Thanks, But No Thanks

In his 1999 State of the Union address to the United States Congress, President Clinton stressed the importance of protecting the confidentiality of every American’s medical records. That’s pretty hard to do once the data leaves the protection of the American legal system. And yet, in the past year, the onslaught of solicitations from offshore transcription vendors has become so obnoxious that MTs and medical transcription service owners are angrily ignoring many of these invitations. The steady barrage of faxes, e-mail messages and phone calls from offshore vendors wanting a piece of the American transcription market has grown from an occasional inquiry to a form of professional stalking by businessmen from India and other Third World nations.

In the beginning, many MTs tried to be gracious and offer advice where appropriate. What has continued to offend many MTs is that the messages they receive are so poorly written and filled with grammatical errors. If American MTs tried to turn in work like that, they would quickly be out of a job. Yet foreign entrepreneurs expect such messages to inspire hospital administrators and medical transcription service owners to “partner” with their offshore transcription firms. Boasting about the number of doctors they have on staff for purposes of proofreading and quality assurance, these Third World entrepreneurs are desperately trying to sell Americans on the “sizzle” of their concept. Unfortunately, these people (many of whose religious beliefs prevent them from eating beef) are contacting Americans -- who know very well how steak should taste.

As a business owner, I’m not just concerned with my company’s profit margins. Due to the peculiar nature of the service I offer, I have to be especially concerned with quality control. Delivering substandard schlock in the selfish hope that doing so will increase my profit margins is a classic case of cutting off my nose to spite my face. If the quality of the work delivered to my clients drops precipitously, I can quickly lose those clients. And if I have to invest more time “putting out fires” with unhappy clients, I am being penny wise and extremely pound foolish.

Technology has leveled the playing field so that anyone with sufficient venture capital can buy the computing strength necessary to perform certain tasks. So let’s not beat around the bush anymore. Offshore investors are scouring America’s health information management industry in search of jobs and profits. The aggressiveness with which many Indian and Pakistani businessmen are attacking this market is appalling to America’s professional medical transcriptionists -- who have no desire to lose their jobs. In many situations, the arrogance of the sales spiel is unbearable and the methodology particularly insulting to MTs.

One colleague described an incident in which an Indian businessman showed up -- unannounced -- at her place of employment late one afternoon and asked to meet with her. After instructing the receptionist that she would have nothing to do with this person, my friend walked through the company’s lobby on her way to the parking lot and noticed that the Indian businessman had cornered the attention of another employee (who remained a captive audience for several hours).

The modus operandi is simple: Corner someone and pump them for every bit of information possible. Keep hammering away at any potential account until they lose resistance.

That approach is quickly losing its luster.

Last year, I received a call from the Indian Embassy asking if I could tell them all about the medical transcription industry in America. As soon as I informed them of my hourly consulting fees, the phone call was abruptly terminated. Others have been courted by Indian businessmen who are extremely eager to have Americans accompany them on sales calls (with no intention of compensating them for their time, effort, or any thoughts to giving the American consultant a percentage of the take).

Whether or not these people reinforce the worst stereotypes about doing business with Third World nations, the bottom line is very simple. Just because someone wants something you have, there’s no rule that says you have to give it to them. Especially if doing so could bring harm to yourself, to your business, to your clients or to your profession.

You can say no. You can also learn from history.

According to Greek mythology, Pandora was bestowed upon humankind as a punishment for Prometheus's theft of fire from the gods. As the first woman on earth, Pandora was entrusted with a beautifully-crafted box that contained all the ills that could plague people. She was carefully warned that once she opened it, she would never be able to replace its contents in the box. But when her curiosity got the best of her, Pandora proceeded to open the box (thus releasing all the evils of human life). Things have never been the same.

History repeats itself.

In 1853, under orders from President Millard Fillmore, Commodore Matthew Perry dropped anchor off the cost of Uraga and demanded that Japan enter into trade agreements with the United States. Because Japan had been isolated from the rest of the world for 250 years, Commodore Perry was confronted with an island culture that saw no reason to cooperate with his wishes. Eventually, Western influences (and the effects of the Industrial Revolution) began to corrupt the purity of Japanese society. The Japanese finally decided that the best defense was to “beat the foreign barbarians at their own game.”

They went about it with a vengeance. Thirty years ago, sushi bars were hard to find in most American cities. But Japan’s economy was on a roll. Products from Toyota, Sony, Matsushita and others were steadily entering the American household. The influx of cheap products “Made in Japan” became so overwhelming that American automobile manufacturers faced a severe crisis.

In January 1976, when Stephen Sondheim’s "Pacific Overtures" premiered on Broadway, the production tried to incorporate elements of Japan’s famed Kabuki, Bunraku and Noh theater traditions. The transition to the final scene was -- and is still -- so blunt that it never fails to confuse and shock audiences. Instead of traditional Japanese characters dressed in kimonos, the cast is suddenly seen in modern dress as Japan aggressively pushes its products overseas while embracing American-style mass marketing of such familiar logos as Coca-Cola and Macdonalds.

The pendulum, of course, can swing the other way. In the past decade, major public relations efforts aimed at convincing Americans to buy cars “Made in America” have helped to revive Detroit’s auto industry. The marketing campaign used by the manufacturers of Saturn vehicles stands as a shining success. And today, many Americans are surprised to hear themselves strongly advocating certain kinds of isolationist policies.

Earlier this year, when a cruise ship attempted to land its passengers at a tiny outpost in Alaska, the townspeople locked their doors and refused to cooperate. Despite management’s promises of taking passengers to one of those “unspoiled destinations,” the natives turned their backs on such efforts, making it patently clear that the cruise ship should leave with the next tide and never come back.

More recently, a subscriber posted a message on the Internet’s KAMT-LIST mailing list which stated “I am planning to start Medical Transcription Services in India. If somebody has done a project report on the same, kindly send it to me. Any suggestions on starting such services are welcome.”

The intensity of one reply startled some of the subscribers to the list. “Oh for Chrissakes, do your own frigging research,” stated a veteran MT. “There are already hundreds of companies like the one that you want to start over there and if you think that American MTs are going to give you any advice to do just that, you are sadly mistaken and barking up the wrong country.”

If refusals to cooperate with offshore transcription firms have become blatantly hostile, it is because America’s medical transcriptionists are turning into sadder but wiser business people. As a professional community, they are becoming more bitter and more cynical with good reason. Thanks to managed care, they have seen MBAs (who have no concept of what transcription involves) force them to work harder to make less money. They’ve sampled the potential of opening Pandora’s box and have a pretty good idea of what might happen if they cooperate with offshore transcription vendors.

It’s not just that these people are afraid of losing their jobs. They’re also afraid of compromising the quality of patient care that they struggle to maintain with their unique contribution to the documentation of medical care. These people understand that when you dance with the devil, you don’t just get burned. As a result, my company has posted a strict policy on its website against sending transcription overseas where my clients -- and their patients -- are not protected by American law.

In case you’re wondering what inspired this article, let me tell you about a particularly hair-raising moment online. One night, as I was reading my e-mail (which included a solicitation from yet another transcription firm in India), an AOL Instant Message from a complete stranger flashed across the screen.

“Are you interested in a 15-year-old?” it read.

Had I been foolish enough to offer a flippant response, I might have inquired if the 15-year-old came with fries. Or if it could play a mean game of Scrabble. But with all the publicity about police entrapment on the Internet, I knew enough not to even think about responding to such a query.

Considering the risks associated with sending transcription beyond the constraints of America’s legal system, I strongly recommend a similar display of restraint if and when you receive requests to partner with offshore transcription vendors.

Don’t ask.

Don’t tell.

Do not pass “Go.”

Do not collect $200.

Do not engage in any dialogue whatsoever with these people.

Unless you’re planning to change your name to Pandora.