Dictation guidelines: How to for new docs

[TalkDocs]

I've always wanted a place to tell doctors how to properly dictate - and here I find you! Pay attention or you'll be... dictating... for... speech... recognition... so.... you .... can.... save... money.... (or watching a computer screen instead of your patient as you point and click your way through an EMR - but hey, what's a little of your time worth? It only takes 2x longer than dictation).

When dictating...

Never ever learn how to use the "pause" button of any recording device. In spite of the fact that transcriptionists get paid by the characters that show up on the finished document - and not the dictated minute - they won't mind a bit as you talk to your co-workers, the patient, the pizza delivery boy, answer the phone, cough, sneeze and/or yawn. If possible, make sure some of the conversation includes at least one reference to the stupid person who types up your reports and how many mistakes they make.

You will earn brownie points for asking the person next to you how to use the "pause" feature. You will not earn brownie points if you take their advice: "I don't know - I never use it."

When using a portable device, it's perfectly acceptable to go to the bathroom or have sex without turning the recorder off or - amazingly - stopping your dictation. After all, we SHOULD be able to figure out that the "oh baby," "don't stop," and "I'm coming" aren't part of the patient record.

Make sure if you have a patient whose name is "Smith" or "Jones" that you spell it. These are difficult names that are often misspelled. Likewise, there's no need to spell the name of the referring physician who lives 150 miles away and whose name sound like "Rotisserian or something like that," especially if you have the chart in front of you.

If the patient tells you they take "peanutbutterballs," there's no need for you to clarify with them further. By all means, dictate "peanutbutterballs" as a current medication - we'll have no trouble figuring out what the patient means, even if you can't.

Never stop dictating when you're yawning. You'll save yourself a good 10 seconds and get home much faster.

Absolutely, your grammar, punctuation and spelling are far superior because you have more diplomas than I have, but I will draw the line at deliberately misspelling words just so you can always be right.

You should know that if you take pride in how fast you can talk when you dictate, somewhere there are transcriptionists wondering if this pride extends to how fast you can finish the sex act.

You're working at a 600-bed facility that generates enough dictation to keep 100 people busy (and that's only if it's not sent to India, in which case there are 300 people being kept busy). Assume the same person will always transcribe your dictation, so don't worry if you rush through your "usual" review of systems, past medical history, and exam - they've heard it before and will know exactly what you mean.

Mumble, stumble and bumble your way through a dictation. Take 15 minutes to say what could have and should have been said in 5, then tell a couple jokes - everyone will laugh. Really.

If the ambient noise level is loud, don't tell anyone to quiet down and never, ever move to a quieter area. Either talk louder and hope you can be heard above the noise, or cup your hand around the mouthpiece and whisper.

Cell phones are great inventions if you can't get a handheld recorder. Don't forget to keep right on dictating even when you notice you've lost signal through the tunnel and around the airport. Make sure you complain about the number of blanks left by the stupid transcriptionist.

Three pages is NOT a "brief history of present illness."

There's a nasty habit in transcription known as "cherry picking." That's when the worst dictators are passed over on purpose because nobody wants their production pay impacted by the worst dictators. If you ever find you're one of the dictators being passed over by the cherry pickers, make sure you have a friend with you when you go out to the parking lot.

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[biohazardgirl]

You made some really good points!
Here is another tip that I learned when I first started dictating as a pathologists' assistant: when describing a wound filled with pus, do NOT use the word *****. Use the word purulent instead. The transcriptionists, or the pathologist doing the diagnostic, never let me live that one down!

 

[Scrub MD]

Thats funny

 

[t33sg1rl]

To the OP:
I understand that many doctors use medical transcriptionists, but I always assumed that these were older doctors who couldn't find a computer with a map and a flashlight. As a first year medical student, I can type faster than I can speak and I hope to be able to spell many things three years from now-right now I can't imagine that I would ever want or need to use dictation. Is it something that I can expect to encounter?

 

[TalkDocs]

To the OP:
I understand that many doctors use medical transcriptionists, but I always assumed that these were older doctors who couldn't find a computer with a map and a flashlight. As a first year medical student, I can type faster than I can speak and I hope to be able to spell many things three years from now-right now I can't imagine that I would ever want or need to use dictation. Is it something that I can expect to encounter?

When you're sitting in front of the computer, typing your own records, calculate how many patients you could be seeing while you're doing that.

When you type your own notes, you are bound to a computer, whereas you can dictate just about anywhere (and many do - I'm not kidding about the bathroom noises and I can tell you who does and doesn't wash his/her hands). This is one big complaint physicians have about electronic records systems that require them to use a computer. While the selling point is that you document the record in real time while you see the patient, the sales people don't mention that your patient isn't going to be too happy that you spent more time looking at the computer monitor than you spent doing your exam. And if, for some reason, you don't finish all your documentation while seeing the patient, you get to stay in front of your computer at work and do it. If you dictate your records, you can be driving home while you do it.

Possibly by the time you've graduated there will be more portable EMRs. Right now, some are available on PC Tablets, but I can't even imagine trying to do the records entry using a PDA.

Speech recognition on the front end is time consuming and most physicians don't have the patience to learn how to use it properly. As a server-based application, it's too expensive to train the engine for temporary docs (such as fellows and residents).

Medical transcription has changed a lot since I started doing it 18 years ago. I expect technology to improve, but I also expect there will be a group of physicians of all ages who recognize it isn't their core competency, and that there is a break-even point between managing their time for maximal income potential and paying someone who is competent to do what the physician doesn't need to do. If you only make money when you see patients, you will want to minimize the things that take you away from that. (And I assume eventually you will have a personal life you will also want to attend to.)

A couple of examples: We have one client who came back to us after leaving for cheaper service overseas. They were losing referrals because the letters and reports were so full of errors. They decided what we charge wasn't so expensive after all.

I have another client who has quite a few standardized notes he does for billing non face-to-face physician time. I offered to make a GUI and macro for his office staff to select the appropriate note, enter the patient name, date of service, etc. (thus making it their headache, not mine!). He refused, saying they were already maxed out and he'd rather pay me to do them. BUT... he has 40% practice overhead costs in a specialty that averages 60%. What he pays me is nothing compared to the value of his time and/or the cost of hiring additional office staff.

 

[rachmoninov3]

To talkdoc, these are so hillarious! However, from a nursing standpoint, there are a few things I see in the H&P's on a regular basis that I'd love to see improved (and this probably isn't you).

'Potassium Chloride' Spoken as 'kay-cee el' is not written Kay CEE EL, but KCl

Same with below the knee amputation...BKA is not 'BeeKay A' or 'a bologna amputation'. However, I'm certain their would be less problems if doctors actually annunciated.

Nonetheless, I do feel you pain...I'm sure some of our doctors moon light as those lawyers who talk really fast at the end of the comercials...it must drive you nuts!

 

[TalkDocs]

To talkdoc, these are so hillarious! However, from a nursing standpoint, there are a few things I see in the H&P's on a regular basis that I'd love to see improved (and this probably isn't you).

Potassium Chloride' Spoken as 'kay-cee el' is not written Kay CEE EL, but KCl

Same with below the knee amputation...BKA is not 'BeeKay A' or 'a bologna amputation'. However, I'm certain their would be less problems if doctors actually annunciated.

This is due to what I call the "how low can you go" game. i.e., if they offer transcription services in India for 6 cpl (cents per line for the uninitiated), can we do it here in the U.S. for 5 cpl?

"Physician's Practice" magazine used to have (I don't know if they still do) a Q&A at their web site and one questions was about charges for transcription services. The answer was "never pay more than 9 cpl."

So for 9 cpl you can get your work done in India. Some of those services are good, some aren't, and many have 100% turnover every couple of months. Some of them will send your work to other prospective clients as samples of the excellent work they do. "See! We do work for XYZ Prestigious Hospital! We can do your work, too!" Then there was the infamous case of the woman in Pakistan who threatened a major university teaching hospital with placing their records on the internet if she wasn't paid, although they didn't contract with her - she was a subcontractor about three levels deep and in violation of the contract not to send anything overseas.

I understand everyone wants to cut costs, but there has to be some understanding that you get what you pay for. Many of my phone calls go like this:

Prospect: We need a new transcription service. The one we're using is just awful. They make a ton of mistakes and never get the work back on time. Three of my people do nothing but fix their mistakes. Our billing is late and we're losing referrals. Your service came highly recommended. Can you tell me what you charge?

Me: Mph.

Prospect: OMG! You're kidding, right?

Me: You have a lot of cost tied up in correcting errors and dictation going out late. I think if you look at it from the viewpoint that those costs will go away with our service, you'll realize the net is actually less than what you pay now.

Prospect: We just can't pay more per line than what we pay now. Can't you just charge us less?

The moral of the story is: When you buy a 99-cent hamburger, all you get is a 99-cent hamburger. No amount of pounding, imploring or threatening will turn it into filet mignon. If you want filet mignon, you have to buy filet mignon.

 

[angel80]

I rotated through a Family Practice office that used EMR. When the patient would come in for the first time, the medical assistant would take all of the PHM, SH, FH, meds, allergies, etc. Those would be stored in the computer by the MA and would never have to be re-inputed on subsequent visits, although updates could be made. Meanwhile, it was up the the physician (or in my case, med student) to take the HPI, ROS, and PE. The ROS and PE consisted of pointing and clicking, which is very quick. The HPI is the only thing that needs to be typed out, but if you can type as fast as you write, it's not any slower than writing it in a paper chart (by the way, writing in a paper chart is hard to do while looking at the patient, but I can easily type without looking at the screen.) The A&P had to be typed in as well, but as long as you can type quickly, it's not a problem. Overall, I think that if done properly, the EMR does not take any more time than the paper chart.

By the way when med students take the USMLE Step 2 CS exam, they give you a choice of whether you want to write everything with pen or paper, or use the EMR. When I took it, about 75% of the students were using the EMR.

 

[ttac]

Did anybody take their post using speech recognition?
I just bought Dragon NaturallySpeaking version 9 and it's actually working out pretty good, I just have to remember to use proper denunciation and remember to say "Period" and "Comma", and the program picks things up pretty good.

I'm actually typing this post using Dragon NaturallySpeaking, but I hope to many people don't buy the program otherwise SDN would get overloaded with nonsense posts, kind of like this one.

ttac

 

[Richard_Hom]

Dear talkdoc,

I also believe that certain transcriptionists do much better on certain specialties.

On a slight digression, are all transcriptionist now doing digital transcription?

 

[technodude]

Anyone that's interested in voice recognition whether NaturallySpeaking or ViaVoice you should visit either the KnowBrainer speech recognition Forum or the Speech Computing forum. I have never posted there but as a lurker I've gained all the information I need to be productive with VR software.