Friday, September 28, 2007

Word Games

Are people attracted to medical transcription simply because they like working with words? As I type this thought, I feel like Sex and the City’s Carrie Bradshaw as she tries to wrap a column around an idea that has popped into her brain. But when I stop to think about the kinds of people who become my friends, I realize that most are facile communicators – people who use language well and enjoy doing crossword puzzles. People who love to solve the “Jumbles,” folks who crave a good game of Scrabble. People who like to press the “scramble” button in their minds to see what other words could possibly make their writing stronger, their criticism sharper, their wit keener, or their game quicker.

In short, people who like to have fun with words. The kinds of folk who would be intrigued by a game of 52-Pickup that used words instead of playing cards. The nerdy-wordy types who relish a good pun. As an example, one of my friends likes to take a common word and see how deliciously it can be bastardized by combining it with inappropriate prefixes and suffixes. This party game produces catchy new terms like procrastinaceous,victorimonious,” and "snortalicious .” Paronomastics who would like to subscribe to Stan Kegel’s “Puns of the Day” users group should point their browsers to Puns-of-the-day Readers who get a kick out of Internet word sites might want to check out and

In recent months, the comedy writers at The Daily Show With Jon Stewart have had great fun creating skits in which reporters murder the English language with even greater clumsiness than President George W. Bush by wildly inventing meaningless words with a self importance that few dictating doctors could ever hope to match. An equally ferocious attack on the English vocabulary runs rampant throughout Word Freak, a fascinating expose of the world of competitive Scrabble players as told by sports writer Stefan Fatsis.

As he relates the history of Scrabble’s creation, Fatsis provides the reader with stunning portraits of some of the game’s most successful – and dysfunctional – players. Two skills quickly emerge as critical to anyone aspiring to play championship Scrabble. First is the ability to memorize valuable words -- whether they be two-letter, three-letter, or the highly-prized seven-letter “bingo” words. Second is the ability to quickly solve anagrams in order to find as many permutations as possible resting within a rack of tiles.

Fatsis is quick to point out that, despite having memorized thousands of words, many English and American players do not know the meanings of the very words they have memorized. Competition players from foreign countries are sometimes barely able to converse in English and yet, according to Romanian player Laurentiu Sandu, “You don’t have to know how to speak.”

As a rule, medical transcriptionists rely on the prefix-root-suffix theory of building words. But when a new medication hits the market, their professional curiosity may extend far beyond what the drug can do. Like a good wine, a new drug name should be savored; its sound rolled around on the tongue to see how it fits into the lexicon of other pharmaceuticals. Once the initial sampling has transpired, a medical transcriptionist can then begin to explore how the new name relates to other words found in medical terminology.

But, as the King of Siam exclaims in a favorite Rodgers & Hammerstein musical, “Is a puzzlement!” On one end of the spectrum are the MTs who have gone through years of formal training and continuing education in order to excel at their work. On the other end are today’s speech recognition engines which, having built databases of medical words, are now attempting to outperform the formally-educated MTs. Caught between the two extremes is a much larger population of medical transcriptionists who have learned a great deal of terminology on the job. Some of these medical language specialists have learned how to spell many words without taking the time to learn what they mean or how they relate to other medical terminology. One MT used to sign Internet posts “I may not be a doctor, but I sure can talk like one.”

Although such MTs may horrify the purists, by and large they are working very well with the support of medical spell checkers, word expanders, macros, and other productivity tools designed to help them pump out a larger volume of work. Often, their strongest point is knowing when they need to look something up -- or their ability to try to find the word a dictator is actually trying to say in order to ensure that the correct term is used in its proper context.

Much as the marketers of speech recognition technology would like us to believe their hype, such word skills are not necessarily built into speech recognition engines. During MTIA’s most recent technology seminar, I watched a demonstration of Dictaphone’s latest speech recognition engine, which is designed for use as back-end support which can handle dictation from any telephone. This time, I wasn’t the only skeptic in the crowd. The fact that Dictaphone’s new technology can recognize and eliminate such stuttering utterances as “ums,” “ers,”andarghs” from a stream of dictation does indeed lead to a more cleanly spaced flow of words. However, this latest edition does nothing to account for the numerous times doctors contradict themselves within one report. Nor should the fact that barely 50-60% of dictating doctors qualify as likely users of this technology inspire great confidence in MTSOs.

Understanding how our minds work – and how words become a key factor in building relationships – is the theme of David Weinberger’s fascinating new book, Small Pieces Loosely Joined – A Unified Theory of The Web. In his book (which I cannot recommend highly enough), Weinberger explains how words form the glue between thoughts that build a connectivity across the Internet in ways that defy all of our previous models for communication. Using easily recognizable samples of Internet-based behavior, he explains how the business world has completely misconstrued the potential of the Internet largely because it has failed to understand how the web allows humans to interact with each other.

How we respond to each other’s thoughts – in real or perceived time frames – is rapidly changing the way we work and function as a species. Unfortunately, word skills and ntelligence are not for everyone. Ron Ritchhart, a research associate with the Harvard Graduate School of Education's ProjectZero, claims that intelligence is not ability centered, but is instead built around a set of dispositions. In his new book, Intellectual Character: What It Is, Why It Matters, and How to Get It, Ritchhart (who received the 1993 Presidential Award for Excellence in Teaching Mathematics) identifies the six traits that people need for intelligence as follows: “They must be curious, open-minded, reflective, strategic, skeptical, and willing to search for truth and understanding.”

Ritchhart’s theory came to mind when I attended a recent performance by a brilliant monologuist named Reno. Rebel without A Pause covers a lot of political and social territory as Reno describes what it was like to live near the st1:place>World Trade Center (in what she now calls “TriBeCaStan”) and how the events of 9/11 have changed her perspective on life. A tough New Yorker with attention deficit disorder whose jaw-dropping political rants can rattle anyone’s cage, Reno doesn’t pull any punches when skewering Creationism or exposing political hypocrisy. A performer who thrives in dangerous territory, Reno doesn’t hesitate to explain why, if you are the most powerful man in the world, it is important to know the difference between words like “democracy” and “demagoguery.”

My reason for directing readers of this column to Reno’s website at (where you can hear samples of her rants) is not because of her politics, her art, or the fact that Lily Tomlin is one of her biggest fans. It is because, as part of her act, Reno stresses that words really do matter. And that, when used inappropriately, words can have disastrous repercussions. With a fierce determination that quality assurance workers in the medical transcription industry could never hope to match, this woman battles to build an audience’s awareness of the importance of using words in their proper context. We need more people like Reno defending the proper use of the English language.

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