I’ve been giving the Antichrist, specifically the car accident variety, a lot of thought today.
On a report one of my coworkers edited today, our speech recognition program had translated a patient’s chief complaint of “I was in a car accident,” as “I was in a car antichrist.”
First question that springs to mind, of course, is “why would a medical program even KNOW the word ‘antichrist?’” I understand that thousands of words were programmed into these systems, and obviously that each individual word could be looked at critically to judge whether it deserved to take up space in the program’s vocabulary--how likely would it be for the word to appear in a medical report? So there will be a lot of superfluous words, words the system “knows” but will never likely use, in its vocabulary, as is true for most of us speakers of a language.
Still . . . . My computer desktop occasionally tells me that there are unused icons on my desktop, do I wish to dispose of them? I would think that, given what I understand to be the fact that speech recognition programs depend on complex mathematical probability models and so forth to make its decisions concerning “le mot juste” in any given context, after producing thousands of documents I would think the program would begin periodically purging itself of the clutter of thousands of words it never, ever uses, or so very rarely that it’s not worth holding onto, if only to avoid embarrassments like calling an accident an antichrist.
We are told that these speech rec systems “learn,” and it’s true, to some degree. But we are also supposedly able to “teach” them. One of my favorites from the medical world is CABG, the acronym for “coronary artery bypass graft.” That particular acronym appears in a significant percentage of reports I transcribe. Speech rec invariably (so far) reproduces it as “cabbage.” The way the system’s “learning” theoretically operates, if “cabbage” gets edited to “CABG” three consecutive times, the system will forget all about cabbage and stick strictly with the bypass. Unless there are a lot of medical transcriptionists out there who REALLY think the heart surgeon is talking about a coleslaw ingredient, the system just cannot grasp acronyms pronounced as words (CABG is pronounced cabbage. Nobody ever says C A B G--if they did, the system doubtlessly would get it).
But I still halfway expect to see, come March 17, a flurry of speech rec produced reports of ER visits all over the country concerning some poor wretch, maybe even the Antichrist, who choked on his “corned beef and CABG.”
Similarly, the same system that invariably spells “Advair Diskus” as “Advair Discus,” come track season or the Summer Olympics, start reproducing lines like, “The spectator unfortunately was hit by a flying Diskus.” “Discus” probably appears in medical reports with approximately the same frequency as “cabbage,” after all.
Getting back to the Antichrist, maybe it’s only that speech rec is developing an ego and wants to autograph its work once in a while.
Showing posts with label medical transcription. Show all posts
Showing posts with label medical transcription. Show all posts
Friday, December 9, 2011
Tuesday, December 6, 2011
Wondering what the climate is like in Tibet . . .
A woman in a Facebook group for medical transcriptionists/editors on our particular team posted this today: “There is no need for temples, no need for complicated philosophies. My brain and my heart are my temples; my philosophy is kindness.--Dalai Lama.”
I love the quote, know virtually nothing about Dalai Lama, although of course I know the name, but it got me restarted wondering some things I’ve been wrestling with for a while.
Useless things, mostly: For instance, what if we all just bailed out of the “corporate world,” quit working for them, quit buying their products, etc. Obviously that is an impossible idea--we all have to work, we all have to eat, and our consumption is the driving force of two-thirds or thereabouts of our nation’s economy. It might make us FEEL all “fuck you” and so forth, but we would be shooting ourselves in the foot, or maybe in the heart.
Still . . . .
The notion of simplifying our lives, learning to live inside the temples of our brains and hearts, can be tantalizing. Who wouldn’t want to dispense with all the BS, all the daily rush (or the daily monotony, depending on what you do for a living), the daily nightmare or daily recalcitrant pain of just trying to make it from one day to another?
Life can be so fatiguing, sometimes, and it really shouldn’t be. Exhausting, yes--exhausting can be a good thing. But fatiguing? Whole ‘nother thing. Life should be glorious. And in fact it is.
“Exhausting” is an exhilarating workout; “fatiguing” is a wear-you-down-to-nothing grind.
There is probably not a person in this country, maybe even in the world, who does not wish, at some point or other, that s/he could simplify his/her life, step off the treadmill, quit simply (or simply quit) worrying so damned day-to-day MUCH about whatever their hearts/minds are really “about.”
There is probably not a person in this country, maybe even in the world, who doesn’t wish that s/he had the luxury of simple time--even just a worry/stress-free hour to spend daydreaming, or watching cats or dogs or bugs or other people. A worry/stress-free hour just to relax.
We spend our lives in a continual state of tension, a continual state of competition, one way or another. Working at home alone, I’m spared some of that, though obviously not all. Most medical transcriptionists, even when employed by companies, are paid by what they produce, not by the time they put in. When you’re an employee, you are in fact limited to 40 hours a week. What this means is that, if you want to make a living at it, every day when you sit down at the keyboard, you have to make every minute count. It’s continual tension because you have to be aware of the “real” cost of every interruption or distraction--a 15-minute chat with a neighbor, for instance, costs you, say, a couple of loaves of bread or a pound of ground chuck. The clock ticks while you chat, and you can never get that time back. (May be a bad example: Sometimes a 15-minute chat with a neighbor is an invaluable break. To pass up the chance is another kind of missed opportunity).
I suppose in some ways tension and competition heighten our awareness, at least in terms of survival. Plus, a life free of tension and competition probably would be BORING.
Would the Garden of Eden really be all that great a place to hang out, every day of our lives, for the rest of our lives?
(I selflessly volunteer to be the first one there!)
I love the quote, know virtually nothing about Dalai Lama, although of course I know the name, but it got me restarted wondering some things I’ve been wrestling with for a while.
Useless things, mostly: For instance, what if we all just bailed out of the “corporate world,” quit working for them, quit buying their products, etc. Obviously that is an impossible idea--we all have to work, we all have to eat, and our consumption is the driving force of two-thirds or thereabouts of our nation’s economy. It might make us FEEL all “fuck you” and so forth, but we would be shooting ourselves in the foot, or maybe in the heart.
Still . . . .
The notion of simplifying our lives, learning to live inside the temples of our brains and hearts, can be tantalizing. Who wouldn’t want to dispense with all the BS, all the daily rush (or the daily monotony, depending on what you do for a living), the daily nightmare or daily recalcitrant pain of just trying to make it from one day to another?
Life can be so fatiguing, sometimes, and it really shouldn’t be. Exhausting, yes--exhausting can be a good thing. But fatiguing? Whole ‘nother thing. Life should be glorious. And in fact it is.
“Exhausting” is an exhilarating workout; “fatiguing” is a wear-you-down-to-nothing grind.
There is probably not a person in this country, maybe even in the world, who does not wish, at some point or other, that s/he could simplify his/her life, step off the treadmill, quit simply (or simply quit) worrying so damned day-to-day MUCH about whatever their hearts/minds are really “about.”
There is probably not a person in this country, maybe even in the world, who doesn’t wish that s/he had the luxury of simple time--even just a worry/stress-free hour to spend daydreaming, or watching cats or dogs or bugs or other people. A worry/stress-free hour just to relax.
We spend our lives in a continual state of tension, a continual state of competition, one way or another. Working at home alone, I’m spared some of that, though obviously not all. Most medical transcriptionists, even when employed by companies, are paid by what they produce, not by the time they put in. When you’re an employee, you are in fact limited to 40 hours a week. What this means is that, if you want to make a living at it, every day when you sit down at the keyboard, you have to make every minute count. It’s continual tension because you have to be aware of the “real” cost of every interruption or distraction--a 15-minute chat with a neighbor, for instance, costs you, say, a couple of loaves of bread or a pound of ground chuck. The clock ticks while you chat, and you can never get that time back. (May be a bad example: Sometimes a 15-minute chat with a neighbor is an invaluable break. To pass up the chance is another kind of missed opportunity).
I suppose in some ways tension and competition heighten our awareness, at least in terms of survival. Plus, a life free of tension and competition probably would be BORING.
Would the Garden of Eden really be all that great a place to hang out, every day of our lives, for the rest of our lives?
(I selflessly volunteer to be the first one there!)
Thursday, December 1, 2011
Any twit can handle a crisis.
Spending eight hours a day, five days a week listening to and transcribing dictated medical reports can twist your brain in odd ways.
For instance, we’ve probably all heard horror stories about catastrophic events in other people’s lives--car crashes, cancer diagnoses, disappearing children, stock market downturns, election of a black guy to the presidency, etc.--and said to ourselves, “there, but for the grace of God,” and so on.
But in the immortal words of Flo Capp, “Any twit can handle a crisis, it’s the day-to-day living that whacks you.” (Or something like that--tried to Google it, came up with a lot of variations on the same theme.)
My own day-to-day living hasn’t particularly whacked me lately--I’ve been lucky in that regard--but still every day I hear stories of people surviving day-to-day stuff that WOULD whack me, if I had to endure it.
It’s not the crises that get my attention. Instead, it is the “little stuff.”
I transcribe mostly acute care reports, hospital stuff--admissions and operations, etc. Many, if not most people admitted to hospitals these days are in pretty bad straits, health-wise, already, or their care would have been handled on an outpatient basis, and damned near anything can be handled on an outpatient basis, these days. That means every day I hear the “worst,” not the “everyday.”
Sometimes it seems, though, that the "everyday" has become the "worst."
Even if the health problems, the diseases or acute events or whatever brought the people to the hospital didn’t get my attention, the details of their everyday lives would. Seems like every patient, every PERSON, is on a dozen or more medications and supplements. Imaginative guy that I am, I envision these poor people imprisoned in a daily routine of taking their heart medicines and cholesterol medicines and diabetes medicines and hypertension medicines and on and on and on, at a dizzying array of intervals, when looked at all together. I cannot imagine even what it would be like having that many medicine bottles in my medicine cabinet, much less remembering to take every one of them at the appropriate time, much less remembering to get them refilled, MUCH less managing to pay for them all.
For an awful lot of people, just keeping themselves medicated strikes me as equivalent to a full-time job (with mandatory overtime).
From my so-far unmedicated vantage point, I cannot help but wonder if a life that has been relegated mostly to a medical regimen is really all that worth living?
At some point, don’t a lot of these folks just want to say, “fuck it, I’ve had a good life, I’ve enjoyed flowers, kittens, exuberant beagles, sunrises and sunsets, grandparents and kids and people, and I cannot even really see any of them anymore, don‘t really even remember them anymore--time to catch the “last train for the coast, today life’s music died,” or something like that?
Sitting here transcribing endless lists of medications and idly envisioning a daily life devoted mostly to taking those medications, and realizing that, unless I step unaware in front of a bus or get tackled from an unfortunate angle by a wannabe-linebacker beagle on one of my morning perambulations, or some other calamity befalls me, such a daily life is inevitably in my future. The medical profession has pretty much ensured that.
I’ve had this conversation with my near-octogenarian dad a few times. “You know who wants most to live to be 100?” he asked me once. I shook my head. “The 99-year-old,” he said.
As I say, my perspective is skewed by what I do for a living. I never hear about happy, healthy people of any age--happy, healthy people don’t check into hospitals and generate “medical records,” after all, so how WOULD I hear about them?
For instance, we’ve probably all heard horror stories about catastrophic events in other people’s lives--car crashes, cancer diagnoses, disappearing children, stock market downturns, election of a black guy to the presidency, etc.--and said to ourselves, “there, but for the grace of God,” and so on.
But in the immortal words of Flo Capp, “Any twit can handle a crisis, it’s the day-to-day living that whacks you.” (Or something like that--tried to Google it, came up with a lot of variations on the same theme.)
My own day-to-day living hasn’t particularly whacked me lately--I’ve been lucky in that regard--but still every day I hear stories of people surviving day-to-day stuff that WOULD whack me, if I had to endure it.
It’s not the crises that get my attention. Instead, it is the “little stuff.”
I transcribe mostly acute care reports, hospital stuff--admissions and operations, etc. Many, if not most people admitted to hospitals these days are in pretty bad straits, health-wise, already, or their care would have been handled on an outpatient basis, and damned near anything can be handled on an outpatient basis, these days. That means every day I hear the “worst,” not the “everyday.”
Sometimes it seems, though, that the "everyday" has become the "worst."
Even if the health problems, the diseases or acute events or whatever brought the people to the hospital didn’t get my attention, the details of their everyday lives would. Seems like every patient, every PERSON, is on a dozen or more medications and supplements. Imaginative guy that I am, I envision these poor people imprisoned in a daily routine of taking their heart medicines and cholesterol medicines and diabetes medicines and hypertension medicines and on and on and on, at a dizzying array of intervals, when looked at all together. I cannot imagine even what it would be like having that many medicine bottles in my medicine cabinet, much less remembering to take every one of them at the appropriate time, much less remembering to get them refilled, MUCH less managing to pay for them all.
For an awful lot of people, just keeping themselves medicated strikes me as equivalent to a full-time job (with mandatory overtime).
From my so-far unmedicated vantage point, I cannot help but wonder if a life that has been relegated mostly to a medical regimen is really all that worth living?
At some point, don’t a lot of these folks just want to say, “fuck it, I’ve had a good life, I’ve enjoyed flowers, kittens, exuberant beagles, sunrises and sunsets, grandparents and kids and people, and I cannot even really see any of them anymore, don‘t really even remember them anymore--time to catch the “last train for the coast, today life’s music died,” or something like that?
Sitting here transcribing endless lists of medications and idly envisioning a daily life devoted mostly to taking those medications, and realizing that, unless I step unaware in front of a bus or get tackled from an unfortunate angle by a wannabe-linebacker beagle on one of my morning perambulations, or some other calamity befalls me, such a daily life is inevitably in my future. The medical profession has pretty much ensured that.
I’ve had this conversation with my near-octogenarian dad a few times. “You know who wants most to live to be 100?” he asked me once. I shook my head. “The 99-year-old,” he said.
As I say, my perspective is skewed by what I do for a living. I never hear about happy, healthy people of any age--happy, healthy people don’t check into hospitals and generate “medical records,” after all, so how WOULD I hear about them?
Wednesday, November 30, 2011
Ashes and Dust.
One of the last reports I transcribed last night was a “death summary.” The patient (whyinhell are they called “patients,” anyway?) was elderly, though not particularly old at 81, had a fairly nondescript past medical history, wasn’t taking the customary 28 medications and supplements that most people her age (and much younger) seem to consume every day, had several family members in attendance for her grand, albeit unexpected, finale. She had just caught a pneumonia a couple of weeks ago, was apparently recovering from that, but then developed a pulmonary embolism from having been flat on her back in a hospital for a few days.
Nothing about her “story,” as I heard it, dictated in slow, measured tones by a doctor who seemed genuinely to care about the lady and her family, was particularly noteworthy, I suppose. As I do with all death summaries, though, I was as careful as I could be to get every dictated detail accurately--death, after all, is not the same thing as a sore throat or a fractured tibia. A death summary is the permanent “permanent record,” so you want to get it as right as you can. Yes, yes, I know--it’s just the final few hours or even moments of a real person’s life, does not begin to capture what the person was, who s/he was, how much s/he might have mattered to the grandkids or the coworkers or even in her role as “crazy cat lady” in some flyover Midwestern neighborhood. Still, it was her last moments, and deserved to be recorded accurately and, more importantly, with respect.
So I made sure the “i’s” got dotted and the “t’s” got crossed and all the commas got put in the right place. It was the least I could do.
Having been in this business for a while, I’ve transcribed a lot of death summaries. The one I remember forever is the first one I ever transcribed, concerning a 4-year-old boy who one day started walking funny--”my little crooked man,” his mother called him. His name was Drew (I even remember his last name, but won’t repeat it here--it’s a privacy thing, you know?). The doctor dictating the report was the general pediatric section chief I worked for, and who had hosted just hours earlier a retirement party for another doctor in our section.
It was late January, snowed a ton that day. I had fortunately just put new all-weather tires on the car, so had little trouble making it over to section chief’s house, where I shoveled snow off her sidewalk and front porch, helped greet people (including another of our pediatricians, who was about 8 months pregnant and took a fall, stumbling over the curb). Good night, at least to that point and even to the end of the party.
Monday morning I came in to find a micro-cassette on my desk, awaiting transcription. I plugged it in, then listened to my boss relate the story of Drew and his final moments, which came to pass about two hours after the retirement party ended. “His eyes rolled back in his head,” my boss dictated--and the 4-year-old was gone.
Two years after that, not long before said boss was getting ready to move to Minnesota, I was at my desk one morning and got a call from an inpatient floor, about one of our longstanding patients with a longstanding “idiopathic pulmonary hemosiderosis.” The patient, a girl named Pam who was born on Valentine’s Day 1972 and who doggedly worked towards a degree in allied health professions even while lugging around an oxygen tank, had been admitted a day or two earlier. “Pam’s gone,” the caller told me. And for the first time in four years of working with her, I tracked my boss down in a patient room and interrupted her examination of a patient. “It’s Pam,” she said, the instant I poked my head in the door.
On Monday, just a couple of days later, I was transcribing Pam’s death summary.
Ashes to ashes, dust to dust is all fine and everything, when the ashes and ashes or the dust and dust have at least a little something--you know, a “life”--separating them.
(And how I got off on this particular tangent, I will never know.)
Nothing about her “story,” as I heard it, dictated in slow, measured tones by a doctor who seemed genuinely to care about the lady and her family, was particularly noteworthy, I suppose. As I do with all death summaries, though, I was as careful as I could be to get every dictated detail accurately--death, after all, is not the same thing as a sore throat or a fractured tibia. A death summary is the permanent “permanent record,” so you want to get it as right as you can. Yes, yes, I know--it’s just the final few hours or even moments of a real person’s life, does not begin to capture what the person was, who s/he was, how much s/he might have mattered to the grandkids or the coworkers or even in her role as “crazy cat lady” in some flyover Midwestern neighborhood. Still, it was her last moments, and deserved to be recorded accurately and, more importantly, with respect.
So I made sure the “i’s” got dotted and the “t’s” got crossed and all the commas got put in the right place. It was the least I could do.
Having been in this business for a while, I’ve transcribed a lot of death summaries. The one I remember forever is the first one I ever transcribed, concerning a 4-year-old boy who one day started walking funny--”my little crooked man,” his mother called him. His name was Drew (I even remember his last name, but won’t repeat it here--it’s a privacy thing, you know?). The doctor dictating the report was the general pediatric section chief I worked for, and who had hosted just hours earlier a retirement party for another doctor in our section.
It was late January, snowed a ton that day. I had fortunately just put new all-weather tires on the car, so had little trouble making it over to section chief’s house, where I shoveled snow off her sidewalk and front porch, helped greet people (including another of our pediatricians, who was about 8 months pregnant and took a fall, stumbling over the curb). Good night, at least to that point and even to the end of the party.
Monday morning I came in to find a micro-cassette on my desk, awaiting transcription. I plugged it in, then listened to my boss relate the story of Drew and his final moments, which came to pass about two hours after the retirement party ended. “His eyes rolled back in his head,” my boss dictated--and the 4-year-old was gone.
Two years after that, not long before said boss was getting ready to move to Minnesota, I was at my desk one morning and got a call from an inpatient floor, about one of our longstanding patients with a longstanding “idiopathic pulmonary hemosiderosis.” The patient, a girl named Pam who was born on Valentine’s Day 1972 and who doggedly worked towards a degree in allied health professions even while lugging around an oxygen tank, had been admitted a day or two earlier. “Pam’s gone,” the caller told me. And for the first time in four years of working with her, I tracked my boss down in a patient room and interrupted her examination of a patient. “It’s Pam,” she said, the instant I poked my head in the door.
On Monday, just a couple of days later, I was transcribing Pam’s death summary.
Ashes to ashes, dust to dust is all fine and everything, when the ashes and ashes or the dust and dust have at least a little something--you know, a “life”--separating them.
(And how I got off on this particular tangent, I will never know.)
Tuesday, November 29, 2011
If familiarity breeds contempt, why does absence make the heart grow fonder?
About halfway through an out-loud polysyllabic characterization of a dictator (physician dictating medical report, that is) a while ago, it occurred to me that the dictator may not in fact indulge in the activity to which that compound term specifically referred (think “suck-start a Harley,” you’ll get the drift), and that I was probably being unfair calling the guy a “blank-blanker,” despite the fact that he seemed to be talking with his mouth full and his teeth tightly clenched (ouch!).
One of the joys of working at home, in this particular profession, is that we never have to meet the people whose voices reverberate continuously in our heads, any given day. While generally I am neither surly nor dismissive enough to call some of these folks to their faces what I call them out loud, in the privacy of my own home office every day, after working at home for nearly 10 years, I’m not sure I could re-learn the necessary skill of keeping one’s mouth shut--discretion being the better part of valor--in a more public workplace again.
Flipside of that is, sometimes even antisocial “I” miss the social contact, the ability actually to ask a dictator what he thought he was saying, or even just say “good morning” to the guy without wanting to reach out and strangle the life out of him so that he can no longer fuck up my production (and paycheck) with his clenched-teeth, mouth-full, incoherent mumbles that I‘m sure he thinks make him sound cool and professional.
Sometimes I miss simple eye contact--and no, stare-downs with cats don’t count.
I was in my forties before I took a work-at-home job, and that was probably good. I’m not sure I could have handled it when I was younger, before I had amassed a solid quarter-century of working “out in the world,” with a variety of people, and had in fact worn my generally introverted self OUT working with said variety.
First thing I learned was that, even from a thousand miles away, our first instinct is to “connect” somehow with the people whose voices are relentlessly invading our heads. Even though we will never meet the owners of those voices, we want almost desperately to care about them and what they do, and by extension, the patients they care for every day of the world--when we care, we become better, more efficient, more productive. We become “value added,” we feel that, and it matters to us.
A long time ago one of the people I transcribed for in an RL environment--that is, we shared the same suite of offices at the same Kansas City address, actually breathed the same air, endured the same weather, took the same elevators, walked the same streets, etc.--was a wonderful pediatrician, about 5 feet 2, blonde, smart and warm and funny as hell but never sarcastic or even accidentally mean, who would retreat into her office with the mini-cassette recorder after seeing a kid referred in from somewhere, spend an hour slaving over a report, with much pausing and rewinding and fast-forwarding and so forth, and finally emerge, hand me the cassette and say, “work your magic!” That my “magic” amounted mostly to punctuating, getting the grammar right (not that she ever had any problem with that), spelling everything correctly, etc., didn’t matter--she truly thought, and made me feel, that I “added value” in the process. And so I probably did.
I cared about her, and wanted to help make her “look” as good as I possibly could.
Working “remotely,” I try to recapture that same kind of “bond,” but it’s tough.
Familiarity may breed contempt, but absence of familiarity can do the same, and either way, it sucks.
One of the joys of working at home, in this particular profession, is that we never have to meet the people whose voices reverberate continuously in our heads, any given day. While generally I am neither surly nor dismissive enough to call some of these folks to their faces what I call them out loud, in the privacy of my own home office every day, after working at home for nearly 10 years, I’m not sure I could re-learn the necessary skill of keeping one’s mouth shut--discretion being the better part of valor--in a more public workplace again.
Flipside of that is, sometimes even antisocial “I” miss the social contact, the ability actually to ask a dictator what he thought he was saying, or even just say “good morning” to the guy without wanting to reach out and strangle the life out of him so that he can no longer fuck up my production (and paycheck) with his clenched-teeth, mouth-full, incoherent mumbles that I‘m sure he thinks make him sound cool and professional.
Sometimes I miss simple eye contact--and no, stare-downs with cats don’t count.
I was in my forties before I took a work-at-home job, and that was probably good. I’m not sure I could have handled it when I was younger, before I had amassed a solid quarter-century of working “out in the world,” with a variety of people, and had in fact worn my generally introverted self OUT working with said variety.
First thing I learned was that, even from a thousand miles away, our first instinct is to “connect” somehow with the people whose voices are relentlessly invading our heads. Even though we will never meet the owners of those voices, we want almost desperately to care about them and what they do, and by extension, the patients they care for every day of the world--when we care, we become better, more efficient, more productive. We become “value added,” we feel that, and it matters to us.
A long time ago one of the people I transcribed for in an RL environment--that is, we shared the same suite of offices at the same Kansas City address, actually breathed the same air, endured the same weather, took the same elevators, walked the same streets, etc.--was a wonderful pediatrician, about 5 feet 2, blonde, smart and warm and funny as hell but never sarcastic or even accidentally mean, who would retreat into her office with the mini-cassette recorder after seeing a kid referred in from somewhere, spend an hour slaving over a report, with much pausing and rewinding and fast-forwarding and so forth, and finally emerge, hand me the cassette and say, “work your magic!” That my “magic” amounted mostly to punctuating, getting the grammar right (not that she ever had any problem with that), spelling everything correctly, etc., didn’t matter--she truly thought, and made me feel, that I “added value” in the process. And so I probably did.
I cared about her, and wanted to help make her “look” as good as I possibly could.
Working “remotely,” I try to recapture that same kind of “bond,” but it’s tough.
Familiarity may breed contempt, but absence of familiarity can do the same, and either way, it sucks.
Monday, November 21, 2011
Pennsylvania 6-5000 and 867-5309 (Jenny!)
There’s a Massachusetts nurse practitioner I sometimes encounter in the course of my work who always closes her reports with, “If you have any questions about this dictation, dial . . .” and she gives a number. “Dial?” To judge from her voice, which is really all I have to go on, at most she is very early middle age, probably in her thirties--does she even REMEMBER rotary phones? I’m pretty slow to adopt new technology, but even I had a touch-tone phone back in the days when there was still an extra charge for it on the phone bill--1980s. Has she ever “dialed” a telephone number?
Then again, I’ll still have people ask that a “carbon copy” be sent somewhere. “Carbon copy?” I think I last used carbon paper in typing class in the mid-1970s. Photocopiers pretty much ended “carbon copies.” The “cc” at the bottom of a document or piece of correspondence now pretty much means “courtesy copy.” Granted, some of the doctors, etc., doing the dictating are long enough in the tooth to remember “carbon copies,” although I’m sure none of them have seen such a thing in more years than they can remember, aside from maybe some forms (but even those are mostly “NCR”--no carbon required--these days). That doesn’t really explain why, say, a medical resident born in the mid to late 1980s would ask for a “carbon copy.”
What I suspect is that at some point they learned that “cc” was an abbreviation for carbon copy; having no reference point, really, to them, “carbon copy” means simply, “copy.”
I get the same feeling sometimes about all the acronyms we use, or that medical professionals use--it is as if the acronym has become the de facto “name” of a given disease entity. COPD--chronic obstructive pulmonary disease--is perhaps my favorite example because I’ll often hear people talk about “chronic COPD,” apparently forgetting what the C in the acronym stands for. As transcriptionists, of course, in certain sections of reports--diagnosis, etc.--we have to expand all abbreviations, and we are also supposed to transcribe “verbatim.” Somehow I’ve never managed to convince myself that it would be okay, even preferable, to type “chronic chronic obstructive pulmonary disease.”
I cannot remember ever hearing a psych professional refer to post-traumatic stress disorder as anything but PTSD, or attention deficit hyperactivity disorder as anything but ADHD, although I’m sure it happens.
I suppose that it really doesn’t matter, in any real sense, whether something is called “CLL” or by the polysyllabic mouthful, “chronic lymphocytic leukemia” (although there are other expansions of that particular acronym, which could conceivably lead to confusion): The physician presumably knows what he’s talking about, and calling it one thing versus the other won’t alter his treatment plan.
Still, sometimes the increasing use--and, to my mind--overuse and over-reliance on acronyms threatens to reduce “medicalese” to a kind of pidgin English, in the same way that a similar process has reduced much “on-line” communication to the same.
I first went on-line in 1996, about a month before AOL (anybody remember AOL?) went “unlimited”--that is, started charging a monthly flat rate rather than a per-minute charge for on-line usage. All the acronyms so widely used now, all the “wtf” and “lol” and “roflmao” and “fml” and so on, were born in the days of per-minute charges. People held on to that language even after the advent of “unlimited use,” when you no longer had to worry about every character you typed into an “instant message” or a chat room costing you money. It evolved somehow from “necessity” to “cool.”
Medicalese seems to have followed a similar progression. What makes me think that is that I hear so many “lay” people--people who are not medical professionals--slinging the acronymic lingo, as if it makes them part of the medical crowd, or something. The “medical crowd” reinforces it by talking to lay people--you know, “patients”--in the same lingo, the same pidgin. Interestingly, nurses seem to be some of the worst offenders. While the nursing profession has gone to great lengths, or so nurses have told me, to develop a language “separate” from that of physicians--a “laceration” becomes an “disruption of skin integrity,” or something like that, a nurse practitioner once told me--once they become advanced practice nurses, they embrace the medical pidgin with gusto, and speak in nothing BUT acronyms unless it cannot be avoided.
This is sometimes problematic from a transcriptionist point of view, of course, especially when so many spoken sounds can be so difficult to distinguish from each other (“f” and “s,” for instance, “m” and “n” to a slightly lesser extent; c and e and d, falling in the middle of a hastily blurted acronym, can be virtually indistinguishable from each other--sometimes all you can really hear is a sort of an “eee” sound).
Acronyms, in online communication or in the medical field, were originally designed as “shortcuts” that would enable us to communicate more information, faster and more efficiently, and they’ve succeeded.
Still, I cannot help but wonder sometimes if, after passage of a generation or two, we are not shortcutting ourselves out of any ability to communicate meaningfully with each other at all.
Random side-note regarding rotary phones: It occurred to me while pondering this stuff today that songs like Glenn Miller’s “Pennsylvania 6-5000” and Tommy Tutone’s “867-5309” could not be written now. Somehow, “613-814-5000” or “913-867-5309” just wouldn’t have the same, um, ring to them.
Gotta love progress!
Then again, I’ll still have people ask that a “carbon copy” be sent somewhere. “Carbon copy?” I think I last used carbon paper in typing class in the mid-1970s. Photocopiers pretty much ended “carbon copies.” The “cc” at the bottom of a document or piece of correspondence now pretty much means “courtesy copy.” Granted, some of the doctors, etc., doing the dictating are long enough in the tooth to remember “carbon copies,” although I’m sure none of them have seen such a thing in more years than they can remember, aside from maybe some forms (but even those are mostly “NCR”--no carbon required--these days). That doesn’t really explain why, say, a medical resident born in the mid to late 1980s would ask for a “carbon copy.”
What I suspect is that at some point they learned that “cc” was an abbreviation for carbon copy; having no reference point, really, to them, “carbon copy” means simply, “copy.”
I get the same feeling sometimes about all the acronyms we use, or that medical professionals use--it is as if the acronym has become the de facto “name” of a given disease entity. COPD--chronic obstructive pulmonary disease--is perhaps my favorite example because I’ll often hear people talk about “chronic COPD,” apparently forgetting what the C in the acronym stands for. As transcriptionists, of course, in certain sections of reports--diagnosis, etc.--we have to expand all abbreviations, and we are also supposed to transcribe “verbatim.” Somehow I’ve never managed to convince myself that it would be okay, even preferable, to type “chronic chronic obstructive pulmonary disease.”
I cannot remember ever hearing a psych professional refer to post-traumatic stress disorder as anything but PTSD, or attention deficit hyperactivity disorder as anything but ADHD, although I’m sure it happens.
I suppose that it really doesn’t matter, in any real sense, whether something is called “CLL” or by the polysyllabic mouthful, “chronic lymphocytic leukemia” (although there are other expansions of that particular acronym, which could conceivably lead to confusion): The physician presumably knows what he’s talking about, and calling it one thing versus the other won’t alter his treatment plan.
Still, sometimes the increasing use--and, to my mind--overuse and over-reliance on acronyms threatens to reduce “medicalese” to a kind of pidgin English, in the same way that a similar process has reduced much “on-line” communication to the same.
I first went on-line in 1996, about a month before AOL (anybody remember AOL?) went “unlimited”--that is, started charging a monthly flat rate rather than a per-minute charge for on-line usage. All the acronyms so widely used now, all the “wtf” and “lol” and “roflmao” and “fml” and so on, were born in the days of per-minute charges. People held on to that language even after the advent of “unlimited use,” when you no longer had to worry about every character you typed into an “instant message” or a chat room costing you money. It evolved somehow from “necessity” to “cool.”
Medicalese seems to have followed a similar progression. What makes me think that is that I hear so many “lay” people--people who are not medical professionals--slinging the acronymic lingo, as if it makes them part of the medical crowd, or something. The “medical crowd” reinforces it by talking to lay people--you know, “patients”--in the same lingo, the same pidgin. Interestingly, nurses seem to be some of the worst offenders. While the nursing profession has gone to great lengths, or so nurses have told me, to develop a language “separate” from that of physicians--a “laceration” becomes an “disruption of skin integrity,” or something like that, a nurse practitioner once told me--once they become advanced practice nurses, they embrace the medical pidgin with gusto, and speak in nothing BUT acronyms unless it cannot be avoided.
This is sometimes problematic from a transcriptionist point of view, of course, especially when so many spoken sounds can be so difficult to distinguish from each other (“f” and “s,” for instance, “m” and “n” to a slightly lesser extent; c and e and d, falling in the middle of a hastily blurted acronym, can be virtually indistinguishable from each other--sometimes all you can really hear is a sort of an “eee” sound).
Acronyms, in online communication or in the medical field, were originally designed as “shortcuts” that would enable us to communicate more information, faster and more efficiently, and they’ve succeeded.
Still, I cannot help but wonder sometimes if, after passage of a generation or two, we are not shortcutting ourselves out of any ability to communicate meaningfully with each other at all.
Random side-note regarding rotary phones: It occurred to me while pondering this stuff today that songs like Glenn Miller’s “Pennsylvania 6-5000” and Tommy Tutone’s “867-5309” could not be written now. Somehow, “613-814-5000” or “913-867-5309” just wouldn’t have the same, um, ring to them.
Gotta love progress!
Sunday, November 20, 2011
Occupational Hazards
Motivating oneself to work on a cloudy, cold Sunday can be challenge enough without seven highly unmotivating factors within easy eyeshot: Two cats asleep on the bed, another asleep on the chair I’ll have to occupy in an hour or so, yet another one asleep on the recliner in the living room, and the last stretched out atop the television case, sleeping quite comfortably. Then there’s the large dog asleep at the foot of my chair, and another one, the puppy, curled up on the couch, happily and increasingly sleepily gnawing away at a rawhide “bone.” The third dog, Nina, is the self-designated protector of the household and all within it, so she prefers to stay outside--but I’m pretty sure that if I were to look out the kitchen window, I would see her curled up in the corner of the yard between the house and the garage, asleep. This is not an environment conducive to maintaining the degree of alertness one needs when tackling medical reports.
When you first start working at home, you will be offered all kinds of advice and warnings from people who have tried it and succeeded (or failed). Prominent, of course, is that you must keep potential distractions--kids, spouses, phone calls, or, in my case, sunshine streaming through a window--to a minimum. You’ll be advised to keep your work space separate from your living space (and my work computer is indeed separated by 4-5 feet from my bed, 6-8 feet from my “play” computer, the one I use to write and go online for news and photo-edit, etc.). One self-described “crazy cat lady” who had a couple dozen cats told me that she put up a screen door between her office and the living room so that the cats could see her, and she could see them, but they couldn’t take up residence on her chair or stretched across her monitor (these were the days before flat screens; cats LOVED stretching out on those old-timey monitors).
Nobody ever warned me about the dangers of the cozily sleeping cat(s) on the kind of day people call “made for sleeping.”
Xena, the large sleeping dog, has now awakened--she apparently senses that it is almost time for me to begin my shift, and wants to make a trip outside. Dogs DO learn your schedule when you work at home, by the way. I used to have a Pomeranian, Pixie, who would get antsy and try to lead me back to my office when it was just about time for me to go to work. Cats are aware, as well, although they handle the situation differently: One or another of my matriarch cats, Sabrina or Evi, will curl up on my work chair about 10 minutes before I need to settle into it, practically daring me to move her.
Guess I’ll follow Xena’s example and step outside for some fresh (frigid) air.
When you first start working at home, you will be offered all kinds of advice and warnings from people who have tried it and succeeded (or failed). Prominent, of course, is that you must keep potential distractions--kids, spouses, phone calls, or, in my case, sunshine streaming through a window--to a minimum. You’ll be advised to keep your work space separate from your living space (and my work computer is indeed separated by 4-5 feet from my bed, 6-8 feet from my “play” computer, the one I use to write and go online for news and photo-edit, etc.). One self-described “crazy cat lady” who had a couple dozen cats told me that she put up a screen door between her office and the living room so that the cats could see her, and she could see them, but they couldn’t take up residence on her chair or stretched across her monitor (these were the days before flat screens; cats LOVED stretching out on those old-timey monitors).
Nobody ever warned me about the dangers of the cozily sleeping cat(s) on the kind of day people call “made for sleeping.”
Xena, the large sleeping dog, has now awakened--she apparently senses that it is almost time for me to begin my shift, and wants to make a trip outside. Dogs DO learn your schedule when you work at home, by the way. I used to have a Pomeranian, Pixie, who would get antsy and try to lead me back to my office when it was just about time for me to go to work. Cats are aware, as well, although they handle the situation differently: One or another of my matriarch cats, Sabrina or Evi, will curl up on my work chair about 10 minutes before I need to settle into it, practically daring me to move her.
Guess I’ll follow Xena’s example and step outside for some fresh (frigid) air.
Wednesday, November 9, 2011
Mr. Roboto World: "Machines to save our lives/Machines de-humanize."
A doctor I used to work with once told me that “80% of diagnosis is history”--the individual stories the patients tell you about what has compelled them to come to your office. Sometimes patients will provide you very detailed, almost hourly chronological compilations of the preceding few hours or days in their lives; more often the history will be only slightly better than a vague, more of an “I-just-feel-yucky” overview that doesn’t tell the doctor much of anything, and the doctor then has to tease information out in bits and pieces and sometimes mumbles and grimaces and “my-balls-are-on-fire” (that’s an actual quote from a patient when I was working as a registration clerk in an ER in the 1980s) verbal ejaculations.
A doctor may not be able to glean much from your current vital signs, for instance: Your current temperature or blood pressure may be perfectly normal; what might matter is, say, that you’ve not been feeling well and so you’ve been checking your own temperature or blood pressure or blood glucose over the last three days and it has been wildly fluctuating, or running higher or lower than normal for no apparent reason.
Details count, even the vague or fuzzy ones--or maybe especially the vague or fuzzy ones.
Got to thinking about this tonight when my incoming work flow mysteriously dried up, I had time on my hands, and I started trying to research the potential/probable impact of the big push toward electronic health records on my own livelihood as a medical transcriptionist.
Frankly, it looks pretty grim from here.
Funny, or perhaps paradoxical, thing about the medical industry, from what I’ve seen over the past couple of decades is an understandable (on one level) desire to eliminate as much of the “human element” as possible--humans make mistakes, after all. Reducing as many aspects as possible to the least common denominator, that is, trying to “idiot proof” them, makes sense in some ways. The more that can be automated, the better and more efficient and less costly and less prone to error the whole system can be.
Right?
But it’s one thing to take the “human element” out of, say, the checkout process at your local Wal-Mart by installing “self-checkout” aisles. The human element removed from that process, of course, is the job of a human cashier (and in effect turns us all into unpaid employees of the retailer, not coincidentally); the corporation cuts its expenses, but the process is no more efficient and no less prone to error, and the corporation gets a lot of free labor. The fact is, though, a customer can drag a box of cereal across a scanner just as well, if not as quickly, as a trained cashier can.
Health care is different, though: It is founded on human-to-human interaction between a patient and a provider.
“History is 80% of diagnosis.” The individual’s story is what drives the provider’s treatment plan more than any other single factor. It is the history that cues the provider to order certain tests, etc., that essentially sets the provider off on one particular course versus another.
It would be difficult, I think, to reduce history-taking to a series of drop-down menus on a computer screen or “palm pilot,” etc.
I haven’t worked in a hospital for a while, but the way things used to work was that a doctor (or nurse practitioner or other provider) would come in, take your history and examine you without so much as a notepad between them and the patient. They might or might not chart their findings right there; where I worked, they did most of their charting in a conference room or in their offices. They wanted to provide the patient at least the illusion of “undivided attention.” Eye contact mattered, and they couldn’t make eye contact if they were scribbling notes in a chart. Plus, and I really am only surmising this based on what I used to do when taking telephone “histories” from patients--that is, took voluminous notes--it forced them, the providers, to instantly separate wheat from chaff, pick out and remember the salient facts from a sometimes rambling or sometimes skeletal story told by a patient. I HAD to take voluminous notes, write down everything someone told me over the phone, because I wasn’t qualified to judge what was important and what wasn’t (although I did get better at it over time, and with a lot of practice).
From what I understand, which may not be much, with electronic health/medical records, providers will have to enter information in a computerized record even as they interview the patient.
So much for eye contact.
I don’t know how all this will evolve; nor, I think, does anyone else, really, although many take stabs at speculation. Probably it means the end of my job at some point, and then maybe rebirth of it when the powers-that-be (the financial PTB, that is), realize that health care is one of those things from which the human element truly cannot be removed, entirely, no matter how “cost-effective” that dream might be.
In the meantime, I’ll be exploring other career options. (Actually dark blue is a good color for me; I would probably look great in one of those vests with “May I Help You?” stenciled across the back.) And I’m really too old for this.
A doctor may not be able to glean much from your current vital signs, for instance: Your current temperature or blood pressure may be perfectly normal; what might matter is, say, that you’ve not been feeling well and so you’ve been checking your own temperature or blood pressure or blood glucose over the last three days and it has been wildly fluctuating, or running higher or lower than normal for no apparent reason.
Details count, even the vague or fuzzy ones--or maybe especially the vague or fuzzy ones.
Got to thinking about this tonight when my incoming work flow mysteriously dried up, I had time on my hands, and I started trying to research the potential/probable impact of the big push toward electronic health records on my own livelihood as a medical transcriptionist.
Frankly, it looks pretty grim from here.
Funny, or perhaps paradoxical, thing about the medical industry, from what I’ve seen over the past couple of decades is an understandable (on one level) desire to eliminate as much of the “human element” as possible--humans make mistakes, after all. Reducing as many aspects as possible to the least common denominator, that is, trying to “idiot proof” them, makes sense in some ways. The more that can be automated, the better and more efficient and less costly and less prone to error the whole system can be.
Right?
But it’s one thing to take the “human element” out of, say, the checkout process at your local Wal-Mart by installing “self-checkout” aisles. The human element removed from that process, of course, is the job of a human cashier (and in effect turns us all into unpaid employees of the retailer, not coincidentally); the corporation cuts its expenses, but the process is no more efficient and no less prone to error, and the corporation gets a lot of free labor. The fact is, though, a customer can drag a box of cereal across a scanner just as well, if not as quickly, as a trained cashier can.
Health care is different, though: It is founded on human-to-human interaction between a patient and a provider.
“History is 80% of diagnosis.” The individual’s story is what drives the provider’s treatment plan more than any other single factor. It is the history that cues the provider to order certain tests, etc., that essentially sets the provider off on one particular course versus another.
It would be difficult, I think, to reduce history-taking to a series of drop-down menus on a computer screen or “palm pilot,” etc.
I haven’t worked in a hospital for a while, but the way things used to work was that a doctor (or nurse practitioner or other provider) would come in, take your history and examine you without so much as a notepad between them and the patient. They might or might not chart their findings right there; where I worked, they did most of their charting in a conference room or in their offices. They wanted to provide the patient at least the illusion of “undivided attention.” Eye contact mattered, and they couldn’t make eye contact if they were scribbling notes in a chart. Plus, and I really am only surmising this based on what I used to do when taking telephone “histories” from patients--that is, took voluminous notes--it forced them, the providers, to instantly separate wheat from chaff, pick out and remember the salient facts from a sometimes rambling or sometimes skeletal story told by a patient. I HAD to take voluminous notes, write down everything someone told me over the phone, because I wasn’t qualified to judge what was important and what wasn’t (although I did get better at it over time, and with a lot of practice).
From what I understand, which may not be much, with electronic health/medical records, providers will have to enter information in a computerized record even as they interview the patient.
So much for eye contact.
I don’t know how all this will evolve; nor, I think, does anyone else, really, although many take stabs at speculation. Probably it means the end of my job at some point, and then maybe rebirth of it when the powers-that-be (the financial PTB, that is), realize that health care is one of those things from which the human element truly cannot be removed, entirely, no matter how “cost-effective” that dream might be.
In the meantime, I’ll be exploring other career options. (Actually dark blue is a good color for me; I would probably look great in one of those vests with “May I Help You?” stenciled across the back.) And I’m really too old for this.
Wednesday, November 2, 2011
Winchester Legs
Those of us involved in the brave new world of medical transcription, that is, editing of reports produced by speech recognition programs, probably should take some solace in the face of ever-diminishing income by the fact that we at least have our "no time to be anything but a machine" days lightened by the stream of what may loosely be termed "malapropisms" spewed out by the ever-creative speech rec.
Today was relatively boring on that front, I suppose, but I must admit that I chuckled at "Winchester legs" when I saw the term a line or two ahead of where I was in the audio (we're told by the geniuses who designed the programs that we should always be reading ahead of the audio, although they never present anything but vague reasons for that). Sometimes I try to think ahead of the audio, try to guess in advance what speech rec "transcribes" actually might be. For instance, if I see "at a band" or "had a van" in a list of medications, I'll know even before I hear the dictator say it that the drug in question is Ativan. Speech rec NEVER gets Ativan. I hesitate to say that the program has a personal problem with the medication, but sometimes I wonder.
It also never gets GERD, which seemingly just about every patient gets at one time or another. If I see a blank in a list of diagnoses produced by speech rec, and if I were a gambling man, and if Las Vegas somehow offered odds, over the long term I would make a ton of money just by plugging "GERD" into the blank spaces.
It is almost unfair even to mention cabbage/CABG. First thing we were all told is that speech rec "learns," that if it "hears" and mis-reproduces something 3 consecutive times and we correct it three consecutive times to the "right" word, the program will pick up on it and "learn." Now, I type "CABG" (coronary artery bypass graft) probably 12,587 times, any given year; I doubt that I have EVER typed the word "cabbage" in a medical report--it's just not one of those things that ever comes up. Nevertheless, despite all my teaching, speech rec persists in referring to an open heart surgery as a vegetable--and not even a particularly tasty vegetable.
It is EASY to make fun of some of what speech rec comes up with. (I won't touch too much on "prepped and draped"--a phrase in almost every operative report ever dictated--coming up as "prepped and raped"). Sad thing is, though, back when I trained medical transcriptionists, some actual human beings, with actual brains and actual life experience and so on, would commit the same kinds of malapropisms.
Sometimes maybe we just let our "critical thinking" go to sleep or take the day off.
Oh, about those Winchester legs? Don't count on taking them deer-hunting this year. What the doc actually said was, "when I touched her legs" (nothing pornographic--the lady was just being seen for pain in her legs).
(And about the quote way up there, about "no time to be anything but a machine"? That's from "Walden," H. D. Thoreau. Credit where credit is due.)
Today was relatively boring on that front, I suppose, but I must admit that I chuckled at "Winchester legs" when I saw the term a line or two ahead of where I was in the audio (we're told by the geniuses who designed the programs that we should always be reading ahead of the audio, although they never present anything but vague reasons for that). Sometimes I try to think ahead of the audio, try to guess in advance what speech rec "transcribes" actually might be. For instance, if I see "at a band" or "had a van" in a list of medications, I'll know even before I hear the dictator say it that the drug in question is Ativan. Speech rec NEVER gets Ativan. I hesitate to say that the program has a personal problem with the medication, but sometimes I wonder.
It also never gets GERD, which seemingly just about every patient gets at one time or another. If I see a blank in a list of diagnoses produced by speech rec, and if I were a gambling man, and if Las Vegas somehow offered odds, over the long term I would make a ton of money just by plugging "GERD" into the blank spaces.
It is almost unfair even to mention cabbage/CABG. First thing we were all told is that speech rec "learns," that if it "hears" and mis-reproduces something 3 consecutive times and we correct it three consecutive times to the "right" word, the program will pick up on it and "learn." Now, I type "CABG" (coronary artery bypass graft) probably 12,587 times, any given year; I doubt that I have EVER typed the word "cabbage" in a medical report--it's just not one of those things that ever comes up. Nevertheless, despite all my teaching, speech rec persists in referring to an open heart surgery as a vegetable--and not even a particularly tasty vegetable.
It is EASY to make fun of some of what speech rec comes up with. (I won't touch too much on "prepped and draped"--a phrase in almost every operative report ever dictated--coming up as "prepped and raped"). Sad thing is, though, back when I trained medical transcriptionists, some actual human beings, with actual brains and actual life experience and so on, would commit the same kinds of malapropisms.
Sometimes maybe we just let our "critical thinking" go to sleep or take the day off.
Oh, about those Winchester legs? Don't count on taking them deer-hunting this year. What the doc actually said was, "when I touched her legs" (nothing pornographic--the lady was just being seen for pain in her legs).
(And about the quote way up there, about "no time to be anything but a machine"? That's from "Walden," H. D. Thoreau. Credit where credit is due.)
Subscribe to:
Posts (Atom)