Wednesday, December 5, 2012

Modern English

The introduction of a medical letter is important. It sets down basic patient data and gives you an idea of their chief complaint. When you screw something that simple up, you just know it's going downhill from there:







I get all kinds of letters from other doctors. Most are understandable (although the computer template ones often give me no clue what they're thinking, if they're thinking at all).

I get some, however, that are full of garbled phrases. I have no idea if this is due to bad language skills, lack of good transcription (yes, Dragonphiles, YOU!), crappy proofreading, or all of the above.


Here we have this sentence (from another neurologist no less) which defies all structural rules of the English language:




Or this:




You see all kinds of odd stuff:






 Some of which makes no sense whatsoever:







At times the salutation at the top isn't particularly flattering:







Lastly we have this doctor, who's apparently so embarrassed by his shitty notes that his name isn't even on them:


 

Thanks to all who sent these in!

30 comments:

Don said...

I make a good living checking engineering drawings and related documentation, so this kind of thing doesn't bother me too much. The exception comes when I have to slog thru an 80 installation procedure written by A. Cretin, and the deadline for review was a week before I received it.
At times like that, I sometimes wish that the Red Pen O' Death would come to life and slaughter those that make misteaks...
Funny examples, though.

Anonymous said...

Im a transcriptionist. We have to transcribe verbatim. That being said I always try to "clean it up" when I can, however, it's not always easy to do. We can't make the ESL docs look any better on paper than they sound on the phone. Voice recognition and bad transcriptionist's are responsible for some of it. That being said we get a crappy amount of pay for this job and most of us are looking for another profession.

Officer Cynical said...

My hovercraft is full of eels.

Stacey Gordon said...

Some of that phrasing does sound a bit like ESL, the rest is illiterate, poorly proofread dreck.

My sudno na vozdushnoy, podushkay polno oogray!
Russian translation for My hovercraft is full of eels

ronstew said...

"I wanted to make reduce the patient's pain."

That sentence would get a B from many English 12 teachers in my neck of the woods. I am going to give the writer credit, however, for a correctly used apostrophe.

Good blog on grammar with lots of funny examples, cartoons and commentary: http://blog.grammarly.com/

Anonymous said...

I am just relieved that none of my dragon/dictated Miss Takes did not appear hear (sic, for laughs)!

Ms. Donna said...

And then we wonder why people get the wrong treatment/no treatment.
Seriously, couldn't you contact the dictation company(ies) and offer your services as a consultant?

Packer said...

So what was wrong sith the guy who flew in the noisy cargo plane for four years ?

IPad or worse I Phone typing. Neever let your Dr. I phone order your RX-- you may find yourself applying icy hot to your nether regions twice a day.

And for policially incorrect fans:
Call the Dr. From University of New Dehli Garage Medical School to translate.

Kevin said...

Just a guess, but I think the one that makes no sense whatsoever should be "He flew in a noisy C-127cargo plane for years"

Anonymous said...

I'm trying to memorize the Russian phrase "My hovercraft is full of eels." I KNOW it will come in handy some day.

Steeny Lou said...

I, too, am a medical transcriber, like "Anonymous" who posted at 7:25 a.m.

I have often quoted the words of a fellow MT, thus: "It is our job to make doctors look smart."

Of course, doctors are smart, but I mean, their focus is fixing broken people, not fixing broken English. Hopefully the poor grammar skills exemplified by some of them are no reflection of their doctoring skills.

Anyway, as "Anon 7:25" has said,

"...we get a crappy amount of pay for this job and most of us are looking for another profession..."

Sadly, this is true.

I see at the top of this page there is an ad for CareerStep. The way things are going with our pay having gone down so much over the years, I strongly urge everyone to ignore such ads.

Dr. Grumpy, would you, or any others in the medical field who are reading this, be interested in hopping on board to help air the concerns of medical transcribers as our pay has become a detriment to our existence? If so, please contact me via leaving a post on my blog, requesting that I not publish your post, and leaving me a way to contact you? Here's my blog link:

http://holy-sheepdip.blogspot.ca/




in this thread said:

"...we get a crappy amount of pay for this job and most of us are looking for another profession

Anonymous said...

As another medical transcriptionist, I will weigh in too.

When I started on this field almost 20 years ago, there was a sense of pride in our skills because most companies wouldn't even consider you a candidate without at least FIVE years of prior acute care experience.

It was a tough field to break into but it was worth the effort. We took pride in doing an excellent job. After all, lives depend on it. Now it seems the only requirements are that you can type at a reasonable speed and have watched every season of Grey's Anatomy so you "get the lingo". BAH!

Here is how voice-wreck has affected me: I have lost 2/3 of my income in the past 10 years, I have lost the pride I took in doing a job well done, and my productivity is at an all time low because I am so brain tired. It takes way more effort to try to listen and read along to edit this garbage than it did to just straight type it.

Medicine has become a mine field in the records part of it and the blame rests solely on corporate greed. Just love it when our "leader" gets a $550,000.00 a year raise while those of us who actually do the work take another pay cut and can barely afford to live.

Nicole @ Just My Type Transcription said...

I LOVE these. This is WHY I still make good money at transcription...because I don't produce junk, EVEN if it's dictated, and there is no way those were dictated, by a doctor, with a degree. Period. That is transcriptionist error or voice-wreck. I get better results from on my Android, lol.

Honestly, I see reports of all kinds from transcriptionists. They are THAT bad and sometimes worse. Problem is that, as we're underpaid, transcriptionsists use expanders and clearly don't proof their work. At the same time, I wish people would think about more than just a paycheck. These are patient records we're working on.

Again,I'm grateful for terrible-quality transcription as that's how I have gotten all my clients. :)

Anonymous said...

Even us lowly pharmacy techs suffer from this crap. We have to decifer stupid e-scripts that say to have the patient a tablet "once in a day" Often it is a garbled mess that we spend an hour trying to get in touch with "Dr. I have no concept of English or computers' who submitted the E-Rx. AND... told the patient we would have the script ready and waiting for him when he showed up at the pharmacy 5 minutes later.

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MDaisy said...

Be careful when you type the words public meeting. I have taken to using Dragon in my advancing years as it's easy to use. Once Dragon had fun with the words peanut butter. I will not write here what Dragon substituted for the words peanut butter, but I was blushing when I proofed what was posted by Dragon.

Unknown said...

Another MT weighing in here. Yep, I see those mistakes too and it takes me a lot longer to fix them from inadequate VR programs and/or doctors who should never be allowed on VR than it does to retype the whole thing myself. I've been in this career for 9 years and VR has hurt us, not only because we've become more "editors" than transcriptionists but the MTSOs somehow have it in their minds that because a machine is doing the typing, those editing are worth less, anywhere from 30 to 50% less than we used to make when we were typing all on our own. It has to come down to what's more important- patient care or saving money? If you want quality patient care then give the MTs a break and pay them a decent wage so they don't feel pressured to skim over a document and miss huge errors like you posted above, so they can actually make a living. Honestly, most MTs now could make more working at the local corner store than they do as the trained professionals they are. I would urge you to take a look at Steeny Lou's blog and see what you can do to influence the doctors to treat MTs as a vital part of YOUR health professional team instead of an expendable commodity that many large transcription companies have made them. I think what you've posted above is a prime example of where the industry is going by not valuing those who stand in the gap of your correspondence to your colleagues.

Anonymous said...

I was attending a classic-motorcycle race when my postillion was struck by a (Vincent Black) Lightning ;-)

Grateful. said...

Another MT here, but I fear I will be shunned from the “cool kids club” once I’m finished. But before I work you ladies (yes, it’s a female-dominated industry) in to a frenzy, I have to say it’s comical to see MTs rant about this post and use poor grammar. ;)

I became an MT because it meant bringing in an income while being close to my daughter with special needs and being able to keep an eye on the skilled nurses responsible for keeping her alive on a daily basis. I made the career switch from a Fortune 500 company because my main concern shifted to spending more time with my kid. I knew it was significantly less pay, but let me tell ya… when your kid learns how to crawl while attached to a ventilator, your priorities change.

Let’s talk about pay and expenses for a sec. My total business-related expenses this year come to a whopping $85, which is split between my business license and production software. I don’t have to go out and spend $40-60 on a pair of slacks and inevitably spend another $20 to get them altered. (Apparently “petite” actually means “petite giant,” and the pants end up being 6 inches too long anyway.) I don’t spend $65 a **week** on gas to commute back and forth to work. I don’t find myself stopping at Starbucks because I didn’t have enough time to make my own cup o’ Joe before leaving the house. I don’t go out to lunch with the receptionist at least once a week to keep things running smoothly. We all know the worst crime you can commit in an office is pissing off the receptionist. While I make less money now, I have substantially less expenses than those who work outside the home. If that wasn’t enough, I now have more free time to spend with my kid. It takes me 30 minutes to get to work in the morning, which includes waking up, taking a shower, putting on clean yet comfortable clothes, getting the coffee started, and sitting down in my home office. Previously I had a 45-minute commute alone, not including getting myself out the door in a presentable manner.

I strongly suggest the next time any home-based MT starts griping about pay, they sit down with good ole Excel and figure out the true pay differences in comparable careers. While you’re at it, figure out how much your time is worth to spend that commute time, a grand 1-1/2 hours for me, with your kid instead. I guarantee your time being a parent is much more valuable.

Just for once, I want to hear some MTs ditch their attitude of entitlement. There isn’t a single person in the world who thinks they are paid adequately for what they do. You, my colleagues, are no different. Lately I find myself wondering if the American dream was ever prosperity as opposed to getting something for nothing.

Steeny Lou said...

True, we have less expenses as working-from-home MTs compared to the expenses we might have in an out-of-the-home job, but the cost of living continues to go up, and our pay goes down - how much longer can we survive?

I, for one, am looking into other options to keep my bills paid.

Sadly, the word processor in Blogger is next to nil and I apologize for any grammatical or typographical errors I have made, at least one glaring one being visible in my last post where I had failed to erase my working copy of a quote.

As for visiting my blog, I have very little mention of the medical transcription industry in it (yet!), so please, if anyone goes to read it, be warned. :)

And, Dr. Grumpy, my apologies for sidetracking your original post. Thank you for the soapbox platform, though. :)

Anonymous said...

I have to chime in my 2 cents on a lot of different comments here; and see how many 'enemies' I can make in one post.

While I too have retrained for this career, I did so after much research and after many promises from the school that I worked very hard to graduate from with High Honours.

I am a single mother. I can not work outside of the home. I was told that this would be a good way to earn my daughter and I a living; and a decent one at that.

While I am grateful to the company that has taken me on fresh out of school, I am not grateful for the pay decreases that I see rolling around the industry because "the new software will make you more productive". OK, so you are forcing me to work harder, work smarter, and work faster; possibly turning out less than stellar quality work, so that I can make ends meet for my daughter and I.

Because I do work from home; I don't have medical benefits. While your priorities may change because your baby is learning to crawl while on a ventilator, I have to make enough to purchase out of my own pocked $400.00 worth of asthma related medications every month FOR MY DAUGHTER. I don't get help with that. OHIP doesn't cover that. So, when a pay decrease is announced, I have to figure out how many more hours I have to sit at my desk and cry every day because some marble mouth can't dictate and enunciate their words; or because it's a VR report (Thanks Dragon) that I would be better of just transcribing because of all of the errors.

But the new software is supposed to make me more productive and justify a pay decrease.

But my cost of living constantly increases. My hours at my desk, away from my daughter; they constantly increase.

And we still barely scrape by; running accounts at the pharmacy so that I can guarantee that I can always get her medications. Not filling my medications because her needs come first. Cutting back on extra activities just so that we can make it from month to month.

And our pay still rolls back.

We're expected to produce perfection; but we're expected to do it in less time every time there is a pay cut.

If you want perfect, it takes time.

Time costs money.

Perhaps it's time for the Physicians to stand up and demand better pay for the people who are making their reports look perfect instead of sending their work off to the lowest bidder.

Steeny Lou said...

In case anyone is still reading in this thread, here is a link for my latest blog entry on the subject of the plight of medical transcribers.

http://holy-sheepdip.blogspot.ca/2012/12/medical-transcribers-underpaid.html

I am hopeful that we can continue this discussion over there on my blog.

Grateful. said...

“I am a single mother. I can not work outside of the home.” I know plenty of single mothers who work outside the home. In fact, our daughter’s nurse is a single mother with twin 2-year-old daughters and manages to work outside her home 4 days a week, occasionally 5. There are many career options that allow accommodations for single parents. Being a single parent doesn’t limit you to a life of home-based jobs. That is your choice.

Regarding insurance, believe me I know. Do you think our private insurance pays the entire cost of a home ventilator and other durable medical equipment? Do you think they cover the entire cost of home nursing? There are large deductibles to meet before our insurance even steps up to the plate to pay their 80%, which doesn’t address what we pay on a monthly basis for our policy.
“…the cost of living continues to go up, and our pay goes down..” Well of course. Do you think we are the only workers with this problem? Ask the doctors how much they are being paid by Medicare for their patients and how many times that amount has been decreased in the past several years. Ask what services they provide for *free* because they are necessary, such as diagnostics. Ask the corn farmers how much they get paid for their work. They sell their crops for *less* than the cost it takes to produce them. The only way they come out on top at the end of the season is by government subsidies.
C’mon ladies! If you are miserable in your career, make a change rather than using a rather comical blog to air your grievances about your chosen profession.

Unknown said...

To the one who commented that we're complaining because we don't make enough just like any other industry, try taking a 30 to 50% pay cut on the same amount of work you do in a day and see if you're still happy about it. It's not that we're upset we're not making $30 an hour... the reality is that this industry has gone from making a decent wage at $20 an hour and the average MT is now making $12 to $14 an hour. Yes, I realize not having car insurance and other expenses can balance that a bit but they don't add up enough at the end of the day to be able to actually live and pay your bills... and for single moms who have to work outside the home, ask them how much they are spending on daycare because I know women in other careers who choose to stay home because daycare costs eat up most of what they bring home anyways. Not everyone has the advantages of friends and/or family who can help with childcare. I can go work at my local Shell station for $15 an hour AND get benefits and NOT have to pay the double portion of Canada Pension Plan (employer and employee portion) that I am currently paying on my yearly taxes. And as stated, the cost of living has gone up and where most industries get a cost of living raise, ours instead has continued to cut the wages. Try putting yourself in our shoes and see the realities of where the industry is going instead of just saying we're a bunch of cry babies because we're not making wages that can't support a family. Not everyone has the option to get a job outside the home in our industry, particularly those of us living in remote areas. I love MT and I know a lot of other MTs do too so it's truly a labour of love to stick it out.

Unknown said...

Broken up into several parts:

I realized there's an assumption on the MTs' part here that those who are reading the comments understand how at-home MTs are paid. We are not paid by the hour as those MTs who work in hospitals or clinics are. This is a production-based industry so if you do a lot, you get paid a lot and if you do little, you get paid little (ideally). There are two ways of paying, by the dictated minute and by the line (and that is split into a 65-character line or a 65-black character line, meaning you don't get paid for spaces... don't get me started on that one!) Since I am more familiar with the dictated minute rate of pay, I'll use that as my example.

When I started MT 9 years ago, it was all straight typing (ST) where we typed every single word and the pay scale was $1.15 per dictated minute. Keep in mind that our job isn't all about typing... there are often a lot of little extras we do that aren't included in our pay, such as searching for doctors to be copied and inserting their addresses into letters, searching for patients because health numbers aren't correctly entered and aren't dictated either, adding that the report is a stat, changing the type of report it is because a doctor has a favourite worktype number he uses for every single report (whether it's an operative report or a letter going out to a colleague), just to name a few. A good MT with a great account with very little set up and who doesn't have to do a lot of fixing of the above issues can do 15 to 20 dictated minutes per hour, meaning at the old rates, you were making up to $23 an hour. Throw some challenging dictators into that mix who have to say an entire paragraph in one breath or don't speak clearly (I had one doctor who used to say what literally sounded like "mushmushmush" for "moist mucous membranes), challenging accents, and doctors who only dictate to CC "Dr. Smith" and that will go down to 10 to 12 dictated minutes an hour or even less, bringing your wage to $11.50 to $14 an hour. Over the past 5 years, I've seen that wage go down now to $1.00 per dictated minute for ST so now an MT's average hourly wage has dropped even further.

Unknown said...

Part 2 of above:

Then comes the advent of voice recognition, which "experts" will tell you will increase your production by 30% so the VR rates now become 70% of the ST rate (70 cents per dictated minutes). MTs have now become editors and are making 70% of what we used to make, which on paper still sounds OK, until you realize that VR still has a LONG way to go as far as accuracy and really only 30% of doctors should actually be using VR because the quality of their voice is such that the program can actually mostly pick up what they say clearly. That leaves 70% of the reports we're dealing with that come through with a lot of garbage and the same errors are made in every single report because the VR can't pick up the phrase correctly, so you can be making the same corrections over and over and over. MTs now have to make major corrections throughout the entire report and there are often quite a few reports where it's actually faster to retype the whole thing than it is to spend the time fixing all the errors. So now if an MT has to do that, they are doing the same work (ST) for 70% of what they make doing ST and that's not even taking into account the rates that have dropped in the last 5 years.

Now let's get to the realistic numbers. I've been doing VR for 2 years and it HAS NOT increased my production by 30%, not even close. I would say probably my production is better by 10% and I have been able to bump that up a bit by incorporating VR into any ST work I get by doing something called "echo-dictation" where I have my own Dragon program so I listen to the dictator then "echo" what he/she says into my computer and edit as I go along. So using the rates of today, if I do 100 dictated minutes a day of ST at a rate of $1.00 per dictated minute, I make $100. If I do 100 dictated minutes a day of VR, I now make $70 a day (70% of the $1.00 per dictated minute ST rate). So you can see that to get to the $100 I'm used to making in a day, I now have to work an extra 2 hours or more to make up that $30 I have lost, using a method of work that only makes me 10% more efficient. One company in Canada actually has cut their VR rates to 50% of their ST rates and their program has to be one of the worst out there.

For pay per line, the rates have gone from 9 to 11 cents per line to 3 to 7 cents per line industry average.

I personally think that it would be more profitable for all involved to provide each MT with their own VR profile than it is to have each doctor use a VR profile. On an average day, I probably transcribe for 30 doctors, each with their own VR profile that I have to edit. One MT with one VR profile can transcribe for multiple doctors and the program only has to be trained to her voice, whereas each doctor has to train VR to their voice and more often than not that training is never done properly, leaving more work for the MT to fix.

I hope that adequately explains the reason that we at-home MTs are "up in arms" about the continuing decreasing rates and more work that is coming our way. The reality is that schools are still promoting MT as a way to make a great wage like you did 9 years ago when I first started but that is no longer the case. MTSOs are finding it increasingly hard to get seasoned MTs to work and many of them ARE leaving the industry because they can't make a living at it, meaning that patient care is suffering because inexperienced MTs are being thrown to the wolves. It takes a good year for an MT to become comfortable in any one speciality and at least 2 to 3 years to become experienced enough that you're not researching every other medical term.

Anonymous said...

As the single mother who paid for and trained for a work at home MT position, I would like to thank all of you who stuck up for the single mom who can't leave the house to work.

For the one who thought it was appropriate to compare my situation; as someone who suffers from severe Combat PTSD, who lives in Ontario Canada, who has a toddler who I am raising ON MY OWN with no help and no family, shame on you for thinking that I am using my child as an 'excuse' to not leave my home to make a better wage. I know I could make more working at Walmart than I do working as an MT (Thank you for the breakdown and clear explanation of how work at home MT's get paid to the other poster) from home; but I CAN NOT. And no, I do not get support, I do not get disability, and I do not get my VA pension. I am ON MY OWN footing the bill for life that has been handed to me. I would gladly take my skills, training, and education elsewhere and made a decent wage with benefits to cover the medical expenses of me and my daughter but, I can not.

And those are the facts of my life. Not that it's any of your business.

Perhaps you should think outside of your box before you start in with your implications.

Jenn said...

Hey, that one word is Cargo Plane. [carboplatin, nice]

Stephen Sample said...

Being in the Air Force, one of your examples came to me immediately. I would be willing to bet good money that the patient in question was being seen for sensorineural hearing loss and the physician dictated that the patient flew in a C17 cargo plane for years. Boom! Those suckers are loud. You are welcome. 50 bucks for the consult. I take PayPal!

Mad Jack said...

I get some, however, that are full of garbled phrases. I have no idea if this is due to bad language skills, lack of good transcription (yes, Dragonphiles, YOU!), crappy proofreading, or all of the above.

It's all of the above. I used to work for a noteworthy medical transcription company as a programmer analyst, and in fact I wrote a lot of the company's software. The problems the MTs had to deal with were significant.

Many of the doctors didn't speak intelligible English. Some phrases were no more than garbled instructions on assembling a left-handed Chinese rice cooker, but a few stood out. The most memorable was a female Chinese doctor who would call the company VP and raise holy hell about the system hanging up on her - you had to get her to slow down before you could understand this. We finally tracked it down to her voice. When she got excited, she'd hit a tone which sent the digital hangup signal to the equipment, which promptly hung up. Then she'd call Customer Service and start raising hell, and the phone system would hang up. Then she'd call back... and raise more hell. And the system would hang up.

We finally got it straightened out, but it wasn't easy. Some of the Indian and Pakistani doctors were pretty bad, to the point where I could only understand about one third of what they were saying. The MTs claimed they understood the whole thing, but I don't see how. I'd have made them pay a surcharge to transcribe those charts.

 
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