Friday, September 28, 2007

Whose Work Is This, Anyway?

When George Bernard Shaw wrote Pygmalion in 1913, he set out to prove that the proper or improper use of the English language could transform a flower girl into a duchess and, conversely, a duchess into a flower girl. A highly successful playwright who felt that his main purpose was to shock people out of conventional ways of thinking, Shaw described his stage works as unpleasant because "their dramatic power is used to force the spectator to face unpleasant facts."

Because language is not well respected in today's society, words get thrown around the medical profession in a very casual and careless manner. Even though they may be charged with creating a medical record, doctors are human beings. When they dictate, they speak the same language they use when off duty. What comes out of their mouths may not sound very professional. It often clashes with the romantic ideas some people have about how a physician should sound.

Because words and numbers form the currency of patient documentation, medical transcriptionists are acutely aware of how words and numbers are used -- and mis-used -- in the creation of medical records. We hear things that other members of the health information management industry do not. Part of our job is to clean up the mess created by a dictating physician before it gets into the medical record.

Why is “mess” the operative word here? Because medicine is a messy practice. Those who do billing, coding and manage charts keep their dainty hands free of bed pans, blood, boogers and bile. Their fingers rarely come in contact with vaginas, vomit, vulvas or varicose veins. As a result, it’s interesting to note their reactions when confronted with the sexual language and/or “curse words” that medical transcriptionists listen to day in and day out.

Although these words are spoken by most people on a casual basis, some feel that such language is inappropriate or unprofessional in a medical situation. They obviously haven’t listened to a surgeon throw a major temper tantrum. Or been on the floor when the clinical staff at a major cancer center voted “Mr. Stinky” as its favorite term for a particular patient’s feces.

It’s no big secret that our society is rooted in denial. Too many Americans rely on euphemisms as a way to avoid confronting difficult issues. That’s why I’m always amused that whenever someone objects to the use of sexual language in articles I’ve written about transcription (in this and other publications), the objection invariably comes from an ART rather than a medical transcriptionist.

I’m certainly not surprised. It’s easy to be a back-seat driver. But, as anyone with a driver’s license knows, things look and sound very different when you’re behind the steering wheel. Medical transcriptionists are used to hearing a doctor mumble “Oh, shit!” as he thumbs through a chart. We’ve even heard them say things like “Jesus Christ, where’s that goddamn lab report?”

The role of the medical transcriptionist is to interpret -- not to diagnose or sit in judgment. Thus, when a physician uses words like “Mom” and “Dad” instead of “Mother” and “Father,” we type what the physician said. When a doctor working at a clinic which services a low-income population dictates “The patient is having trouble peeing,” it is not the editorial prerogative of the transcriptionist to change what the doctor said so that it will fall gently on the ears of others.

There are even times when crude language must be included in a medical record. The doctor who dictates “The patient then became extremely abusive to the staff -- telling this physician that he could personally go fuck himself -- and was eventually escorted from the area by the security guard,” may be using such language in his dictated report for his own legal protection.

With so much violence in our daily lives, it should come as no surprise that the violent language which accompanies so many violent acts has become a part of our society’s cultural landscape. As the language of our culture changes it is reflected in every form of media we encounter.

  • A poster from the popular cartoon South Park has the caption “Please excuse me, I have explosive diarrhea.”

  • Tune into the Ricki Lake or Jerry Springer show and you’ll notice a steady stream of invective that has been bleeped out of the broadcast.

  • Shock jock” Howard Stern has become an idol to millions who listen to his radio show.

  • Filmmaker Todd Solendz (Welcome to The Dollhouse, Happiness) refers to 1998's Hollywood film crop as “the year of the semen shot.”

  • Last year, Americans watched media icons like Dan Rather and Barbara Walters fumble for words as they were forced to discuss oral sex before the camera.

Some words offend people by conjuring up frightening thoughts. But they are merely words. Their power over the reader is only as great as the reader’s deepest fears and darkest secrets. If a physician can feel comfortable sticking his hand inside a patient's rib cage and holding a person's beating heart between his fingers, then words should never threaten him.

However, if the power of language rattles someone’s nerves so severely that s/he cannot manage to use words properly, then that person has no business dictating or transcribing medical reports. Blunt and crude language comes with the territory. Listening to that language is part of our work.

If the sight of blood makes you squeamish, you probably shouldn’t become a doctor. If you don’t like snakes, you’d be well advised to avoid a career in zoology.

My message to the ARTs who are affronted by the use of language they consider to be inappropriate or unprofessional is simple. One of the best ways to understand someone else’s work process is to spend some time doing it. Or, as the popular saying goes, walk a hundred miles in their shoes.

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