Tuesday, September 25, 2007

Religion Versus Transcription

Let’s not kid ourselves. This is an election year. As Democratic and Republican candidates for Presidential office continue to lock horns, one of the most vicious wedge issues is the topic of abortion. Is a candidate pro-choice? Pro-life? And, as earth nears the six billion mark in population growth, how does each candidate feel about that little French pill (RU-486) that could soon make abortions completely unnecessary?

The political circus has already witnessed charges that one candidate is anti-Catholic, that another is backed by hate-filled televangelists, and that whoever becomes President will have the power to stack the Supreme Court in such a way that women may no longer have the choice of having a legal abortion. In an interview published in Playboy in 1999, Minnesota’s quotable Governor Jesse Ventura minced no words in stating his opinion that “religion is a sham, a crutch for weak people.”

What does any of this have to do with medical transcription? More than you ever imagined. If you look in the Yellow Pages for any large metropolitan area and examine the listings for “Hospitals,” the chances are pretty strong that you’ll see the Saints come marching in. St. Rose. St. Jude. St. Francis. St. Luke’s. St. John’s. St. Elsewhere. Lots of saints are administering healthcare. Lots of these facilities accept Medicare and Medicaid reimbursements.

How does religion impact medical transcription? In subtle and not-so-subtle ways it affects the individual medical transcriptionist as well as the corporate culture in which the transcriptionist must function. Let’s start by examining a transcriptionist’s basic education.

Just as doctors, nurses and physician’s assistants must learn about medicine as a science, medical transcriptionists must understand the biological, anatomical, chemical and linguistic foundations upon which their profession is based. British naturalist Charles Darwin revolutionized modern biology with the theory of evolution he developed in the 19th century. Attacks on Darwin’s “Evolution of the Species” started with the 1925 trial of Tennessee science teacher John Thomas Scopes, who was fined for teaching that humans descended from animals. The Scopes conviction was later reversed on a technicality by the State Supreme Court.

The infamous Scopes trial has been depicted on stage, screen and television by playwrights Jerome Lawrence and Robert E. Lee in their drama entitled “Inherit the Wind.” However, in July of 1997, the Illinois Board of Education approved standards that contained no explicit reference to evolution, only the phrase "change over time.” According to the Chicago Tribune, in 1999 the Illinois Board of Education quietly eliminated the term "evolution" from state school standards adopted in 1997 (the new standards do not ban the teaching of evolution but leave explicit mention of it to the discretion of local schools). The revised Illinois standards gained national attention because a Christian conservative group affiliated with former Republican presidential candidate Gary Bauer took credit for influencing the state's decision to exclude the language about evolution.

In August of 1999, the Kansas Board of Education rejected evolution as a scientific principle, thereby re-igniting the national debate over the teaching of Darwin’s theory (which claims that humans evolved from earlier life forms over millions of years) as opposed to Bible-based Christian teachings about the creation of man and the universe. In Kansas, the Board of Education has set new standards for teaching in public schools that completely eliminate evolution from the required curriculum (schools can still teach evolution in science classes, but knowledge of evolution will not be needed to pass state-sanctioned tests).

Illinois and Kansas lie at the center of America’s Midwest, which is often referred to as “the Bible Belt.” In many communities where religion plays a strong role in a child’s education (and in reinforcing a family’s beliefs), medical transcriptionists are working in hospitals, at medical transcription services, and in their home offices. Although these people are not medical
practitioners – and do not administer medical care to patients – they bring a strong moral and religious view of the world with them when they begin their work. Some have staunchly refused to transcribe surgical reports which involve dilatation and evacuation procedures (therapeutic abortions), claiming that such work offends their morals and is against their religious beliefs.

“What we do is far removed from the actual event itself. We are not actively performing any physical act upon a patient,” cautions Renee Priest, who acts as moderator for “The Hot Zone” on www.mtdesk.com. “All we are is scribes, carefully preserving a written record of something that has already happened. An MT has no right to judge, prejudge, or comment on any medical record that comes through his/her hands. To refuse to do a dictation because of ‘religious principles’ is ludicrous to me. If an MT does not approve of abortion, HIV, lobotomies then he/she can go join any number of societies to lobby against them on their own time.”

“If it really got right down to it, any MT could have a hissy fit about something that was ‘wrong’ from the aspect of a religion they practiced, whether it be Christian, Buddhist, Jewish, Mormon, Mennonite, etc. Shoot, you would have them lined up in the halls waving lists of things that are ‘not acceptable.’ I don't think that anyone who follows the precepts of a ‘religion’ so totally (word for word) has any place in medicine at all,” insists Priest. “Frankly, I don't want to be the one lying on the table bleeding to death cause some religious tenet somewhere has a physician, nurse, or even the stretcher carrier all in a dither.”

How easily can a hospital’s or MTSO’s management accommodate an individual MT’s morals and phobias? That depends on how easily the work flow can be re-routed to other transcriptionists. The situation becomes genuinely difficult when transcriptionists refuse to do work for reasons that are not even religious.

  • “I don’t like typing those reports because they make me cry.”

  • I don’t want to work on any reports on cancer patients because they’re too depressing.”

  • “Why should I have to learn any vocabulary about AIDS? It’s not a part of MY life!”

When push comes to shove, some employees may need to review their job descriptions to see whether the terms of employment allow for such choices. If they don’t, squeamish MTs may have to knuckle down and do the work or else find another way to earn a living.

Institutional decisions about the kinds of work to be done and how such work is to be performed within a corporate culture can also have a strong impact on medical transcriptionists. The past decade has witnessed some very interesting hospital mergers in California. When Providence Hospital and Samuel Merritt Hospital -- located on Oakland’s “Pill Hill” -- merged to become Summit Medical Center, part of the merger agreement was that therapeutic abortions (which had been performed at Merritt but were not consistent with the Catholic legacy of Providence Hospital) would not be offered at Summit Medical Center.

I’ll admit to being perversely amused upon discovering that one of the surgeons performing therapeutic abortions whose career was affected by these mergers was a Filipina physician whose first name was “Purificacion.”

Several years later, a similar situation developed when Morgan Hill’s St. Louise Hospital merged with Gilroy’s South Valley Hospital to become St. Louise Regional Hospital. Once again, as part of the merger agreement, it was announced that family planning services would not be offered by the newly-formed institution. However, among the cultural issues brought to light by these hospital mergers was the fact that large communities of low income Hispanics and African Americans would have to look elsewhere for family planning services.

Luckily, California has a large network of low-income community health clinics that cater to such populations Whether patients ended up getting family planning services from community clinics or therapeutic abortions from sources such as Planned Parenthood, the medical transcriptionists servicing those healthcare institutions no longer had to worry about transcribing D&E reports.

By eliminating an entire category of medical procedures, these institutions may have saved some medical transcriptionists from confronting a moral dilemma. However, a new phenomenon has taken root in the past 15 years as a result of a cultural clash between two societal forces: the movement to embrace “diversity in the workplace” and increased proselytizing by Christian conservatives. A colleague recently approached me for advice about how to handle a particularly delicate situation.

As a home-based MT working for a large national transcription service, she had been through three supervisors in four months and complained that the situation was bordering on chaos. The second and third supervisors routinely put scriptural references in their company e-mail. One had even written an inspirational story about her granddaughter and God and balloons. “When I spoke to the new supervisor and mentioned that I could do without the scriptural references, she responded by saying “Well, I am a Christian."

“That's fine,” my friend replied, “but these messages are not appropriate in company e-mail.”

“And you find this offensive?” asked the supervisor.

“Yes, I do,” my friend replied. “Inappropriate is a better word. This is a business.”

“No one else objected,” countered the supervisor.

“That is not my concern,” insisted my friend. “This is not appropriate in company e-mail.”

“Well then, I will take you off the list so you do not receive them and I won't hold this against you that you mentioned it,” said the supervisor.

“Why should you hold it against me?” asked my friend. “That’s ridiculous.” My friend was absolutely stunned by what happened next.

“ The first thing this supervisor did was send me a glorious color photograph of her daughter in a tiara, gown and sash. Should I complain to the head of Human Resources and to her boss, the regional manager? What list am I on now? The non-Christian list? The anti-Christian list? Who the hell do these people think they are? The ACLU would love this electronic assault on the workers. This is not right. These people have no sense of professionalism.”

During the past quarter century American employers and employees have developed a heightened awareness of sexual harassment in the workplace. The situation outlined above is a textbook case of religious harassment in the workplace. What has happened here is that a professional medical transcriptionist has locked horns with a group of supervisors whose religious beliefs are dominating -- and perhaps terrorizing -- the work force. By using company e-mail to promote their religious beliefs, these supervisors (who no doubt feel they are acting with the purest of motives) have driven a wedge between employees and created a corporate culture wherein those who do not side with the bullies in power are doomed to second class status in the workplace. This form of intimidation in the workplace comes sugar-coated
with a new age Christian fervor. As long as it continues, the CEO of this company may have no knowledge – or may not wish to understand – that his company is leaving itself wide open to a class action discrimination lawsuit if enough medical transcriptionists can claim that their earnings were impacted simply because their religious beliefs differed from those of their supervisors.

What I see is a very ugly employment situation -- quite Orwellian in character -- wherein “all animals are created equal but some animals are more equal than others.” Those who accommodate this tyrannical form of intimidation by a religious minority are not just being unprofessional, they are failing to acknowledge and respect the rights of co-workers who do not subscribe to a particular set of religious beliefs. In a day and age when good professional medical transcriptionists are hard to find, this is the worst kind of managerial stupidity. The bottom line is that the business of religion has absolutely no business forcing itself upon the business of health information management.

None whatsoever.

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