Doctors protect our health. Doctors can be meticulous and thoughtful. Doctors attend to the details.
And doctors can make mistakes, especially when it comes to dictating reports.
I get it. Doctors have to see patients and attend conferences and do
consultations and have to deal with insurance and therapists and have a
lot on their plates. They hire staff do streamline their offices and
deal with the minutiae that comes with their jobs. Dictating reports is
far down their list of things to do, and often doctors want to get
through the reports as quickly as possible so they rush, speaking faster
than the speed of sound, speaking while they're eating or chatting with
colleagues and staff and friends, speaking with colds and out in the
wind and rain or while sitting at a light in traffic, speaking while the
television is on or their child is practicing scales on the piano,
trombone, or other musical instrument. Doctors speak when they can,
often between patients, without thinking of what that will cost them in
time and effort down the road.
The fact is that doctors forget
the most important person: the medical transcriptionists
who decipher what doctors dictate and get it right every
single time because ultimately it is the patients who will suffer if a
lab value, procedure, dosage, or part of the body is wrong.
Doctors do
not realize--or maybe they have forgotten or never knew--what level of
skills transcriptionists possess and use every day.
A medical
transcriptionist must be skilled at typing/data processing first and
foremost, but that is the least of her skills. A medical
transcriptionist (MT or MLS for medical language specialist) must also
be up to date on grammar, punctuation, spelling, and the use of
computers since most dictation is done over the Internet; however, these
are basic skills. We are not talking about high school grammar, but the
grammar, punctuation, spelling, and style guides for medical
transcription, which is a very different ball game from what is learned
in high school or even college. Just as journalism and business use
different style guides, medical transcription requires its own style
guide. But there are more skills involved in the MT's arsenal.
An MT must also be proficient in normal lab values for every test run
by a doctor and hospitals so that when a normal lab value for a complete
blood count (CBC) or liver function test (LFT) is wrong, the MT catches
it, flags it, and returns it to the doctor or hospital for
verification.
Medical terminology is another useful tool in the
MTs arsenal and central to the job she does. It's not enough to know
how to spell tibia and olecranon bursa and every other Latin-based word
used in the medical profession, but the MT must also know where the
tibia and olecranon bursa are and why on a radiology report that a CT of
the pelvis would not include either the tibia or the olecranon bursa
because one is a bone of the leg and the other is the membrane in the
elbow. In addition to medical terminology obviously anatomy is another
tool necessary for an MT to do the job correctly. How many people on
the street can tell the difference between the capitellum and the
cerebellum and where both are located?
An MT must also be
proficient in the tools used for operations and why a Bookwalter
retractor would not be used in setting an humerus fracture. The tools
used in major and minor surgeries are specific to each surgery. An Allis
or Kocher can be used during the same operation, but each serves a
different function just as the lancet and a scalpel. The equipment and
tools used changes frequently and the MT must be proficient in knowing
the latest techniques and tools, from robot-controlled surgery to an
appendectomy, neither of which is simple.
Knowing which
medications are used and in what quantities is crucial to patient safety
and avoiding lawsuits as is whether or not a patient is allergic to a
medication or group of medications, like sulfas and penicillins.
Although it seems as though an MT would not be aware of a patient's
history, even when it is often part of the report a doctor dictates,
little things like a cephalosporin or statin allergy where a doctor
dictates in the same report that the patient is prescribed Fortaz and
Lipitor, both of which will kill or cause serious problems because one
is a cephalosporin and the other a statin. The MT must also be familiar
with the dosages of medications prescribed so that errors will not end
up causing a mistake that can lead to a malpractice lawsuit if it is not
caught, often by the MT, and reported to the doctor.
From
brain surgeries as delicate as an aneurysm coiling to setting a break
from a fall off the monkey bars at school, the MT types it all -- and
knows a lot more than they are given credit for. Oncology drugs and
treatments, the waveforms and epileptiform discharges on an EEG, the
variable rates and states of the heart on EKG, skin grafting, the
delicate bones in the hand, the difference between a floater and a
posterior vitreal detachment, sizes of drains, and every single
discipline and specialty in the medical service, as well as the the
diagnoses and treatments for everything from a flu bug to schizophrenia
are part of the knowledge and abilities of every MT. With all that
knowledge and expertise, every MT relies on the doctor to do his job and
dictate clear and easily understood reports so that time is not lost
and patient care compromised in the meantime.
The biggest hurdle
that the MT must manage is the doctor who is too busy or tries to fit
in dictating reports whenever he can. Is it because the doctor doesn't
care about the patient or is it because he does not consider dictating
the report as important as treating the patient or attending a morbidity
and mortality conference? Whatever the reason, doctors are most often
the part of the medical machinery that causes the most problems when it
comes to accurately documenting patient care. I think it is because the
doctor is not aware of how much time and effort costs when the report
ends up back in the doctor's hands with blanks and questions about
dosages, allergies, and discrepancies in the report he dashed off hours
or days ago. The doctor has forgotten that there is a bottom line and a
price to pay for hurrying through dictations and ultimately it is the
patient who will pay.
When a doctor speaks too fast, mumbles
and fumbles through a dictation, doesn't speak clearly, speaks when
there is too much noise in the background, or doesn't read the chart
before dictating, the doctor creates problems, not just with the timely
processing of the dictation, but also the documentation of the patient's
treatment. When English is the doctor's second language, that doctor
has the added responsibility of speaking as clearly as possible,
spelling out words difficult to pronounce correctly.
The MT
listens to the report, typing everything the doctor says because each
report is a legal document, correcting minor errors like grammar,
punctuation, and style, but the report must be accurate as well as
correctly typed and processed. Misdiagnoses, wrong dosages and
medications, incorrect materials and equipment, and wrong lab values
must be flagged and sent back to the doctor to correct before each error
is finally documented as proof of the doctor's treatment and care of
the patient. All of this information is admissible in a court of law if
the doctor is ever sued for malpractice. It is more important to the
patient who can be harmed by incorrect dosages and types of medication,
treatment, and errors in lab values, or sites of surgery. Most, if not
all, of these errors are preventable by the doctor speaking clearly and
at a natural conversational rate of speed so that the report does not
have to go through the MT, 2 or more quality control specialists, the
hospital, and finally back to the doctor who rushed off the dictation in
a spare moment and now must read the report and correct the errors,
matching it against the patient's chart for a second, and often third
time.
Not only has he wasted the time dictating the report, but
the report has wasted the time of everyone that had to handle the
information to try to tease out what the doctor said or meant to say,
sending it back up the line to the doctor to correct before the report
becomes a part of the patient's chart and cast in legal stone. Had the
doctor taken the time to dictate the report clearly and accurately the
first time, the report would not end up back on the doctor's desk to be
corrected.
Every time an MT complains about a doctor who
chronically wastes her or his time, it is not the MT whining or
complaining for the sake of complaining, but a message to the doctor
that patient care is at stake and valuable time has been lost by
everyone that had to listen to the original dictation numerous times to
puzzle out what the doctor meant, doing everything possible so that the
report does not end up back on the doctor's desk to be corrected and the
blanks filled in. Each time that happens, money and time are lost, but
more importantly patient care and safety are lost or left in a holding
pattern in limbo, which may also hold up care and proper treatment when
the consulting doctor or therapist or surgeon has to wait for those
blanks to be filled in and the errors corrected.
The bottom
line is that patient care and safety are at stake every time the doctor
rushes through a dictation because dictating that report is low on his
list of priorities as he rushes to get it done. Rushing leads to errors
and that leads to compromising the patient's care and safety -- and that
often leads to malpractice lawsuits for the hospital and the doctor.
I ask you, doctor, is it worth it?
My grandmother taught me that doing a thing right the first time means I
didn't make mistakes I would have to correct -- and answer for --
later. I learned that lesson early. It is a lesson we all must learn.
Most mistakes on hospital reports are not a result of mistakes made by
Medical Transcriptionists, but are made by doctors who do not take the
time to dictate slowly and clearly enough. Mispronounced words make it
difficult for the MTs to do their jobs with the precision and skill of
which they are able. An MT can only do so much. In the end, it always
comes back to the doctor. The doctor ultimately has the power to make
the MT's job easier or make more work for him/herself and avoid
compromising the patient's care and safety.