Attention, QA: Your Sats are Showing

My evening shift last Saturday was a grind. In the absence of my usual partner-in-crime, the other transcriptionist on evening duty whose shift overlaps mine by about five hours, the work pool consisting of histories and physicals with tight TATs was all mine to plow through.

"Plow" is not an exaggeration. Our hospitalists (and the staff NPs who dictate for them by proxy) have a tendency to go on (and on, and on) with H&Ps in excruciating detail. This is good news for my coding colleagues, who have a richness and depth of information for their detective work, but for us it means a good half-hour to 45 minutes or longer to complete each of these monster dictations. And that's if we're speedy and also familiar with the voices.

Audio files for H&Ps exceeding 20 minutes in length aren't unusual any more. In fact, except for a couple of physicians known to be blessedly brief by comparison with 5 to 8-minute dictations, when I see a short audio length in my queue for that work type I anticipate hearing not a full dictation but an addendum. Incredibly, the more lengthy the original dictation, the more often some small detail seems to be forgotten.

I had just such an addendum on Saturday. I searched out the original report, made the required notation about the addendum job number and such, transcribed the bit of additional information, and re-ended the report. On our transcription platform, this automatically triggers a spell-check. And there they were, up in the previously transcribed portion.

The sats, and their satting relatives. Arrrgh.

I've had a rant about these before, but not here on my blog, so I'm going to rant again.

Dear QA:
WHEREAS, it is well-known that verbal medical jargon as a clinical expedient does not always translate well to the written record; and
WHEREAS, the terms "sat" (as a noun), "satted", "satting" and other variations are not only jargon but also not found in any medical or English language dictionary; and
WHEREAS, in the interest of clarity and the integrity of an individual's medical record these terms are and should be correctly expressed as "saturation", "saturated" and "saturating", preferably with a clear reference to oxygenation as well;
NOW, THEREFORE, be it resolved that when a clinician or his/her proxy dictates such jargon, the terms should and must be changed by the transcriptionist to their proper and accurate form. Failure to do so shall be considered a major error.

I feel much better now.

Changing Focus and Catching Up

Ever get the feeling that you're always just a couple of steps behind the power curve, a day late and a dollar short, jogging along at the back of the pack, perennially playing catch-up?

That would be me.

I hear about a writing contest that's right in my wheelhouse ... only to find I've missed the deadline by mere hours.

I get too busy to check my e-mail one day ... and miss the "today only!" bargain on something I really want (with free shipping!), or find that all available seats on a time-limited airfare deal have been snatched up.

For that matter, I hear a great new song on the car radio, come home and tell my 30-something daughter about it .. and she gently tells me that this song was released last year, she's downloaded it, and it's been her cell phone ringtone for months.

So it came as no surprise to me that, once I pulled my head out of the sand with respect to what's been happening in the healthcare documentation world for the last few years and tuned back in, I've missed some opportunities.

The Name Game for MTs: Time to Decide

For MTs like me, in the process of re-assessing our skill set and knowledge base to figure out how and where we fit into the changing face of healthcare documentation, the answer to "what's in a name?" deserves careful consideration.

We've had various titles before, of course, but it was largely matter of preference whether to be known as a medical transcriptionist or a medical language specialist. The latter had a nice ring to it, and some of us chose the appellation on that basis alone.

It seems that while we readily adopted "transcriptionist" to set our skills and knowledge apart (accurately) from secretaries, typists, etc., most of us became medical language specialists only when we spiffed up our resumes or introduced ourselves at cocktail parties.

As it turns out, even if the majority of MTs had become MLS(s? Where's that BOS when I need it?) and HR analysts had backed that up, we'd be due for another look at this today regardless.

ESL dictation? Bring It.

When medical transcriptionists –whether seasoned, or newly graduated – get together and “talk shop”, it's almost a given that someone will bring up ESL dictation… and everyone else will nod, groan, and roll their eyes.

ESL: English as a second language. In medical transcription it's defined as dictation by individuals who speak other languages in addition to English, and whose accents (and often syntax) are colored by their native tongues.

Here's a thought to consider: There's almost no such thing as UN-accented English, even from native speakers. It's largely a subjective call. One's perception of whether or not a speaker has an "accent” has less to do with the speaker's region of origin than one's own. In any case, it can't be assumed that dictation from a physician born and raised in the USA is going to be any easier to decipher than that of his colleague who immigrated from Kenya or Pakistan or Brazil. 

Case in point: My introduction to medical transcription. Here's the story.

Still Transcribing After All These Years

I do acute care medical transcription, and I'm good at it.

From Tuesday through Saturday every week I log onto my VPN and download the first of the day's available dictation files into my queue, entering the "zone" where my fingers key what my ears hear and my eyes verify, over and over, at an average speed of about 300 lines an hour. It's straight typing at this point, augmented with an abbreviation expander and a few macros, and the mechanics of how I do my job haven't substantially changed in over a decade and a half. We haven't yet implemented speech recognition (SR) editing. I am still a home-based hospital employee.

In the current medical transcription world, I'm considered fortunate. I have a job with benefits; my per-line production pay rate is above the national average; I don't have to deal with SR editing (yet); and I haven't been outsourced (yet).

If I didn't give occasional thought to the fact that all of this could change in a heartbeat, though, I'd be kidding myself.