To all the doctors who may be reading this, if you truly care about the quality of your reports, then I suggest you care about the people who actually know how to provide them to you.

Doctors, for the most part, are not grammarians. Those of us with the “CMT” after our names have worked long and hard to get that degree. I was a medical professional (a registered radiologic technologist) before I retired and started transcription at our local hospital. I came into the profession with a far better medical background than most, yet it still took me 5 years to become really good and over 15 years to be superb.

Yet what do I make now? I make far less (almost half as much) than I could have made had I continued my x-ray career. I have been passed over for promotion by the twenty-somethings who are my bosses, who know virtually nothing about what we do. Why? Because the job of transcriptionists is one that is done quietly–a job that is often forgotten until a doctor somewhere needs a report.

It has taken me years–years–to make $20 an hour. If I was still in radiography, I would be making almost double that. Now our hospital has changed to eScription; our jobs will only be valid until we have “trained” the new system, probably another 6 months or so. The hospital is trying to save money, and I completely understand that. However, no one in the hospital truly understands the role we transcriptionists play.

I can get another job; that’s no problem. However, our patients will not be served appropriately if their reports are not edited by educated, experienced transcriptionists. Most doctors simply do not have–or will not take–the time to edit their reports properly. Some simply do not know the English language well enough to edit their jobs appropriately; I know. Our hospital employs an extraordinary number of clinicians for whom English is a second language.

To all physicians, there are better ways to save money than to pay transcriptionists by the line. A required degree and an honest hourly wage would be the best answer for everyone concerned.

I recall one of our docs who used to stop his dictations and just talk to the “typists” a bit and then resume his dictation. they had the sense to edit out his irrelevant banter and they loved him for it. He actually got flowers from them once.

Why be such a jerk?

The few of us who actually know HOW to edit and WHAT to edit and what to leave alone are often not ALLOWED to edit by our bosses; which means, in effect, we are not allowed to think. “Just type what you hear” is what the boss at my last job told me. I actually ended up risking my job in order to give the doc what I KNEW s/he meant when s/he said (and these are real examples):

*lateral surface of her right angle (ankle – I didn’t mis-hear it).
*hip fracture had been performed in 1972 (he meant either “sustained” or “hip fracture repair had been performed”).
*femoral enderectomy (endarterectomy).
*general anesthesia was admitted (administered).
*For her reflux, she has seen a gastroenteritis (gastroenterologist).
*She tended to memorize any memory difficulties she was having (minimize).
*After describing the procedure in detail, the patient understands and agrees (the DOC described it in detail, not the patient – sentence should be rewritten as “after I described the procedure in detail, the patient understands and agrees).
*Patient had well-compromised CHF (well-compensated).
*Consultation was kindly obtained from Dr. Smith (it was kindly PROVIDED by Dr. Smith).
*She developed pain in her head and lied down (lay down).
*I have discussed this with she and her daughter (her and her daughter).
*Patient has expressive dysphagia (aphasia).
*Patient drinks half of a fifth of a bottle of Scotch a day (half of a fifth of a bottle????? how much exactly IS that???? half a fifth? half a bottle? or what?)
*The patient in her shoulder was migratory in nature (pain).
*She contributed this to some weakness (attributed).
*He was only born with one kidney (born with only one kidney – this is a misplaced modifier).
*She had no temperature (fever) and the rest of her vital signs were normal as well.
*The surgery was done by myself (by me – or else the surgeon was the only person in the operating room).
*Rectus diasthesis (diastasis).

and so on ad nauseam – these are just some examples from the past year – I have 19 other years of transcribing from which I could cull similar examples.

I correct grammar, syntax, spelling (don’t spell drug names and medical conditions for me – I bet I know just as many if not more than you do, AND how to spell them), sentence structure, dangling participles (“patient was brought in by two police officers in handcuffs”), misplaced modifiers, etc. I make you sound like William F. Buckley instead of George W. Bush. I don’t guess or presume without leaving a blank and a “S/L” (Sounds Like) after it. I Google stuff I don’t know or look it up in one of dozens of transcription specialty reference books I have. I call pharmacists. I sometimes call a patient’s primary care physician’s office if what I can’t hear is something like an allergy which may be important.

Most of all, when I hear something that I cannot figure out, I don’t get hung up on “what it sounds like.” I try to think about “what it could BE.” I use the whole dictation to help me figure this out. If I am at a hospital and my computer has the ability to access old records on this patient, I do that, and read them for clues.

I am worth way more than the 7 cents a line a transcription service like Spheris pays me (transcriptionists in the Caribbean and India are paid 1 to 2 cents a line but if you choose this option to outsource, you get what you pay for). Every time my fingers stop transcribing while I look something up or Google it, my pay stops. Is it easier to just guess or leave a blank? You bet it is. That is why so much CRAP ends up in most transcriptions. They just don’t pay us enough to care, so many of us do not. And if a doc is dictating while eating crackers and rustling the bag while he snaps x-rays in front of the microphone, and smacks in my ear as he dictates through the bolus of food in his mouth, it is REALLY hard to care about how his dictation comes out. But still, I try to care. At the other end of the phone or handheld dictation device, there is a person trying to make a living. Many of us excel in our field. Many do not. Many transcription services hire people with one year of experience and turn us loose transcribing doctors we have no business transcribing. And instead of mentoring us and reading every word we transcribe, they scream at us and cut our pay when we don’t do well.

Please don’t EVER call me a typist or a transcriber. A typist is a person who types. A transcriber is a machine used to record and play dictation.

I am a medical transcriptionist, a college graduate, and I went to school for 2 years to learn how to do this and only this (not combined with the rest of the Medical Assistant program). I finished that program with a 4.0 at the top of my class. When I worked for a hospital, my work was consistently “QA’d” above the national average for margin of error. I deserve a salary on which I can live, and a little respect. Thanks for letting me vent.