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Serving Over 20,000 US Medical Transcriptionists

ESLs aren't always the worst

Posted By: OTHMT on 2006-05-22
In Reply to: I'm fed up too, but it is our job to produce - me

Some of those guys who can speak perfect English but won't are the worst.  ie  the ones who take a deep breath and get the whole report out before taking another - or the ones who whisper or mumble as if afraid the CIA is listening, not just us.  Well you get the picture - my mantrum has always been "GIGO - garbage in, garbage out.  We can't be expected to make a silk purse out of a sow's ear or even a mummmbler. 

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Thank you, QA person. IMO, ESLs aren't the enemy, it's POOR VOICE QUALITY!!! No excuse for

that in this day and age.  These accounts really must clean up their acts and disallow docs using cell phones, speaker phones, lounging and eating while dictating, ad nauseum.  I can't count how many times my ears hurt for hours after transcribing squealing reports.  And then the poor QA person gets an earful, too!  If I were an MTSO, I'd not accept an account with poor voice.  It's a "garbage in, garbage out" situation.  I've transcribed much clearer dictation on tapes! 

Thank you for your kind comments.  It is really appreciated.  You're admired also!!

Worst types for me are oncology and ENT. Worst dialect
definitely Arabic, Indian, Pakistani.  No problem with Asian though.  Of course, warp speed, mush mouth American dictation can be the pits, also. 
I would rather do some ESLs that some of the
sloppy southern drawls that you cannot ever understand. Wish those people would learn that not everyone is in love with a southerner.
What is an ESL ..... and I agree with you completely about the time spent on GRAMMAR!!!!

They can take the smallest so-called "errors" and put a black check by your name. We are medical transcriptionists, NOT English teaches.

Any GOOD MT has equally good grammar. Plus there should be less emphasis on grammar and more emphasis on the medical terminology. Do you REALLY think the doctor cares if a comma was put in or left out? NOT !!!!

I wasted a lot of time agonizing over GRAMMAR when I could have been getting in more lines and doing what is best for the patient .... accurate medical terminology.
Bad ESLs

Wouldn't it make sense for companies with bad ESLs, to hire US MTs who speak the dictator's mother language to do the transcription? 

If it makes you feel any better, I once worked part-time for a doctor in his office. I wanted to get back into a hospital setting so I gave him my notice. He couldn't understand what I loved about being an MT. He said, "At least I have the benefit of reading their lips." AND I was once transcribing for this absolutely miserable ESL one day, pretty much the way you described, and waiting for him to hang up. Instead he was chatting with someone when I heard "I don't know how they do it, but I give them a lot of credit." I had to rewind to make sure he was talking about transcription and he was. Not all of them are that sweet. I once had to show an English book and the BOS to an extremely arrogant ESL oncologist. I hope you had a little chuckle here and feel better!
That's why AAMT is no longer a valid entity for us. The standards have been lowered to accommodate the ESLS because they can't make a decent sentence and don't know how to convey what they did or did not do to the patient. How the hell are we supposed to read their minds???? Those who can speak English and demand verbatim get what they deserve. Just the other day, the doc gave a female who had a vasectomy. He was a verbatim ESL and he got exactly what he dictated. When enough of them get sued or reprimanded, maybe standards will return, but I have no doubt in my mind that ESLs have lowered the standards at the hospitals and that's why we no longer change the dictation to make it sound like they at least passed English class. When I started it was not verbatim. We edited to change context and not content. Hospitals should make it clear they either speak clearly, or write clearly, and failing both of those, they should hire a PA or someone who can dictate like it should be, and some of the PA's aren't much better.
ESLs sm
Once they know you're good at it, expect them to send you nothing but!
Hey, we all were horrible at ESLs (and I have to be honest that I often still struggle myself), so don't feel bad about that is how it goes. :) Good luck to you.
Had it up to here with ESLs....
I used to be one of those conscientious MTs who went back and re-listened sometimes 2 and 3 times, because I hate to send blanks to QA. After this morning, NO MORE !!!! This particular ESL doesn't even say the complete word, only the first syllable which is mumbled and scrunched into the first syllable of the next word. From this moment on, I go through it once, proof it and off it goes. If it's shot full of holes, then so be it!!! I'm telling ya, Wal-Mart is looking better and better. UGH !!!!!
What about ESLs
who dictate 1, 2, 3, 4, 8, 10, etc.? These people are prescribing medications and they can't even COUNT in English? I can see messing up and missing a number, but totally messing up like that? On more than one report?
If only the ESLs would be more
organized, be briefer, and pay attention and use normal phrasing instead of these long, awkward sentences they put together. They are strangely worded whether they are routine or made up on the fly. If only they would notice which phrases we can't understand and study the non-ELS dictators' short reports. If they could keep their reports short, we could knock them out much faster and be done with them.
Speed up the dictation and listen carefully..then repeat by slowing down the speed. Think in terms of how the ESLs would transpose certain leters. What nationality is the dictactor? Example: S might actually be a T. Hope this helps. Good luck!
I can totally relate.  I get SO fustrated with some of these ESL dictators because like you say they cannot speak decent English.  And yes I wonder how do they understand their patients?  If they can't speak English properly can they just understand it when spoken to them?  I cannot believe they actually have MDs either.  I swear sometimes I sit and just curse when trying to figure out what they are saying.  I am glad I am not the only one.  I just feel like saying if you can't even speak where I can understand what you are saying then you don't need to be a doctor.  I know being a doctor entails much more than speaking properly but geez they are terrible. 
I do a lot of ESLs too and I can actually take

an Asian with a very thick accent and do him without any blanks at all, but then I get the fast talking, slurring, nonenunciating American born doc and I have problems.  Even if I had a copy of his physical exam that he says the same every time I still would not be able to hear it because it is so slurred.

I recently started a new account and I have doctors with 13 or more letters in their last name and I just take a deep breath and prepare to have a difficult report, but they have no accent at all and then I get a Dr. John Smith and his accent is so strong that I have a headache and am cross-eyed when I get through his dictation. 

Like it or not the ESLs are here to stay and you can learn to do them or you will find your options limited, especially if you do acute care. 

Yeah she made the comment let his own people figure out what he is saying. She said this out of fustration. I for one know how fustrating it is when you are struggling to understand what a dictator is saying. You just get so fustrated. It is our job to transcribe no matter if it is an ESL or American, that is true. That doesn't mean we can't get fustrated when we have to struggle to transcribe what they say.
Also I think she meant the MTs in India are the ones doing it for 3-4 cpl. That's why alot of outsourcing goes over there because they work much cheaper. I guess what I am trying to say is I understand your point. It is our job. But I understand hers too. It is very fustrating. :)
You know that is a great way to look at it. I hope I gain something for all the struggle I have to go through to understand them. At least I will have gained some experience.
Not only the ESLs
We're being awful hard on ESLs, and alot of the defense for them is they are no worse (or possibly better) than poor-speaking English speakers. The bottom line is that if you are speaking for other people, you should speak clearly, regardless of where you are from.
I have had a real difficult time with some ESLs too. But I was on an account where basically I could do them or not work. So I pretty much had to just do it. It got a little better the more I would hear the accents. And I mean a little. Do they provide you with samples for these ESLs? That often helps alot. Good luck!
I totally agree with you. It is just as important to know how to speak it as write it if not more so in medicine. There is no excuse. It doesn't matter what nationality -- Latino, Indian, European, or Asian. It makes no difference. They should learn the language fluently to practice medicine. An accent is one thing. But just flat out not being able to communicate clearly. There is no excuse. And no you don't see ESL lawyers. At least I haven't. I am sure you will get some posts telling you you are racist or a bigot. But it won't be from me. And by no means do I have a problem with ESLs who are fluent speaking in English.
I have one who says "please use inverted commas," which means (to you and me) quotation marks.
I have also heard them refer to blood pressure as 120 by 80 for example. I don't know.
You know you are just preaching to the choir.  So what if they say 120 by 80.  You are a professional.  You should know what to put down.  If you want to gripe about something, make it something that matters. 
If ESLs want our $, should be able to
A lot of ESLs
I was told that they have a lot of ESLs so if you are ok with them you will probably like them. 
You said VR does not get ESLs
but the platform I work on does them better probably than I could. I am totally amazed it can but it does.
Well, fortunately for me, ESLs were my specialty because of my strong background in foreign languages, so I loved them when I was working. BUT I've known many excellent MTs, including my own sister, who had an extremely hard time with them and would literally weep, wail and gnash their teeth! And you're right, on some accounts, the great majority of dictators are (or were) ESLs. Why, I don't know. I retired at about the time when everything was starting to be sent offshore, a few years ago. I'm glad I was able to retire before our whole profession had gone down the tubes.
Well, fortunately for me, ESLs were my specialty because of my strong background in foreign languages, so I loved them when I was working. BUT I've known many excellent MTs, including my own sister, who had an extremely hard time with them and would literally weep, wail and gnash their teeth! And you're right, on some accounts, the great majority of dictators are (or were) ESLs. Why, I don't know. I retired at about the time when everything was starting to be sent offshore, a few years ago. I'm glad I was able to retire before our whole profession had gone down the tubes.
Probably best for ESLs.
Or really anybody who can type better than they can dictate.

My PCP has a point-and-click system and during my visits the PCP spends most of the time typing comments into the space provided. I have a feeling that a lot of providers may quickly grow weary/frustrated with the constant typing/spelling/grammar when they should be seeing patients. I'd hate to see what their medical records look like.
I have had my share of hard ESL doctors, but by far the worst dictators are English and just go too darn fast or speak sloppy.
But ALL ESLs ALL the time? Please say it isn't so!
It is your job to learn the ESLs and if you can't/won't then you need to
find a new job because you are in the wrong one.
I am very good at ESLs, but if I see an ad
that says lots of ESLs I bypass it.  Most companies have at least a few, but I figure if they post ESLs they must have a bunch or some really hard ones.   There isn't enough $$ to it for me to do it every day, unless I had just a couple of the same ones all the time and then could learn them. 
I have done ESLs I worked for SS before
Look I understand the difficulty with ESLs but for 6 months I never heard a word about my work or quality of, so just to fire me was not fair...because I am sure everyone has had a bad doctor or a bad day.. I am not starting any flame throwing but I'm sure every MT has had a doctor and said "What did he say, is that English????"  The doctors should learn how to dictate and I am sure that someone with experience could have handled it... I could not ... I asked for help no one responded because it was late at night, I'm I looking to cry on anyones shoulder, I am just stating the fact that we are a profession of experienced and newbies, everyone deserves a chance and should not be thrown away like your nothing
ESLs are hard enough for exp MTs...sm
I was wondering if you had a QA department to rely on (tell them you are sending a report with blanks and ask them to send it back to you when corrected), or if you had a leader you could have told that the ESL was just too hard, and you needed some help. I think, and hope, that QA would not mind helping in this kind of situation.

When I have a troublesome doc, I do my best to finish the report leaving blanks throughout, then I go back through the report and fill in what I can, and then send to QA or supervisor. Unfortunately, the last 2 nationals I have worked for did not look kindly on that, and one national ignored my request and never sent it back for me to learn from. (I've been transcribing for 24 years, and getting the corrected report back and being able to relisten is great way to learn, I think).

I really feel for you, and we're not garbage (new or old). Most of us have been there, done that, so please don't let this keep you down. Keep applying; you will find a job where they will support you.

I hate to recommend a national that I left because I felt so taken and the work dwindled down to nothing, but I have heard Medquist accepts new MTs. Don't work for free, but you may have to work for a reduced rate, I'm not sure. Keep your chin up fellow MT, you will find your place!
I don't think 25% ESLs is an overload and most are
fairly easy. So far, Transtech has been a great place to work, great people, plenty of work, and easy to maintain a consistent line count.
Amphion ESLs
There are many ESL doctors on some accounts.  It would depend on which one they assign you to.
tips on ESLs
I am new to acute care at a hospital where there are many ESL docs. I find it helps not to slow them down because it makes it worse. Also, try asking for the same doc because repetitive listening really helps. Good luck to you.
Of course some non-ESLs can be worse...
than the ESLs. Having said that, I prefer long reports because it forces me to type more. I don't stop typing until I have completed the report. I am happy to see a 4-minute report or higher. However, if it is a clear dictator, it doesn't matter whether it is a long or short report because I will usually forget to take a break and just keep typing away.

I get frustrated with ESLs as well,
I take exception to your statement that *whites are smarter and work harder* and *can't help it if we're born white* Do you REALLY believe that? Do you know how racist you sound? ESLs are ESLs because their primary language is something other than English---how does this prove they are are not as smart or don't work as hard as *whites*. I guess ESLs also had the choice of being something other than *white*. I feel sorry for you if this is how you genuinely feel, because you sound like a Nazi.
Discrimination and ESLs
What do you think should be done about the inferior treatment that was heaped upon other groups of people for centuries? I believe your comments were mean spirited and insensitive, and if I were you, I would search my heart and think about what is in it. ESLs help to keep MTs busy and sharpen our listening skills. One of the worst accents I ever had to transcribe for was from the United Kingdom--where "proper" English is spoken. We now live in a global society, a diverse America, and there is no going back to how things were before. Thank God for that!
Radiology usually has few ESLs.
But they may use a huge English vocabulary because many have PhDs, LOL.
All clear and no ESLs, only wish
I would be in 7th heaven if this were the case. I have my share of ESLs but the ones I have the VR picks them up much better sometimes than our English ones. I have no clue why? One English physician I think really good, the VR fails on this one??? I have some dictators (as probably all do) who talk with speaker phones, snort and go on but I am very pleased with VR and really love.
ESLs -- How do they understand

what a patient is telling them if they don't know English well enough to dictate an H&P? I have one of the most frustrating dictators right now. He makes no sense when he speaks b/c he doesn't know proper subject/verb agreement. He makes his dictation usually one long sentence. He confuses one English word for another and I'm supposed to sort his mess out. Does he seriously have an MD?

Why don't they send this work overseas and let his own people figure out his language for 3-4 cents per line and let me do the American doctors? The overseas MTs are probably getting our American dictators while we're stuck with these.

I prefer ESLs

I personally prefer an ESL to a native English speaker any day of the week.  At least I know with an ESL, I am dealing with a tougher ear level, a level not many folks can do or are willing to do, and 99% of the time, they happen to be the best dictators out there, they don't rush their dictation or speak half-thoughts/utter a sound that means 10 words, they do their best to speak clearly...all I need to do is learn their accent and clean up their grammar. 

I have only 1 current ESL who speed talks with a thick accent...Just 1 of out say 50+ that I handle between 5 acute care accounts.  I handle a lot more ESLs than that due to the logistics of 3 accounts being major city hospitals, but I didn't want it to seem an inflated, BS number. 

In the long run, my willingness and desire to deal with ESLs allows me to build my ear skills further.  When it comes time to job hunt, that little line on my resume, Heavy ESL experience gets my foot in the door to show what I am able to hear and do, making me a bit more marketable.  Don't get me wrong, MOST ESLs I can handle.  Russian accent still leaves me saying WHAT?!?!  but hey, at least I am willing to try to step up to that battle to conquer and learn them.

I worked for a company that NO ONE wanted to transcribe the 52 ESLs.  I kid you not.  The TAT on those files was disgusting.  MTs would actually refuse to transcribe them.  I took them on, they became my primary workload, my preferred work.  I'd log in for the day, my supervisor would ask me what I wanted for "breakfast" as she read me off the list of who she had.  I had the freedom to choose back then, and let me tell you, it was CAKE, I was loving it and laughing all the way to the bank.  My queue for the day was set with just about 120 minutes of assorted accents, my daily line requirement, as a part timer, exceeded the full-time requirement.  I never ran out of work, I never NEEDED to worked late, never felt pressured, and didn't have to worry about leaving a blank, for it became clear to my supervisor/QA/team leader, as well as the CMT/owner, that if I couldn't get that blank, there was no way they could either.   I took care of my supervisor/QA/team leader and she took care of me, we were in a win-win situation.  But, that job is gone now, as the company folded and closed its doors.  My comfort zone is gone.

Currently, I work for 2 nationals.  They do not filter and distribute files broken down between ESL and native English speakers.  I pull my daily workloads from a pool, so I never know who I will end up with.  It's in my own best interest NOT to shy away from an accent.

And how many are ESLs? Or you've been
I did it from day one at present job, 80% ESLs, but then I'm sm
It will all depend on your experience as an MT, with ESLs and acute care more specifically, and what platform you are on.

It IS doable, but will take most moderately experienced, moderately fast MTs a bit of time to achieve. While I can and did to this from my very first day, I am NOT your benchmark, but I am here to tell you, YOU CAN DO IT with some effort.
I wonder how some of these ESLs ever got past - sm

the employment interview for their hospital positions?  I'll bet they spoke the King's English then.

Or, have you ever dealt with a foreign merchant, cab driver, etc., who didn't (or pretended not to) understand you -- but when the almight subject of $$$ came up - Voila!!  Perfect English all of a sudden, lest they be misunderstood where it counts most to them. 

US dictators worse than ESLs
I absolutely agree, some US dictators are far worse than ESLs. Some US dictators take the transcriptionist for granted that because they are English-speaking that we are supposed to understand them clearly, when the mumble, or deep throat the mic, or whisper, or even when they act as if they are a auctioneer! At least the ESLs try to slow down so we can understand - as far as them learning our language - They obviously did, that is why they are called ESLs (English as a SECOND language). It is just an accent that we have to conform to. What is the difference in a New Yorker not understanding a Southerner's accent?? They both speak english - Just with different accents!
ESLs are about 60-70% of the dictators, we as language
With this particular doc did you just guess, or did you leave blanks? How many times did you listen?  Did you ask for help?  They all basically have the same or similar awful accents, so in the beginning you need to take the time to really listen and get to know the accent, that way in the future you can zip through them.  What did you do to make them fire you, what was the mistake exactly?