Friday, September 28, 2007

What's In A Name?

A favorite cartoon shows a physician’s tombstone with the epitaph “He never spelled the patient’s name.” Many transcriptionists have experienced the nightmare of listening to a doctor dictate “This is a report on John Kryzmanowski. That’s J-O-H-N.”

Have you ever listened to a Russian physician with an accent thicker than mud dictate that “The patient is having trouble pronouncing names.” Or a Chinese doctor try to pronounce and spell a Russian patient’s name? What about the Chinese physician who dictates a letter to Dr. Tse but refers to him as “Dr. Cho”?

Amusing is not the word that comes to mind.

Late one night, about a year after I had entered the field of medical transcription, I found myself pacing back and forth in the medical records department of a local hospital. A word was bothering me (a phenomenon well known to medical transcriptionists). What bothered me about this word was that I could not find it in a medical dictionary. Or any other available medical reference book, for that matter. I knew I had heard that word before. I was almost sure I had typed it that week. But for the life of me, I couldn’t remember what it meant. And I was mad at myself for not being able to remember.

There wasn’t much help at hand. By that time, only the swing shift crew was present in our department. Ken, a very polite African American file clerk, didn’t mind when people “axed him questions,” but didn’t have too many answers. Lillian was an elderly transcriptionist who was legally blind and smoked like a house on fire. Caroline was the image of an aging cheerleader who was rumored to be screwing one of the OBGYN surgeons. And Maryann, bless her soul, was a prim and proper librarian type (a superb transcriptionist who worked a second job to pay for her mother’s medical bills) who pretty much minded her own business. I couldn’t get any answers from them.

The word that was driving me nuts was “Ochoa.” But it wasn’t until two weeks went by -- and another patient named Ochoa got admitted to the hospital -- that I realized I had been obsessing over a patient’s name rather than an item of medical terminology.

That was back in 1974. Although the hospital where I worked had a large number of Filipino and Hispanic employees, it had never dawned on me that Ochoa might have been a patient’s name. I never would have guessed that my answer could have been found in a telephone directory because I was only thinking in terms of medical and pharmaceutical terminology.

Doctors often like to think that, without their godly presence, people like medical transcriptionists wouldn’t have jobs. But the truth is that without patients there would be no practice of medicine, no health information management industry, and a major dent in the world’s economy. Since 2000 is a census year, it’s important to understand how changes in America’s demographics affect the knowledge base of a professional medical transcriptionist.

When I was a child, it was a pretty fair assumption that the doctor who treated you would be a Caucasian male. It has taken many years for the demographics of physicians and medical transcriptionists to catch up with the demographics of the population at large. But the times, they are a-changing! A sure indicator of the altered face of medical care in America is to examine the names of the patients who are being treated and the healthcare providers to whom they turn for their care.

Most medical transcriptionists wouldn’t be expected to know the names of the Native Americans who welcomed the first wave of immigrants. Some patients are indeed named Pocahontas and Hiawatha. Many towns in New England (Matunuck, Pawtucket, Narragansett, Chepachet), were named after local Indian tribes. Street signs and business names in the American Southwest often include tribal names like Pima, Osage and Navajo. But few transcription courses offer clear instructions on the proper hyphenation of a patient’s name when that name is “Benjamin Brings-Plenty.” I doubt there are any medical transcription courses which teach that a contaminated quahog could be a source of food poisoning. Yet these words are part of the language which forms our American heritage.

Recent years have seen huge numbers of immigrants arriving in the United States to seek a better life. Whether they came from Europe, Mexico, Central America, or countries along the Pacific Rim, these people have had a tremendous impact on America’s healthcare services. Be honest: Until the Elian Gonzalez story hit the news, how many women named Marisleysis were a part of your daily life?

Whether recent immigrants have been Haitian boat people attempting to enter the country illegally or relatives being brought to the United States by naturalized Filipino-American citizens -- whether they were newly-free Russians or families that fled Hong Kong before it came under Communist rule -- they all brought their past medical histories, healthcare needs, and ethnic vocabularies with them. Some have created a need for physicians who speak a foreign dialect. Others have created a growing market for interpreters.

Many cities now have large ethnic populations. And, for many minorities, the desire to keep the money flowing “within the community” is matched by a distrust of people from other backgrounds. For these reasons, a Hispanic physician is likely to attract a Latino-identified patient base the same way that a black physician might attract a largely African-American patient base.

However, searching a database for a patient named “Chan” in San Francisco, “Hernandez” in Los Angeles, or “Schwartz” in New York might reveal hundreds of patients with the same last name. A medical record number may be the only way of finding the correct “Carlos Hernandez,” “John Chan,” or “Paul Schwartz.” Other, more subtle variations, must also be recognized. In many ways these reflect the language of a subculture and, to a certain extent, the musical rhythms with which that language is spoken.

  • Is the proper spelling of a patient’s last name Gonzalez or Gonzales? Does that change in spelling indicate a different heritage or country of birth?

  • Should a Hispanic woman’s first name be spelled Ofelia or be spelled the same way as Shakespeare’s Ophelia?

  • Should another patient’s name be spelled Mohammed? Muhammed? Or Mohamet?

The further one delves into the spelling of family names within ethnic subcultures, the more difficult it is to be sure that a medical record is referring to the proper person. Especially when doctors continue to dictate names without spelling them.

For example: San Francisco has a huge Asian population. With an increasingly large number of Asian patients in many cities, it is often difficult to identify which word represents the patient's first, middle, or last name. Names like Boon Hang Ling or Fang Nguyen can easily be transposed to read Ling Hang Boon or Nguyen Fang. Once again, a medical record number serves as a crucial identifying marker.

The term “Asian,” however, is no longer restricted to people from China and Japan. It also encompasses the Korean, Thai, Burmese, Vietnamese, Cambodian and Filipino subcultures. Under this huge umbrella of nationalities stand endless numbers of patients whose names sound alike but may be spelled very differently.

  • Is the patient’s last name Wu or Woo?

  • Li or Lee?

  • Low, Lo or Lowe?

  • Young, Yang or Yong?

  • Chen, Chan, Tsang or Tsiang?

  • Leung, Leong or Liang?

What about the Chinese physician who pronounce things very differently than a transcriptionist might expect? Suppose he is dictating a letter to a physician named Dr. Kwok? Could he really mean to dictate a letter to Dr. Quock (whose office is in the same building as Dr. Kwok’s)? What about the physician who sends referral letters to both colleagues but pronounces their names “Dr. Kwa”? Or refers to Dr. Hsu as Dr. Shoe? How is speech recognition going to make these distinctions when the medical transcriptionists who are familiar with this doctor’s work can barely figure out what he is trying to say? Should we be demanding equal rights for homophones?

There can be no doubt that the medical transcriptionist who works on an account with a high percentage of patients and physicians from any ethnic background must tune his ears to the finer shadings of words which will never be found in medical reference books. These words reflect the community served by the hospital as well as the subset of physicians from the same ethnic background.

However, there are times when not even a knowledge of a community’s ethnography can prepare a medical transcriptionist for coping with the kind of name recognition that accompanies fundraising for nonprofit organizations. In certain healthcare facilities there are rooms, wards, and entire wings that have been named in honor of philanthropic donors. Building-specific names like the “Krietzler Ward,” “Magrob Unit,” or “DeSantis Wing” would never be found in medical reference books. How does an MT properly enter “The Artist Formerly Known as Prince” into an electronic field limited to a specific number of digits?

The Hippie era witnessed the birth of children with names like Unicorn, Atom and Chastity. We now have performers who have adopted single-word names like Cher, Carrottop and visual artists named Stephan and Pumpkin. A transcriptionist in the Midwest once told me of a new (and rather illiterate) mother who, when presented with birth certificates that read “Twin A” and “Twin B,” was utterly relieved and profusely thanked the confused hospital staff for saving her from having to decide what to name her children.

The piece de resistance, however, is a story once told to me by a woman who transcribed for a hospital near Detroit. “One family was extremely well known to the medical records staff because we could never figure out how or why the mother gave her children their names,” my friend chuckled. “Her kids were named Park, Drive, Second and Neutral. My theory has always been that each child was named after the gear the car was in at the moment of conception!”

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