First Walk A Mile In My Shoes

In the 1995 film entitled Swimming With Sharks, Kevin Spacey delivers a bravura performance as Buddy Ackerman, a spoiled, brutally selfish Hollywood executive who takes great delight in making his underlings miserable. Anyone who has worked as a legal secretary, medical transcriptionist or administrative assistant for a megalomaniacal monster like Ackerman will recognize each sadistic bit of needless humiliation, power tripping and job-related abuse. Viewers may swallow their horror long enough to cheer when Ackerman’s assistant Guy (played by Frank Whaley) turns the tables on his boss and proves how sweetly detailed revenge can be.

Those who have never worked for such prima donna personalities can’t believe that people actually behave that way in the workplace. However, the poor souls who have hung onto their jobs through thick and thin – suffering constant streams of invective mixed with daily doses of humiliation -- often find it difficult to describe the personal hell they have endured.

Medical transcriptionists often find themselves in a similar situation. And there is little solace in knowing that only people who transcribe on a regular basis truly understand what they are subjected to while trying to do their work. It’s the folks who are in the trenches day in and day out – listening to some muckmouth doctor’s mumbling, screaming, or other distorted attempts at dictation -- who know what professional MTs must listen to in order to produce a finished report.

It doesn’t matter whether doctors are dictating onto cassette tapes, using a cell phone (which broadcasts their dictation over radio frequencies and thereby compromises patient confidentiality), or dictating over a secure phone line. Their constant lack of attention to the acoustics of the environment in which they are dictating causes severe problems for medical transcriptionists which can impede productivity and dramatically increase job stress.

Here are some real life examples (taken from my own experiences as well as from colleagues in the industry) of what MTs are forced to listen to as they attempt to work:

• The doctor who insists on dictating next to ringing phones, high-impact printers, beeping cardiac monitors, vacuum cleaners, or simply prefers to hold his pager next to the telephone as he dictates reports. This has the same effect as someone holding a highly sensitized microphone next to chalk that is repeatedly being scraped against a blackboard.

• The physician who dictates reports while sitting in his jacuzzi.

• The physician who dictates reports over his cell phone from an airport lounge or from the first class cabin of his plane (either while in flight or on the ground) knowing full well that his voice is in direct competition with the public address system, the noise from the plane’s engines and the general hubbub in the cabin.

• The physician who tries to dictate over a cell phone while driving to work and can’t understand why transcriptionists are unable to hear every word of dictation while the doctor is driving through a tunnel.

• The physician who tries to dictate in English while holding a conversation in Mandarin with someone else in the office.

• The physician who tries to make the most of his time by dictating while he eats his lunch.

• The physician who loudly sneezes, belches, coughs and burps throughout his dictation.

• The physician who dictates while seated next to his pet parrot (who has a nasty habit of making loud – and lewd – comments which drown out the doctor’s dictation).

• The physician who, not wanting to waste a moment of time, carries his microcassette recorder into the bathroom and continues to dictate while urinating, defecating, wiping himself and flushing the toilet.

• The physician who watches The Late Show With David Letterman while trying to dictate reports.

• The physician who attempts to cook dinner, feed her infant and dictate reports while her two other children scream at each other and watch television in the background.

• The physician who is too busy comparing dating techniques with her fellow residents to pay attention to the report she is dictating and thus keeps mixing up all of the information about the patient’s surgery.

• The physician who is trying to dictate on an office phone, talk to her boyfriend on a cell phone and hold a conversation with someone in the hallway at the same time.

If you talk to other transcriptionists about how such problems affect their work, they knowingly shake their heads and start to share their war stories with you. However, when you talk to managers who don’t transcribe – and don’t have a clue about how seriously bad acoustics on the dictator’s end of the conversation can affect the quality assurance of transcribed reports – it becomes obvious that most transcriptionists’ complaints and criticisms fall on deaf ears.

Management typically thinks that transcriptionists make up these little stories because they have nothing else to complain about. Or because they’re unhappy. Or because they think these stories are funny. A standard clueless reaction recently came to me from a HIM manager who contacted me by e-mail. The fact that this person would not even sign her name to her correspondence told me that she had some problems with cowardice and insecurity. Here are some excerpts from her e-mail:

• “I am an RHIA and manage a middle-sized hospital department, including 4.5 Transcriptionists. I have never typed a report outside a classroom (okay, I tried it once). However, I do not believe this makes me any less of a good manager.”

• “Just as my boss has enough Health Information Management knowledge to make him dangerous, direct work experience is not always necessary to get the job done.”

• “You are very knowledgeable in your area of expertise & I feel that the Transcriptionists who work in my department would find your articles a good resource for information. However, due to the constant unfounded negative comments & suggestions towards administration and management, I feel that more harm than good would be done to the self-esteem and self-worth of the Transcriptionists.”

Her comments would be laughable if they were not so pathetic. By taking on the role of the superprotective schoolmarm, this RHIA insults the intelligence of her medical transcriptionists as a means of covering up for the fact that other people know more about their work process than she does. Not only does this RHIA exhibit serious control issues, she obviously does not trust her transcriptionists enough to allow them to read and digest information about their work (what they do every day) without her censoring their reading material.

This is the kind of manager who does not know how much she does not know. And certainly doesn’t want anyone pointing out that the Empress is wearing no clothes. But what about some of the real problems facing her transcriptionists? Who can they seek help from when confronted with such an ignorant and unsympathetic supervisor? Who can they turn to who will challenge the doctors at this facility to improve the quality of their dictation?

Often, when medical transcriptionists complain to management, no one seems to care or want to ruffle the feathers of “the poor doctors.” Unfortunately, many doctors have reached a level of success where they are no longer interested in learning how to do something better. The chances of making them change their dictation habits are really very slight.

How can the problem be fixed when the people who are capable of initiating change are in such a strong state of denial that they refuse to admit a problem even exists? In situations where a transcriptionist or MTSO has a casual, personal relationship with a doctor, progress can often be made over drinks or dinner as part of “continuing medical education.” If you are a doctor’s patient, a fail-safe technique is to grab his attention in the examining room when you can lock eyes with him.

For those who lack such options, let me offer a fantasy scenario akin to the treatment Buddy Ackerman receives from his vengeful assistant in Swimming With Sharks. Some might call it “Paybacks Are A Bitch.” I prefer to think of it as a consciousness-raising exercise that should earn credits for continuing medical education. Here’s how it works:

• Insist that your doctor make a deal with a male teenager who is not a member of the physician’s immediate family. The doctor must give the teenager an apple, a can of warm soda, a copy of the daily newspaper's sports section and promise to pay the teenager with a $100 bill as soon as he acts out the following script.

• The teenager goes home and gets ready to place a phone call to the doctor. Before he dials the physician’s number, he makes sure that a radio or television can clearly be heard in the background. He then drinks the can of warm soda as quickly as possible.

• The teenager then calls the doctor on the phone. As soon as the doctor answers, the teenager says "Testing, testing," and spits into the mouthpiece three times. The teenager then starts to eat the apple as he reads the sports page aloud.

• After reading the first paragraph, the teenager taps the phone's mouthpiece five times with a pen.

• After reading the second paragraph, the teenager belches as loudly as possible into the mouthpiece. Once he has finished belching, the teenager positions the mouthpiece near his forehead and mumbles a set of game scores as quickly as he can while finishing off the apple.

• When he has finished, the teenager slams the phone down without any warning and quickly returns to the physician’s house. Upon storming into the physician’s home, he grabs the $100 bill from the physician’s hand and screams: "Whaddaya mean you couldn’t understand my dictation and had to leave blanks? How dare you criticize a teenager! You've got a lot of nerve, biting the hand that feeds you. Why, if it weren't for us teenagers, you wouldn't have a job!"

• At this point, the physician must apologize profusely to the teenager, tell him how sorry he is to have upset him, and promise never, ever, to upset him again.

Managers like the RHIA who wrote to me may not understand this. They may think it is a horrifically rude and petulant assault on physicians. So would anyone who lacked real life experience working as a medical transcriptionist. However, the medical transcriptionists reading this article will know exactly what I’m talking about.