A Question of Style
When it comes to language, there are accepted formulae for how things work--not just the actual words used, but specifics as to punctuation, grammar, etc. They used to teach that in school, right? In the workplace, the rules are supposed to be more formal. Those college essays where you had to follow perfect formatting and lived by the old Harbrace College Handbook were a pain (ugh--footnotes!), but prepared you well for communicating with grown-ups on the job. If you manage to land a job as an actual writer, of course, you're expected to follow accepted style guides, like the trusty, old Chicago Manual of Style. The rules can be a pain to learn, but there is a liberation that comes with knowing how to do things properly and in the end, it spares us all having our time wasted by nitwits. The last decade or so, many publishing houses have actually tried to cut back on expenses by eliminating editors or leaving it up to the writers to employ their own, and the result has been an increasing number of incredibly aggravating errors which 1) Merely contribute to the general dumbing-down of America and 2) Make people like me even less willing to spend good money on badly-written books. Newspapers, too, have become more about the advertising than the content, and for non-writers everywhere else? Suffice to say there is a disturbing trend toward chatspeak and illiteracy in business communications, as more (sorry, but have to say it--younger) people seem to make no distinction between personal email versus work email.
So. Medical transcription, being all about language, certainly must have its own style rules, right? I assumed in the beginning that Chicago (or similar) ruled the day here, with a special, loving emphasis on Latin for all those medications. In the beginning, that was pretty much true. There were strict rules so that a doctor could look at that medication list and tell at a glance what a patient was taking, even if it looked like gibberish to a layperson:
1. Metoprolol 50 mg p.o. b.i.d.
2. Aricept 10 mg p.o. q.d.
3. Synthroid 112 mcg p.o. q.d.
4. Amoxacillin 500 mg p.o. b.i.d. x14 days.
5. Percocet 5/325 one to two p.o. q.4 h. prn pain #30.
No too confusing, eh? So what happens? First, JCAHO decides that doctors have horrible handwriting and too many mistakes are being made because no one can tell what they're scribbling on the chart. They come out with The List of "dangerous abbreviations." Okay, so some of it makes sense: Does that dude mean "MS" as in morphine sulfate or magnesium sulfate? Sure, it makes sense not to abbreviate medications--and boy, do doctors like to throw around those acronyms (not all of which are based in reality)!
They start to lose me, though, when they start saying things like not to use the measurement "cc" for medications and to substitute "mL" because "cc" can be mistaken for a "U." Huh? Strictly speaking, cc and mL are NOT even equivalent measurements. We're no longer to say "q.d." because "people might confuse Q.D., QD, q.d., and qd"--all of which mean "daily." We are instead to change that to "daily." Mkay. . . so I change my expander to change "q.d." to "daily" so that when I'm transcribing what's said, it will automatically change to the accepted form. I'm not sure how a doctor's lousy penmanship really affects a transcribed medical record, but if you say this is how to do it, fine. As long as we're not forced to mix Latin and English terms, I guess it's not so painful.
In all of this, of course, I've ignored the fact that we don't use a proper style guide at all, but a quirky mess concocted by AAMT that often has nothing to do with proper language rules. I generally avoid said guide because it has never been easily navigable and they seem to make a handful of weird changes every few years simply to get MTs to shell out another $100 (incl. S&H). Between these two entities, the weirdness just keeps coming.
Now, we're getting instructions that we ARE to mix Latin and English if someone dictates "q. day," even if we're not working a verbatim account. We're also supposed to start typing neologisms (those incredibly stupid made-up words) if a doctor insists on using them. . . because "he knows what he means, even if it isn't a real word." Phrases that have served as nails on a chalkboard to MTs over the ages (think "neuroforaminal") are now in common enough usage that we should treat them as correct, to say nothing of the goofy words one doc makes up because he thinks it makes him sound smart?
I'm sorry, but what exactly is the point of an MT anyway? In throwing all these rules out the window and moving everyone toward verbatim nonsense, we are being robbed of one of our greatest contributions to the medical record--editing for sense and proper language usage. It is my opinion that we are simply being squeezed from another direction to train the client to accept the lowest common denominator--speech recognition--instead of expecting a medical record to help doctors not sound like illiterate boobies. Will it really help the bottom line when someone sees their medical record (say. . . as they gather evidence in a malpractice suit. . .) and see their file is full of gibberish? I'm sorry, but a doctor may be the most brilliant surgeon of all time, but that does not mean he cares enough to have paid attention in English class. Left to their own devices, a doctor is prone to dictate a series of run-on sentences (sometimes, even just one long one), and they don't fare any better with spelling than they do with punctuation.
Honestly, is it any wonder the rest of the world is leaving us behind when our kids are lucky to graduate with a fourth grade education and even technical jobs are being dumbed down to accommodate them? Will the pendulum start to swing the other way before it's too late? Here's hoping "smart" once again becomes something desirable again--hopefully before the Third World passes us by. . . and AAMT and JCAHO decide we're due for another style update.