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Serving Over 20,000 US Medical Transcriptionists

Thank God for some nurses who DO dictate...

Posted By: Cindy M on 2008-12-02
In Reply to: Has anyone heard of this? sm - gettinold

for the docs who are horrible dictators. I do progress notes for an ICN nursery almost nightly. Thank GOD for those nurses. There are 2 docs right from the old country who can't string a sentence together in English though good docs they may be. We're talking 7-8 page very detailed reports on some of these babies. The other night, one of these gals dictated the first part, God love her, and actually handed the phone to the doc to give his 2 cents worth, awful dictator. Hey, the best thing some of these docs can do is let their PAC's do the dictating!!!


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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.
That's almost as bad as having nurses do it!
n
MT Bashing by nurses

I found this on a nurse's blog - they were talking about MT mistakes they found in charts...


Nurse #1:
I tried to get a job as a medical Transcriptionist for extra money, and no one would hire me because my 15 years experience of direct patient care does not qualify me to be a transcriptionist. Oh really? Or, I guess I mean, Owe Reilly?


Nurse #2:


I have no idea why they wouldn't let you work as a transcriptionist - what sort of special training would you need that you wouldn't already have?! It might be a good way to make ends meet if there came a point where a nurse couldn't stand up for so long anymore. It doesn't seem like it would take much in the way of critical thinking skills...


We don't use critical thinking skills?  Darn, then maybe I should look into the career opportunities at Burger King...


 


The nurses do all that, except maybe the scalpels.
x
And Why?? Because nurses are presented
x
any previous nurses MTing now?

Hi there, I have been an MT for 4 1/2 years now, and I enjoy it for the most part, but I've really been thinking of finishing my BSN degree.  I had started college as a nursing major back in 1988, but dropped out after two years of completion of the prerequisite classes.  I have always had an interest in the medical field so MT'ing has been interesting, but I've really been wanting to finish up my nursing degree though, I have always regretted not finishing it.  Especially when I do the operative eports I really would like to be in the operating room working.  So, anyway, I have put my application in for the BSN program again and waiting to see if I get readmitted.  Are there are any former nurses out there who are MT'ing on this board, or perhaps any nurses doing MT'ing too who have any opinions?  Or are there any other fellow MT's going to nursing school on here and have any input about it?  If you are a previous nurse who is now a MT how come, and vice versa, if there are any MT's who are presently in nursing school please let me know how it is going for you. 


The very WORST MTs I have ever done QA for were nurses for 20 plus years!
Mind you, this was after they graduated from one of the *Big 3* schools to boot. I know most MTs can type circles around them. They were asleep at the wheel most of the time!
And just how many MTs transcribe NURSES' notes?
Nurses document about 2 sentences, so their work is amenable to point-and-click.

Physicians who typically scribble very short notes don't dictate anyway, so you're not losing anything by them using point-and-click.

The ones who dictate do so because their notes are too long to write. It's just about as annoying to point-and-click them in an EMR as it is to type them out by hand, so most physicians who value their time do not wish to waste it fooling with computers. At our facility, they continue to dictate.

Hospital dictation is not usually suitable for point-and-click. It's too long and some physicians are able to dictate at the speed of light, so they would lose too much time writing it themselves.

I'll share one reason some doctors do want to do it themselves: the quality of the transcribed reports they get back is so bad they can't stand it. They figure if it looks terrible and is crammed full of nonsense, they might as well do it themselves. At least, it'll make sense.


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.
Then again you could end up w/one that nurses q2h like mine did! Lucky to get a shower in even. nm
s
Was nurses aid, then aide in ICU, then ward clerk, then
MORE medical terms cuz halo the docs were professors, and they let me play PA under their supervision, then w/comp supervisor, then pregnant, then had to find a PMs job and landed in transcription dept as trainee. If I could meet their requirements, I stuck. If not, I was fired. I stuck.
The docs and nurses enter from keyboard themselves. sm
It is VERY irritating. They spend all their time looking at the keyboard and screen and not at you, the patient. Worse yet, when you go back the next time, you find they entered wrong information.
nursing shortage includes nurses for instructors...sm
you can't teach nursing classes without nurses to teach the classes - that's part of the shortage and part of the reason why the shortage continues. Also more nurses are going for the bachelor's degree (4 years vs. 2 years) and that is extending the time before they are out in the work force.
remember when nurses wore the little hats...hahaha
nm
Do you think nurses and front office professionals look sloppy?
I don't like to go around looking "sloppy all day" either, but is it really practical to work comfortably in nylons and suit jackets when I am sitting and typing all day? No thanks -- I can't work well that way!

I refuse to wear sweats or jammies because I want my work to reflect my professionalism and I think the way I feel about myself reflects that -- hence, scrubs, which medical professionals wear. I am a medical professional and I don't think there is anything sloppy about wearing tasteful, professional, and comfortable scrubs.

Do you think that front office people, nurses, and doctors look "sloppy all day" by wearing scrubs?
Scarry!!! Docs and nurses entering drugs and dosages into online charts. (sm)

Most of my docs cannot spell medical terms.  They can't pronounce or spell drugs.  The nurses are for the most part useless - no ARNP I ever asked could help me with a medical term.


I just spoke to my HMO.  They are now offering personal Online-charts showing


visits, tests, immunizations, etc. of what you personally had done.


I asked EXACTLY HOW DOES THIS INFO GET INTO THE SYSTEM, at what point?


The woman said:  It is input by the doc and the nurses.


I shuttered!


There goes the end of quality health care as we used to know it!


 


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.
I have several who regularly dictate sm
30 minute reports. Unfortunately, they only give me 100 lines. On the other hand, I have a female PA who dictates 4 minutes notes and that gives me 100 lines, too, because she dictates at the speed of sound. I have to slow her down to turtle speed to hear her correctly. I prefer to do the 30 minutes ones since they talk reaaaalllll slowwwww and I can run the voice file at chipmunk speed and zing through it.
Do counselors dictate? sm
I was going to send out another round of postcards to drum up business and was going to send to counselors but wasn't sure if they dictate like psychiatrists.  Maybe any of you know this?
I don't believe it. I don't think even the doctors can DICTATE 700 LPH! sm
I think she's yankin' your chain.

She has to be using templates or something to get that.
As an IC the employer cannot dictate the
times you work. They can ask you when you will be working or you can tell them. If they have work available and you are not working, they can let you know so that if you want to work you can; but if there is no work available when you want to work, they do not have to supply any. You, as an IC, decide when you work.
Express Dictate

Hello


I currently use Express Scribe software for dictation. I was wondering if anyone has used the Express Dictate system. I am looking to expand and add more doctors and was wondering how this system worked.


Also, if you have any advice on a cheap start up not using tapes please let me know.


 


thanks!


I had one dictate from the jon and flush over and over again sm
Through, get this FOUR DICTATIONS!!! The pregnant pauses, the bobbing of the roll as he pulled out paper, the echo of the small room followed by FLUSH!!!
Express Dictate
My doctors are considering using Express Dictate.  I did a search here to see if there were any comments one way or the other about this and if it was hard to set up and use, but I didn't really find anything recent or helpful.  We went from a Lanier Voicewriter to EMR, and now there is 1 doctor who doesn't want to use the EMR and a couple others who just want to do a little bit of dictation, so they are putting me on contract to do this.  I don't know much about how things like this work.  I have used Express Scribe to test for on-line companies, but I don't know anything about Express Dictate.  Any comments?
My take on how these physicians dictate
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!
Actually, they can dictate a schedule and even pay.
It's not a black and white line on those issues. It is very gray and very subjective.

A client/company can state when they want the work done (time frames) or even how much they are willing to pay and even other issues.

Our working at home blurs the line and casts so much problem in defining this accurately.

But yes, they can definitely define those factors.

If only they would dictate/speak - sm

as clearly as they did when going for their interview for medical school or hospital position.  If they spoke then they way they dictate now - they'd never have gotten into school or gotten their MD jobs -- so WE KNOW that THEY KNOW how to speak intelligibly when they want to; they just don't think we're worth the effort.


I appreciate and respect the ESL who puts forth an honest effort to be understood, over someone (usually English as FIRST language) slurring at 78 rpm, going through the HPI/PMH with ..ah, ... um ... (2 words) ... er ... (1 word) ....uh, ...(2 minutes pause) ... uh...uh... and then speed-racing through meds, labs, and whenever reading diagnostic reports verbatim .. so everyone knows that they know how to say those long words and which they wouldn't be able to come up with on their own.  My pet peeve??  We're BORN knowing how to spell any doc's name, just because THEY know how: i.e, ."CC to Dr. Kryswkowskizhausen and then spells J-O-N-E-S.


Called that great 800 dictate and the

guy who answered did not even know what I was talking about !!!!!


So where do I go now????


I don't see how any company can dictate what you send to QA
That is preposterous to think that you can have say how many to send to QA!! At any given time, ANY doctor can dictate something that you would question or something you have no idea what it is. Noise, ESLs, mumbling.. just to name a few factors involved. All that does is tend to make the MT quess in order to keep down a QA count. The company I work for has NO limits on what goes to QA. They would rather it go to QA than guess. Under no circumstance, would they say to NOT send something to QA. You can't control the doctors, PA-C, NP, etc. to make them dictated where all could understand every word!
Do you think any of these dictators ever LISTEN to themselves dictate.
Sometimes they're downright HORRIBLE!!!!
to dictate if you cannot speak English.
Sorry to gripe about this, as I know it comes with this industry, but I just transcribed (ha) a doctor, who sounded like this......

ditdada..ditditdadada..ummm, aaahh, shimaprazole, shinequapam, ditdootoday, patient no feel no good...ditditdazow. I quit.
doctors who dictate badly
I typed for a doctor who dictated once from the stands at a pro baseball game, once apparently at his kid's Sunday school 'cause they were all singing "Jesus Loves Me," and in the car on the way to Grandma's--both parents were dictating (both were doctors, my clients) with the kids carrying on about "When will we be there?"  and one of the parent yelling at them without, of course, turning off their recorder.  HIPAA would have had a ball with them!
I have one that can't even dictate by reading the H&P without errors!

He works for 6 doctors and always, always, mixes the doctor's names up on the reports, talks a mile a minute, and always screws up on the dosage amounts. He will dictate a discharge summary by reading the full H&P, with errors of course.  He spends 2 weekends a month filling up the discharge summary line with hours of work, some reports 4 months behind!  Yet, we can't let it go through like that, so we fix it, and the doctors think he is the greatest....love it.


Another one is a MA who can't even pronounce the word creatinine, let alone the drugs. Then there is the other one who always says "It was noted that..."


also depends on how fast they dictate

Depends on how fast the doc dictates -- if they compete with Superman's bullet for speed, they will knock out the lines.  If they spend half of their time looking for the information they need to dictate (such as in discharge summaries or lab tests), then they will fall way short.  The national average is 10 lines per minute of dictation.  I have one doc that takes 25 minutes to dictate less than 100 lines (discharge summaries) and another who can belt out 16 lines per minute.  You can speed them up or slow them down once you get used to them, but I don't recommend adjusting the speed much until you are used to them -- otherwise you will misunderstand words or skip words.  Also depends on the software you are using.  If you are using an internet based software, it will take you longer since you have to stop and upload the document and download the voice each job.  If you download a bunch of files and work off your hard drive and then batch upload, then you will produce more.  Lots of variables.


...sorry, with pictures. :( He didn't even dictate it. nm
s
What is it about radiologists who dictate mammograms?

We had one at a hospital where I worked who was constantly making jokes. If someone had an unusual name, he would find a humorous way to mispronounce it, and then say, "Boy, that's a mouthful! Oops - not supposed to say that when I'm dictating mammograms!" Or if the patient had the same name as someone famous, like Elizabeth Taylor, he would say, "Just call me 'radiologist to the stars'!"


Silly, but it certainly brightened up my day.