The Natives Are Restless

On May 30, 2003 the American Association for Medical Transcription released a “Statement on Quality Assurance for Medical Transcription” that called for no less than 100% accuracy with respect to critical errors (those errors that have the potential of compromising patient care) and 98% accuracy with respect to all errors in a transcribed report. “This focus on quality reflects an understanding that errors in the record have the potential of creating health risks for a patient and can diminish the credibility and perceived competence of the healthcare provider,” claimed AAMT.

I’ve got some earth shattering news for the pious ladies of AAMT. There are many physicians who absolutely do lack credibility and deserve to have their competency called into question. I’ve just finished listening to 40 minutes of dictation from one such doctor who can’t decide whether the lesion he excised was a basal cell carcinoma, a superficial basal cell carcinoma, a nodular basal cell carcinoma, whoops, a melanoma in situ, or was it a squamous cell carcinoma? “Was that on the right? Or the left. No. Change it. Yeah, it’s the right, um, left nasal dorsum. Okay.”

This is no genius. This is a dork with poor communication skills who can’t even read data off a simple surgery form!!!

If AAMT has decided to embrace the style guide from the Ari Fleischer School of Corporate Communications, then what little clout the organization has must be called into question. With a severe new strain of STD (stodgy transcriptionists in denial) festering in Modesto, I doubt it would do much good to suggest that AAMT wake up and smell the coffee. Dunking these people in a vat of scalding hot coffee couldn’t shake them out of their co-dependent mindset.

Just to be sure I wasn’t overreacting, I queried some of my fellow medical transcriptionists to see how they felt about AAMT’s statement.

• “What are they doing over there, drinking bong water?” asked Susan Rojo.
• “This frosts my babushka,” wrote my good friend Judith Marshall (who has written extensively about medical transcription in the past). “Another statement from the mountain and onus on the MT. Where the hell is the statement on doctor dictation? I spent all day typing total fools who are senile, drunk, coughing, eating, and non-English speaking, but AAMT wants me held to 100-98 % standards (and no blanks allowed, I might add) at this hospital that employs these crazy people?”
• “A radiologist once told me he made a game of his dictation: dictating so fast and purposely mispronouncing a word, etc., just to see if the transcriptionists could transcribe him,” noted another MT. “I won't accept responsibility for such garbage as that and shouldn't be expected to.”
• "I think 100% accuracy as far as spelling terminology goes is reasonable, even expected. However, if a doctor dictates ‘left AKA,’ then next paragraph says ‘right AKA,’ and does so several times, I will not be held responsible for that,” warned Yenna. “I will not purchase insurance to cover my ass for that, but I would advise the good old doc to make sure his malpractice insurance is up to date. If a dictator mumbles and I can’t tell if (s)he is saying ‘respirations are 56' or ‘respirations are 66,’ I won't be backed into a corner by guessing. I will flag it. If I hear 56 and QA hears 66, so be it. QA can take the heat for changing it. With ESL dictators, it is sometimes more difficult to achieve 100% accuracy simply because they may speak softer (being self conscious of their accent) if there are others in the room. I have one ESL I hate doing. He has a deep, low voice. He mumbles and sometimes he dictates at the speed of light. But I have made it a personal challenge to learn to do him without it taking me an hour and leaving more blanks than Carter has liver pills. I have most of his ROS and physical exam down pat and have made an expander for them. I have asked for a corrected copy of every report of his I have had to send to QA. But there is no way that I will accept responsibility for his bad dictation.”
• As I read through my emails, it became obvious that the disconnect between AAMT’s self-image and the image the organization has acquired in the online transcription community was growing like Pinocchio’s nose.
• “What's the target audience for this position paper? For whom was this document prepared?” asked an astute subscriber to the KAMT-list. “Not we who work in the industry. Not MTs. Not MT service owners. Talk about restating the obvious, and, might I add, in most simplistic terms. So whom???? Someone who requires this basic explanation is not remotely going to grasp the complexities of this work.”
• “Fortunately the AAMT has made itself an irrelevant organization with little-to-no credibility in the healthcare industry. While I completely agree with the assessment that errors in medical records have the potential of creating health care risks for a patient, I do not believe it is a medical transcriptionist's duty to make a healthcare provider appear competent when the quality of their dictation may reflect otherwise,” stated Annie Ranieri, the outspoken webmaster of www.Mtchat.com. “If the AAMT were truly concerned with patient care, their time would be better spent educating physicians on the importance of good dictation skills and reading their transcribed reports before signing them before laying the blame at the feet of the MT for errors in medical records.”
• “This is someone's notion of politically correct verbiage. The statement is simply a vague, appropriate-sounding snow job that's supposed to impress....someone,” wrote another KAMTster. “This would make sit-com fodder: ‘Gee, Shirley, we ought to have a position paper. All really swell organizations have position papers.’ ‘OK, Marge, let's write one up...’ followed by draft after discarded draft, until this homogenized, sanitized, say-nothing document was deemed suitable and posted on the web. How about coming out of that ivory tower, folks, and joining the ranks of working MTs, at all skill levels, and taking our pulse once in a while? Either truly represent us or quit pretending to be the voice of authority in a complex, challenging, and largely invisible industry which has become more and more lucrative, more and more prone to outside influence, and supremely cynical. There is nothing in that document to suggest what might be done, or how to do it, or an acknowledgment of the people who do the work, no matter how deadly dull, demanding, repetitive, and all those other things it has become.”
  
  Of course, not everyone reacted with such vitriol.
• “In a perfect MT world (one that neither one of us yet inhabits, unfortunately), doctors would clean up their acts and we could all produce flawless reports in a minimum of time and with only reasonable effort,” opined a retired MT. “I truly wish I could say this will happen, but heck, I’ll be 67 next month, and it just ain’t gonna happen in my lifetime. However, if we could get copies of your articles into the sweaty little palms of medical students...!”
• “Granted there needs to be a standard that we all should work towards, but 100%?” scoffed a woman who has been transcribing for 15 years. “There is human error to take into consideration here, transcriptionist and dictator alike. We can do our best on the transcription end but we are not mind readers when a physician doesn't remember right from left, dictates ‘she’ rather than ‘he,’ or vice versa. Garbage in, garbage out, as well as those who have difficulty speaking English (this includes the ones that were born and bred here). We cannot be held responsible for their errors -- only for our own.”
• “I'm not sure where the AAMT feels they have the authority to call for any measure of accuracy or how the industry operates,” challenged Erin. “As far as I'm concerned, the agreement for accuracy requirement should be made between the client and the MT or MTSO. It seems to me that AAMT is trying to get a tighter hold on the industry because they realize that no one really supports them or feels bound by them anymore and the industry is slowly but surely drifting away from the almighty AAMT. What percentage of MTs are certified or even belong to AAMT anymore? I would guess that number is rather low for an organization that touts its vision as ‘to direct the evolution of the medical transcription profession.”
  
  Who would have imagined that a simple press release could release such a torrent of criticism? But that’s what happens when you deal with an overeducated, highly opinionated population. The bottom line is that AAMT cannot keep marginalizing the issue of sloppy dictation habits. It is one of the most critical factors contributing to documentation errors in healthcare. Until AAMT, AHIMA, AMA, JCAHO, or any other organization finally wrestles that bull to the ground, pompous press releases such as AAMT’s “Statement on Quality Assurance for Medical Transcription” are nothing more than a bunch of politically-correct bull.