ELSE AROUND to help orient me. So I don't really think that's much different than working at home. Anyway, the test I was given was not an ESL -- rather an American doctor who completely and totally mumbled the whole report, or should I say slurred and blurred. The report was full of numbers. However, the main sticking point for me was, I happened to "draw" one particular type of report which I don't remember having had any experience with -- at least nothing comparable to what I was faced with, even remotely.

One of two things is true: 1) We will some day know EVERYTHING. 2) We will NEVER know EVERYTHING.

I have applied myself in the same fashion you have, to taking my course which is EXCELLENT and to studying the material, and going BEYOND by downloading information from the internet, etc. One day I stood in front of my computer and downloaded an alhabetical listing of chemotherapy agents that wound up being about 30 pages of print. BUT WHAT GOOD would it do me if the doctor who is dictating mumbles. When I say mumble, I mean a mumble which EVERYONE, both new and experienced MTs would AGREE is a mumble. I am willing to go even more than the extra mile in my serious pursuit of excellence and a start in MT work. If I WERE FAMILIAR WITH THE SUBJECT MATTER, I MIGHT be able to get SOMEWHERE by using what I know and researching. If it is UNFAMILIAR material that is truly mumbled --- uh.

Here's where it will be interesting to see how a variety of people respond to your question. What is expected of the MT confronting above-described circumstances? I mean gee whiz .....

[This message has been edited by Fiddler (edited September 11, 1999).]

Gaile, here's what I did my first few months of transcribing at home when it was difficult:
1) Cried. Just cried right at the computer. Frequently.
2) Looked up everything in my reference books, then got frustrated and threw them around the room. I have now taken to stomping on them.
3) Called my MT co-workers to see if they could decipher the dictation. Most helpful!
4) If all else fails, called my boss, who ALWAYS knew the answers.

Now if I if have a hard time, I usually pop onto MT Desk. I am also a lot more thorough with my searches and more patient. That is, after I have stomped on my reference books!

Perhaps you have found the true KEY TO SURVIVAL in the situation we are discussing. Perhaps there is nothing quite as satisfying, as rewarding, as helpful, as stomping on your books or throwing them at a wall, when all else fails. Or perhaps we should all review techniques in primal scream therapy which was so popular 15 or 20 years ago.

One thing I am certain of -- the more you transcribe, the better you transcribe. As I review the General Medicine tapes from our course, I am really honing in on some details that I missed the first time around. Sometimes I find it takes two or three confrontations with the same problem before I KNOW THAT I AM NEVER GOING TO MIS-HEAR that word again. I can even give you a perfect example here. A doctor is dictating a report on a man with respiratory infection, possible pneumonia. He says what sounds like "no bronchomal disease.: I look and look. bronchomal is not a word I can find anyone. My imagination goes wild trying to figure this one out. Well, it was PARENCHYMAL. WHAT'S MORE, I HAVE HAD THIS SAME PROBLEM BEFORE! Repetition, repetition, repetition. I am NEVER going to have this problem again. I hit critical mass this time. The next time I hear what distinctly sounds like "bronchomal" I will immediately flash to parenchymal. THAT IS --EXPERIENCE AT WORK. Take that experience and multiply it by a million different variables, and I guess you have the first couple of years of work as an MT.

Fidd

[This message has been edited by Fiddler (edited September 12, 1999).]

In the situation I was describing, there was no way to even get a "sounds like" clue! I wouldn't even know which book to stomp on.

I think the difficulty level is somehow increased because it is a hospital. I mean, if I were transcribing for the same group of doctors over and over again, it wouldn't take long to get used to their specialty and their manner of speech. We have 500 doctors.

Also, in order to be actually admitted to a hospital now-a-days, you practically have to have some dreaded disease that nobody has ever heard, or, at a minimum, an illness that involves multiple diagnoses consisting of things like "siderotica granulomatosis." Given an ESL doctor, who mumbles, talks fast, and runs that together as one word, about all I would get is "sadakfskgieona sftas-osis."

MooCow, your final solution is exactly what I wind up doing: Waiting for a more experienced MT to listen to it. I can't exactly look at the chart or call the dr and ask, "What are you saying?" Like Fiddler says, it hasta be in the experience.

Gaile

P.S. And exactly WHO starts out by making $35K/year? hehehe

[This message has been edited by Gaile Stevens (edited September 12, 1999).]

P.S. I still smile when I recall that the only two medical words I knew how to spell were tonsillitis and enuresis!!

This is why I think it is SOOOO important for us to realize, it is not ALWAYS US!!!! Let's get that straight right at the start. After reading of your plight with this dictation, I have to say, NOT EVEN EXPERIENCE can provide for some things. Not until the day that we can KNOW EVERYTHING THERE IS TO KNOW, which will be never -- will we be able to solve every problem like this one.

Fiddler

But I wanted to add something else. What does your hospital really expect of you in that situation, or of any transcriptionist?? What if even the experienced transcriptionist couldn't "GET IT?"

It really sounds to me like not every doctor in the world takes the "transcription" part of their work at all seriously.

I wish the AAMT WOULD do something for transcriptionists. That something would be make a persuasive statement to the teaching hospitals that dictation IS IMPORTANT if the MEDICAL RECORD IS IMPORTANT. As long as there is going to be a medical record, unless the physician does every scrap of creating that final record, there are going to be intermediaries involved in the process. The intermediaries are going to be either transcriptionists or editors of "VR input" or the people who will be confirming the information on the computer-input record at times. What of the QA person at an agency who says to the transcriptionist calling in, "GEE -- I DUNNO -- I CAN'T UNDERSTAND IT EITHER -- I HAVE NO IDEA WHAT THE DOCTOR WAS SAYING???" And then the dictation gets flagged and sent back to the hospital marked as "UNTRANSCRIBABLE" (is that a word????)

If the doctors don't think the dictation is an important or critical element of their work, where does that leave the transcriptionists?

I read somewhere on this Board that only one medical school in the country has ANY component AT ALL in their education which addresses the dictation of a medical record.

I'm willing to put in the time to learn as MUCH as I can learn and give the job my all. But that still isn't going to allow me to create a good product if the dictation coming from the doctor sounds like extraterrestrial language, as Gaile noted in her previous post on this thread, i.e., her BEST GUESS at the dictation which STUMPED her.

I vote this way: IF the medical record is IMPORTANT, then a statement to that effect should be made in medical school and dictating the record should merit discussion in the medical school. If the medical record isn't important, then fine.

Fiddler

Fiddler

As for the dictation quality, we aren't going to change them. At least not in a hospital environment. I am told that our doctors are told time and time again how to dictate, and it doesn't do any good. Especially, with the ELSs. They are paid for production. Anything that takes time away from patient interface means they're not making money. I can understand that.

The whole reason I brought up this topic was to find out what people do AT HOME !!!!!

My experience is far, far more upsetting to me than it is to my trainer. She told me not to worry. They KNOW he's difficult and they KNOW I'm a trainee and new to these hospital reports. They EXPECT to correct all my work. Nobody is losing money because I had 50 blanks because I work directly at the hospital.

Now.... if I worked for an outside company DOING that report and it got returned to our hospital with 50 blanks, the outside company would get fired and rightfully so. A hospital hires an outside company and PAYS for a certain error rate. If they get poor service, the outside company should be replaced.

There has to be a TREMENDOUS amount of pressure on newbies who start out working from home on hospital reports. Or maybe they don't DO hospital reports ???

I've read here so many times to "get outside experience first before working from home." Wow, once you get hospital experience, I'm sure you can handle about anything. No wonder so many places want 1 - 2 years hospital experience. This is tough. hehehe

Fid, we'll get through this. You'll get a great job because you ARE just as dedicated as I am. It's just not as easy for two BRILLIANT students (such as we are)as we thought.

Gaile

You might be interested in knowing this: an experienced MT told me that there are plenty of times when dictation is submitted for transcribing which IS SIMPLY INCOMPREHENSIBLE, AND EVEN THE QA PEOPLE DON'T STAND A CHANCE OF COMPREHENDING IT. I was told at that point, with the failure of the best effort of an experienced QA person at an agency, the material is simply marked INCOMPREHENSIBLE, by the agency, and returned to the Medical Records Department with the flags on it.

Look, we are human beings. We have limitations. If somebody starts beaming signals from Alpha Centauri down to Earth, I don't expect to be able to de-code them. By the same token, if the dictation sounds like signals being beamed down to Earth from Alpha Centauri, I don't expect to be able to decode it either. Nor do I expect the QA person to be able to decode it. Perhpas the QA person would manage to piece together some of it. But my understanding is, THERE IS DICTATION SUBMITTED WHICH SIMPLY IS "beyond..... falls off the scale of what would be considered manageable." If somebody comes to me and tells me to make a silk purse out of a sow's ear I don't think I'm gonna be able to do it. All I can do is educate myself in every way possible, make every effort, and try to develop a perception about when "impossible" is IMPOSSIBLE.

Let's face it, this is a new endeavor for us. I've yet to find out whether it is a viable endeavor for me. I WANT IT TO BE. I've put enough into it. I worked my butt off and I haven't even finished school yet. I certainly have a tremendous desire to make this work for me. But I am only going to find out by trying it.

You seem to be utterly and absolutely convinced that it is not wise, or even really possible, to begin from home. However, there are people who manage to do it, Gaile. It does seem quite possible that with the tremendous fluctuance, pulling and tugging and yanking going on in this field right now, more national companies will decide to instigate some sort of training programs for graduates of the best schools.

And finally, I'm no Pollyanna because I already went through that phase of my life and came out the other side. If I find out this isn't practical, then believe me, I'll be looking for the next step forward which is practical. As you once stated in a previous post, this is NOT A HOBBY. This is a means of self-support, or NOT.

Linda R.

What if "the company" is handling transcription for 90 doctors from that same hospital and most of the reports meet all acceptable criteria for accuracy and turnaround time? But there is this one doctor who sends in dictation which is incomprehensible. Is that the fault of the COMPANY????? I don't think so. Why should the company lose the contract for all the good work they are doing, transcribing for 90 doctors, because one doctor likes to say three words at the same time? My understanding is, the administrators in the hospitals come to know which doctors are impossible to transcribe and they are probably used to getting those doctors' reports back flagged and marked "CANNOT BE UNDERSTOOD" or something to that effect, by the Q/A Department of a transcription company.

That is, at least, what an experienced person told me.

The "Buck has to stop somewhere." I guess it is the Company, be it a national agency or a small transcription service owner, who has to have a policy and wrangle with this sort of issue. I have read George Heymount's posts about some of his interactions with his clients!

We each seem to be stuck, or hung up, on one point that we really want to make. Your point is, "A new trancriptionist shouldn't start working from home and won't be able to do the job working from home."
My point is, there are certain human limitations to my ability. I can only educate myself well, be willing to continue to educate myself, and produce my best product; that product may depend on what I am given to work with.

Linda

Linda R.

[This message has been edited by Fiddler (edited September 13, 1999).]

About leaving blanks....
If it is a doctor foul-up, something pronounced of spelled wrong, we usually leave a blank so that the doc may write it in. If it is a term you cannot find, you wear youself out trying to find it, ask others, etc. If it is something you are completely unable to hear (and no one else is able to hear), we slap a big INAUDIBLE DICTATION on it. Maybe if one particular doctor keeps seeing his reports come back with this bold message on it, someday he will realize he needs to clean up his act. Of course, others still would not change. Can't teach old docs new tricks, I suppose.

Gaile, don't lose heart about this. After my 4-month in-office internship doing hospital reports, I felt fairly confident about my abilities. My ability to transcribe and also to research information. Then I worked in another office for 1 week and then went home. Some people would say this was absurd. I won't lie to you all, I was very nervous. But I knew that I had the ability to do this. Looking back on it, I don't think I would have done it differently. In a way, it was a true test of how well I could perform. Guess what? I passed. Not to toot my own horn or anything, I just want to assure you that it is possible. Learning takes time and practice makes perfect. Just because something is difficult at first, does not been it won't get better.

Thank you for responding. I was really waiting for SOMEONE to say SOMETHING! What you said serves to re-enforce what I was told before: in fact, there are some doctors whose dictation NO ONE CAN UNDERSTAND, not matter what; and if it truly falls into that category, neither the transcriptionist nor the Q/A person can be expected to do anything about it. Only the doctor COULD do something about it.

Fiddler

It works -- I did it for the new housestaff practically every semester for 30 years! There was a period when I did all the OR reports for the hospital, and during that time I also provided copies of really difficult operations for the other transcriptionists I worked with. We are basically a kindly bunch!

You can even ask the hospital or the service for sample reports from the bad dictators, or samples of various operations, etc.... They will be impressed with your dedication and eagerness to learn!

I wish you all, all the best -- it is very clear that you are well on the way to being exellent transcriptionists -- in fact I would say that more than half the battle is over. It is wonderful to know that there is going to be someone to carry the torch...

carolT

Even MooCow says she had 4 months IN-HOUSE first, before going home.

I can also see how it would be possible to work for a small clinic or group of docs from home. It would be rough at first, but I think one would easily learn/adapt. Plus, you could possibly even talk to them directly.

The prior reports are VITAL. As I said, I DID have access to them, and, of course, they had all been reviewed, corrected, etc. and were perfect. To look at them, you would never know he was a difficult dictator. Unfortunately, they were no help to me as I couldn't even get a clue what part of the ROS he was doing! (no headings)

Perhaps I was a bit hasty about the "firing" of a subcontractor. I honestly don't know how our facility handles that. I'll ask my supervisor and let you know.

Fiddler, you'll be fine !!!! Do you have any other tests or applications out there?

I sure hope that others who are thinking of entering this field read this thread. While I LOVE what I'm doing, it can be frustrating, difficult, and a real shock to find out that we've just begun learning AFTER we leave school.

G.

P.S. I almost forgot, but I have found that these message boards for transcriptionists have always netted me a correct answer to a problem. It is terriffic!

[This message has been edited by Inflight (edited September 14, 1999).]

Anyway, I'm a newbie working from home with no intership. It wasn't exactly an option. From what I have found out, hospital reports are done by the hospitals - at least where I live. BUT, just about any doctor mumbles and eats and crinkles paper and yawns, etc. into their recorder - YUK! Anyway, I am subcontracting with another MT who has been very helpful. And as noted above, I, too, keep copies of a doctor's previous reports. It really has been helpful since they seem to repeat themselves a lot on certain parts of the reports. Also, I have found that if I make a referrence of what that mumbled word sounded like and then what the word actually WAS (if I find out), chances are I'll get it the next time the doctor mumbles it. They really ARE creatures of habit.

And sometimes, you just can't figure it out to save your life. In which case, the referrence guide "Medical Transcription Guide Do' and Don'ts" has been extremely helpful. In it, the authors address this same issue by suggesting a form to use to submit to the doctor when you can't make out what was dictated.

All you can do is try!

-Ronny

Boy, could I relate to this topic. I, too, like inflight, etc. am a newbie, working for a service from home (tho I agree it is wiser to do in-house first) and am doing ER reports. Have learned much in my few short months.

First few weeks got an ESL doc--struggled thru for almost an hour with four blanks, so had to call and have report re-assigned; was told by owner"No one can do Dr. XX" so that made me feel better. Then, one week later, there she was again. So, rather than call EVERY time, I was determined to do the report, and I did--this time only three blanks, and after doing her I could understand almost all of what she was saying. I got copies of her reports to fill in the common phrases she was using (unique to her, of course) which helped immensely. I now can do her!! This also helped my overall confidence immensely.

Anyway, like the others said, sometimes you just can't hear, especially on mumbles, volume or poor quality issues--even on my favorite doc tonight there was a large amount of static. It is always something.

My advice--try, try again, and it will come. Use all your resources to fill in the blanks--books at home, and this site has been wonderful.

Good luck!!

Lynn

will edit

[This message has been edited by kimalyn (edited September 14, 1999).]

[This message has been edited by kimalyn (edited September 14, 1999).]

There are a couple of things I noticed that you all said in common:

1. You get your corrected reports BACK.
2. Everyone really relies on prior reports and/or templates.

Sooooooo.... It seems that those are important items for a newbie to ask potential employers, as having those items might save some tears and stomped on books.

AND...in a roundabout way...
3. Everyone agrees that In-House first is ideal, but not always possible.

Ronny -
I had M. Diehl's book as my text !! Lots of good information in it. As to using a note back to the Dr., in my case, that is not really an option. We have ZERO interface with the dictators. I would imagine the same is true when working for a national company.

Again, thanks for your replies! I'll just keep plugging along and someday all the experience will "fall into place."

Gaile