Sunday, February 05, 2006
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.