My Review of Systems as a Medical Transcriptionist

I am writing this article to pass on some of the wonderful experiences I have had through the profession of medical transcription. This wonderful part of my life started like this. I have been a medical transcriptionist for 20 years, but I did not know about this profession until after I had tried nursing, waitressing and insurance sales. After wandering through these other occupations unfulfilled, I was primed and ready for a career I felt I was suited for. But what could I possibly be suited for? I was equipped with a degree in nursing, but what do you do with a nursing degree when you don?t like nursing? Starvation was a very real consequence when I sold insurance, so I knew I was not a sales person. I could always wait tables, but how much longer would my feet hold out? During this time when I was soul searching and trying to figure out what to do, I took a job as a medical secretary which involved scheduling surgery, making appointments, filing and a very small amount of transcribing office notes. In the job interview, I told the office manager I had a good bit of medical terminology knowledge and some, ?experience,? in a hospital. I deliberately did not tell her I had an RN degree and wanted this job as a secretary instead as this would probably have led to her looking at me wide eyed and then saying,?I?m sorry, you?re over qualified.? This job perked along just adequately, but it was here I realized I found transcription to be fun. I looked forward to it and was disappointed every day when the tape ran out after only an hour. I was one step closer to finding the profession of my dreams.

My first full-time transcription job (heaven!) was in a hospital in the city where I live. For the first time, I knew the career area in my life had gelled. All my education and experiences (good and bad, recent and distant) had come together and culminated in my becoming a medical transcriptionist. Any other kind of transcription simply is not the same as the medical field. Legal transcription, for example, I found to be extraordinarily boring. It is both the medical field and the transcription field put together that produces this unique profession.

When I have trained new transcriptionists who were really new with no experience in the field, I could decide within 15 minutes if they were going to stay at the job or leave flabbergasted and astounded that we actually do this. They never get comfortable sitting at the keyboard and actually look as if they are about to get up at any time. The keyboard is an awkward contraption that?s impossible to operate with only 10 fingers. Word Perfect is Word Insanity to them. Their headphones are an awkward instrument of sensory deprivation. After they have entered the correct directory, pulled up the proper form and named it, they always look at you wanting to know how much money they have made so far. When they look up a word, they aimlessly wander around the book, hoping the correct term will jump up and say hello. I give these poor souls one day at the most, but there was one pitiful girl who lasted less than one day, unfortunately because of something I said.

Three-quarters of the way through the day, I stupidly asked her if she had remembered to save before leaving the document. She replied she had left the computer turned on. Long story short, she never even came back to get her glasses. There was one new recruit who actually exclaimed, ?Why do you do this?? to which I responded, ?I enjoy it and the money?s good.? This has always gotten me a look from them that meant they thought I was insane. A physician told me once, ? I don?t see why you don?t go stark raving mad, sitting here all day and typing.? I replied, ?who says we don?t?? I?ve always felt you had to be a little quirky to honestly want to do this job. After all, you sit and type and sit and type and sit and type, and then you sit and type some more. It?s not unusual to continue to hear doctor?s voices dictating in your head after you?ve gone home from work, although I?ve learned to be careful how I say that, especially to someone who?s not a transcriptionist. Another occasion where someone looked at me like they thought I was insane (who says I?m not?).

Having been in this profession for so long, I have also become able to spot the, ?real,? transcriptionists, so they are called by the veterans. You judge for yourself. The, ?real,? transcriptionists actually enjoy sitting and typing, plugged into headphones for hours on end. Production is their passion, and they pound away tediously, completely content, pausing only to look up words or do the ever necessary proofreading.

Then, (eyes rolling) there are the people who like to call themselves transcriptionists and end up irritating the life out of the rest of us who really are. They come to work chattering, they work chattering and they leave chattering. When your concentration is broken , it takes a few minutes to get back to that point. These guys rattle on and on about every doctor, every patient, every irrelevant detail they can think of to talk out loud about. This usually results in the serious transcriptionists staring steadily at the chatterbox and typing all the while (which is a real transcriptionist?s talent akin to patting your head and scratching your stomach) until the offender notices they are being stared down by a clerical lynch mob and finally hush. Then, they give the rest of us that, ?you?re insane,? look with a hint of, ?I?m offended, I thought I was entertaining you guys.?

A so-called transcriptionist who asks the same question three times in one week is usually dubbed an, ?Alzheimer?s patient.? These people have a defective short-term memory and cannot remember what they were told or what they looked up for longer than a couple days. A good transcriptionist has a memory that never fails. The Alzheimer?s patients are also the people who ask about a word out loud instead of looking it up. They get in as much trouble as the chatterboxes.

There are also the comedians who have to announce to everyone in the room something humorous (or is it humerus?) they heard in dictation. This produces a polite, very small smile from the rest of us while never missing a keystroke (or the lynch mob might gather), silently hoping the, ?typist,? would either hush or go home. To be labeled a typist is the strongest putdown that can be bestowed. You see, a typist is someone who mechanically manipulates the keys on a keyboard, and nothing more. Your average monkey could accomplish this. They usually hunt and peck which produces a large silent grin (never missing a keystroke) from the rest of us that they never know about. A transcriptionist (harrumph!) is a professional with an extensive knowledge of medical terminology, editing, spelling, punctuation, English, word processing, pharmacology, lab and pathology, and sometimes foreign accent interpretation who melds all these abilities together seamlessly at 100 words per minute. We also have the necessary ability to communicate with each other with our eyes and expressions. As mentioned before, the professional transcriptionist is capable of transcribing and socializing silently at the same time.

Another valuable source of experience is the mental hospital. Let me explain! The patients there are usually required to have a general physical exam before they start having psychotherapy with their psychiatrists. In my mental hospital experience (as an employee, not a patient, mind you), I found the social histories fascinating. They read like good books and are very interesting.

I?ve always thought it would be risky for me or any transcriptionist to undergo general anesthesia because I just might spout someone?s private information. Incidentally, knowing a celebrity?s medical diagnoses is unnerving, not exciting, especially if it?s something like a sexually transmitted disease or a mental problem. Public figures and movie stars see doctors also; they are not immune needing medical treatment. Needless to say, that?s all the details I?ll put in this particular paragraph, citing confidentiality! You can?t be a transcriptionist and play Rona Barrett or a reporter for the National Enquirer.

When I worked in medical records in a mental hospital, I found that mental illness can strike anyone at any time. In this job, the psychiatrists (shrinks) visit their patients every day and dictate daily progress notes. Now, you have a serial TV show-type situation where every day there are new developments. When we heard that old familiar whir and click of the machine activating, we waited anxiously like housewives waiting for their favorite soap opera to come on. The machine would stop and the lucky one of us to grab the dictation first would tell us the news (only within the transcription room, mind you!) Some patients sank deeper and deeper into insanity, and others made a wonderful recovery. Just a bit of trivia; shrinks have the most entertaining sense of humor of all doctors I have ever known.

Back to maintaining confidentiality, this includes not repeating to anyone the statements or innuendoes made on the dictation whether knowingly or accidentally by the dictator. A word of advice: don?t dictate in bed. If someone remembers something they need to dictate after climbing into bed, then they should get up before dictating and be doubly sure the recording has ended lest they document whatever else takes place in their bed and who it takes place with! Sorry, no more details with this one, except to mention that dictating right after you eat can provide the transcriptionist with some entertainment, accidental or not. Everyone should remember, most recorders pick up all sound that occurs in the room, and some dictators foolishly think they are, ?alone,? in the room even when the recorder is running. We don?t type in ?eructation,? or ?flatus;? we just laugh and report it to everyone in the room. For the aspiring transcriptionist, look up eructation and flatus, and get a good laugh. Due to events described in this paragraph, there are doctors I can?t look in the eye any more and they don?t know why.

So many good experiences, so little space. I?ll sign off now with no chief complaints, only a review of systems within wonderful limits and a bright prognosis. See you in a follow-up visit!

You can contact Carol Roberts through by email at: meditrans@aol.com

Carol has been a medical transcriptionist for over 20 years and has been certified by the American Association for Medical Transcription. She owns and operates Carol Roberts Transcription in Pembroke Georgia and is a staff consultant for Meditrans Help, the medical transcription help site, http://www.meditranshelp.com