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Regarding the Advance article, here's how I would have handled the examples

Posted By: given in the article... on 2008-08-12
In Reply to:


I'm curious how other MTs would have handled them?


1. Hemoglobin 9, hematocrit 39. (I would have flagged this with a blank for the hemoglobin and sent to QA).


2. The nose and mouth were suctioned on the perineum (during a C-section dictation).  (I would have changed "perineum" to "abdomen" and sent it on).


3. SKIN: Without lesions, rashes or scars (Patient has HIV and kaposi sacroma).  (I'm not the doctor.  I did not examine the patient.  Therefore, I would have transcribed as dictated and sent it as usual).


4. Left atrium is normal, measuring 4.6 cm.  (I don't get paid enough to second guess the doctor on whether the LA is "normal" or not.  You get what you pay for.)


5. VITAL SIGNS: Heart rate 70, respirations 18, BP 120/70 (in an 18-year-old with a comminuted ankle fracture).  (Again, the patient may have gotten pain medication by the time the doctor saw him, so perhaps he/she didn't have pain at the time of examination and so the vitals were normalized.  I wasn't there, I don't know.  Type verbatim and send it on!)




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Article in Advance
Did anyone read the article in Advance: Is Mandatory Credentialing Next?

The article says: "we have more and more companies paying premium for credentialed MTs." Is that true? The author is president-elect of AHDI. You all know what that is? Never heard of em. Or is it that new organization that used to be called something else, what was it... I think it had the words Medical Transcription in it. Maybe we should write a letter to tell about the reality of working out here.


Advance article
Thanks for sharing this article in Advance - don't get magazine anymore since I dropped my AHDI membership. Proud to be part of ATA - we MTs deserve an assocation that will advocate for us.
did anyone see the article in Advance magazine

about how wonderful it is to train Indians to do our job.  OH YAAAYYY, LET'S HERE IT FOR SPHERIS AND HEALTHSCRIBE   Let's give a big whoopie and cheer them on while they continue to post for transcriptionists on this board and yet outsource and TRAIN Indians to do our job.  I guess I'm angry about the article on other levels, such as the fact that it seems that Advance magazine is constantly promoting offshore transcription.  This is not the first time they have printed articles like this. 


 


Our hospital used Spheris and Cbay and we spent hours up hours redoing the reports, yet these companies got paid in full.  Where is the logic in that?  Thank God, administration wised up and brought the work back in.  Now we can go back to doing what we've always done ... OUR OWN TRANSCRIPTION ACCURATELY!


 


Great article about this in Advance (sm)
early this summer -- explained the 3-prong test (instead of the old 20+ questions).

If the service insists you use their software, if the service tells you when you can invoice them (instead of the 2 of you deciding together), if the service, not the client, decides turnaround time and quality, and if the service says you can't subcontract the work and insists on a noncompete clause, then you are an employee.

You can file a form with the IRS if you want your status clarified. Also contact Dept of Labor office in your state.

If you don't have an attorney and accountant on retainer, then you aren't professional enough to be an IC.

Also check the Nolo Press site as they have some excellent reference books regarding IC/employment issues.
Lasted Advance MT article
I was wondering if any of you have read the latest article in Advance about MTs? It's called The MT Critic.  Color me stupid but I did not know MTs had to go to medical school to do their jobs?  How many of you know the average size of the left atrium of the heart? How many of you would contradict the doctor's vital signs because the patient had a fractured ankle and you just knew that because of his pain, those vitals could not possibly be correct?  It is no wonder we are not attracting qualified people to our profession.  What are your thoughts?
Link to Advance IC v. employee article (sm)

which discusses the 3-fold test that the IRS is using instead of the former 20-factor list.


I know of very few MTSOs which really treat ICs like ICs. 


My best friend successfully challenged the company she worked for -- she got unemployment and a nice tax credit; the company owner got hit with huge penalties. 


This is how I handled it.
I also worked for a physician for over 10 years. It was an awful choice I had to make and I couldnt stand the thought of having to tell him right to his face. I knew I would get choked up, or stammer, mumble around or something. It was much eiasier for me to do an "official" resignation on paper at first. That way I knew I could say everything I needed to say and he could read it and have time to process it before we talked. I feel like when you just walk up to them and "drop the bomb" they just do not have the time to process it so they may react out of disappointment by even just a look on their face and you'll never finish what you wanted to say or what you wanted them to know as far as why your making this choice. I just expressed how I had loved my job with him but I felt it was time for me to give more time to my family etc.. I mean, really, what could someone say to the fact that you have made a choice to put your life and your family before a job. Good luck on however you approach it. We all do what is best for ourselves. Letters work for me and also because I am not a confrontal type of person.
She handled it graciously (sm)
It would have been just as awkward if not more so if she had not acknowledged it, especially after it being talked about on the show yesterday. I would imagine Star would probably think that nothing would have been said and she would just have been obviously absent. As Joy said, nothing stays the same and this is a perfect example. I guess it will almost be like a whole new show in the fall with Meredith and Star gone and Rosie and ???? replacing them. Wonder if they have people in mind yet? I've heard Gail (Oprah's best friend) as a possibility. Wouldn't it be cool if they late people at home vote on the person? That would be interesting. Then again, if they had done that with Rosie, I don't suspect she would have made the cut.
Sorry - but I think you could have handled it differently
I am assuming you are an IC - which means who you work WITH is your biz and no one else's - and no one's business if you took on a second contract.  An IC works for who she wants when she wants and within reason sets her own deadlines.  A company understands this and does not give you a 2 hour TAT unless you request it or can handle it and you have an understanding with them
However your client wants it handled.
This should be addressed somewhere in their instructions. Check with your supervisor.
Sounds like your company handled it wrong there.
Was the company threatening the MTs? It sounds like the account was threatening the company to leave.

If your company did nothing to let the MTs know they were not in danger, the company failed.

There is nothing wrong with MTs knowing that an account is in danger of quitting but the company needs to let the MTs understand whether or not that will effect their employer relationship. Two tee-totally different topics.

I think you handled it well. You wouldn't feel so good about those clothes if you cut off your
nm
"Very wise post" meant for "company handled
x
Examples
thanks sm.  Which other mt board are you talking about?  Thanks for the help!
ok..examples..sm
Ok, admittedly, my Expander was huge, containing many sample reports which I type over and over almost word for word such as in op notes, etc. Most of those are now gone; but, also gone are those such as prz for prednisone, ARMC for Auburn Regional Medical Center and others such as that, along with my capital I which i really depend on to be sure i get a capital I when I need a capital I....pd for per day, and I could go on and on, but you get the point. Just wondering if anybody else has lost parts of their expander?
Any examples?

Could you give me any examples of questions asked?  I am just curious.


Thanks!


I believe all of the examples you have here are

more examples....
*j* would be used such as "precj" for precaution, or *prcj* for procedure.  *z* would be used such as *stabz* for stabilization.  I should have put these examples in my earlier post.  Also, I use *g* for words that end in *ing* such *bgg* for beginning. Have other words such as reviewed as *rvd*, reviewing is *rvg*.  But as stated, I have been using abbreviations for about 7years. Some of my abbreviations don't make any sense, but I remember them that way!! LOL.  Words that I don't like to type get abbreviated!!!  Hope this all helps!  Good luck!
some of my examples...
One thing I do is use a j in place of -ion. For example, hos = hospital
hosj = hospitalization

I also use a 2 to make everything all caps - for example hpi2 = HPI chf2 = CHF

If I have a PA dictating for a doctor I have their last name with a 4 to spell out the signature line; for example - brown4 is Joe Brown, P.A., dictating for Jane Doe, M.D.

I also use the first letter of each word for long phrases such as tpcit for the patient comes in today...

Hope some of these suggestions help!
examples?
what are some of the things horrid QA people do? I lucked out by getting a good one back when I had QA years and years ago... i'm just curious...
Examples of flyers

I am looking for examples of flyers to in the physican's boxes at the hospital for medical transcriptionist services.  Does anyone know where I could find some good examples....or does anyone have something they would like to share with me (from someone that is not very creative making flyers/resumes).  If you have something you wouldn't mind sharing you can email me at norma_OK@yahoo.com.  Thanks for the help.


some examples of errors

You did not specify how many examples you wanted, so I included quite a few, hope it helps.  All of these are from one group of radiologists, all american.  In answer to your question, unfortunately most of these I believe to be the result of laziness.


THREE-VIEW RIGHT HAND


There is decreased relative small of the distal aspect of the 4th metacarpal. (There is diminished size of the distal aspect of the 4th metacarpal.) Otherwise, the hand is unremarkable in appearance for a patient of this young age. 


MRI LUMBAR SPINE


 


This is best visualized from L3-4 through L5-S1 where there are actual images in addition to the sagittal imaging through the entire lumbar spine.( This is best visualized from L3-4 through L5-S1 where there are axial images in addition to the sagittal imaging through the entire lumbar spine.)


 


 


ABDOMEN, THREE VIEWS


 


The colon has lost his Hounsfield markings in the transverse portion and splenic flexure. (The colon has lost its haustral markings in the transverse portion and splenic flexure. )


 


CT ABDOMEN W/WO CONTRAST


There is a small left inguinal hernia with fat within the hernia sac but no bile (no bowel).  No inguinal lymphadenopathy.


 


NAME OF EXAMINATION:  Sinuses.


FINDINGS:  Paranasal sinuses demonstrate generally some metric pneumatization.( Paranasal sinuses demonstrate generally symmetric pneumatization)  No bony abnormality is seen.


 


MRI OF THE LUMBAR SPINE


 


Compared to December 23, 2003, there has been no objective change in the L5-S1 left posterolateral disk herniation. It causes narrowing at the left lateral recess. It doe snot produce central stenosis. ( It does not produce central stenosis.)


 


OB ULTRASOUND COMPLETE


 


There is no polyhydramnios. However, the fetal kidneys are abnormally hyperechoic. This has been associated with polycystic kidney disease and so I recommend a postnasal follow-up study.( This has been associated with polycystic kidney disease and so I recommend a postnatal follow-up study.)


 


MRI OF THE HIPS WITHOUT IV CONTRAST


 


The muscles about the shoulder show normal signal on all sequences.( The muscles about the hips show normal signal on all sequences. ) There are no soft tissue masses.


 


RIGHT HIP TWO VIEWS


 


DISCUSSION: There has been destruction of the right femoral headache and femoral neck.( There has been destruction of the right femoral head and femoral neck. )


 


AP PORTABLE CHEST


 


EXAM DATE: January 22, 2005 at January 12, 2005 hours(January 22, 2005 )


 


 


MRI ANGIO ABDOMEN BEFORE AND AFTER IV CONTRAST


 


TECHNIQUE: 3-D time of flight MRA of the abdominal aorta and renal arteries was obtained following contrast administration. In addition, evidence of the kidneys was also obtained before and after IV contrast.( In addition, imaging of the kidneys was also obtained before and after IV contrast.)


 


TWO-VIEW CHEST


 


FINDINGS: Left apical pneumothorax measuring 1-2% is stable. Left lower lobe maxillary sinus is again demonstrated.( Left lower lobe mass is again demonstrated. )There are no other findings.


GALLBLADDER ULTRASOUND


 In the porta hepatis, there is a consistent with echogenic lesion measuring 1.1 cm.( In the porta hepatis, there is an echogenic lesion measuring 1.1 cm) This could represent a lymph node in the porta but also could represent an exophytic hepatic meningioma. (This could represent a lymph node in the porta but also could represent an exophytic hepatic hemangioma. )


OB ULTRASOUND COMPLETE


 


 


DISCUSSION: There is moderate dilatation of the left renal pelvis. There is mild dilatation on the right. However, neither uterus is abnormally dilated. (However, neither ureter is abnormally dilated. )


 


 ULTRASOUND OF RIGHT BREAST


There is heterogeneous echo texture in that region compatible with typical combination of breast parenchyma and fatty/femoral tissue, but a discrete mass lesion is not identified. (There is heterogeneous echo texture in that region compatible with typical combination of breast parenchyma and fatty/normal tissue, but a discrete mass lesion is not identified.)


AP PORTABLE CHEST


Underlying fusion is suggested, again worse on the left than the right.  (Underlying effusion is suggested, again worse on the left than the right.)


LEFT SECOND TOE


 


There is an old, healed fracture of the proximal phalanx of th cleft third toe.( There is an old, healed fracture of the proximal phalanx of the left third toe.)


 


TWO-VIEW CHEST


 


There are remote compression fractures involving the right 5th and 6th ribs.( There are remote fractures involving the right 5th and 6th ribs. ) The lungs are otherwise clear.


 


THYROID ULTRASOUND


 


DISCUSSION: In the left lobe of the thyroid, there is a moderately large maxillary sinus that measures 2.2 cm in greatest diameter and is mostly sold and have a cystic center. (In the left lobe of the thyroid, there is a moderately large complex mass that measures 2.2 cm in greatest diameter and is mostly solid and has a cystic center.) The remainder of the left lobe is normal.


 


There is a small 6 mm nodule in the inferior aspect of the right lobe. The gland itself is not overall enlargement. (The gland itself is not overall enlarged.) The gland is heterogeneous overall in echogenicity.


 


 


TWO-VIEW ABDOMEN


 


No convincing evidence of small bowel obstruction, although developing shortness of breath could theoretically give this appearance and follow-up is recommended. (No convincing evidence of small bowel obstruction, although developing small bowel obstruction could theoretically give this appearance and follow-up is recommended.)


 


 


OB ULTRASOUND


 


DISCUSSION: There is an intrauterine gestation with a large yolk sac. However, the crown-rump length measures 7 mm and this corresponds to an estimated gestational age of about 6 weeks 4 days. However, there is no detectable cardiac activity. The amniotic fluid volume is probably normal of ra fetus of this age.( The amniotic fluid volume is probably normal for a fetus of this age. )    The placenta is closed. (The cervix is closed.)


 


 


EXAM OF LEFT FOREARM


 


 


FINDINGS: No fracture. There is prominence of the anterior fat patient which suggests effusion. (There is prominence of the anterior fat pad which suggests effusion) No other findings.


 


MRI LUMBAR SPINE WITHOUT CONTRAST


 


Tip desiccation of L4-5. (Disk desiccation of L4-5.)


 


 


TWO-VIEW ABDOMEN


 


FINDINGS: Findings of right chest, cardiac size is normal, no infiltrates or effusion. (FINDINGS: Upright chest, cardiac size is normal, no infiltrates or effusion.


 


 


TWO-VIEW CHEST


 


Stable right breast opacity, likely represents


fibrosis.( Stable right basilar opacity, likely represents


fibrosis.)


 


AP CHEST


 


 


Picture of congestive heart failure/volume


overload not significantly changed from


exam 4-hours earlier.( Features of congestive heart failure/volume


overload not significantly changed from


exam 4-hours earlier.)


 


 


RIGHT SHOULDER


 


FINDINGS: The patient has history of a right humeral fracture, plus surgical fixation noted.( The patient has history of a right humeral fracture, postsurgical fixation noted. ) Alignment is intact.


 


IMPRESSION


1. Postsurgical change involving the right


proximal femur.( Postsurgical change involving the right


proximal humeral.)  Alignment is anatomic.


 


 


 


OB SONOGRAM


 


FINDINGS: Transabdominal and transvaginal evaluation of the pelvis was performed. An intrauterine collection and yoke sac is identified. (An intrauterine collection and yolk sac is identified. )


 


 LEFT HIP


 


 


FINDINGS/IMPRESSION: Two-view left hip demonstrate a fracture of the neck of the left humerus in varus angulation.(  Two-view left hip demonstrate a fracture of the neck of the left femur with varus angulation.) No additional fractures identified.


 


 


THREE-VIEW ABDOMEN


 


In this since, bowel gas pattern slightly improved since the 14th, but otherwise there has been no significant change. (In this sense, bowel gas pattern slightly improved since the 14th, but otherwise there has been no significant change. )


 


NUCLEAR MEDICINE CHOLESCINTIGRAM WITH GALLBLADDER EJECTION FRACTION


 


.After initial accumulation of tracer within the gallbladder, the patient was given solid bolus intravenous injection of CCK and additional anterior sequential imaging was obtained.( After initial accumulation of tracer within the gallbladder, the patient was given slow bolus intravenous injection of CCK and additional anterior sequential imaging was obtained. )


 


MRI BRAIN BEFORE AND AFTER IV CONTRAST -


 


 


There is confluent periventricular signal abnormality in the lungs bilaterally consistent with chronic small-vessel ischemic change.( There is confluent periventricular signal abnormality in the pons bilaterally consistent with chronic small-vessel ischemic change.) Probable remote lacunar infarcts noted in the left posterior frontal subcortical white matter.


 


THREE-VIEW ABDOMEN -


There is gas within the large and small-bowel. No distension. There is a round calcification in the pelvis which probably represents calcification in the wall of a cyst. There are no suspicious calcifications. No pathologic skin or nipple alterations(this sentence does not belong in this report). Mild hypertrophic change in the lumbar spine.


 


 


TWO-VIEW CHEST


 


 


REPORT: Bones free of consolidative infiltrate.( Lungs free of consolidative infiltrate.) No pneumothorax or pleural effusion identified.


 


LUMBAR SPINE SERIES


 


 


REPORT: There is very mild levocurvature of the cervicalium spine. (There is very mild levocurvature of the thoracolumbar spine.)


 


THREE-VIEW ABDOMEN


 


No evidence of bowel destruction. (No evidence of bowel obstruction.)


 


 


CERVICAL SPINE SERIES


 


FINDINGS: There is a fracture of the CT vertebral body inferior to the junction of the dens with the body.( There is a fracture of the C2 vertebral body inferior to the junction of the dens with the body.)There is retrolisthesis of the dens in relation to the CT vertebral body. (There is retrolisthesis of the dens in relation to the C2 vertebral body. )


 


What are some examples of deductions you use?
nm
I was just giving examples.
I didn't see the posts in question where people were complaining about only making $20/hr. I was just trying to point out that all of us have various issues, and there is no way to know why someone can't make it on $20/hr. It isn't always pure greed. Sometimes I think it is just to easy to judge someone on a forum when we don't have the full story, especially this one where everyone is completely anonymous. We don't know the posters issues and why they are having trouble. Most people don't share their whole life stories on an open forum. Some just want to vent somewhere where others are facing the same issue.

If you want to hear complaining though, you should hear to the millionaires around here complaining that they had to sell their jet or their 3rd vacation home because of the money they are losing in this economy. Poor things! LOL.


Which ones, give some examples.....
We are NOT talking about TYPOS here, there is a difference between TYPOS and not knowing the right spelling.

You should know the DIFFERENCE !

Give some examples of posts with wrong SPELLING, IF YOU CAN!
Which ones, give some examples.....
We are NOT talking about TYPOS here, there is a difference between TYPOS and not knowing the right spelling.

You should know the DIFFERENCE !

Give some examples of posts with OH, SOOO TERRIBLE SPELLING. These are mostly just typos.

I noticed that there are a lot of matron-MTs who have NO, absolutely no idea where to put commas, so that I was pondering if they have a keyboard without a comma key.

Example: MT way tooooo long and others too.
I'd be interested in some examples. There are absolutes, and then there are
nm
I would use hyphens in the examples you provided. sm

I would put 32-year-old male, but no hyphen if it's something like *Patient is 32 years old.*  (Same with 11-pound weight loss vs pt has lost 11 pounds.)  I can't quote the rule on this offhand, but whatever the rule is, I personally I think the hyphens make it easier to read/understand. 


Can you give us some examples of the contradictions?
It's pretty normal to be really freaking stressed out when starting a new MT job, let alone being a newbie with a new MT job. However, I'd like to know specific examples of what they are doing to help with advice. Good luck!
We try to set good examples for our kids. We rarely

drink, don't have alcohol in the house except for cooking wine/sherry, don't smoke, don't do drugs, are honest, hard working people.  My oldest son has "friends" who smoke, who put vodka in their Coke cans, cuss, steal, etc.  My son is a good kid and no I'm not naive and he isn't doing this stuff behind my back because we spend lots of time together.   My son is a health freak and won't allow anyone to smoke around him.  We've also tried to explain to him that even if he isn't drinking if someone he is with is caught drinking then he is guilty by association and he knows he needs to avoid these kids.  He has come home before upset that kids were using seriously foul language.  The "F" word at our house is spelled f-a-r-t. 


We live in a country club community.  The kids around here get new cars when they turn 16.  The parents don't keep up with their kids, just give them money.   My son has to earn his car with saving $$, keeping out of trouble, and good grades.  I don't keep tabs on him 24/7, but I know where he is at ALL times so that if I need to find him I can.  He even asks me if he can get on-line so I know he isn't using the computer for porn.  He is concerned that he doesn't have enough testosterone because he isn't wanting to sleep with anything that stays still long enough.  Don't know that his friends are, but they talk a good talk anyway.  


I think you are wise to be concerned and just need to keep open communication with your kids and hope that he makes good choices.  My son was a follower when he was younger and I had serious concerns about how he would be growing up, but now he has become a leader and I'm very proud of him because so far he is making good choices. 


We need actual examples of patients harmed by outsourcing
to take to the media. Then we could probably get enough interest for someone to do an expose on it.
quality as in ethics/morals/education/parenting/will to do one's best and set examples for others
qualities as to working hard to make your life better and not settling for second best so you can drink your six-pack and rent videos while your kids run wild. you know what i'm talking about. quality as to have no grasp of consequences of one's behavior.
Advance
I too saw it and was as angry as you are! I'm canceling my subscription, how 'bout you?
Thank you in advance it should be !! nm
TYIF -- something like Thank goodness it's Friday, but not that either. OOOPS !
thanks in advance..................nm
x
Advance is another one.
x
Since ADVANCE is free, there would
be little immediate impact if we cancel our subscriptions. Contact the advertisers and express your displeasure. They're the ones who provide the income stream for ADVANCE. They need to know that the people they're trying to reach are displeased and that their companies are associated with an extremely unpopular position.
how to advance in the MT field ...

I am wondering what it takes to advance to another position in the MT field.  I've been an MT for about 13 years, acute care for 12 of those years.  I'm tired of typing and have done QA as well, but the pay is horrible.  What does it take to move up the ladder to another position, such as MT supervisor or account manager?  I'm just curious. I know there are probably many more qualified people than I out there for any such position, but curiosity has got me as to the general qualifications and average salaries of each.  Anyone know?  Thanks....


how is Advance irrelevant?
nm
I sent Advance magazine an email
I think if enough people did, then maybe they will stop glamourizing the overseas work. This is the third article in a year's time that they have done. A few months back Advance actually interviewed an Indian owner, picture and all, about his company!!!


If we cancel our subscriptions, Advance won't be able to
sell as much advertising.  THAT is where they make their money, not by promoting offshoring.  If they can't distribute XX numbers of copies per month, the advertisers will go elsewhere.  Boycott ADVANCE and spread the word.  Shut the traitors down.
lol=laughing out loud, tia= thanks in advance
b
Current ADVANCE issue is MT pay

Cover story:  Are MTs Paid Fairly.  This story needs rebuttals.  (I don't know if I spelled that right -- too mad to look it up.)  There is another article about MTing as well as some good letters to the editor.  No, I didn't write them.  Not promoting self.


Look, this magazine wants feedback.  Controversy creates publicity which creates readership.  Please think about sending your own letters to the editor.  Write what you write here.  Let more people involved in our field know your thoughts whether they be MTs or not. 


No, I don't work for ADVANCE.  I'm just an MT just like most of you.  I just want our voices to be heard by more people who call the shots that affect us.  This is one venue.  Even if you don't like the publication, fight back and make your voices heard!!!  What a lot of you write here would be fantastic letters to the Editor which would reach a wider spectrum of our associates than this forum for MTs.  We've got to keep the topic of the MT situation HOT in the media.  You can submit articles to them as well.  Get busy, PLEASE!!


Advance is irrelevant. Who cares what they say?
x
Letter to Editor-Advance

I will  write a letter...


Advance to the 21st Century and get a new job

I couldn't believe it either. Advance has gone the way of offshore, just like AAMT

I sent a comment to Advance and heard back from them
supposedly, they are going to put my letter in the next edition in Letter to the Editor .... we'll see. But I did not cancel my subscription.
You mean that MSN link to Melbourne IT? (it comes up each time). Thanks in advance. nm
nm
Try off of the Advance Magazine web site, pasted inside. nm
http://health-information.advanceweb.com/main.aspx
Mayo Clinic in AZ has an ad for in-house MT in Advance Mag, $19/hr base pay. sm

Plus shift diff and bonus, plus $1000 sign-on bonus, and relocation $. What a great offer if it's true.