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My take on how these physicians dictate

Posted By: Crapola on 2009-04-09
In Reply to: Any other MTs deal with this constantly? - Frustrated MT

I question and I mean question about every day whether the person coming in as physician is really that. I have 1 that basically cannot string a sentence together, changes sentences 3, 4 or 5 times each sentence. I have physicians who pull the same stuff, going several paragraphs down and then asking you to add or delete something. I get really ticked when I hear all this and donít hold my cool. The person in the room with me usually hears my ranting and raving. It is hard enough to get through the ESLs, mumbling, crunching, snorting, eating, sucking, sniffing, sorting papers and the list goes on without putting up with this. One change that was made at the hospital I work for was to tell dictators they could NOT use a cell phone to dictate. It worked. I only wish I were in charge so I could tell them more about how to dictate!


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Yep, they dictate in noisy nursing stations, dictate in the ER, dictate in the OR when they are
cleaning up banging around and we are supposed to hear them. So much for HIPPA.
You are so right. Its up to the physicians and
also your local competition. Its all about offering the physicians something better than the competition - better rates, better TAT, and if your competitors are certified, you can bet that's part of their "sell"...But you could never predict the certified issue until you check the waters. Good luck to you! Its not that hard to pick up a local account or two. Enjoy!
Do you think ER physicians actually do as thorough
a physical exam as they dictate or do you think they fabricate a lot of the details of the physical exam?
Not all physicians are like that .....sm
I work for very generous, kind and caring orthopedic surgeons who see patients, with little to no income, and charge them nothing. They ask for no payment and nothing in return. These docs would give you the shirt off their back.

Not every physician cares only about money.
It is bad enough for the ESL physicians but
today I had an ESL PA dictating and when she dictates hypertension she says hypertensions, as in the patient has hypertensions and heart disease is diseases and lukemia is well you catch how it goes EXCEPT if you have the patient's wife, then she says the patient wife or the patient daughter. I am TICKED
Is it just me, or are physicians getting worse
with dictation. I transcribe several that use speaker phones to dictate. I think ER docs are the worst. Not only do they use the speaker phone, but that talk at a rate of about 150 miles per hour. Do they not realize (or maybe they just don't care) how difficult they are to transcribe. I really don't understand why the companies we work for allow this.
I ask the physicians! Haven't had one yet
who didn't tell me what they were already being charged. You should be able to call the MT department at your hospital and ask around there too.
About incompetent physicians...
Yes, they are definitely out there and getting scarrier day by day. Actually, the great majority of them are quite pathetic.
local physicians

I was wondering if any one knows if local physicians would rather hire certified MT to do their work from home.  I am thinking about supplementing my income with a national and wondering if this would be a good way to go.  Any insight into this would be greatly appreciated!!


Prospecting physicians??

I currenlty have one account of my own and am an IC through a very small local transcription company.  However, I want more of my own accounts.  I have sent letters and am willing to do more.  Does anyone have any idea on what it takes to "land" an account?  Thanks so much for any ideas/help/suggestions!!


Physicians by State
www.healthcarehiring.com.  Scroll down to the bottom and you'll find all of the states.  This is a great site to search by state, and you can search by specialty even within that state.  It is in alphabetical order, which is very, very helpful.  I love this site myself and use it every day.  
Yep, been there,done that. Many physicians today
have gone to EMR. I talked with one not long ago who said I needed to find another line of work since EMR is replacing the MT. Even my own personal physician uses EMR.

We are either being replaced with technology (EMR or VR)or work is going offshore. Somehow for me, editing is really not something I am interested in, as I would rather transcribe.

Hopefully, others here will be able to direct you and encourage you, perhaps giving you ideas of how you can obtain clients. Much success in whatever path you choose.
We have many Muslim physicians in the US.
Would you be so quick to condemn someone who had a problem with "We took a moment to praise to Allah"? Would you be as tolerant as you claim to be in that situation?
The physicians used to have to be bribed
to come in and dictate charts, have seen for myself. I would love to know how it went from not wanting to dictate to suddenly everyone getting out their EMRs and typing away.
I've found that most physicians who
dictate at such a ridiculous pace are trying to make up for other deficiencies....you know like "male menopause" where the older guy goes out and buys an expensive sports car, etc., etc.  Seems most of the speeders on my account are DOs, NOT MDs.....guess they feel inferior in some way. 
Physicians are willing to share their knowledge with (sm)

anyone who will listen.  They love young bright eyed students. I expected the MT world to be just like medicine.  


Why is cost the only issue? It is unprofessional to only think about money. What about pride in the profession and wanting to share knowledge? Isn't that how professions advance and grow? 


I am surprised.


 


 


 


State Licensure for physicians
I use the State licensing agency for whatever state the physician is in.  I just Google State License or Health State licenses and it brings that particular website up and then I do a search.  Great Tool!
When do physicians give feedback to MTs?
x
I have heard American physicians say that. What is the
big deal? You know what they mean.
A lot of physicians refer to their patients
as heterosexual or having same sex partners, it is very relevant in some aspects, as in exposure to AIDS/HIV, etc.
physicians pinching pennies
while making over $100K a year (after insurance premiums), for a service that is tax deductable.... they really dont have a clue...
To my knowledge, you can't print the physicians'....sm
list and I doubt they are in there by specialty, too. You can print the contents of your ESP file if you save it to your desktop and then print it. Hope this helps.
There are no dictators, physicians, nurses, PAs or the like
who donít dictate on the VR I use, wish I did not have the crap dictators as you call them but they are not left out on my end. I really, really hate it now when I do get a straight report to type I am so happy with the VR I do. I think before long most big places will go that route, little ones not so much as I think VR costs quite a bit.
A great site for referring physicians

that includes credentials and you can search by state is:


http://www.healthcarehiring.com/physician_pennsylvania.php


Down at the bottom you can change the state.  I have used this site quite a bit. 


 


Good gried!!! Plenty of physicians
mispronounce terminology, medications, etc. that they are not familiar with in their specialities. Get a life and find something worthwhile to gripe about. Did you understand what they meant? Apparently so, so just do the work.
Physicians and caring or lack thereof

recently I have experienced both sides of this aspect.  In January I was hospitalized for asthma by my then family physician.  I had been to him 3 times in the month before that with problems but he made no effort to adjust meds, etc.  About a month later, he walks into his office and tells his staff today is your last day. I'm closing the office. 


I got strep throat and went to a different doctor.  She was absolutely the best.  She looked at ME while she was in the room, not at the chart or her PDA in her hand (like the first doctor used to do).  She talked to ME.  Asked ME questions and answered any I had.  asked about allergies (which I have many). The first doctor tried to give me medicine I was allergic to (and he had been told multiple times).  Two weeks ago I was hospitalized through the emergency room with another asthma attack (brought on by the flu).  My new doctor sat down beside me in the room. Talked to me.  Got a very detailed history.  Explained what tests she was going to do.  Explained the results of what tests had already been done.  Told me she was going to refer me to a pulmonologist to evaluate if my meds need tweaking.  Even asked me which one I preferred based on how my insurance would pay.   I have only seen her in the office twice and then while hospitalized and I already feel more at ease and reassured that 2 years of using the other doctor. 


Also, at work this past week a patient was admitted after lunch.  Because the patient had missed the noon meal, the PHYSICIAN went to the cafeteria and bought lunch for the patient and took it to him.  Now THAT is a physician that cares about the welbeing of their patient!


I wish all doctors could be like these two - both of them female!  Maybe it has something to do with our nurturing instincts! 


I have to agree. I would be uneasy having some ESLs as my physicians - sm
at times, too, for that same reason -- I've seen too many errors creep into the medical record because of the language barrier (though I would place equal, or greater, blame upon the MTs and/or QA who allowed it to happen through the "god help us, we can't have a blank so fill that blank with SOME kind of word, quickly!" mindset).

I once had an ESL psychiatrist who had a terribly thick accent. After doing hundreds of his reports I would still have a difficult time understanding him at times, yet when he was interviewing his patients and they didn't follow the conversation well he would often enter that into the record by saying that "the patient had a difficult time understanding this examiner and following the conversation" ... well, h--l, anyone would, doc.
I'm sorry, but the physicians are supposed to review the medical records for
accuracy, then sign off on them.  THEY are the people who went to medical school, did their internship, and actually saw the patients.  THEY know what they were trying, often badly, to say.  THEY are the ones making the big bucks.  NOT US.  We go to maybe a year-long correspondence school, make crappy money, and watch our butts spread wider every day while we TYPE, yes, I said TYPE, medical records for them.  Anyone who thinks it's more than that is kidding themselves.  And save your speeches on patient care and work ethics.  I know all about that stuff.  The harsh reality is that this job does not require a college education to get into, and your income is tied to your production level.  The doctors don't care enough about the medical records to speak slowly, enunciate, and double check everything before signing off.  How are we supposed to read their minds?  Anyone in this field who knows more than grammar and medical terminology ought to be working as an RN or MD, because you'd be better at it than half the medical providers we type for.
switchboard.com is another good site for finding physicians
x
Many physicians in my area don't want to take Medicare, Medicaid, Tricare
or other insurances because the insurance companies require a huge buydown of charges and then disallow quite a bit for being "above the reasonable amount."

For example, I had double insurance of Blue Cross/Blue Shield and Tricare when I had surgery. The bills totaled $15,000. Blue Cross knocked $5,000 off the physician's $7,800 bill, paid him $600 and left Tricare and me to deal with the $1,200 balance. Tricare wouldn't pay because they disallowed the amount as unreasonable, the physician's office forced me to make payments on it, and I had to fight just so I didn't owe them another $1,200. It was ridiculous that I had double insurance coverage and wound up owing anything. Meanwhile, the doctor didn't even get paid that much, and he did my presurgery appointments, the actual surgery, two postsurgery appointments to remove hardware, plus coordinating everything between cardiology, radiology, anesthesia, laboratory, surgery, and having special equipment trucked in from out of state.

If I had not had insurance at all, I would have had to pay the entire amount. I think it's crazy that noninsureds have to pay the full amount but insurance companies can disallow or buy down the amounts due. Anyway, you hit a big rant of mine. Shortly after I lost my Blue Cross coverage, my son needed to be seen but we couldn't find a provider to even take Tricare at all. So much for my husband serving his country and being away from his family in the line of duty. The doctors get rich and refuse to treat military personnel who fight for their freedom. Talk about a total lack of appreciation.
Same situation here. When worked in-house or for physicians offices,

never as much as a single episode of no work available.  Much to my dismay, I have found out that MTing from home for a nation is so unpredictable, in so far as what your paycheck is going to be every week or 2.  They all say "there is plenty of work," which is probably factual.  However, the nationals are primarily interested in pleasing the client with their promised swift turn-around-times.  What they forget is that if it weren't for the MTs, there would be no turn-around-time whatsoever.  It's really very discouraging and quite unfair.  Most people try to adhere to their monthly budget, which is impossible when one never knows how much they are going to make from one week to the next. We ARE the providers, not peeons, and resent being treated as such.   


 


Does anyone know where to find a listing of the V.A. Medical Center physicians?
Thanks for the help.
Medicare is offering free installation of EMR to physicians and hospitals.
http://www.medscape.com/px/instantpollservlet/result?PollID=1502
I also have two offices w/mult physicians on tapes, but going digital this month (sm)
at my encouragement.  I am training them with a consulting fee by the hour.  They were resistant, very old fashioned, but after multiple problems with a few docs dictating over each other's tapes, and the cost of gas, paper, and everything else... I encouraged this.  In fact one service just added another physician and I told them I could not handle their transcription anymore, but they said whatever I can do to continue, so we are going digital and longer turn-around time.  It will be a time saver and more cost effective for me right away. I will still be going in to the offices probably twice a month because I feel the personal touch is really important.  I also work PT for a national, by my choice, as I feel it keeps me on my toes with different types of transcription.  Also the national is a guaranteed paycheck via direct deposit every 2 weeks, whereas my own customers, thought good money, well sometimes they are late. 
They are physicians, not grammarians. I transcribe it so it is grammatically correct, but my accoun

800 dictate can help you set it up.

Cannot dictate for MDs
You cannot dictate for a physician unless you have a PA or MD degree.  We volunteered at the last in-house position I held to dictate the discharge summaries instead of paying quite a bit for interns/residents to do the dictating and were told it is not legal.
If they dictate
your hours, you are not an IC and the IRS will sooner or later jump on it.  Do you file a schedule C with your income tax?  Be careful, because if you're not a real IC your deductions may not be allowed.  
I often dictate for a doc sm
that will send his patients to a therpaist named Candace Jones, but he always sends them to Candice Bergan.
If they dictate them, they want them on there.
x
1-800-dictate (342-8283) [mq]
nm
so, where do you get the information to dictate?
I mean, how much time do you spend on listening to a report and turning around and dictating into your machine.

Just curious...a male friend of mine suggested I do this years ago already.

He said, why not get a voice recog machine, and use it with your job.

Is this what you do, Snow Bunny? I am awful curious, because I was thinking of asking my employer, if they would pay for one of those machines so I can do my job better.

We could probably eliminate about half the MT work force...maybe that is what is happening already, why MQ is always out of work.

If that is the case, however, the only problem I have with that is that everyone should be able to have access to this technology, and it should be above-board from employer to employee...it should be like general knowledge that a company either uses this or allows this...

You have been doing this a long time and whether you know it or not are probably paving the way for the future.

I am the one who keeps trying to get everyone to check out what the MOHCA is doing...within a decade (my opinion) med records may not even need editors at all...

They are pushing for standardized text rather than free text, where a doctor does not even dictate anymore...will be a thing of the past.

My question is, then what?

Thanks.
they seem to be trained to dictate that way.
I worked at a hospital that had a podiatric residency program, and the residents were often required to do the dictation for operations performed by others.  Obviously the long format wasn't something the resident made up on his own, it was something they had been trained to do.  Other doctors tend to stumble into dictation without much in the way of instruction.
before they dictate....I presume...nm
x
Yeah, become a PA and dictate really WELL.

most surgeons dictate very well sm
That is one of the best things about ops.  When I say "dictate well" I mean that they normally know exactly what they are going to say and use the same phrases over and over, which means a better line count for you.  Plus, you are much more likely to get normals doing ops than you are consults and H&Ps (especially in acute care).  Instead of doing one of these docs who repeat everything, or change everything, or a resident who is all over the report back and forth.  That is what slows you down.  I absolutely love op notes; they keep you up-to-date on equipment, etc., and the line count is great, but most of them get farmed out to Spheris (gee, I wonder why?)  However, if you never type OP notes, they can be difficult at first. 
Will it is true that not just anyone can dictate
notes, you have have other degrees and dictate.   They have to be certified by the hospital to be able to dictate, at least at the hospital I work for.  With psych dictation I often have RNs that dictate.  I also have lots of NP that dictate.
LOL, did granny dictate????? NM
.
the doctor themselves dictate SS#
You are way off base here dear.
If this is your only job and the dictate when you work - sm
then by the IRS definition you are an employee, though it does not sound like you are having taxes taken out. I take care of this problem myself by having another IC job that all I have is a deadline and I must have my work in by then, they could care less when I do it, as long as it is done on time. I have another IC job, where they asked when I would be working, a schedule of sorts, sort of what you are doing, but I do not firmly stick to it. I think it is more to give them an idea of what days you plan to work and what time of day. They do not chew on me if I vary my schedule as long as I log in and do the work. They know as an IC they cannot dictate the hours I work. I don't/cannot write off my home office as it is in my bedroom, but I write off everything else I can. If you need clarification call the company you work for and tell them of your dilemma and how your tax person says the IRS considers you an employee and since they require "set" hours then they should start taking taxes out, etc. from your pay, and see how they backpedal on the set hours issue.
There are some accounts that do not dictate - sm
every day, very true, but some people also refuse to do anything but one thing. If they only want one doctor, then yes they can expect to run out of work. I work many different specialities and can type the majority of docs (and have). This LTS is in Richmond, VA; I have never heard of another but you never know.