Sunday, October 27, 2013

Six degrees of separation (or A toast to medical transcriptionists everywhere)


Imagine you’re an ill American patient. (Ok, imagine someone you don’t like – hereinafter referred to as ‘you’ – is an ill American patient.) You walk into a clinic/hospital, have your problem addressed, and leave (hopefully, not horizontally). You give no thought to who writes your report, what it contains, where it’s stored, how many people will look at it. You’re the patient, remember? You have enough troubles of your own. In the well-regulated American healthcare industry, you’re a crucial player. Your job is to fall sick and either stay sick or get well enough to fall sick all over again with great gusto. If you can’t fall sick, you can do other clever things like sawing off your thumb, getting shot in a drive-by shooting (formerly a crime, now a sport), dropping something heavy on your foot, dislocating your shoulder in a skiing accident…America is a land of infinite opportunities.

We’ve all heard how big the American healthcare industry is (12 billion US dollars at last count). Apart from you, the industry comprises medical facilities, doctors, non-doctor healthcare professionals, rehab facilities, pharmacies, insurance companies, and laws to govern everyone and everything. But you, dear sick patient, and all your fellow players, will collapse like a house of cards without me because I am the medical transcriptionist. I prepare your medical records and in that short time when I’m doing it, your life quite literally is in my hands. An accurate patient medical record is the link that connects all the dots in the healthcare industry and if there are only six degrees of separation, I’m the healthcare industry’s right arm.

As professions go, medical transcription must rank as one of the most intelligent and most demanding; it requires a wide range of premium skills such as research and logic/reasoning abilities, command over the English language, matchless typing skills, listening skills, medical knowledge in the areas of human anatomy, disease conditions, diagnostics, treatment, and pharmacology, and most of all a focused attention span of no less than a minimum of 7 hours – a minute’s distraction can literally prove fatal to a patient a continent away. Above all, it requires a commitment to lifelong learning. Transcriptionists not only must know almost as much medical language as a doctor, we must also be able to interpret the language of medicine accurately. We should be able to tell, for example, whether the patient needs a pill, a procedure, or a pastor by looking at his BNP. To prepare an accurate medical record and return it to its owner within its deadline, transcriptionists must synchronize all these skills perfectly every single minute on the job.

But despite our skills and technological advances, we still rely on a human voice talking to us from 10,000 miles away, to create a patient record – this is a transcriptionist’s greatest challenge. Though we’re service providers for the American healthcare industry, we actually service a global community of doctors who speak English in their own native tongues. Doctors not only come in different accents, they come in different moods, with varied dictation styles, dictating from you don’t want to know where. After a long tiring day spent listening to other people’s miseries, physicians are not exactly thrilled to dictate them into a recorder; they fumble, yawn, rasp, growl, whisper and sleepwalk their way through reports; regardless of how chaotic their dictations are, what they expect to sign is a well-researched, well-punctuated, grammatically sound medical document – a document that will be referred by their colleagues, filed for insurance claims, quoted by medical personnel, relied on by pharmacies, and hopefully never picked up by a lawyer.

Most times, we take our challenges in our stride and our skills for granted. The nature of our trade demands that we strive for perfection every single minute on the job, and we rise to the occasion more often than not. As medical transcriptionists, we’re acutely aware that our reports are not just about lines and deadlines – they are human stories, most of which are unfortunate and deeply disturbing. When we return quality work to our clients, we’re actually respecting the dignity of a faceless, sick patient. Sometimes, we forget what a vital role we play in patient healthcare and treatment planning and how much doctors depend on us to do their jobs well. What it takes to deliver a 99% accurate report is 110% of ourselves - that's what we bring to our profession every day. That's something we can be very proud of.

"Where's the patient, Ma'am?"

PART I - ADMISSION
"Where's the patient, Ma'am?" the girl behind the desk asked me politely.
"I'm the patient, Ma'am," I smiled.
"Oh...are you alone?" she asked looking around.
"Not if you count the other 10,542 patients you're housing right now in your hospital," I said smiling.
"But why have you come alone? Why didn't you bring someone with you?"
"Because I'm the only one I know who needs hospitalization at this point in time."
"Oh..." she said again uncertainly, "so you're admitting yourself?"
"Surprise, surprise..." I said cheerfully giving her my best grin.
"Are you ill?" She looked worried, like I could be dangerously ill and she wouldn't know.
"No," I said, "just blind...in this eye" I pointed to my right eye.
"Oh!" her hand flew to her mouth and her eyes widened in terror - like I had told her SHE was blind. "Why didn't you tell me, Ma'am?" she asked.
"I told you just now."
"Why didn't you tell me before?"
"Because you didn't ask me before."
"Madam," she said somewhat irritated at the witless exchange "I don't go around asking people 'Are you the patient and are you blind?' "
"Madam," I said "I don't go around telling people "I'm Aparna and I'm blind."

PART II - INPATIENT
"Where's the patient, Ma'am?" asked the nurse politely as she wheeled in the IV.
I pointed to myself, smiled and waved.
"Oh! Why are you walking around? Can you lie down? Why have you not changed into the hospital gown? Where is your attender?"
"Which question should I answer first?" I asked her.
"Madam, please change your clothes and lie down, I have to start the IV. Please tell your attender to come in. Doctor will come in now and he will want to speak with your attender."
"I'm the attender," I said.
She looked at me like I'd said I'm Mickey Mouse. "You said just now you're the patient," she said accusingly.
"I'm the patient and the attender," I said "Are we good now?"
"Who is with you?" she asked me and she was unnecessarily loud.
"You" I said very softly.
She gave me the I-want-to-hit-you-now look. "Where is your husband?" she demanded and I thanked my stars I didn't have one.
"I don't have one," I said.
"You're not married?" she asked incredulously "But your chart says you're 41!"
"How time flies," I said cheerfully.

PART III - MRI
"Sit in the wheelchair Ma'am, we're taking you to MRI," the bored wheelchair pusher yawned.
"I can walk, I don't need a wheelchair," I said and began walking.
"Sit in the wheelchair!!!" he said firmly, "you can't walk into the MRI room."
"Why not?" I asked perplexed.
He fixed me with a steely glare "Because you might not be able to walk back, you might be unsteady when you come out of the MRI machine."
"In that case, why don't YOU sit in the wheelchair and I'll push. We can swap on the return ride," I said smiling.
"Sister!!" he called "patient is refusing to sit in the wheelchair, sister," he whined.
"Patient is refusing to sit in the wheelchair sister," I mimicked in a soft sing-song under my breath and sat.
"Why would I be unsteady? We're not going on the Ferris wheel, are we? I know what an MRI is, okay?" I grumbled as he wheeled me whistling softly.

PART IV - POST-DISCHARGE
"Where's the patient, Ma'am?"
"I'm the patient, Ma'am" I was at the hospital pharmacy buying supplies for my infusion.
"Oh...so this IV is for you?"
"Bingo!"
"Do you know the infusion will take 4 hours? Why have you come alone?"
"Yes, I know the infusion will take 4 hours and that's exactly why I've come alone."
She looked a little miffed "We encourage patients to bring somebody with them; if something happens, we won't be responsible."
"Believe me, if something happens, you will be responsible and I will sue you," I said smiling.

MORAL OF STORY: Always wear a T-shirt that says "I'm the patient"....when you're going on the Ferris wheel.