“When
people talk, listen completely. Most people never listen.” – Ernest Hemingway
“Most
people do not listen with the intent to understand; they listen with the intent
to reply.” – Stephen R.
Covey
“We
have two ears and one mouth, so we should listen more than we say.” – Zeno of
Citium (Greek philosopher)
All
right, that’s enough. I think you know where I’m going with this. Everyone
knows that medical transcription is all about listening. But no one tells you
that the hard part is learning to listen.
Every time an MT gets a new doctor, he/she has to learn the dictator’s style,
accent, and preferences.
Clinics
and hospitals cannot do without MTSOs (medical transcription service
organisations). It is their transcripts that help dictators in malpractice
cases, their connection if they forget to dictate a letter needed for pre-authorisation,
and their go-to person who puts their words to print. At one time or the other
in their career, most MTSO employees have felt that what they do does not
matter to anyone but themselves, but the truth is that it matters to the
doctors, nurses, insurance
companies, malpractice attorneys, and last, but certainly not least, the
patients themselves (even if they don’t know it).
In
spite of this, not all dictators take care while dictating. MTs do not expect dictators
to speak in slow motion, spell out every word, or exaggerate enunciations. But
sometimes it becomes very difficult to make out what a dictator is saying. They
may eat while they’re talking and they mumble or stutter, or they’re tired and
they yawn while dictating. Occasionally, they forget there is a human at the
other end of the process who has to figure out exactly what is being said.
A bad
dictator can spoil the whole day for an MTSO employee, since not only is the
transcribing MT forced to reduce speed in order to concentrate on accuracy, but
the QA who proofreads the file also has his/her other files held up due to that
one poor dictator. Also affected are other MTs and/or QAs whose assistance is
sought with the dictator.
Given
below are some of most common problems faced by MTSOs.
- Dictating punctuations
Most dictators assume that the MT will insert
the correct punctuation where required, but some dictators tend to specific
them by saying “comma”, “hyphen” and “period” or “full stop.” If the MT doesn’t
realise what that word is, he/she may struggle to figure it out, and thus lose
precious time and effort. Solution: Practice.
- Word endings
Sometimes, the dictator may not pronounce the
final letter or syllable in a word or may add one instead. For example, fine instead of find, ih-stop instead of stop, or fever-ah instead of fever.
Solution: Practice.
- Sound substitutions
Letters and sounds that are present in one
language may not be present in another. So, since not all dictators are native
speakers of English, they might exchange the sound or letter with the closest
one they know. The exact substitutions vary by culture, but some are listed
below:
COMMON SOUND SUBSTITUTIONS
|
Actual Sound
|
Dictated Sound
|
|
sh (she, sheet)
|
ch (chee, cheet)
|
|
th (this, these, catheter)
|
D, T, or Z (dis/tis, dees/zees, cadeter)
|
|
G or J (gentleman, just)
|
Y (yentleman, yust)
|
|
W (wound, white)
|
V (vound, vite)
|
|
V (virus, Vicryl)
|
B or W (birus/wirus, Bicryl)
|
|
L (collect)
|
R (correct)
|
Solution: Practice.
- Changing genders and tenses
If a dictator starts out by clearly stating
that the patient is male or female and then halfway through the dictator
randomly shifts between the opposite pronouns (she/her or he/his), it is okay
to change it back to the correct one. The same rule applies for random change
of tense – past, present, and future – in the course of the dictation.
Solution: 1. Alertness. 2. Use Ctrl + F after completing transcription to
search for gender or tense changes through the dictation. This is actually advisable
for all dictators over all files.
- Hesitation sounds and pauses
Some dictators tend to say hmm, ah,
eh, er, etc. when thinking about what to say next. If a word is unclear
try to figure out if it might be one of these words. Solution: Alertness and
practice.
- Incorrect dosages
Some dictators might dictate incorrect
dosages, which could be catastrophic. Because treatment decisions are based on
information in the chart, accuracy is crucial. A good transcriptionist must
therefore cross-check all dosage information dictated, by either using software
such as the QuickLook drug index or by looking it up on the Internet. If a
doubt still exists in the MT’s mind, he/she must time-stamp or highlight the
dosage so that it may be verified by the dictator or the concerned healthcare
worker.
As
you can see from the above, the solution to most problems with poor or
difficult dictators is practice since, as they say, practice makes perfect, and
doing something over and over is the best way to learn it well. Though practice
takes both time and effort, it is ultimately of tremendous benefit to those
wishing to pursue a career in MT.
Given
below are some other suggestions to handle such dictators.
1. Reducing the bass or speed: Many physicians are so bad at
dictating that you need some special techniques to understand exactly what they
are saying. If you find it very difficult to understand a particular dictator,
try these approaches: Try to reduce or remove the “bass” to hear the words more
clearly. You can also try adjusting the audio file playback speed from very
slow to fast. Sometimes varying the speed can allow one to pick up on what is
being said.
2. Telling it like it is: One of the best cures for a
chronically bad dictator is to return transcription with every questionable
word or passage left blank. By doing this regularly, you are indicating that
the dictation is constantly poor. If someone, including the bad dictator, tries
to imply you just don’t have the skill to perform their work, show them
successful transcriptions you have done from other physicians who know how to
dictate properly. When all else fails, simply refuse to do their work, if you
are in a position to do so.
3. Quiet work environment: Seasoned medical transcriptionists
know how important it is to have their surroundings as quiet as possible. If
you work from home, you may find that working in the evening or through the
night becomes the most productive time for you, if you can fit that kind of
shift into your life. If working in a pool of MTs and QAs, ensure that your
work environment is peaceful as it can possibly get.
4. Taking a break: Things always
seem better when the mind is not fretting or worrying about anything. So try
taking a break – eat a snack, drink some fluids, talk to a relative or friend,
listen to some music or just take a walk – and then come back to the dictation
with a fresh mind.
5. Asking a colleague: Medical transcription
is one of those fields where egos should be left at the door along with the
lunchboxes. Nobody, and I mean nobody, can give 100% accurate files at all
times. Every MT and QA requires help at one point or another. So do what most
MTSOs implore, request and advise their employees to do: never hesitate to ask a co-worker or a superior for help when it
comes to difficult or hard to decipher words or phrases. This becomes even more
important when processing files of difficult dictators.
6. No guessing: The first and
foremost quality of a good
transcriptionist is that he/she should avoid
guessing what is unclearly dictated or heard. If the problem dictation
involves drug names, drug dosages, patient-described symptoms, etc., guessing
incorrectly could have dangerous, even life-threatening implications if the error
goes unnoticed through the health system. The safest, most professional and
ethical approach is to leave a blank in the transcription, preferably with a
time-stamp.
The above
suggestions are based on years of experience and research into the field.
However, each MT needs to develop a system that works for them with the
difficult dictators. Maybe you go through the entire report and leave blanks
where you are stuck, coming back to listen at the end. Maybe you have a rule about
how long you will try to get something before you send it to QA for help. There
is no right or wrong answer here; everyone has their own system. What is
important is finding a system that works for you and using it to make things
easier.
