Tuesday, September 18, 2007

Connecting The Dots

My former workout partner has spent the past few years working in the corporate offices of a multinational retail giant. Recently, over breakfast, he described the kind of idiocy which can occur in corporate circles. When his company announced an “employees only” sale on accessories, a female executive who works in his department leapt at the opportunity to stock up on purses and handbags. She was so thrilled with her discounted purchases that, after she had gathered all of them up in her arms, she left her laptop on a commuter train. Her laptop that contained the company’s huge payroll file. Her laptop that had the computer’s passwords written on a sheet of paper neatly stored in its carrying case.


To my friend’s utter consternation, no one at his company seemed particularly concerned. Did it not occur to them, he wondered, that the passwords could give someone access to a file containing critical information (addresses, phone numbers, medical information, etc.) about each and every employee in the United States and overseas? Did no one care that access to so many Social Security numbers could represent a huge corporate liability in the event of identity theft? Apparently not. After all, purses were on sale!

I mention this incident because, in today’s world of sound bites, publicity hype, and action-packed media, two issues have increasingly become cause for concern. One is our society’s diminished span of attention. The other is a growing inability to connect the dots between cause and effect.

First, let’s examine our problem with attention span. In the past ten years we’ve been asked to absorb new information and process change at a faster pace than ever before. Banner ads on web pages no longer just sit there advertising a product. They blink, spin, rotate, change colors – some even run mini-movies in their effort to capture your mouse click. CNN no longer simply delivers the news through talking heads. On the bottom of the screen a ticker tries to capture your attention while other parts of the screen shoot factoids at the viewer. Multitasking used to imply working between two or more computer programs. Now one is likely to multitask while talking into a headset, reading e-mail, and eating at the same time.

The overall effect of all these distractions has been to shorten the length of attention we give to any one item while increasing the number of items demanding our attention. Like a computer’s clock, we can give some attention to all of these items, or all of our attention to one item at a time. But there is just so much attention to go around.

What happens, then, to the medical transcriptionist who is not allowed to concentrate on her work? Or who must respond to the demands of numerous distractions? Those who work in-hospital have no problem understanding that productivity suffers when they are asked to respond to phone calls, doctor requests, and other interruptions that ruin their concentration and take them away from transcribing. Yet they are routinely being asked to increase their productivity without being (a) given the electronic tools to do so, or (b) freed from a variety of nuisance factors.

At-home transcriptionists trying to cope with phone calls, household chores, and the nagging demands of their family are equally stressed. Since most of these people are working on a production basis, their earning capacity is directly proportional to their ability to stay focused on their work. The insidious call of one’s e-mail inbox, the lure of one’s favorite online game, or
the vicarious thrill of reading the latest gossip on a newsgroup, bulletin board, or Internet chat room act like sirens luring a transcriptionist away from her work.

Meanwhile, seemingly intelligent people become paralyzed by reality because they simply cannot connect the dots between cause and effect. Let me give you some embarrassing examples. I recently interviewed a potential transcriptionist who had all the experience necessary for the job. He had had years of in-hospital experience, had worked for Workers’ Compensation firms, in law offices, and seemed like a stellar candidate for the job. Because of his experience in the legal field, he clearly understood issues of confidentiality and had no trouble grasping the differences between working as an employee and working as an independent contractor. And yet, after signing a contract, and telling me how eager he was to start transcribing from home so that he could boost his income (he already had a full-time job), he abruptly informed me that this wasn’t going to work and he was returning all of our materials.

What happened? He had somehow managed to ignore the fact that being an independent contractor essentially means that you are running your own business. “I just wanted to sit down and work – I didn’t want to have to do any of this administrative stuff,” he explained.

Physicians can be equally shortsighted when it comes to diagnosing a problem. One of our clients recently kept dictating despite a horrible buzz on his phone line. He even apologized to the transcriptionist about the poor acoustics on the phone line while in the middle of dictating a report. When I spoke to him a few days later, I asked why he hadn’t just hung up the phone and tried calling in again. He explained that (a) he had been in a rush, and (b) this happened with his phone whenever there were heavy rains. “Hang on, there’s that noise again,” he said. “Let me see what happens if I use my partner’s phone.”

Sure enough, once he switched phones the sound on the line was crystal clear. After a few choice words he agreed that maybe it was time for him to replace the phone – if I thought that might really be part of the problem. “Can I ask you something?” I said. “Didn’t the fact that you were having trouble with the noise on the line while you were dictating ever make you think that the transcriptionist might have trouble listening to you with all of that horrible noise in the background?”

“You know, I never thought about it that way” he confided. “I just thought that because of the rains.........” (Note: this man is a surgeon.)

What can I say about the physician who never understands what happens when he turns off his computer? The next morning, moments after he goes to look for his electronic delivery, he calls me in a state of near panic. “Where’s the icon? I can’t find the icon my screen. How am I supposed to get the documents if I can’t find the icon?” After calming him down I routinely asked him if he has logged back in to the service’s website after booting up his computer. “Huh? Where’s that? How am I supposed to know these things? What’s my password, anyway?” After calming him down I explain – again -- that if his DSL service drops out -- or the web service’s servers go offline for routine maintenance -- the connection can be lost. When this happens, the solution is to simply log in again and re-establish his connection. The information must go in one ear and right out the other because I receive similarly panicky phone calls every few weeks.

There are, however, rare opportunities to explain cause and effect to a physician. One such opportunity recently presented itself on a silver platter when one of our doctors (the ESL nightmare from hell) sent me an e-mail asking why his work wasn’t being turned over as quickly as in the past. Going on the premise that honesty is the best policy, I explained that transcriptionists get paid on production and the excellent transcriptionist who had been giving him such rapid turnaround had nformed us that she no longer wanted to work on his account because she did not earn good money on his dictation.

“Is there something not desirable about my dictation?” he asked. “I’d really like to know so I can try to improve. I’m willing to learn.”

I explained that all of the problems with his dictation were mechanical and could be corrected if he put some effort into it. And that, if he succeeded in improving his dictation, it would probably take our transcriptionists less time to process his work and he might get his reports back faster. Some of his problems included:

  • Wet dictation (the tendency to dictate with a mouthful of saliva). This garbles some sounds and also gives transcriptionists the impression that the dictator is spitting into their ears. Transcriptionists do not like this kind of sound. Indeed, it can cause them to scream and curse at a dictator on a regular basis.

  • Acceleration/deceleration. A tendency to speed up dictation on items which may not interest the doctor (usually segments of the physical examination or the patient's list
    of medications), but which the transcriptionist needs to hear clearly.

  • A tendency to transpose “L” and “R” sounds. Is the doctor talking about a 24-hour urine collection or a 24-hour urine correction? How much second guessing must a transcriptionist do in order to cut through a physician’s impaired speech habits?

  • Neglecting to carefully spell the names of patients and doctors (especially those with Asian names).

The good doctor swore that he would work hard to improve his dictation. Of course, he did no such thing. When I asked what happened to his heartfelt determination to improve the quality of his dictation, he replied “Yeah, well, I was in a hurry to leave that day.”

Cause and effect, folks. Cause and effect.

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