I remember back when my daughter was born, getting a card that gave me permission to let my regular work go to seed because there was a new baby in the house--not that I really care what anyone thinks of that dust bunny collection behind the toilet anyway, but there was just something reassuring about having society's okay to be lazy for a window of time. I guess I'm claiming that right again because I once again have a new baby in the house. Well, not a "new" baby, but new to me. In a week where I would be normally whining about the demands of another dismal all-day training session on a platform I resent (working three consecutive shifts is no picnic!), I've been able to float above it all, relatively unscathed (except for these puffy feet and double vision), because Karma figured out how to distract me from all that by dumping a little sunshine in my lap.

After grieving over wee Ailis since the end of January, I've had periods of masochism where I'd pore over animal shelter and rescue sites and this last month, it's been a weekly routine--so I knew it must be time. It just hurt more to not have a dog than it did to think of the one we lost.

What ensued was a frustrating and depressing ordeal. The shelters are full of little more than discarded pit bulls, Jack Russells, and a few lab mixes. If you're looking for a proper terrier, you're mostly out of luck. Classifieds aren't much better--just add poodles and Yorkies to the mix. Pet shops almost invariably deal with puppy mills, so they're out. Breeders are getting as much as $2500 for dogs, which makes little sense when you're looking for a pet, not a show dog, and besides, it's practically criminal to demand a purebred when there are hundreds of animals euthanized for lack of homes.

Even the rescue organizations were bleak. I appreciate them wanting to ensure a good, forever home for dogs who need stability and love, but when they want an application comparable to a bank loan, home inspections for the next three years, an agreement to participate in their obedience/training classes, it involves traveling hours to get there, and they still want you to pay hundreds of dollars for previous vet bills and care, it's a bit daunting and I suspect loses them a lot of potential participants. Even a gun purchase isn't this involved. . . Still, I was at that point and almost ready to file an application. . . when I stumbled across an ad for a pair of wire fox terriers. For free. I saw the photo and knew this was my dog.

Fast forward past the phone tag, crossed emails, a waiting list of people to see the dogs, and straight to the part where I came home with the sweetest little guy you ever met, a 2-year-old male, now going by the name of Duncan. Apart from the thing where he wants to eat the cats (wow--hoping to get a handle on that terrier instinct!), he is a baby doll. Thinks he's a lap dog and has assumed the proper position at my foot pedal all through my shift. After living in someone's lanai for the last six months, he seems gobsmacked, wondering what the heck he did to deserve air conditioning and endless attention. What a smile! (At least until the vet next week, when only Bob Barker will be pleased. . .)

The hole has been filled and my universe is a lot less off kilter. I heartily recommend for anyone looking for their own new fur baby to please consider rescuing one yourselves. It's a heartbreaker to rummage through Pet Finder (virtually all shelters list through this site) and see all those sweet faces, knowing the vast majority will be euthanized for lack of homes. So maybe a pit bull isn't for you, either--there are even more cats than dogs looking for homes. In this era of shrinking pay and disappearing jobs--something we know too well in MT--a lot of families are having to give up cherished pets. When you're working from home--alone, as so many MTs are--a pet is often the thing that keeps us from feeling totally isolated and loony. I suspect that there are enough crusty MTs who have at least a treasured feline for company that the cat could qualify as our industry mascot (we're equally impossible to herd so hard to tell apart, anyway).

It's not often you can do something for someone else that feels like you're mostly doing yourself a favor.

I suppose there is no real mystery in why I almost killed my computer. After a painful $300 for a new power supply, I vowed to mend my ways and not leave the poor dear up and running endlessly--yet here it hums since I got it back home. The fact that I do this has always been a source of consternation to my kids--though not as much as the fact that I also tend to leave my browser going with a couple dozen tabs open to pages I feel moved to "do something" with, rather than squirrel them away in my data dump (AKA "Bookmarks"). I guess I think this is crucial information, so the tabs sit for a week or two until I make use of them or totally forget why they intrigued me. Undoubtedly, the trivia is the biggest reason for not being able to shut down my computer willy nilly.

To that end, I have a few seemingly related things that I think are bound to intersect--with each other and with us as MTs--and today is the day I get them out there, close the tabs, and move on.

First item (wow, I've been harboring this since May 4--no wonder my computer got tired!): Obama Cracking Down On Tax Havens:

This was a promise going way back to the endless presidential campaign and anyone working in MT should have no trouble seeing that this might affect our livelihoods--hopefully, in a good way. At a time when more and more MTSOs are investing in infrastructure and personnel overseas, will this actually have an impact? Well, since I bailed on the accounting major, tax law is really Greek to me. Experience has taught me that weasels will always work the system to their advantage in ways that the rest of us honest suckers wouldn't even think of. Perhaps by buying physical assets offshore, they are cushioning the blow and that will exempt them from penalties. Perhaps by increasing their offshore personnel, they will simply be saving so much in payroll that any "penalties" (actually in the form of tax breaks no longer received) won't really have a negative impact on their bottom line.

While we're left to ponder why Americans' healthcare records are even allowed to be farmed out beyond our borders, we get this reaction to the president's plan from the greedy jerks in the business sector at large, led by that paragon of virtue, Micro$oft, who says Tax Would Move Microsoft Jobs Offshore:

Better off for who, Steve? I guess customers never have figured high on the agenda there. . . To help the clueless (like myself), a DC economist gives this lesson in US tax evasion via one of the currently legal loopholes:

Sweet, huh? The way I see it, these people are not so much talking about being hurt financially as they are about being told there is a finite point to their profits. In promising to fire even more US workers to even the score, they are adding insult to injury. They are selling out their own country. Welcome to the New World Order-- where they've leveled the playing field so we ALL live in third-world nations so that 5% of the population owns the other 95%. (The punchline will come when they realize there's no one left who can afford to buy.) I guess if we're outraged that hospitals are perfectly fine offshoring our health records just to save a few bucks, we might ask ourselves why we, as consumers, are perfectly fine buying products from companies that do likewise. The answer, I'm afraid is that we've grown lazy and apathetic. Remember when WalMart's sales pitch was that everything they sold was Made in America? Good luck finding US goods there today--but they're still turning a hefty profit.

I've already groused about the news that IBM has even come up with a computer application to maximize the benefits of offshoring jobs, but it bears repeating. Of course, once the patent application was leaked, they backpedaled and called it an "error," but I seriously doubt that means they aren't using it.

Of course, I still believe that the damage done by these tactics as it pertains to our livelihood is beyond the point of no return. Our work has been so devalued and our benefits so gutted that there is hardly room to get worse, and MTSOs are not likely to reverse and start restoring MT wages to where they were even 5 years ago--not when they're so heavily invested in the speech recognition technology they seem to think will eventually eliminate us. Indeed, in failing to put their collective foot down and catering to clients' fantasies of cheaper/faster/better, they've painted us all in a corner. This is why I've also predicted that the very technology they use to kill MT will soon after kill the MTSOs themselves, because the clients will be able to simply invest in the software and do it themselves.

Lest you scoff at me for my vivid imagination, there are those making even more astounding predictions--that the medical field in general will eventually suffer the same disintegration that beset the music industry.

Very interesting points made here, acknowledging that there will always be a place for MDs who excel, but the vast majority could easily be replaced by a P2P-style approach to healthcare that cuts them out of the loop entirely. Before you laugh it off, think of where you turn for medical issues. Do you have insurance? A hefty co-pay? Even if money isn't an issue for you, how many go straight to WebMD, eMedicine, or other favorite site? How many of those times does that answer your question well enough that an office visit isn't necessary at all? If you're like me, that's about 99% of the time.

You can see why I was so anxious to clean up my browser--it's quite a depressing little collection of "the sky is falling" schtuff that gets me thinking in circles--a lot like watching conspiracy videos on youtube all weekend. . . I guess my next order of business should be to keep an eye out for Pollyanna stories to balance these out, maybe a hint about how to protect ourselves once all this bad mojo hits the fan and MT just up and keels over on us once and for all. In an economy that is over three-quarters geared toward services instead of actual products, figuring out how to repackage our skills to is a tall order indeed. . .

That line from Steve Martin's book, Cruel Shoes--where he thought it would be clever, if he ever had a child, to teach him the wrong words to everything so that when he went to school, no one would understand what he was talking about--used to be hysterical to me. . . but that was before speech "recognition." I have now had my first-hand exposure to this boondoggle and no longer have to qualify my rants with the fact that I'm merely repeating what my peers are saying. It really IS that bad.

In the latest comedy of errors, I was inadvertently sent SR reports before I was trained for them, and what I found was jaw-droppingly bad. It didn't seem to matter if the reports were from a facility that was as new to the platform as I was or another one that had been using it for almost a year (supposedly "training" the system to recognize the various dictators' routines). They were all astoundingly, horrifically bad, and the platform itself was so riddled with bugs that it was impossible to use as intended. It even breaks other applications that I need to be able to use in conjunction, most notably Shorthand. After spending twice as long trying to edit the mistakes, I opted--like many MTs--to simply erase the whole mess and transcribe it from scratch. Bad enough I should get paid half for doing that than getting paid a tenth as much because it took me five times longer to simply fight the whole setup. I still had a production quota to meet, after all.

I tried to describe this to my son, who has a degree in digital media and has written no small amount of application and web code himself. He recognized it immediately as he has been a victim of it from the other side: Someone with more money than know-how gets a brainstorm to create an application that will make him millions. He hires guys like my son to write it--often building off someone else's application, to boot, which means you're not saving time as much as simply adopting bugs that someone's already cultivated. The code monkeys quickly get sick of the project, meaning there is massive turnover in the course of getting the application to potential clients. The code is a mess, the guy with the money keeps demanding new tweaks and additions, which only compound the problems, and in the end, it's all such a bloated mess that no one knows how to really make it work right. Unfortunately, it works well enough to do a demo and sell a bunch of suckers on the concept with lofty promises of money and time saved, lower payroll expense, and burgeoning profit margins. If the idea guy is really lucky, he will do such a bang-up sales job that another development company will swoop in and offer to buy the application, meaning his fortune is made AND he's spared the ugly whiplash when clients learn the thing doesn't really work. At that point, the suckers left holding the bag have no choice but to whistle in the dark, as it were, and pretend they didn't make the worst investment of the decade. Why, with enough cheerleading about how terrific this is, they should be able to buy enough time to get their own geeks on the case and fix everything wrong with it, right? Of course, from its inception, no one has even bothered to ask the actual end users and investigate what would be needed to use said application in terms of features and functionality, until the mess is complete and they're ready to roll out the beta and see how it works.

Meanwhile, who is left to pay the dearest price when they're forced to utilize this glorified trash heap? In our case, it's the transcriptionists--the very people who are the backbone of every MTSO because they're doing the actual production of the product being sold. The clients probably don't care so much because they are being charged less. The MTSO doesn't really care because their payroll is also lower, and jobs are more and more scarce so that a majority of MTs do not have the luxury of walking off the job. If we do, there are always MTs in India and wherever else the Crappy Schools are training them today (not only the Philippines, but google your way to see who's training MTs in Jamaica next). Indeed, we've had our pay and benefits whittled away so often, we're pretty much the equivalent of an abused spouse. . . hack away at our self esteem, beat us down, then placate us with soothing words about how you really, really care and are thinking hard about how fair those latest wage cuts were, and we're just too stinkin' tired to pack up our bags and head for the women's shelter like we ought to.

Two weeks ago, my computer died as I was composing a lengthy reply to Rebecca, who asked, "Why stick with a company that burdens you with such a horrible platform?" Why, indeed. I should have hand-written my reply again instead of just pining away for my internet all the time my baby was in the shop because I'm sure I've forgotten my best points by now. I'm afraid part of it hearkens to my history of staying in a lousy marriage for 20 years "for the sake of the kids," despite an emotionally abusive jerk who was a horrible excuse for a father figure. In retrospect, I can kick myself for taking two decades to scrape up enough anger to muster my courage and just bail on him, but at the time, even though I knew I deserved better, you get into this helpless rut where you just don't feel like you can make it. I don't like change. I don't like risking what little I have for an unknown that may turn out to be worse (even when I know it couldn't possibly be). The same seems to apply here. I've told myself that it doesn't make sense to go through the stress of changing jobs/account specs/platforms in a field I hope to get out of in the foreseeable future. I am abused, taken for granted, and more stressed and miserable than I've ever been in this job, but until they've gutted my paycheck to the point where I suddenly can't pay all my bills, I'm having a hard time mustering my Libra temper and heading for greener pastures.

It's a sickness, I know. If I were a believer in 12-step programs, I would probably look for one. I can say that the night these SR reports suddenly appeared in my queue, I came as close as I ever have in my life to walking off a job. If my computer hadn't been in the shop, preventing me from surfing the 'net to find a new one, I may well have done just that. Once SR becomes an irreversible part of my life, I may finally reach that point of no return. I am desperately trying to recapture that feeling of glee when I finally made the jump across that divorce chasm and realized it had actually been just an easy hop to freedom and the promise of self-fulfillment. For now, however, the worrywart on my shoulder is talking louder than the cheerleader on the other and it's still looking like another big jump from here. I still need to pace the track and feel like I've got a running start.

If you remember the lovely essay I quoted a couple months back from another MT in the same position, you will remember how funny it first seemed. That, however, could be shrugged off by MTSOs as fiction. I'd like to know how they can continue to shrug off the real thing, knowing that it is taking MTs as long--or longer--to fix this kind of mess and that they are paying us a fraction of our already-low wages to do so because they've convinced themselves that SR is SUPPOSED to make our jobs so much easier. Do they even care how long it would take to transcribe this normally versus how long it would take to merely edit "a few" SR mistakes, or are they laughing all the way to the bank because they've found the ultimate way to oppress the peons for their own financial gain? Do they realize that fully half of these reports are complete gibberish and routinely make hash out of critical medical information? I can't even imagine how SR can botch the best of dictators, turning, "This is Dr. Potter, dictating on med record 12345, Jane Doe. Date of admission is May 25, 2009," into an abortion like this: "Dr. prostatism axes of the T5-T6-0 range on a calculated indications Ms. 20/50 2009."

And this was the least nonsensical part of the whole report. May I mambo dogface to the banana patch, indeed. . .

I am beat. Spent the last week being thrown into the deep end of the pool without swimming lessons (well, I had them, but that was almost 10 months ago and I forgot most of it) and am just now feeling like I'm starting to learn how to float again. I used to love to swim, so what happened?

Well, in this case, what happened was a new transcription platform that is so bloated and slow that it not only slows me down to a fraction of my usual speed, but I'm having to completely revamp my expander macros to allow for all the extra crapola involved in creating headings, removing spaces, etc. This was compounded by the fact that we work on disgusting peecees to begin with and mine had randomly decided to revert to a previous version of my macro file (from before I changed accounts a few months ago) and I had only come close to recreating all those macros to begin with. No, I didn't change a thing--it has a habit of ruining a lot of settings every time someone remotely performs maintenance or upgrades. Yes, I disobeyed the general computer rule of backing things up regularly, or I wouldn't be suffering so much.

As if that didn't make me an unhappy camper (er. . . swimmer) as it was, I know that it's going to be a very short trip before I'm informed that I have to completely unlearn how I do things and start integrating speech "recognition" (a misnomer if there ever was one), which I fully expect to be the equivalent of being thrown a hefty rock for use as a flotation device.

Too late to help me, but for the love of Pete. . . to any of you brainiacs who think you're going to make a fortune by writing the next great transcription platform, I beg you to get serious input from the people who will be forced to use it before you start churning out code. What is often touted as a great compilation of features is too often so full of extraneous crap that nothing works quickly and you end up robbing us of productivity for the sake of inclusiveness. I can't even begin to whine about everything I hate about this, so suffice to say it's not fair that I should have to spend almost as much time sitting idly waiting for my CPU to catch up to me as I do actually transcribing. It's forever choking--either the audio and cursor stop completely or the audio is unstoppable until I mash the pedal 20 times. Since it took the better part of a year to even transition, I'm not even at a point where anyone wants to hear what doesn't work--they're focused on the SR side, in hopes of maximizing profit and minimizing trained MT input. It is the ultimate insult to be asked to train the technology that robs you of your pay and ultimately, your job.

I spent hours over my precious weekend going through my Shorthand entries (all 18,000 of 'em) in an attempt to tweak and try to bypass many of the awkward formatting commands and compensate for the many shortcomings, but the goddess only knows if I'll have the patience to adapt once the SR anchor drops. Much as I dislike change, I have to say I am coming perilously close to bidding the abuse farewell. Surely, there is a patch of dry land out there yet where MTs are actually valued and integrated into the decisions that impact their livelihood. Heck, if I could just grit my teeth and survive a 160-hour course at the vo-tech, I could be making the same/more money as a phlebotomist, with a heckuva lot more bennies and respect. . . I've already got the vampire thing down pat, stuck on the graveyard shift all these years.

I do find myself wondering how Karma will come into play. I will be very surprised if the very MTSOs who are working so hard to eliminate MTs are even still around in the next 5-10 years. Once they succeed in doing away with us and automating the vast majority of patient records, what's to stop clients from bypassing MTSOs altogether? There are already some good open source EMR and coding applications out there, as well as a move to real-time documentation--some of the best written by doctors themselves. As the old-school docs fade away, I fully expect the younger generation will not only be willing to futz around the computer and fill in their own blanks versus the onus of dictation, but will view it as the only way to go. Transcription has always been the first line when budget-cutting, after all. Just imagine the savings when they finally figure out how to slash it to the nub. Yes, I truly do believe this. All those greedy folk talking about garbage that will never happen (i.e. mandatory credentialing for a field that already does not reward us for knowledge and experience) are totally ignoring what's coming down the pike. This tidal wave MTs have been whining about for a while now is coming for us all.

Maybe that's the hypoxia and fatigue talking. For now, I'd do well to keep working on my stinkin' breaststroke.

Some of us in the medical field (especially transcriptionists, I think) are in a unique position to observe certain trends in society. If you work a clinic account, your work has definite seasons, even if you don't: Fall brings school physicals and general checkups, winter brings winter sports injuries and colds. At the end of the year, you see a lot of seniors getting in one last checkup before their Medicare rolls over. In the spring, you get summer camp physicals and summer brings everything from skateboard fractures and soccer injuries to sunburns and Lyme disease. There's a kind of reassurance through it all that the world is operating on schedule.

We are also privy to the first waves of fad or panic. Even before I was an MT, I saw this in the natural foods shop--some lame article in the paper or segment on a morning infotainment show, and we'd be overrun by people desperate to stock up on lecithin granules, red rice yeast, melatonin, oat bran, flax seed, or whatever the latest "discovery" was. Now, I see the same thing, only it's more apt to involve the marketing of disease (cholesterol, mood disorders, hair loss, erectile dysfunction), and not such a benign thing. It seems that the public in general is a very easy sell and likes to let someone do the thinking and research for them. I think there are many doctors who like to see a more informed patient but I suspect more often, they are merely annoyed because there are so many who come in armed with snippets of truth, demanding the latest quick fix.

The latest swine flu outbreak is another facet of all this. Like a well-written eBay auction (I often find myself wondering who bought the hippie bus and whether they hit it off with the little brother who went with it), there are stories that go viral almost overnight. The news flashes images of people wearing dust masks in Mexico and suddenly, there is outright panic. Instead of researching information on how to avoid germs, how not to spread them yourself, and whether there really is a threat to us personally, people simply start to panic. A sudden influx into the ERs meant I was called upon to help out a bit, and I was amazed--and more than a little sympathetic for the docs there. Everyone and his uncle was coming in with a snot nose or a cough (It was there last week, I swear!) and demanding a Rhino-Probe to see if they had swine flu.

Perhaps it's a testament to our present culture that in less than a week, hardly anyone was coming in for this, though the local news still seems determined to maintain the fear. Has our collective attention span become so short that we can only stay interested in a topic for a week or so? It seems like swine flu was THE news and everyone was trying to hitch their wagon to it (i.e. the extremists who insisted we stop immigration NOW, never mind the virus came here courtesy of school kids from Queens) and now. . . it's slipping into the background as it barely ranks a single entry near the bottom of the page when you google today's top news stories. Clearly, Supreme Court speculation, Madonna's preoccupation with adoption, and the upcoming Star Trek prequel are more important in the grand scheme of things. (I mean some of this in a not-so-snarky way, as clearly, Star Trek does rank way up there.)

I don't know why it bothers me, but I wish just once, people would take the opportunity to educate themselves so they were better prepared for the next fad or panic. Perhaps this should be a time to reassess your diet, as this particular virus is acknowledged to have come from a Smithfield meat factory (check out the Rolling Stone exposé here for a little background info). It isn't only pigs, either--it's virtually everything farmed on a monster scale. Is it any wonder organic and locally grown foods are becoming exponentially more popular? I suspect more of us are realizing that the best offense is a good defense--that's what "survival of the fittest" involves, after all. Take good care of yourself and be healthy, eat well, keep your hands washed and away from your face, and research the antivirals that occur naturally (Tamiflu? made from star anise--only herbal remedies don't benefit stockholders like Rumsfeld, in this case, so no one's going to market them). Most of all, don't go running to the emergency room at the first sign of a sniffle--hospitals are full of sick people, after all! At least call your primary care first for reassurance.

FYI, here's a great timeline of pandemics in recorded history. Obviously, influenza is the key player here, but again, being healthy has always been the best defense. Well, that and working from the isolation of your own home, as so many MTs do. . . Real threat or imagined, this actually is one of those perks of the job, getting a front-row seat without actually having to be in the trenches.

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.

Ahhh, it must be springtime because the scams are bursting out all over. On one MT message board alone, I have counted no fewer than six threads this last week or so from starry-eyed MT wannabes hoping for advice on school choice, or thinly-veiled propaganda promoting lousy schools that apparently feel the need to get out there and stir the waters from time to time and remind people they're still an option. I suspect as badly as things look for MTs in general right now, the numbers of potential students is looking even worse, so I suppose it should be no surprise. This has always been a cyclical thing, besides, and there is truly an actual flow of "seasons" where various scenarios play out routinely--not just bad schools that never quite go away, but people trolling with "special" information that they're not willing to post in public--but anyone interested is welcome to shoot them a PM and they'll gladly share. (What they don't say is that this probably involves a "bargain" price and doesn't amount to a pinch of hooey.) I suppose if I were to check the local hotel schedules, there would probably be steady bookings for correspondence course seminars, too.

I've already ranted ad nauseam about the matchbook schools and other predators, but what still amazes me are the seemingly unlimited numbers of willing victims--especially nowadays (people still want to become MTs?) When you see someone asking advice about a particular school (invariably one with a lousy reputation), 99.9% of the time, they don't really want to hear anything that doesn't validate the decision they've already made--to opt for the cheapest route possible and hope for the best. All it takes to succeed is hard work and desire, right? Nope. You can't learn what isn't taught--or what is taught badly. You can't learn if you're grading yourself. You can't honestly believe that a handful of practice reports truly prepares you in the same way as completing a couple thousand with an actual certified instructor giving feedback on each and every one.

The biggest irony is that most of these information seekers have not only already forked over their tuition, but are also well into the course--if not already done. Yet this is when they choose to pop their heads up and ask advice on the wisdom of their choice. Logically, does it make sense to wait until you're a week away from your final exam to ask, "Is this a good school?" or, "How many grads of School X have managed to get jobs?" Almost invariably, though, they don't really want an answer. They want validation. Try to answer with anything approaching reality and you are denounced as a meanie, a killjoy, or (LOL) trying to prop up another school's reputation by tearing another's down. The outrage is misplaced, I'm afraid. It's scary to realize you've bought a pig in a poke. I suspect all they really want is for someone to reassure them those rose-colored glasses will indeed serve them well and their original plan will indeed come to fruition. . . or maybe I have it wrong and these are simply attempts to get out there and "network," so they don't have to work any harder on the job search than they did on the schoolwork.

To succeed more than ever--there are dues you simply must pay. There are no shortcuts, and false economy is not going to make it easier. Caveat emptor ("let the buyer beware," for those of you who missed Latin 101) is best employed before you act, people. Once you've committed your nonrefundable time and money into something like this, there's no point in even asking. If you're that offended by unvarnished truth, it is much less painful if you seek it before you've committed to something. Sadly, once you've chosen not to exercise your option to be a careful shopper, there is no one to blame for your locus poenitentiae ("buyer's remorse") but yourself.

It's apparently time to go shopping for walkers because the unthinkable has happened. I have apparently jumped a generation gap.

Amazingly, it's already been a year since Doctor Appreciation Day (never fear--they're as neglected on their day as MTs are during MT Week). I find it no less difficult to find some warm, fuzzy thoughts for the vast majority of my dictators but obviously, the difference this year is that I'm now working an account that is a teaching hospital and full of greenhorns. Suddenly, half my dictators are young men who could use a lesson in the benefits of a vigorous session with a hankie and girls who sound like they probably still have a Barbie or two in their locker. This whole thing came to a head recently, though, when I got one who sounds like she's no more than four years old--nearly impossible to understand, thanks to her infantile voice--so tiny, she's nearly impossible to boost into hearing range, and the fact that she can't seem to wrap herself around the English language, let alone medicalese, makes me wide-eyed with horror and frustration. This is not even a fourth-year medical student--this is an actual resident. What MUST her patients think when she appears on the case, without even a "real" doctor hovering over her? No matter how fond people might have been of Doogie Howser, I can't imagine they would easily accept someone who sounds as though she's just graduated to big girl underwear. It strikes me as frightening as much as amazing.

Holy cow. When did I get so old? Maybe part of it is that my own baby just turned 20 last week--but even so, she hasn't sounded tiny for a decade, and she isn't making life and death decisions for other people. What's next--will I stop bristling the next time a doctor refers to a 40-year-old as "middle-aged?" Will I actually pause before tossing those AARP invites into the circular file?

Thankfully, even the youngsters I get are (for the most part) excellent dictators. Perhaps they're now teaching dictation skills in medical school (dare we hope?), because these folks do seem to take care to enunciate, spell when they trip over a pronunciation, and rarely race through just to escape an unpleasant task. Perhaps it's the hospital itself, which is actually a major player and should be leading the way. Whatever the reason, I am thankful. As much as I stressed out about the move to a new account last year, it was a move for the better.

This sudden sense of ageism I'm flirting with cannot be a good sign, however. Even though my mom assured me years ago that everyone's self image gets stuck around age 20, I feel I should up my vitamin intake and head for the henna before someone mistakes me for a grandma. Cue the identity crisis.

I notice that Advance has no one here blogging about coding, yet the discussion forum is predominantly skewed that way. Does the topic just not lend itself to conversation because it is so black and white, like accounting? When I realized my art major would probably mean having to teach, I did a 180 and changed to accounting/business, so I grok the geekier aspects of coding. Perhaps it would be too difficult to blog weekly about something so technical.

Still, I have questions that can't be answered with an ICD code or school recommendation, and it's kind of an offshoot of the things that have plagued transcription for so long.

Back in my dreaded Computers in Healthcare course, we did a unit on coding--specifically, the software used to facilitate it. After playing with a few examples, I found it fun and easy, yet couldn't help wondering if it wasn't polished enough that coders would soon find themselves on the brink of extinction, much like the considerably less elegant mess that is speech recognition (which still needs us, but valued at a fraction of the work actually put into it) or EMR software, some of which is easy enough that the clients can enter their own information, bypassing MTs altogether. If anything, coders seem more apt to be replaced, simply because the process is so black and white. It's all left-brain stuff, none of the nebulous narrative we deal with in MT, but information you can easily plug into little boxes.

Then, I saw this: ICDMeister, an online application that allows healthcare providers do their own coding. Granted, it doesn't have all the bells and whistles the full-blown coding apps do (i.e. no illustrated references or wizards to lead you down the right trails because it assumes you already have the medical know-how), but it's slick, and if you view the demo videos you can see it's designed with the idea of plugging the information into your EMR, to boot. Undoubtedly, it needs the periodic updates to integrate the changes that continually take place in coding (as the coder-oriented software does), but I can see why doctors would view this as an irresistible option for cost-cutting. Healthcare providers have always erroneously viewed clerical costs as the first line of budget cuts, after all.

It has never made sense to me why a doctor making six figures or better would consider it economical to handle his own transcription--especially since so many of them are severely handicapped in spelling and general language rules--but I think we're starting to see a generational shift. Many of these software applications have been written BY doctors (Synapse and ICDMeister prime examples). These guys aren't necessarily going to make any more financial sense spending their own time plugging data into these things than hiring some peon to do it for them, but they are far more tech-savvy than their predecessors and conceivably could think this was a great way to spend their time away from patient care--or perhaps foisting the task off onto the office staff they already employ. All they need to see is insurance claims accepted and money flowing into the practice and they're convinced it's worthwhile, right?

It all makes me flash back to what Robert Anton Wilson predicted a couple decades ago regarding evolution--that the intervals between major discoveries/inventions decrease exponentially, i.e. the time between fire, wheel, Industrial Revolution, computers, microprocessors, etc. all appear twice as fast as the last discovery, and the closer we get to the cosmic trigger that will signal our next human evolution (yes, cue the monolith from 2001), the discoveries will be coming so fast that we will have a hard time comprehending it all.

When the status quo changes so fast and so many of us find our livelihood rendered all but obsolete, it really makes you wonder how long to dig your heels in and when you're going to have to give in and change your path lest you find the world's passed you by. We've been reeling from that in MT for quite some time and it suddenly seems apparent that MTs don't have an exclusive on that angst.

Just when I've started to despair that we are going to give spring a miss and head straight into the Florida summer, I found a bright spot in my week to counteract these winter blahs. . .

Actually, the story starts out on a grumpy note because it all started when commiserating about this stinkin' Pharmacology and Pathophysiology course. Seems a medical student I bumped into in an online message board has been feeling very low because he failed his mid-terms. Badly. I have whined in detail about the fact that AHIMA's course utilizes what may be the most uninspiring texts possible (and don't even get me started on the fact that they require TWO texts--the second of which is used very little, for a handful of math problems that could easily have been provided as online course materials for free). As much as I loved their Anatomy and Physiology course, I despise this one. It's only challenging in that it's deadly dull. Perhaps if it had some accompanying interactive exercises, it would engage the student more, but there's nothing. Just a big book and a lot of text. The A&P had tons of flash games and quizzes, plus Elsevier's great online supplements, also interactive--most pretty primitive in terms of design, but they made you think and process the information in a way that sticks. (This text is also put out by Elsevier, but lacks the bells and whistles I loved in the other course.) Honestly, when I got so bogged down in family crises one after another, it completely sucked my will to continue to a whisper. But here was someone in a similar course--and in an actual college setting--suffering from the same angst and equally bored and discouraged. I took some solace in that fact. It's not just me! The material really IS that dull!

I was starting to wonder about other CTR courses and whether they would be presented in a more do-able format. Additionally, as I am now having to face the fact that the requirements to test for the CTR have now changed and I need to be thinking about an actual degree in addition to completing this course, I've been pondering my options. I actually have over three years of college credits and may well have everything I need to get an AA, but then I have to consider whether these prerequisite courses I'm taking will actually transfer and factor in. I was sorely disappointed to learn that AHIMA's A&P course would not provide credits anywhere else. When I started requesting transcripts via the ACE website (American College Education, which for our purposes as students, provides a transcript to certify college credits earned), I found that the last time AHIMA's A&P qualified for credit was in 1999. I was out of luck. I wrote to ACE and AHIMA to whine and was told sorry, too bad, but maybe they'll accredit the course eventually.

Which is where my ray of sunshine comes in. I have to question why AHIMA would not automatically inform people there's been a change, but after rummaging around both websites for information, I found that they finally have added the current course to the list and it is retroactive to when I completed the course. Just a few clicks and I have successfully added four credits to my transcript. Hooray!

Honestly, in the face of this current boondoggle with the never-ending pharmacology course, I wasn't confident I could face having to repeat the A&P course again. That is still the hardest course I've ever taken and I worked incredibly hard for that A. If you also took this course, you might make a point of adding the credits to your transcript, too. Even if you don't need them now, you've earned them.

For now, I guess I will slog ahead and stick to my original plan as this is my only remaining requisite course and I think once I get into the actual CTR classes, it's going to get fun again.

I love the internet, but it does bring out the worst in some people. . . Whilst it is wildly liberating to people with limited ability to make connections in real life, the polar opposite is that it enables some real narcissists to run amok, as well. Over the years, I've witnessed friendly message boards that devolve into WW III, personality disintegrations, and scenarios too silly for even the worst soap opera storylines. I always thought it would be fascinating to write a thesis on the social dynamics of an internet message board, but having lived through several doozies, I'm not sure I would have the patience to get that close to the fray again. Sometimes, though, there seems to be no avoiding it. Everyone and his brother has a blog these days, so I figured it shouldn't be too difficult to lie (relatively) low and stay out of trouble. Once in a while, we get an enterprising fanatic who wanders in after googling the 'net for his favorite key words (my fave here was the guy incensed because I dared to suggest we cut doctors a little slack--he apparently lives for malpractice stories and had a blog devoted to them), but for the most part, it's quite a task to get Advance readers to quit sitting on their hands and join in any discussion.

Imagine my surprise, then, when last week's entry inspired at least two people to use my rant against SR as a means to promote their own blogs, as evidenced by the manic self-pimping across MTville. I figure if they really wanted to create a dialogue, they would have posted here--but then in doing so, they don't get that revenue traffic or attention, which I suspect is the real motive. Not that I really care to discuss the failings of SR with people who either have never even worked with it or have tried to actively profit from it. It's hard to take criticism seriously when that's the case. I do resent the implication that I am a moron for speaking out against the technology because I hadn't read up on it (no, the sales pitches are part of the problem). It seems that working with a few thousand other peons being forced into SR lends me no authority with some folks. Granted, I've only seen comments from a fraction of my coworkers, but a statistical sampling doesn't require an entire population to render an accurate result. The fact is that the vast majority of comments I see from MTs themselves are that it doesn't work well and is costing them money--on the order of anywhere from $100 to $300 a paycheck, even after several months.

The real booger, I think, is the condescending contention that MTs who cry about SR are either too lazy or rigid to change with the times or to stand up against employers and refuse to take half wages for something that requires almost as much work as straight transcription. The Airheads are undoubtedly hoping this will bolster their plans to push for credentialing, with a promise that in doing so, it will lend an air of legitimacy to the field (forget that it makes no sense to have to work that hard for a job that pays less than you'd make as barista at Starbuck's). To a myopic MTSO, it may seem it should be a small matter to throw off those shackles and unionize, or at least stage a walk-out in protest, with no grasp of what it really means to rely on that paycheck. We should stand up for ourselves or quit whining, right?

Duhhh. . . then again, you're talking about people (mostly women) who are already living paycheck to paycheck and can't afford to just walk. Yes, I have groused about the hobbyists who've helped drive wages down because they're willing to work for "anything" just as long as they can earn a little pin money from home, but I would guess that over half of us are either our families' sole support or very necessary contributors to keep the wolves away. If we do walk, where are we going to go? Every big national is already implementing SR and no one's paying that well anymore. Many of them have been in a holding pattern, if not an outright hiring freeze, for quite some time now. The small-time MTSOs are even losing their grip on clinic accounts these days as the nationals gobble them up. Where are we supposed to go with unemployment in general trending ever upward? Besides, given the failings of AAMT to rally us all, I seriously doubt a union would even work these days. Now more than ever, we're even less than names on a company payroll--we're faceless numbers bobbing out here in cyberspace, most of whom will never even see a coworker in the flesh, let alone our bosses. There's no loyalty to the peons and at 2-7 cents per line, the peons aren't going to go out of their way for a show of solidarity when there's no picket line to be seen crossing. Face it--the pink collar ghetto is the last bastion of the sweatshops and there's no one advocating for us.

So. I've heard enough from salesmen, apologists, company cheerleaders desperate to believe their own hype for the sake of profits, and know-it-alls with zero hands-on experience. Since my own observations don't seem to hold much water with some, I think it would be very useful to get some legitimate feedback from MTs (especially those of you who've been doing this for a while and can compare and contrast) who work with SR and can attest to whether it works or not. Where do you think this is heading? Are you optimistic? Frustrated? Frantically scoping out the room for your own exit? Now's the time to get off your hands and let it fly. No one here even gets any ad revenue if you do, and you just might feel better. At least "whining" anonymously on the interwebs is a way to stand up for yourself without jeopardizing the family farm.

I hate the term, and I find it intensely annoying that not only MTs are using this as a pet name for that silly, old speech recognition now making our lives miserable, but even employers are sending out "humorous" emails with today's funny from the engine that will not learn. Except for recent grads who went straight into SR editing and don't have a clue how big a step down it is from straight transcription or the full ramifications of it on our perceived value in the workplace, I don't know any MTs who are happy with it. After years of typing on a normal QWERTY or Dvorak keyboard, SR utilizes an awkward set of key commands, resulting in a whole new generation of occupational injuries. All those normals you've spent years creating in Shorthand, Instant Text, or other expander? Sorry, you're not supposed to just plug them in when SR makes mincemeat of what's actually dictated because unless you fix each mistake it makes individually, the poor thing can't learn from its mistakes and you will make it take longer to replace you.

Honestly, the only ones I've heard rave about SR are the crap sales people who foist it off on unsuspecting clients and the management of those greedy and gullible companies who are desperate to whip up some enthusiasm amongst their employees, who are now faced with the choice of working twice as hard for half the pay or not working at all. They seem unwilling to accept that this isn't equitable and is lousy for morale. There are incredible numbers of veteran MTs who are now crying because they are seeing their paychecks fall precipitously because there's no way to double production to make up for half the wages. MTs are finding there are fewer and fewer straight transcription jobs to go to, the ones out there are not paying any more for experience than for new grads, and many who have supported themselves adequately for years are now facing bankruptcy and foreclosure as a result. Hardly a joking matter.

Thanks to a friend who suffers as bad an internet addiction as I do, I was linked to a brilliant illustration of this on a message board I don't normally frequent. I've tried in vain to contact the author, who apparently (and justifiably) feels the need to remain anonymous, but perhaps when she leaves her position (retiring to clean toilets or something more lucrative, I wager), she'll put in an appearance and accept the kudos she so richly deserves. I predict this could be one of those things that appears for years to come in email forwards and MT message boards. It is just that good. If MTSOs are smart, they will take this as more than a harmless joke because, though it is funny on the surface, the message is anything but.

As an empty with plenty years experience comma eye was vary this dress to learn that I will shortly be demoted from an empty to a VR quote editor unquote making far less money than my training and years of experience deserve period you are comma node out comma counting on technology to eventually fix the bugs in yore VR soft wear period mean while comma you are ????? a viable resource period sum of us wood much rather retire than see our tail ends miss used by working as VR editors period to whom will you turn when this VR idea fails to pan out question mark period paragraph person alley what I have all ways enjoyed a bout transcription work is the actual typing comma the rhythm and flow comma inserting a punk situation mark here comma subtly colorectal sin tax there comma and turning a complete mismatch of a dictation in to a real double report period lets face it comma many doctors are complete idiots period the dictate the rung medications comma or the rite medications at potentially fetal doe sages period they mambo comma wrestle peppers comma talk to colleges comma eat comma bleach into the phone and make other bodily noises while they dictate period even naive English beakers often do not have the first idea of proper sentence structure or grammar period yet comma you expect olive us to clean up a VR mess for half the money we are making now question mark we think not explanation point paragraph so cut costs as you wish comma in one or 2 years when VR comes to our accounts parenthesis or before parenthesis we will have found something else to do comma and the profess shun will be pourer for the lost of all of us period have a nice stay explanation point

For those of you who aren't skilled transcriptionists (or are merely overwrought from dealing with this garbage on the job and are getting woozy at the prospect of having to waste your personal time on it, as well), here's the translation:

As an MT with 20 years’ experience, I was very distressed to learn that I will shortly be demoted from an MT to a VR “editor” making far less money than my training and years of experience deserve. You are, no doubt, counting on technology to eventually fix the bugs in your VR software. Meanwhile, you are jeopardizing a valuable resource. Some of us would much rather retire than see our talents misused by working as VR editors. To whom will you turn when this VR idea fails to pan out? Many of us believe it is time to retire or find another line of work.

Personally, what I have always enjoyed about transcription work is the actual typing, the rhythm and flow, inserting a punctuation mark here, subtly correcting syntax there, and turning a complete mishmash of a dictation into a readable report. Let’s face it, many doctors are complete idiots. They dictate the wrong medications, or the right ones at potentially fatal doses. They mumble, rustle papers, talk to colleagues, eat, belch into the phone and make other bodily noises while they dictate. Even native English speakers often do not have the first idea of proper sentence structure or grammar. Yet, you expect all of us to clean up a VR mess for half the money we are making now? We think not!

So, cut costs as you wish, in 1 or 2 years when VR comes to our accounts (or before) we will have found something else to do, and the profession will be poorer for the loss of all of us. Have a nice day!

To "so disappointed," the author of this masterpiece, I doff my hat to you. To the rest of the MTs out there who aren't at all happy at the prospect of being assimilated by this Borg, I'm afraid I don't see a solution because no one's ever bothered to ask for our input on the front end of this abomination. When clients start tearing their hair out and screaming about the sorry de-evolution of the medical record, we'll at least be able to say, "I told you so."

I see this week there is some outrage offshore over the new stimulus bill, specifically the part relating to the H-1B visas that have allowed foreign workers to come to the US, illustrated nicely in this article on India Times--and especially in the ensuing comments. Of course, many of these visas have gone to Indian engineers, IT specialists, and medical professionals, creating a very powerful subculture (both here and there) . The threat of losing these visas has many angry at the US. As our new President has indicated, there are still more important changes coming that may well impact us more directly, depending on specifics. Just off the top of my (admittedly lazy) head, I believe at the very least, companies that offshore will lose certain tax breaks, and though they certainly won't try to clamp down outright on firms that already have substantial offshore investments, I'm betting they will figure out a way to discourage any from moving more of their workforce away.

Those MTs who remember the resentment over the last decade or so about the loss of our jobs offshore and the resultant impact (all bad) on our wages are sensing a little irony here. We were admonished on the realities of globalization when our jobs filtered offshore, but now when someone threatens to bring jobs back, it's protectionism? I can't help but wonder if they'd see this in a little different light if they were talking about Indian jobs going to Chinese workers willing to work for a fraction of their wages. . .

I have to admit that I can see the rationale for globalization. A most fascinating demonstration of how that works correctly is evident in a game devised by Buckminster Fuller (creator of the geodesic dome), called the World Game, which is kind of the antithesis to the war game, Risk. Players (anyone from grade school kids to corporate bigwigs) represent countries, corporations, human interest organizations, etc., and are given unique resources and assets. In the ensuing hours, players trade their assets and quickly learn that it is possible to remain competitive AND profit if everyone cooperates. Greed may make for short-term profit, but it's necessary to factor in public opinion and mutual benefit for long-term successes. In the end, everyone compares notes and realizes that friendly cooperation makes for the most profits all around, to say nothing of world harmony. (Cue sunshine and daisies.)

Of course, communism works well in theory, too. The problem is that human nature tends to ruin things, especially when greed, profit, and personal gain manage to dominate as they have in the last two to three decades, which have been all about corporate profit and not at all about equity, and the entire world economy has reached the breaking point. The sweeping changes that threaten to rock our world are simultaneously frightening and exciting, and may well test the sensibilities borne of the Boomer generation. Can peace, love, and harmony really defeat the "evil axis" of world bankers, corporations, Big Oil, Big Pharma, and the insurance industries? Close to home, will a "government of the people, by the people, and for the people" once again become something more than lip service?

Obviously, we're running on hope here. I think there is still room for globalization and mutual benefit, but not at breakneck speed for the benefit of the elite few at the expense of the rest of us. If you go back to the feedback from this article, there is as much understanding as there is anger. Some are crying for a boycott of US companies overseas, which I think is just fine because face it--McDonald's, KFC, and Coca-Cola haven't added much to world culture as they have served to homogenize and dilute it. In emulating America, many countries seem to have lost sight of what makes them unique and worth preserving. I find many replies to this article especially insightful, like the one who suggests it's silly to expect the US to offer jobs to foreign workers whilst Americans sit around jobless and homeless, advocating logic because, "No one will share his food with an outsider if his family is starving."

Of course, this is only the tip of the iceberg and the effects of the stimulus package and more specific measures to undo the damage offshoring has caused are more likely to impact us personally. It will be interesting to see the long-term effects on wages now that MT wages have been driven so low that many of us can't even afford to stay in the field even if we can find jobs and few people are willing to consider entering the field given its dim prospects. The law of supply and demand would indicate that wages should go up, but now that speech recognition has replaced the offshore MT as our biggest nemesis, I'm not holding my breath.

"Interesting" times indeed.

I know I whine a lot about MTs being the first and hardest-hit casualties in a budget crunch (and I wasn't even around with you vets who were relegated to the supply room downstairs next to the morgue because MTs have always been so highly respected), but obviously, that's my reality and it's hard to see beyond your world when you're struggling to simply survive. With all the talk of the economic stimulus package and how much of an impact it will really have on real people, you pretty much have to poke your head up and see how everyone else is doing. End result is that I've had a little wake-up call this week to give me even more to feel pessimistic about.

Those of you who decry the bastardization of what was supposed to be our representative (AAMT is long dead--it's every MT for herself) and advocate channeling our indignation into organizing a union are, in my humble opinion, dreamers. Cats lend themselves to herding better than MTs, and with most of us working harder than ever for less money than ever, there's not a lot of incentive to volunteer our precious time to any extracurricular activities. We are long past the point of no return. The ship has sailed. MT is fading fast and it's all about automation, baby. Yadayadayada and so forth.

What has reinforced my rosy outlook, you ask? If I have to pick one thing, it might be this message board thread. I can't even distill it into a pithy Reader's Digest version, so I hope you do go and read at least the first post. The gist is that MTs may have simply served as the canary, dying in the mines to warn the rest of the healthcare system that something Bad is swooping in. Obviously, executive bonuses are as big a problem in our world as they are on Wall Street, but I was naïve enough to believe that nurses--people with a strong union, fer cryin' out loud--were probably safe from all this. Apparently, nothing could be further from the truth. Nurses are hurting. Budgets are shrinking, nursing staff is dwindling, nurse-to-patient ratios are growing, and they are leaving the field in droves--if not bailing out of the acute care scene for an easier life in private practice, simply leaving nursing altogether. One poster here claims 50% of nurses have left already (sorry, I'm too pressed for time to research that figure, but it's not hard to believe). These are people who are crucial to the system--the backbone, if you will. Anyone who's ever been in the hospital knows you're lucky to see a doctor for three minutes a day; it's the nurses who do the work, which means everything from monitoring vital signs to scrubbing Granddad's butt when he's been incontinent to simply connecting with an anxious patient as a human being. I thank a nurse for my son's life, because she recognized he was septic when no one else did. The fact that nurses even need a union to fight for their due is obscene.

Heck, when someone asks my opinion for a field to get into, I've always recommended nursing. I've nudged my own daughter that way. It's a field that should always be secure, right? It pays well, especially in comparison to other jobs these days. It comes with great benefits and perks. It's got to be a soul-satisfying job--you're not selling someone junk they don't need, you're providing something society really needs and values, right? It's something that can't be outsourced (oops--not so fast there. . . imported nurses are gaining a huge foothold in hospitals in some markets) and it's a job that you can do anywhere in the country, yes? In our area, nurses are so desperately needed that the local public hospital is helping to pay your way through vo-tech, getting you into a job after only three months' training so you can earn as you learn, and even buying up property around the hospital to provide affordable housing to its employees. Great deal, huh?

It seems I have to rethink that now. I've seen how hospitals are breaking under the weight of uninsured patients using the ERs as their only source of primary care. Indigent care has been the demise of many hospitals already, leaving large communities with no public hospital at all. Well-insured patients get the lowest negotiated rates, indigents get totally free care, and the rest of us who either have to pay cash or find our so-called health insurance covers next to nothing are charged the highest rates of all, to take up the slack. (Honestly, what use is insurance that has a $6000 deductible and cap of $80K when a single catastrophic injury can add up to twice that amount?) Doctors, like nurses, are sick of the rigamarole and cookbook medicine they're forced to practice in hospitals (honestly, if there's a strict protocol for every condition, why don't they just use that tech support in India since they love those savings?) and are retreating to private practice. And now, I see that nurses are just as abused as everyone else.

When the foundation of our healthcare system is breaking down, it's time for someone to just scrap the whole system and start over. When you do the research, you see that every other developed country in the world values its people enough to treat health care as a right, not a privilege. Even not-so-swift countries (Cuba anyone?) provide better, cheaper care to every citizen. What is wrong with this system is that we are sheep. Too many people believe the nonsense that universal healthcare = socialism and the end of society as we know it. I bet dollars to doughnuts that sentiment has been fostered by the people who stand to lose the most if we get it: Big Pharma and the insurance industry.

Other countries are run by governments that are afraid of their citizens. When those people are not happy, they protest. Where all of France stages a walkout, government listens. In the US, however, we've lost our rebellious nature. Maybe we've just allowed ourselves to be distracted with celebrity gossip and reality teevee. We have become complacent and afraid of our government. Sure, we can rally a bit of support to "Throw the bums out!" at election time, but I don't see the level of outrage necessary to demand the kind of representation we pay for. We need to become outraged, proactive, and ready to make some demands of our own. There are bankers who have burned through millions of dollars in bailout money, haven't changed the way they do business, and are demanding more. In the meantime, 95% of the country is suffering, including the people we rely on for our most basic needs.

I am just astounded that nursing in particular--and all of health care in general--are not even safe from what's happening. It's not just about MTs anymore, and woe to us all if someone doesn't fix this.

As I watched this week's first official presidential press conference, the thing that stood out to me (well, after the outrage at all the political posturing and stonewalling that are getting the stimulus plan nowhere) was a comment that reminded me of Pres. Obama's gung ho stance on EMRs. Mainly, I guess my feeling about this subject has been tainted by my own experiences with the automation of medical transcription and the abysmal impact speech recognition has had, not only on the field of MT, but also in driving the quality of the medical record down to the lowest common denominator. How will the EMR fare any better?

As a patient (more accurately, the daughter and mother of patients), my own experiences with EMR are mixed, but leaning heavily toward the negative. When I had to take my mom to the ER with an allergic reaction (repeatedly), we spent hours repeating the same information to everyone we dealt with--the receptionist, the triage nurse, the nurse in the cubicle, the doctor (when he finally came). Oddly enough, entering the information in that form did not seem to mean it was there for the next person, merely that they had to enter it all again, too. Shiny new workstations took up precious space and in the exam room; that even meant that every person who came in to treat the patient was guaranteed of hitting their head on the monitor and/or running into the keyboard. Subsequent trips were similarly not simplified by the information monster, sadly enough. It wasn't enough to simply show her ID bracelet so they could key in the number and call up her very recent past medical history. . . We once again had to repeat everything to everyone. By the third visit and after sitting in the waiting room for three hours (apparently, it was prime heart attack time at the nursing homes), she finally allowed me to play doctor and we bailed to head to the nearest drug store for a box of Benadryl.

This was a very expensive private hospital (the only one in my little burg) and clearly, some software salesman had sold them a very expensive system with the promise of saving them transcription expense and streamlining their record keeping. I notice he wasn't around for the fallout when they put it into practice and had doctors and nurses doing my job for them. Is it a savings when you pay a nurse $30/hr to enter data versus a transcriptionist who's nowadays lucky to get hired for 6-7 cents per line? How about that doctor who has to spend 15 minutes fumbling through a wizard and then has no patience to deal with the face-to-face patient care because he's got to run off to the next one and do it again? (My mom's doctor looked up from the monitor, declared that she didn't look too bad and dashed off a prescription. We waited three hours for less than 60 seconds of actual care.)

When my son was recently hospitalized with an infection, we opted for a much bigger, better, and public hospital. Once again, they had that evil EMR, only this was a more manageable laptop on wheels. We answered questions once and though people occasionally asked again, it was usually to clarify details as they read from the screen. They were indeed able to call up prior admissions to help jog our memories of past history. The real advantage I saw here was that in everything they did, they were able to answer questions. My son (probably not the easiest of patients because he has to ask WHY and HOW about everything) would ask for specifics and his doctor or nurse could pull it to the bedside and say, "Let's look at your lab values and imaging studies," or "I bet I can find a good illustration online." They utilized this to make the patient a working part of the team and not merely a victim or child. At discharge, they were also able to generate instructions and followup.

Nothing with the finesse of a carefully crafted and conversational dictation, but clearly more along the lines of how an EMR is supposed to work. After the latter experience, I have to say my sadness at being put out of a job was not uppermost in my mind. The biggest danger I saw was that a keyboard itself has got to be a major player in the spread of pathogens. As most of the patients I transcribe end up suffering as much (or more) from opportunistic infections, maybe I'm just attuned to this negative, but clearly, there is no way to prevent the spread of germs when everyone's sharing a keyboard and that device is being wheeled from room to room. This hospital also has instituted a protocol that provides antibacterial foam dispensers to use as you enter and leave each room, but does nothing to sterilize computers, IV poles, and other equipment.

But I digress. In my world, speech recognition engines are poised to eliminate straight transcription. This isn't because the technology is good, but because there are software people selling the product as though it were. I have yet to hear from an MT who's been asked to help develop a platform that truly works and in the end, we're merely asked to correct the gibberish, essentially working twice as hard as we do now, but for half the money. All those great Shorthand macros we've created over the years for those dictators who always say the same thing every time? Forget that it's a time-saver, a wrist-saver, and just plain more accurate to have a whole paragraph pop up with a few keystrokes. Nope, can't use them because the SR engine won't learn unless we work with what's already given to us and make specific corrections. We are working crap wages to train computers to take our jobs, and are supposed to be grateful to have jobs at all. In the end, those long, rambling office notes will no longer contain information that conveys a patient's humanity, but only the facts necessary to fill those key boxes on a form. I suspect the only thing holding them back is the fact that there are too many old-school docs who refuse to dictate carefully enough for SR to understand them. The new kids are learning and the old ways will die off as their generation takes over.

So how will EMR be any better? Once again, we're talking software developers, salesmen, and little to no input from the people who actually have to work with these things. To complicate matters, how does the government mandate a nationwide compliance with EMRs when competing platforms can't even communicate with each other? I think the answer is simple, but I don't see the money guys being too happy about it: There are already FREE EMRs out there (Practice Fusion and Synapse are good examples and seem to get favorable reviews), many developed by doctors with a geek gene on the side. The new technology czar (yes, we're actually supposed to be getting a cabinet position along those lines) should study what's already available and pick the best one. Make it open source--i.e. free to use and to customize--so that everyone's on the same page, and so that no one stands to profit at the expense of our healthcare or livelihoods. This would be totally in keeping with the new agenda to make our government itself more transparent and accessible to citizens.

Of course, I still think the EMR's greatest potential for evil lies in the fact it will serve as a storehouse of private information that can be farmed to deny us care on the basis of preexisting conditions, to deny us employment based on facts no employer should have access to, or to target us for marketers and other unscrupulous people, but at least we could avoid the snafus that have plagued the transcription world. If this administration does manage to do this right, who knows--maybe they really will succeed in disabling Big Pharma and Big Insurance, too, and making health care for all a right, not a privilege.

MTs are clearly not the only ones in a bad place right now. Change is inevitable, but it will be interesting to see if greed continues to make policy or if common sense finally becomes a player.