Why Should I Make A Donation?

Let’s not kid ourselves. Textbooks cost money.

In recent years, rising costs of paper, ink, and delivery have narrowed – if not totally destroyed – the profit margin on books which fail to become bestsellers. The amount of time and energy needed to get a book into the hands of its readers means that many works become obsolete by their date of publication.

That all changes with electronic publishing. Not only can bloggers retain complete artistic control over their intellectual product, bloggers quickly bypass some of the traditional obstacles encountered when publishing a text in hard copy:


Cost considerations:

• Bloggers are not held hostage by variations in the prices of ink, postage, and/or paper.

• Bloggers don’t need to worry about physical restrictions imposed by page size, book size, shipping weight and/or availability of shelf space.

• Bloggers face no extra cost to add color to their presentations.

• Bloggers don’t need to worry about the high price of binding a book – or publishing a book whose binding eventually falls apart.

• Bloggers don’t need to budget for a sales/marketing campaign or particular size of print run.

• Bloggers don’t need to pay the costs of warehousing inventory which might end up being remaindered.
  

Strategic risks:

• Bloggers don’t need to compete against other titles in a publishing house's line of books.

• Bloggers don’t need to negotiate with publishers through agents.

• Bloggers don’t need to battle ridiculously outdated publishing concepts such as claims that "You can't have a murder mystery that's more than 225 pages....."
  

On the flip side, however, are the creative advantages:

• Bloggers can update their work at any time.

• By taking advantage of the hypertext links, bloggers can insert value-added reference links to intellectual content which is available to anyone on the Internet without any violation of copyright law.

• Bloggers can get direct feedback from their readers.
  

One of my favorite quotes comes from the final scene of Hello, Dolly! at the moment when most of the principal characters have gone upstairs to get their money out of Horace’s safe. Left alone in Vandergelder’s Hay & Feed Store, Dolly Levi lovingly wraps her arms around the cash register, turns to the audience, and utters Thornton Wilder’s famous words:

“Money, money, money, money, money -- it’s like the sun we walk under -- it can kill and it can cure. Horace Vandergelder never tires of saying that 99% of the people in this world are fools and, in a way, I suppose he’s right. We’re all fools. Himself, Irene, Cornelius, myself. We’re all fools – and we’re all in grave danger of destroying the world in our folly. Yet the surest way to keep us safe from harm is to give us those few things in life which will make us happy – and that takes a little bit of money!

“Now, the difference between a little bit of money and no money at all is enormous – and it can shatter the world. And the difference between a little bit of money and an enormous amount of money is very slight. But that, too, can shatter the world. It’s all a question of how it’s used. As my late husband, Ephraim Levi, always used to say: Money -- you should pardon the expression -- is a little like manure. It doesn’t do anyone a bit of good unless it’s spread all around, encouraging young things to grow.”

A lot of hard work went into creating Dictation Therapy For Doctors. If this blog has been of value to you and you would like to make a donation to its author, please feel free to use one of the following options (the amount you donate is entirely your choice).


Online: You can make a donation via PayPal, credit card, or e-check, by clicking on the link in the right-hand column of your screen.

Snail Mail: You can send a donation via check or money order to the following address:

George Heymont
584 Castro Street, #275
San Francisco, California 94114

Please make checks payable to "George Heymont."

Thank you for supporting and spreading the word about

Dictation Therapy For Doctors.

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Consciousness Raising Exercise #39

Recent studies have exposed how the extreme levels of stress placed on medical students during the long hours they must work while in training to become physicians have made sleep deprivation an occupational hazard. Most of us have experienced what it feels like to fall asleep while watching television or reading a book. However, the threat of increased somnolence at work can cause a major problem with medical documentation.

Unfortunately, many doctors and medical students are great procrastinators when it comes to dictating reports and correspondence. By the time they actually sit down to dictate, some can barely keep their eyes open. I personally have listened to doctors start snoring while in the middle of a report, followed by a grunt and a confused dictator mumbling, “Huh? Where was I?”

During such moments, focus and memory are hardly in peak form. As a result, it is all too easy to make a mistake that will subsequently metastasize throughout a patient’s medical record.

Falling asleep at your desk is such a minor and embarrassing event that most people just laugh it off. However, when you see someone with an active case of narcolepsy, you get a very different view of the dangers involved.

A friend of mine who is normally quite healthy, athletic, and fit suffers from a peculiar form of narcolepsy in which his nervous system seems to suddenly need rebooting. Thankfully, he now has a devoted service dog who keeps a close eye for symptoms of a crash. But he will happily recite the story of how he once fell asleep at the wheel and was lucky enough to wake up in time to avoid a motor vehicle accident.

It all sounds quite theatrical and fantastic until you see it happen right in front of your eyes. Once, while we were on an Alaskan cruise, I witnessed such an event. We had just started looking at our menus when Richard’s head collided with his dinner setting. His three cruise companions looked up from their menus to see him slumped over the table, out cold. For a minute we weren’t sure what to do, as we were all aware of his attacks but had never really witnessed one. Just as we were about to call for medical help, Richard sat bolt upright and asked “Okay, what are we going to eat?”

Anyone who has earned a driver’s license should have learned to pull over to the side of the road when he is too tired to drive safely. In 150 words or more, explain why dictating medical reports when you are exhausted raises a risk management issue with regard to quality of patient care.

Reference Tools

The following titles may be of value to you as reference books or for purposes of entertainment.

Next: Recommended Viewing

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Creating A Documentation Assembly Line

Designing effective documents and learning how to produce them in an assembly-like pattern (so that they end up looking like customized letters and reports), involves a similar process to the one used by the chef who creates customized omelets for a Sunday hotel brunch. The basic parts of the documents to be created should be engineered in advance so that you can assemble data in a modular style and then add in the frills and embellishments necessary to customize each report you dictate.

The key to success is learning how to organize your thoughts. Most physicians are forced to dictate when they are tired, rushed, or stressed out. As a result, they find it difficult to concentrate while dictating.

Frequently, physicians will dial into a digital dictation system and then hang on the line while they try to find the information they are looking for. Often they will skip back and forth through a patient's chart while looking for pertinent details (and making no sense whatsoever).

You would be shocked to discover how many doctors, after dictating thousands of reports, still cannot think on their feet. Listening to them fumble through the same report they must dictate day after day is embarrassing.

When dictating, you must always remember that the person receiving information from you is only getting aural input. Although that person can see what is on the computer screen in front of him, he cannot read your mind. As a result, you have to act like a seeing-eye dog for the transcriptionist by delivering the proper vocal cues each and every time you transmit information.

Next: Practice Makes Perfect

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Acoustical Considerations

Think, for a minute, about how most people react to the sound of chalk scraping on a blackboard. Then try to imagine what that sounds like if amplified and delivered directly to your eardrums through a highly-sensitized microphone. With that image in mind, try to imagine how medical transcriptionists react to the following sounds, which are routinely heard when transcribing reports:

• The physician who speaks with a whistling "S."
  
  
• The physician who coughs directly into the telephone.
  
  
• The physician who loudly sneezes into the telephone.
  
  
• The physician whose beeper goes off next to the phone as he is dictating.
  
  
• The physician who is very tired and keeps yawning while trying to speak.
  
  
• The physician who only dictates when he is drunk and his speech is slurred.
  
  

A simple rule of thumb:

If you would have second thoughts about doing any of these things while talking on the phone with your mother, do not do them when dictating medical reports.

While digital dictation systems have gone a long way toward improving the quality of recorded sound, they cannot always filter out extraneous sound from the area in which a physician is dictating. Because such sounds are part of a familiar environment, the dictating physician may automatically tune them out of his mind. Nonetheless, they are being recorded with stunning accuracy by the digital dictation system into which he is dictating.

"I had a doc once who dictated on a handheld mini tape. May God strike me dead if I'm lying -- he actually took the tape into the bathroom with him and kept dictating while he did his thing," recalls one transcriptionist. "Thereafter, I could never look at him when he came into the office. I would sneak off to the lounge to giggle uncontrollably. I mean, I just never wanted to know the guy quite that well."

Next: Sound Distortion From Peripheral Noise

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Rave Review from "For The Record Magazine"

In his new electronic "textbook," Dictation Therapy for Doctors, George Heymont has a bone to pick, and he's not bashful about picking it publicly. Taking aim against what many consider an unassailable target, he fires off an audacious salvo: doctors are frequently "language-impaired," and they must be made accountable for the mistakes they make in medical documentation. It's not an original thought -- no doubt it's traceable to the advent of the tape recorder -- still few have dared to state it outright.

As a veteran journalist who's written for publications ranging from GQ to American Medical News, from Opera Monthly to the Journal of the American Association for Medical Transcription, Heymont has a clear love of language and a respect for its power. As a medical transcriptionist (MT), he's witnessed the misuse of language in medical documentation and laments the fact that a transcriptionist's product "is totally dependent on the quality of dictation which reaches his ears."

Heymont tallies the enormous, yet often unacknowledged, cost of such dictating sins as mumbling, misspellings, misplaced modifiers, and malapropisms, and illustrates the consequences of these errors -- consequences that affect not only healthcare organizations and their patients, but also the physicians who make these mistakes and the professional medical transcriptionists who must make sense of them.

But Dictation Therapy for Doctors is no mere diatribe against the dictation-challenged. Heymont, cofounder of Alert & Oriented Medical Transcription Services, creator of the Internet's KAMT-LIST (Keeping Abreast of Medical Transcription) mailing list for MTs, and past president of the Golden Gate Chapter of the American Association for Medical Transcription (GGC-AAMT), doesn't simply diagnose the dictation disorders suffered by doctors. He offers treatment as well -- "preventive medicine" for dictating doctors. First, Heymont clearly explains the role of the medical transcriptionist in documentation and the MT's place in the healthcare organization's hierarchy. He offers doctors an understanding of the tools, techniques, and technology used by MTs, including digital dictation systems, word expanders, voice recognition technology, standard references, and word processing programs.

With both bite and humor, he illustrates the ways in which physicians create barriers to clear communication and discusses the ways in which they can prevent such obstacles. On the flip side, he offers MTs a road map to the common errors made by dictators and helps them avoid the pitfalls.

Heymont offers clear guidance on dictation techniques, addressing, for example, abbreviations, units of measure, standardized templates, enunciation, spelling, grammar, consistency, and special formatting.

Dictation Therapy for Doctors uses a hypertext system of inter-linked HTML files to provide a new form of continuing medical education -- an interactive teaching tool. The interactive format allows users to move in whatever fashion they wish between text, language skills worksheets, and consciousness raising exercises, or to sample the wry humor of Gerard Donelan's cartoons. The book also offers internal and external links to sources of additional information. Internal links take the user to files prepared specifically for Dictation Therapy for Doctors. External links offer side-trips to various home pages on the World Wide Web that offer resources for medical transcriptionists, general resources on healthcare, and sites concerning social issues that affect healthcare. Other external links may lead the readers to subjects as seemingly distant from medical records as politics, sex, drugs, and rock 'n roll. You may find links, for example, to information about Gilbert and Sullivan operettas or "The X-Files." Not standard fare for a transcription text, but navigating the twists and turns promises an unorthodox and interesting journey.

This dynamic teaching tool is not just remedial reading for doctors -- it's a must for anyone concerned with the integrity of the medical record, particularly medical records managers, transcription department managers, hospital administrators, and risk managers -- and anyone interested in improving communication between medical record personnel and physicians. It should be required reading as well for students, allied health professionals, nurses, physician assistants, and other members of the healthcare team. For medical transcriptionists, it's a primer on the profession and a tool to help them better decipher the "medical mush that emanates from the mouths of dictating physicians."

Kate Jackson, Editor
May 4, 1998 issue of For The Record Magazine

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