Intro: To understand and accurately transcribe dictated reports, medical transcriptionists must have an understanding of medical nomenclature such as anatomy and physiology, diagnostic procedures, pharmacology, and much more. Meet Tracey Frost, who uses her knowledge of medical terminology to translate medical jargon and abbreviations into their expanded forms.
The Story: I am a multispecialty medical transcriber. This means that I can work for every conceivable kind of medical specialist, as well as general practitioners. Various types of surgeons, laboratory technicians, radiologists, audiologists, dieticians, respiratory therapists, sleep study technicians, nurse practitioners, psychologists, social workers and physical therapists are some of those whose dictation I transcribe. Currently, I work for an Emergency Room and do my work primarily from home.
The job tasks of a medical transcriber and that of a secretary are not to be confused. I am not a secretary, I don't take shorthand. Medicine has its own shorthand but it is not related to the kind of shorthand that one would learn as a stenographer. Speed in completing a document is important but, accuracy is even more critical because that document is what's used as a guideline to help specialists treat their patients. And the documents go with each patient throughout all the years of medical care. That document may be shared with multiple people who are treating the same patient, which is another reason for ultimate accuracy, especially in regard to medication dosages, laboratory values, vital signs, medication names, times, dates, diagnosis names and treatment names.
Utmost confidentiality is very serious and must be exercised as well, never sharing information about patients with anyone other than the treating physicians and other members of the healthcare team; never with your friends, family or anyone not directly concerned with the patient's care. Patient privacy must be protected to the max and failing to do so could land you in jail and/or get your facility superior in jail with huge fines to pay as well.
I am totally blind and use JAWS and a braille display simultaneously as I am working with templates and, when editing and spell checking, using both media makes accuracy much faster, more exact, and ensures that I am filling in the proper fields of the templates the way they should be. In this job, time is money because I am usually paid by the line and I have specific deadlines in which to complete my work. This is especially true when faced with what is known as a STAT, which is when doctors need a record immediately if not yesterday. Usually, physicians dictate records right after seeing patients but, sometimes there will be a delay and they may not dictate until a few hours later. For Emergency Room records, there is a four-hour turnaround and all charts have to be updated within a 24-hour period.
To make my workspace more efficient, I had some extra shelving put in which holds braille dictionaries and periodicals regarding various specialty associations, including drug references. This information is also in my computer but sometimes I need to do extra research and the Braille materials can be valuable for that. After my shift is complete, I use a Braille Note to keep a necessary log of each medical record that I transcribe. This log is submitted daily so that strict records are kept of what was transcribed that day. The records include which patients were seen, date dictated, who did the dictation, date transcribed, what type of documents they were and who needs access to those records.
Usually my day begins with checking e-mail, as some physicians may leave me messages about needing something before going on vacation, as a priority due to malpractice issues, emergency procedures, etc. Also, there are always new physicians who may be dictating, whether they are residents in training or new attending physicians and I need to know about them, things such as the spelling of their names, how they like their work set up and if there is anything urgently needed.
As you might expect, Emergency Room records are a priority and turnaround time to get them back to the hospital is four hours from when I receive them. If the records are lengthy and/or have a lot of dictation, the stress can be high and there is a lot of pressure. Depending on the volume of urgent transcription, this might take me into the early afternoon or it might encompass my whole day with almost no time for breaks or a decent lunch. If there is a lot of research to do or, the dictator has a difficult accent or dictation is particularly challenging, this can further enhance the pressure level. If I am uncertain about what I've heard, have a question about what was said or know from knowledge that something is erroneous and I need to bring it to the attention of the dictator, that part of the transcription is left out and addressed in separate notes so that the document can be reviewed either by the dictator or other staff receiving the documents so that corrections can be made. In previous jobs, I could speak directly with the dictator or dictator's assistant/nurse, and could make the corrections myself before submitting the documents. In this particular job, I rarely have to make the correction myself; just alert them to the fact that a correction is needed.
After the urgent records are finished, I can then tackle things such as letters, Operative Notes, follow-up Clinic Notes, Discharge Summaries, Preoperative physical examinations, Radiology reports, pulmonary function studies, electrocardiograms, sleep studies and countless other types of documents. At the end of my day, I again check e-mail to see if any messages were left by physicians or whether I left any notes or other things that I need to know for tomorrow's work. Once this is done I log every document I transcribed and electronically send it to the hospital as well. It's definitely a fast-paced world!
As previously mentioned, I work out of my home so I guess you could say my Seeing Eye dog is my nearest co-worker. However, in the past, I worked with other transcribers in various surroundings, some quite cramped. By working from home, now I have the most space of anybody with an oversized desk and adequate shelf space. Over the years I have noticed that some transcribers are younger, some older, good in English, love medicine, good readers and on the whole, passionate about their work. Medical transcription is not "just a job," but rather, a very meaningful career where you contribute to the well being of other people.
For almost twenty-three years, I worked for the oldest and largest medical group on the East Coast. The backgrounds of the doctors were as varied as their specialties. Most had sub-specialties, all highly educated and graduated at the top of their classes. Some were family-oriented, others not. Most were American but the foreign doctors had excellent command of English, though I did work in places where some of the foreign physicians, probably due to cultural differences, did not seem to have good manners or interpersonal skills, and were not as fluent in English. This seemed especially true when working for government agencies. Some of us used to joke that the wrong people went home at 04:30 PM. However, in this current climate where physicians are working fourteen- to sixteen-hour days, not to mention burdened with massive amounts of paperwork, I tend to give them a lot of slack. Years ago, we were highly appreciated and there were a lot of gifts given to me, dinners and lunches eaten together, and some pretty great parties for occasions. If you were a good transcriber, you were complimented often and the perks were a lot. Things are a good bit different nowadays.
My first job I found through my rehab counselor while other jobs, I found on my own. My first employer had actually approached the New Jersey Commission for the Blind, knowing that the majority of medical transcribers were blind and they wanted people who could do excellent quality work. New Jersey did not have training for medical transcribers but I had trained at Johns Hopkins Hospital and had certification at the time I graduated from high school. Unfortunately, Johns Hopkins no longer has this program but, at the time, over half of their transcription unit were visually impaired. My mentor was totally blind and gave me broad experience in using medical references, organizing different documents; because when I first started, we didn't have computers and used typewriters. These experiences helped me to be a good employee and while working for the Veterans Administration, I received a national disabled Employee of the Year Award.
My current work fits very well with my previous jobs. Medicine is constantly changing and new drugs, procedures, protocols and, yes, even ethics are changing. This is probably one reason I like this work so much—you don't stay bored for long. Working with the Veterans Administration went a long way in helping me work with Crisis Intervention people in my community. When working for a group of physicians, they asked me to work with people losing their sight and sort of be a mentor to them if the doctors didn't have answers to give them. I have been told that my life and job experiences have gone a long way in making me a more valuable employee and that is true.
In office settings outside my home, when typing my documents, I used a sectioned file tray that I labeled for specific types of documents. The bottoms of the pages were notched so that I could tell the top of the page where the printing was. If there was a signature line at the bottom of the page, there was a notch put there as well. With the advent of computers, notching wasn’t necessary but the sectioned tray still remained so that I could load my printer with the proper forms. However, as the work flow increased, my printer was filled by sighted assistants; freeing me to do other things. When doing templates, I kept key sheets on each document and followed the directions when transcribing. A sighted clerk assembled the charts, periodically spot-checking my work, though with increased usage of spell checkers and proofreading each document before sending it to print, everything has been good. When working in an office setting where I had to print my documents myself, I did not share a printer. This way, I could monitor what I was doing and my equipment wasn't compromised.
I love my job because I feel like part of a team of people who are going to make an impact on a patient's life and health. I know that multiple people will be reading my work and decisions will be made based on what has been transcribed regarding care and treatment. If the legal system is involved with that patient's care for whatever reason, judges will also access my work which further emphasizes accuracy must be of the utmost. Even if something doesn't make sense, I still have to transcribe what the dictator said because enough isn't always known to make changes. And if that document is in the legal system, the judges need to know exactly what transpired according to the treating team or single physician.
I’ve said a lot about why I like my job. But, there are also things I don't like too much any more. Some examples would be losing that close knit team feeling with the advent of outsourcing and there are no more parties or special lunches and dinners that used to be the norm, so things can be rather isolating. Working holidays and weekends isn't always fun either. Once in a while I might have to work different shifts, especially a midnight shift. Being paid by the line is also very grueling. To make a good living with medical transcription, unless you have the privilege of working for a medical group or small number of physicians, one would probably need to work as hard as the physicians, around seventy or eighty hours a week. Also, during the course of a day dictation and transcription systems can crash. Sometimes you lose your document and have to re-transcribe it; sometimes you may be sitting around for a while until equipment is fixed. Occasionally an employer might compensate you; but again, in this climate of outsourcing, "What you do is what you get."
In my opinion, it takes approximately four years for a transcriptionist to learn to be a multispecialty transcriber because of the wealth of knowledge you must learn including being familiar with medical ethics and medical environments. So, if you want a rewarding career and not just another job, love writing and English and are passionate about helping people, then I would encourage you to get into this field. With the advent of speech recognition dictation where the physicians dictate their work and it is automatically generated, the physicians have to proof their own dictation. But some hospitals still retain some transcribers to proof the doctors' work so they don't have to do this. With voice recognition, a lot of medical terms sound the same but are spelled differently and being that machines are generating the work, there are still many inaccuracies, necessitating people editing work, as opposed to transcribing it. From what I understand, some systems allow for Braille and assistive technology to be employed in doing this editing, so transcription is far from becoming an obsolete career.
The Contact: Tracey Frost
Projected Job Growth: Faster than average (14% - 20%). 26,000 more Medical Transcriptionist needed by the year 2016.