Thursday, September 27, 2007

Asleep At The Wheal

These days it’s hard to tell which is more fascinating: the business of culture or the culture of business. As the Internet and other forms of digital media have made it possible for people around the world to experience each other’s cultures (which can result in greater understanding or increased religious hatred), the business of importing and exporting culture has grown by leaps and bounds. In June, the San Francisco Gay & Lesbian Film Festival had nearly 300 offerings, with a preponderance of films coming from Asia. Documentaries covering the two-spirit people of Hawaii’s fading culture Ke Kulana He Mahu, the spirit mediums of Burma who, defying military rule and the official religion of Buddhism, continue to make a living by communicating with popular Burmese household gods Friends In High Places, and a magnificently imaginative dance short from France Ere Mela Mela, showcased the creativity of filmmakers working in other cultures. American filmmakers countered handsomely with HIV Basics for Corrections Officers as well as documentaries about the tragedy of homeless teens Out in the Cold, the popularity of certain hairstyles, American Mullett and F**K The Disabled (the story of a gay standup comic with cerebral palsy who lives in Harlem).

Several weeks later, the San Francisco Silent Film Festival showed a beautifully restored copy of Harold Lloyd's Girl Shy (1924) with live accompaniment on the Castro Theater’s Mighty Wurlitzer organ (Lloyd’s granddaughter announced that his entire collection of silent films will soon be released on DVD with both organ and orchestral accompaniments). India’s Shiraz (1928) was introduced by the Consulate General of India in San Francisco and accompanied on tabla and sarode by musicians from the Ali Akbar College of Music. Later in July, the San Francisco Jewish Film Festival featured programs about the role of the Jewish mother in cinema as well as a documentary about a cowboy who sings to his flocks in Yiddish. A fascinating smorgasbord of international cinema within eight short weeks!

Meanwhile, the business world was experiencing some white-knuckle thrills as the market reacted to massive corporate meltdowns at companies like Enron, Global Crossing, Worldcom, and Tyco. Cultural icon Martha Stewart got caught with her exquisitely floral patterned pants down and was accused of insider trading (definitely not “a good thing”). John Rigas (the devout Christian founder of Adelphia Communications) was arrested after looting the company of billions of dollars. James A.Traficant Jr. of Youngstown, Ohio was ousted from the House of Representatives following his conviction on bribery, fraud, and tax-evasion charges. Wal-Mart was sued for its system-wide efforts to avoid labor costs by insisting that employees continue to work after punching out. And Alan Greenspan bemoaned the shift from a financial atmosphere of “irrational exuberance” to one of “infectious greed.”

“Confidence in the equity markets is nearly non-existent. Analysts and stockbrokers have overtaken mechanics, lawyers, and politicians as the professional class most despised (and distrusted) by the American public,” notes financial planner Tom Swift of Financial Avengers. “Other than a brief foray into Enron, we have avoided companies with excess debt and we always will. We prefer companies that grow organically, rather than companies that grow through acquisition.”

The popular street question “Got any E?” might now have people wondering if one is trying to score a hit of Ecstasy or find a business with a sense of ethics. In July, I was asked by a medical transcriptionist which came first – my company or an MTSO in India that had obviously plagiarized several pages from Alert & Oriented’s website (a strongly-worded e-mail with a copy to the Indian Consulate promptly got the offending material removed from the Indian MTSO’s website). One MT vented her rage at listening to a resident who, while trying to simultaneously dictate reports and converse with a friend, could clearly be heard to say “I am making so many mistakes! This is so messed up. I'll just blame it on the transcriptionist.”

Whether it’s a dizzy doctor, the former CEO of Halliburton Industries, or the folks at Arthur Andersen, the people who are supposed to be taking the high road are doing a phenomenal job of screwing things up (don’t get me started on the Catholic church’s handling of pedophilic priests). The abrogation of responsibility in favor of defying laws and regulations has led to an American business culture in which the ends justify the means (no matter how sleazy they might be). Anyone who doubts this phenomenon should get their hands on David Brock’s new book, Blinded By The Right, to witness the evil some people embrace to justify their actions in the name of doing business.

If one applies Elizabeth Kubler-Ross’s four stages of grieving to the current crop of corporate corruption scandals, it won’t take long to realize that Americans are at the point in the process they handle best – affixing blame. In doing so, some remarkable parallels can be seen between the small investors and workers who have suffered as a result of losing their money in companies like Enron and Worldcom, and the culture of blame which has been institutionalized within the field of medical transcription. Never mind that medical transcriptionists must often work with dictation that is unintelligible and makes no sense whatsoever. While some of America’s largest medical transcription companies woo new recruits with sign-on bonuses and glowing descriptions of their incentive programs, others operate like miniature penal colonies in which each infraction incurred by a medical transcriptionist can lead to a reduction in earnings.

  • If you’re forced to leave a blank because you can’t understand what the dictating physician is saying, you can be penalized.

  • Suppose the good doctor goofs and dictates “Temperature 120/80, blood pressure 98.” If you automatically correct it to “Blood pressure 120/80, temperature 98" you could still get penalized because your transcribed work does not match the dictation verbatim.

  • If you get stuck with a bunch of dictations from doctors who speak English as a second language and have to hand in a series of documents containing blanks, guess what? You can get marked down and gather enough points against you that you fail to earn the higher line rate that was dangled in front of you as part of your MTSO’s so-called incentive program.

  • Last, but not least, once you’ve uploaded your work, who is to say that it will be proofread with any consistency? Suppose one QA person grades your work with an entirely different set of standards from another?

While this is all done under the rubric of “quality assurance,” it is primarily a numbers game to boost profit margins while decreasing labor costs. Most often, it leaves medical transcriptionists feeling as if they are standing on a vibrating platform in a video arcade and attempting to shoot at targets that keep popping up at random while their supervisors toss water balloons at them and throw sand on their keyboards.

Anyone who has tried to transcribe while angry knows that they are prone to make more mistakes and will likely experience a decrease in productivity. The more mistakes in one’s work, the more one gets penalized. The more one gets penalized, the less one earns. The more institutionalized the system of penal enhancements, the easier it is for transcriptionists to be demoralized by their work and lose concentration. But because some MTSOs have instituted quality assurance programs that dwarf the dictation/transcription process, these business owners spend more time and energy intimidating transcriptionists with penalties than supporting them and helping them to perform their craft.

“The way they have figured and refigured lines and how to scam (I mean pay) you – I work three times the hours for not even close to the pay I used to make. I made $17,000 dollars less last year than the year before. Do you think I worked less hours?” asks a subscriber to the KAMT-list. “I find this ‘new’ (or at least new to me) trend of docking wages for mistakes incredible. Where are the bonuses for saving these dumbass illiterate doctors’ asses when they screw up their dictation? Where is the reward there?”

When MTSOs wonder why they have such a large turnover in personnel (and assume that it is because of the shortage of good transcriptionists), these people often fail to understand that they have created a corporate culture which so severely alienates and punishes medical transcriptionists that only the most desperate and masochistic MTs remain on board. Many medical transcriptionists have noticed a strong parallel between their feelings of hopelessness and helplessness and the emotions of the hundreds of thousands of workers who recently lost their jobs while corporate executives were awarded million dollar bonus packages. Even if their skills are excellent, some medical transcriptionists are forced to vote with their feet in order to find a situation that will not cripple their earnings with penalties.

The steady erosion of ethics in the health information management community has been a continuing cause for concern. Watching Laura Dern’s poignant portrayal of Dr. Linda Peeno inS howtime’s Damaged Care (the story of the physician who blew the whistle on Humana’s scurrilous methods of denying health coverage in order to contain costs) offered little comfort to those who document patient care. Managers and MTSOs may not be sensitive to how deeply punitive values have become entrenched within the culture of the medical transcription industry. But if they have any doubts about how the fear of being penalized can affect the accuracy, productivity, and profitability of their operations, they need only refer to the letter FBI agent Coleen Rowley sent to Director Robert Mueller describing the culture of risk aversion which may have contributed to the agency’s tragic internal failures in the months prior to 9/11.

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