Medical Transcription: The Common Well


Medical transcription is a field where one has to stay on one's intellectual toes every single day. Unlike other careers where you concentrate on a specific field of knowledge (for example, accounting or XML conversion) that changes perhaps once in one or two years, medical transcription, by virtue of its dealing with the human condition, encompasses all areas of knowledge and needs to be constantly updated. You have no way of knowing that just after dictating the pros and cons of congenital malformation screening, the dictator is not going to launch into a letter to the governor on the futility of lobbying with Scots for tort reforms. Just being up on the latest medical terminology is not a guarantee that you will be transcribing 100% accurate documents.

At a recent training session, we tried listing out all the areas of knowledge that needed to be included in a personal program of ongoing education in the field of medical transcription. To the surprise of all the participants, the list grew and grew till it had almost every conceivable subject in it. This aspect of transcription is also what makes it so exciting and so much more challenging than most other IT enabled fields. The most minimalist common body of knowledge for a newbie MT is just about everything there is to know on the face of this planet.

I was fortunate in being walked through my initial days in transcription by mentors whose zest for transcription was paralleled only by their zest for life. I learnt two big lessons from them. The first is that one does not give up till there is even a remote resource yet to be checked out, and when all resources are exhausted, to gracefully acknowledge your not knowing. The other is that one has to continuously strive to excel and to improve.

Down the line, I was lucky to have come into contact with other people who instilled in me the enthusiasm and passion for the work that has served me well through the years. I have formed a few beliefs and paradigms of my own as I have traveled along. These are all things that probably your mother always told you, but they hold true in every way.

The first thing that an MT needs to keep in mind is that they are a part of a communication process. The process begins with the patient contact and the exchange between the patient and the physician. That communication process has its own rituals, the presenting complaint, the history taking and the physical exam , the lab studies, the impression and the plan. That done, the physician then dictates it for the transcriptionist, where he structures it according to his frame of reference. This is what we get to work with. What we do is put down on paper what the dictator communicated to us, and communicate it back to his office.

The common grouse of many an MT is that the dictation was tough, the audio was poor, the terms were obscure and the grammar was off. But if we look at it as just another communication process, the troubles seem lesser. Think of a person with atrocious Hindi, shouting from across a noisy room about more efficient ways to keep your whites really white. If you give it the attention you would if you were having trouble keeping your whites really white, you would figure it out, right? What made the difference was your desire to know about and willingness to decipher how to keep your whites really white. The same thing applies to the dictation.

What makes a dictation difficult is a mix of factors. On top of the list for MTs in India is probably vocabulary and syntax. Physicians in the US go through the best of education. They usually end up spending a lot of money by the time they have an MD after their name. This education is often reflected in a very large vocabulary and in the use of syntax not commonly used. You wouldn't buy a Ritu Beri outfit only to sleep in would you? The other category of "challenging" dictators are the ESL dictators. These physicians carry with them, apart from their heavily accented pronunciation, the syntax of their own language, which is difficult to understand if you do not know their language. The solution of course is to get a basic understanding of the grammar of that particular language, it surely helps, but it might not always be possible. However, what is possible, especially if you have large volumes of dictation from that particular dictator, is to try and understand the way his mind structures things. It is similar to how we recognize and distinguish a spoof on Shatrughan Sinha from one on Shahrukh Khan, one on Dharmendra from one on Dev Anand.

The other most common factor that makes a dictation difficult is the terminology. This does not always mean medical terminology, although that can be a stumbling block when you start doing superspecialties. (It is like being the member of a secret club with its own secret passwords and code language. But with the wide range of wordbooks, and specialty books available today, searching for specialty or even superspecialty words is no longer the task it was even five years back.) However, this difficulty often comes when the dictation has references to culture or lifestyle. The only way to overcome this is to familiarize oneself with the basic reference points of geography, history, economics, contemporary culture, etc., particular to where the dictator is coming from. The Internet is a blessing in this area, since it makes available to you local flavors at the click of a mouse. However, one would be well advised to keep in mind that the Internet is an unregulated medium and there is no way to be sure that what you find on the net is correct unless you are using reliable portals or websites.

The bottomline is that every component in the field of healthcare documentation is human, starting from the patient to the physician to the MT to the office manager who okays the transcript. The process is one of communication, the contents of which have to do with the human condition, and the tools, language, spoken and written. The possibilities are infinite but all of it have to do with the issues basic to us as a human race. Once we have that in place in our frame of reference, the task of transcription not only becomes easier but also vastly enjoyable and illuminating.

The journey into the world of transcription is an exciting one. The joys and rewards of the journey do not lie at the end of it, they lie along the way. If you keep your eyes and your ears open, you will find that every passing day brings you gifts, be they in the form of new knowledge or words or usage, or in the form of feeling fulfilled at being part of bringing quality healthcare to your kind.

13 comments:

  1. Very well expressed, reflects the passion.

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  2. i also had been blessed with some great seniors, whose passion to their work was exemplary. To many of the guys in my batch, Deepak Sir was God. Even though we were scolded a few times by him for keying in sound alikes when we could have with little application of "common sense" arrived at the right word, we held him in high regard. I am reminded of Rahul Dravid's speech yesterday where he said that each match that an individual plays becomes a part of cricketing history, so players must be careful once they step on to the field as they are role models. I feel role of seniors like Deepak sir is very important in development of newbie MTs.

    Btw well written article Subho bhai.....:-)

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  3. The industry and the man power perhaps deserves more accolades than what it is currently getting. No matter what festival is there, how big natural calamity is there, how many bandhs/strikes are there, this profession still managers to give a 24 hour delivery to clients always. This requires lot of dedication, hard work, sincerity and passion and love towards work.

    The knowledge of this job profession is also not understood by most people, if you try to explain 4 common people what your job profession is, half will conclude that you sell medicines and the rest half will say you are typewritist for a doctor. Some will even come up asking your help to get the treated by American doctors. The worse part is many businessman/finances who have come into this profession also thought it to be a quick earning avenue and they rarely understood the business, which result in more failures than success.

    An effort needs to be made seriously by all in this sector to make this more popular, more attractive. For training, choosing good candidates who will excel in this field is also a very important thing. There should be more seminars in colleges to make the youth know and get attracted towards this profession. More good training will impart more manpower which will help in bringing more business and revenues to this sector.

    Health industry is set to have a bigger opening in the coming years and many more avenues related to health care will be coming into picture soon too.

    Lets aim in making our small fraternity into a bigger sizable community

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  4. Madhav Rao9:07 AM

    Sir, most of the very good transcriptionists have all left MT because of no recognition, low salaries, and exploitation with no growth. Our batchmates are now in big positions in big companies like Waitrose, Amazon, HSBC, and Google. Some of them are senior people now, but before that, they were QAs and proofreaders in companies where they slogged for 12 and 14 hours a day. This is simply because no one in management understands what transcription is.

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  5. thanks for dropping by at one of my lens.

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  6. Medical transcription has got a new name now a days "Frustration." To every individual I speak, they have only one common point to share "We are frustrated."

    This sums up the whole thing. Where are we heading and what can be done to stem this syndrome of frustration. After spending around 12 years in this industry I feel nothing much is left to be done now. Things have taken a downward route and its very difficult to stop the process.

    Am I sounding a pessimistic. True, I am, because after all these years today I feel I am "no-one."

    Two things needs to be done immediately. Organizations should understand the value of people and the work they do. Today in the industry we have "too many managers" managing things and this is a dangerous trend. The moment I become senior it becomes my birthright "not to put on head phones any more" and as soon as I do it I ruin my career and my organization too. So what do these managers do, they attend some silly meetings all day round and each of them in their role of supervisor come and advise their subordinates of what to do and what not to do. This spoils everything, believe me. What is simply needed is a pool of work, give ids to MTs and QAs and ask them to log in and work and go home and just keeping tab on their productivity and quality which a software can easily manage. We seriously do not need 50 managers at one place. This is pulling us down.

    The second thing that needs to be done is the monetary part. People are really not paid enough for the effort they put in. I know many seniors and some juniors in the industry who go home, get some work from other sources and get them done themselves or by others and in the process make some money. This is seriously leading to ethical degradation. If I am making others work for me privately, then I am bound to look after their interests which may not be in the favor of the organization. And also this is leading to fatigue, which in turn will affect everyone's career. So the compensation for working in an organization should be enough to sustain a person's life so that he/she is not forced to take up these extra work. If compensation is not good, we cannot attract the best graduates to this industry and that will decay the base as we have already started feeling the tremors.

    I know none of the above can be achieved in the near future. Some of us will stay behind, some will move forward. Only time will tell who gained and who lost.

    If after spending 12 years in this industry, I am sounding so much pessimistic, then there is something truly wrong in our journey.

    PLEASE LISTEN

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  7. extensively covered.
    i was associated with MT filed briefly as a trainer & could relate & agree to the views in your post
    & what ails the industry is rightly pointed out by you.
    hope someone makes a note AND implements it too

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  8. @Dr. Baig - It is great to have you dropping by. Do visit more often. There is stuff here that will give you a respite from your challenges at work. Trust all is going well.

    @Madhav - Do take care of yourself during the winter, I know how bad it is in your neck of the woods. Thanks for your comment, am still trying to verbalize a response to you, Soumitra and Sudeep.

    @Sujatha - it is a small world. With whom, where, and when were you training MTs? I strongly feel that the trends in MT that have emerged over the last few years is due for rethinking and revision. The how and why of it still appears unclear, especially in the face of technology and consolidation, but the wheels will turn, this much I know.

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  9. @Deekay - With much of dictation going the voice wreck way, most companies now are looking for MTs who can edit the machine output and do direct uploads. Almost all companies have stopped training freshers, and very few companies are recruiting newbies. This is not a good thing for the future of the industry. People like Madhav, you, me, and many others have gone on to other fields. The disappointment and the concerns of those who are still trying to make a difference to those in the field is a very valid one that will have to be addressed.

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  10. I can easily understand and empathize with the views expressed by my good friends Soumitra and Sudeep. I might not agree with all of their views, but yes in essence what they are saying is in most cases true. Employees in this industry must realize that with technology catching up, we will see rapid downsizing and yes people will be hurt and hurt badly at that. You will survive only if you are capable of beating and bettering the machine. The pendulum has swung in favor of the employer and mediocre employees will find it very hard to survive.

    EMR will prove to be a death knell for companies predominantly into clinic work. The subsidies the US government is offering and the disincentive to the doctor if he will not join the EMR bandwagon are such that we will see such work totally disappearing in an year or two. We have already noticed this phenomenon and it is my opinion that economics will propel these clinics to go the EMR route, even though they would prefer to stay with the transcription companies.

    So, in a year or two there will only be hospital work and by that time the "voice wreck" engines will be even more accurate. If I were to wear my precog hat I would say that in two years employee numbers will shrink by at least 50% if not more, only talented employees capable of handling hospital work will survive and it is my guess that they will be paid handsomely.

    It is not my intention to increase anxiety levels, but if any reader were to enhance his skills so that he can survive the coming days or think it is time to see the writing on the wall and decide on an alternate career choice, my purpose in writing this comment would have been well served.

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  11. and knowledge of all the medical terminologies which even the doctors don't have to go through because the doctors deal with specific areas whereas a transcriptionist has to know everything which is there in cardiology to dermatology. and name of one billion medicines.

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  12. @Editor's Choice - Thanks for dropping by, Doc. Your observations make a lot of sense in these unusual times. Though the optimist in me says that the tables have to turn in favor of reason and sustainability, the short term realities are a little discouraging. The problem with such a trend is that it tends to feed on itself. Time will tell how things turn out.

    @Facts&Nonsense - Nice to see your comment on this post, brother, that too as soon as I stuck the link on WUC! I am hoping you will send us the *some text missing* bit soon. My favorite definition of a medical transcriptionist (if I have not already said so in the post) is one who is an underpaid physician and an overpaid typist.

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  13. Anonymous3:38 AM

    I joined MT because i had not had a very good academic background. It has been 8 years since I am into this field. I am now 34. To think about that there would not be any transcription in another 4-5 years is giving me a nightmare. Finding another career at this age and to expect a same salary which I am getting at present after 8 years in MT field is impossible. Even if this MT field stays, HOW MANY LINES AN MT CAN EVENTUALLY DO IN A DAY? 1000-1500-2000 and for how long? YOU SIMPLY CANNOT INCREASE YOUR LINES. Same salary is not going to beat inflation. This salary of 20-25000 will look peanuts in the next 5 years. OBAMA POLICY OF EMR AND VOICE RECOGNITION HAS DONE A IRREPARABLE DAMAGE TO THIS FIELD. ALL THOSE WHO ARE THINKING OF JOINING THIS FIELD .....PLEASE DO NOT MAKE THIS MISTAKE AT ANY COST.

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