Conspicuous Consumption

Shortly after my 50th birthday, I realized that if I was going to have a mid-life crisis I’d damned well better have one before it was too late. Some men buy themselves a Miata, others go in for plastic surgery. Some guys get a prescription for Viagra, others take on a mistress.

I bought myself a 21" monitor.

My purchase wasn’t just motivated by the fact that I was battling the effects of presbyopia. Or because my life was getting more complicated. I broke down and bought myself a “luxury” monitor because I was spending more and more time working at the computer and decided to splurge on a creature comfort that would make my work easier while reducing eye strain.

The ability to snap up the latest toys to hit the market is not an option for many medical transcriptionists. Those who work in hospitals (or for large services) have little or no purchasing power. In some cases, proprietary software prevents them from installing computer add-ons that would make their professional lives much easier. So they struggle along, trying to remain productive while continually being handicapped by their employers.

Back in 1992, when my business partner and I launched Alert & Oriented Medical Transcription Services, we became acutely aware of how much our creativity and freedom to make decisions (both as business owners and as gay men without any children to support) affected our purchases.

• After analyzing where technology seemed to be taking the transcription industry, we didn’t hesitate to purchase a digital dictation system. With his background as a computer programmer, Tom rejected the expensive proprietary systems marketed by Dictaphone and Lanier. Instead, he chose a less costly Digital Voice system built with off-the-shelf products so that we would still have a computer we could use for other applications in case our business failed.

• Whenever an important upgrade was announced that would take us one step further, we didn’thesitate to purchase it. We quickly moved from WordPerfect 5.1 to 6.1 and eventually on up to Corel’s medical edition of WordPerfect for Windows (which has Stedman’s Electronic Medical Dictionary and medical and pharmaceutical spell-checkers integrated into the word processing package).

• Whenever we could find a piece of add-on software which could help us keep our fingers on the keyboard (thereby increasing our productivity) we bought it, analyzed it to see if it was right for us and if we liked it, put it to work.

Our goal was to constantly refine our work process by using state-of-the-art tools of the trade to keep our overhead low and our efficiency high. Based on the principle that “lost time is lost money,” our business has been designed to turn a profit rather than lose money by trying to rescue or pamper inefficient doctors who suffer from sloppy work habits. As businessmen, we were determined to discover what worked for us and eliminate anything that didn’t.

• When our first client (an excellent dictator whose wife was the control freak from hell) refused to put down his microcassette recorder and dictate over the phone, we dropped his account.

• When another doctor with a thick foreign accent (who was a terrible mumbler and a late pay) insisted on dictating from pay phones in airports and bus terminals, we let him know that none of our transcriptionists would do his work and dropped his account, too.

• Instead of jumping up and down with glee every time a doctor inquired about our services, we built a checklist to determine whether or not a potential client would be “a good fit.” As a result, doctors who refused to dictate over the phone (and instead wanted us to pick up and deliver their cassette tapes) were told to find another service. Physicians who could not accept electronic transmission of transcribed documents because they were too cheap to install a computer with a modem in their offices were told “Thanks, but no thanks.”

Today, when we take on a new client, I carefully explain that a very important role reversal is about to take place. The doctor/clinic will become our patient while my partner and I act as consulting physicians to the client’s medical practice. If clients wish to get their offices working better, they will follow our treatment program. If they don’t— or can’t — get their acts together, they can face managed care’s administrative nightmares on their own.

Why are we so tough on doctors? Because although doctors rarely know anything about office software, they will frequently try to bluff their way through telling transcriptionists how to work. We’ve also learned that if you very politely ask a doctor to do something, he’ll think you’re sucking up to him and ignore you. But if you give the doctor orders, he’ll do what he’s told. (There’s a little bit of military-style medical school training left in most physicians).

Statistics show that nearly 98% of medical transcriptionists are women. Over the years, many of these MTs have been socialized to react in dangerously co-dependent ways to the dysfunctional demands of dictating doctors and medical transcription service owners. As a result, many MTs have been conditioned to jump through numerous self-destructive hoops in order to make something work for a doctor (with absolutely no regard for the financial, emotional, and spiritual costs they might suffer as a result of their actions). Even as MTs have transitioned from being employees to becoming independent contractors and business owners, many have had trouble putting their own needs and priorities ahead of the needs of their families, friends and clients.

Since this is the era of managed care, it’s time to wake up and smell the coffee being served in the electronic sweatshop. Because every dollar counts, I’ve decided to devote this column to shamelessly plugging some products which can increase productivity for medical transcriptionists. Some of these items have greatly enhanced my own productivity. Some of them I rely on to earn more money.

Why am I doing this?

• The leadership of the American Association for Medical Transcription (AAMT) is hell-bent on pursuing a path of action which will create industry standards that reduce earnings by forcing MTs to do more formatting work and take on more liability without any extra compensation.

• I am frequently asked which products or reference tools I can recommend to MTs. From past experience, I know that MTs should never expect a manager to figure out which tools they need in order to improve their productivity. If management doesn’t transcribe — and if the necessary tools are not a product that a manager needs— there is absolutely no reason for any manager to care about what MTs really need.

• It is often easier to factor software or hardware purchases into a departmental budget than to battle the politics of raising a full-time employee’s hourly rate (or the rate of compensation for someone who is working on a production basis).

• I strongly feel that medical transcriptionists with no purchasing power of their own should at least have the option of telling their supervisors “If you can’t — or won’t — get me a raise, then the least you could do is buy me the tools I need to do my job properly.”

More tactfully stated: “If you want me to increase my productivity so that (come budget time next year) your track record as a manager looks better, then it’s your responsibility to get me the electronic tools to make that happen. Here’s what you need to order.”

HARDWARE

• A decent monitor. If you’re forced to stare at a computer screen all day, get yourself a monitor that will reduce eye strain. Prices have come down sufficiently that your office should be able to afford 17" or even 19" monitor.

• A faster chip. These days, a computer with a 300-MHZ chip is no big deal and can be purchased for less than $1,000. If your office is still struggling with 286, 386, 486 or first-generation Pentium processors, now is the time to run screaming toward the millennium.

• More RAM memory. This should be a no-brainer. Your computer processes information faster with more memory. The less time you spend waiting for your computer to process data, the more productive you become. If you are working on a stand-alone PC that uses Windows 95 or 98, you should have at least 32 MB of RAM on your machine.

• A telephone headset. If you are frequently fielding telephone calls while at your computer work station, it isessential that you avoid injuries that can be caused by trying to crook the phone receiver between your neck and shoulder while using your hands to continue keyboarding. If your supervisors are unclear on this concept, loudly ask them if they’ve ever heard about ergonomics, work-related injuries and the high cost of Workers’ Compensation claims. Most office supply stores sell a variety of products by Plantronics and other manufacturers. You can get Hello Direct's superb catalog by calling 1-800-444-3556 or visiting their website.

• A device for massaging sore muscles in your neck and shoulders. Several years ago, a neck injury introduced me to Panasonic’s Shiatsu Accu-Tap II (which features a J-shaped design that allows you to reach the back of your neck when you’re in too much pain to turn your head or lift your arm). When used in certain ways, this kind of tool can almost make you see “white” light.

SOFTWARE

• · Stedman’s Plus Spellchecker. This medical and pharmaceutical spell checker is a must-have item. It saves lots of time while proofing documents and easily integrates into your DOS or Windows word processor.

• Stedman’s Electronic Medical Dictionary. A fabulous reference tool which does not weigh enough to hurt your wrists. The ability to search for medical terms using an electronic “wild card” makes this another must-have item. The latest release, version 4.0, contains lots of graphics.

• Quick Look Electronic Drug Reference. When the going gets tough, the tough can now switch to another application. Forget all the chicken scratches you’ve been making in traditional drug reference books and dog-eared, photocopied wordlists. Whenever some physician makes a feeble attempt to spell out a drug name, this tool allows you to search for medications you can’t find and get tons of information about them within seconds — without taking your fingers off the keyboard! After installing this program, I thought I’d died and gone to heaven!

The above-mentioned software products are available from Williams & Wilkins (a major publisher of reference sources for medical transcriptionists). To order, call 1-800-527-5597 or visit their website.

This last piece of software I can only recommend with an extreme bias, so let me be upfront about why. Other than your word processing program (which will most likely be MS Word or Corel WordPerfect), choosing a word expander is the most personal choice you will need to make. Many of us started off using DOS-based word expansion programs like JOT! and PRD+. But as operating systems continue to migrate away from DOS (and DOS-based word expansion programs like Explode-It! and SmartType), the question became: Which Windows-based word expander will work best for me?

I am currently working with a beta version of an exciting new product which should be available on the Internet by Christmas. All I’ll tell you is that I like it a lot.

Last, but certainly not least, I want to stress the value of a professional CMT (certified massage therapist). For Christmas, for your birthday, for National Medical Transcription Week and any other reason you can invoke, make it a point to treat yourself to a professional massage that will relieve tension in your neck, shoulders, and other areas of your body. If you’re the kind of person who has trouble justifying such an expenditure — or lacks the chutzpah to tell people that a gift certificate for a 90-minute massage would be a wonderful present— then let me give you some ammunition.

When friends of mine bought a second home on Cape Cod, they made the acquaintance of an elderly gent who could, at best, be labeled a Swamp Yankee curmudgeon. A stubborn old skinflint if ever there was one, Henry had lived a Spartan lifestyle for many years. Nearly 80 years old (and close to a millionaire), he was not about to let fools lure him into wasting his money on mere frivolities.

Nevertheless, the day finally came when Henry stunned his neighbors byannouncing that he had gone out and bought himself one of those new-fangled stereo systems. When asked what had inspired him to make such a purchase, he snickered to himself and whispered “God owes it to me.”

If your employer won’t get you the tools of your trade and you have trouble spending your own hard-earned money on a massage, then I suggest you try Henry’s rationale for spending money on yourself:

God owes it to you.