Passage

Say What What?

Jeanne Johnston — Fri, 25 Jul 2008 11:22:00 GMT

Everyone loves a boner. Reader’s Digest has practically made a career of them, as they comprise a good percentage of their various humor columns. I’ve always found their articles to lean toward the superficial and sappy, but hey--who isn’t agreeable to skimming through Laughter is the Best Medicine when sitting in the bathroom or whilst waiting for your tires to be rotated? MTs seem to especially love them--I suspect because so many of us are working from home and a good, “Can you believe the goofy thing this dictator said?” thread can quickly become a pile-up of hilarity and commiseration. It not only reassures you that you’re “superior” to someone out there who apparently doesn’t know that “chiefically” isn’t a word or doesn’t click that Mr. Smith shouldn’t have a hysterectomy in his past medical history, but it lets you know you’re not crazy, and there are other MTs out there who see this stuff, too. Doesn’t matter if you can top or just marvel at someone else’s bit, it’s all in good fun. We get our camaraderie where we can, to help stave off that feeling of isolation. Even Advance has taken advantage of this with the column, “Say what?” wherein MTs are invited to share their favorite gaffes. It was always one of the first things I read on the way back from the mailbox.

There’s been a disturbing trend in these submissions, though, thanks to the spectre of speech recognition. . . Many of the submissions are not spoonerisms dictated by some tired doctor or finger-tied transcriptionist who catches herself before sending a typo or Freudian slip. Nope, more and more, it’s the ridiculous gibberish churned out by SR that poor MTs-turned-editors are getting to correct (this month, I see gems like, “Wound will heal by secondary infection.”). Despite the wild claims of vendors and MTSOs who seem to think this technology is the greatest thing since electricity, most of us are seeing the ugly truth behind that. Much of it is so nonsensical that the only way to fix it is to scratch it and start over.

Of course, it’s been my contention for a long while that SR has been eyed to replace us. MTSOs who are implementing it assure us that MTs will never be replaced because there are so many dictators who will never cooperate and learn to dictate coherently. The Organization Formerly Known as AAMT assure us that we’re now “more” than MTs, we’re “medical language specialists” (gahh) and if we use our magic parachute, we will float effortlessly into our future roles as minimum wage editors.

But wait. . . according to an article this week, even AAMT bigwigs like Claudia Tessier (what acute care MT doesn’t consider her Surgical Word Book to be a requisite?) is sounding the death knell for MT (article here--you may need to register to read it):

“The movement is toward real-time documentation, which improves patient care and patient safety,” she said. “As this happens, it diminishes the need for medical transcription as we know it. It’s not going to happen overnight, but it’s a reality.”

***

The goal is for all MeritCare clinicians to fill out electronic patient records in other ways, such as by pointing and clicking and using voice-recognition software to add notes, she said.

At first, those notes will need to be edited and proofed by a transcriptionist, but eventually the health organization wants technology to allow physicians and nurses to self-edit, eliminating the need for those services, Hewitt said.

***

Completing patient records during an examination or visit is the goal of the industry, said Tessier, who spent 20 years as chief executive officer of an association for medical transcriptionists.

Technology can make that happen, but clinicians also need to be willing to use tools like handwriting recognition software and direct data entry, she said. Some adapt readily to the technology; others don’t.

The $28 billion a year industry won’t disappear immediately, but she expects it to diminish over the next decade.

Say what? Not exactly the AAMT party line of “MT isn’t going anywhere,” is it?

I have personally suffered at the hand of our local hospital's new point-and-click EMR, wherein the same information was laboriously reentered every time we were shuffled to the next room and spelling errors were shrugged off as unimportant. Sure, it's funny when we see that SR has declared that, "both breasts are equal and reactive to light and accommodation," but somehow, I get nervous thinking that my chart could be one of those travesties lost in translation. It sounds like it's every man for himself in this brave new world, and I think I'll take charge of my own health records and just come armed with my history already transcribed and in digital and hard copy formats.

Maybe it'll get so bad that MTs can start marketing themselves directly to consumers.

Dichotomy

Jeanne Johnston — Thu, 17 Jul 2008 11:23:00 GMT

I had an interesting “meaning of life” type conversation with my son this last weekend that got me pondering what I’m doing--not really in an “OMG, I need to bail on this!” kind of way, but more of a curiosity that I’ve chosen a field (or fields) that runs so contrary to my own lifestyle.

An original Earth Mother, I’ve always gone for a whole foods, do-it-yourself, kitchen witch approach to life. For many years, I was a FT mom and had mastered my job well enough that I was feeding a family of four on about $25 a week. I sewed. I gardened and preserved a great deal of what we consumed. We typically only went to a doctor for things like shattered bones, sutures, and really serious, acute matters. After being pushed into a C-section simply because my son was breech (forget that he was already falling out. . .), I even took it upon myself to do my own prenatal care for the next baby and deliver her at home on the sofa bed (admittedly, not a life and death decision I would advocate anyone else to take lightly). When we get sick, we figure out what herbs to take to bring us back into balance, we turn to massage or acupuncture and the occasional juice fast. I suppose part of it was simply not having the funds to live extravagantly, but a large part was just that I lean toward the natural, the basic, and have the genes for stubbornness and self sufficiency. We are a stoic bunch.

So how the heck did I wind up so fascinated by Western medicine? I never did care for soap operas, so I can’t blame General Hospital (I’m trying to ignore the fact that shows like ER and Grey’s Anatomy really fall into the soap category because I’m apparently a snob). I did always gravitate toward TV like TLC’s The Operation and all those documentary-style reality shows. As an art major in college, I loved life drawing and the anatomy you had to learn to do it well. I guess when I discovered MT, it was the language that really spoke to me. I love the puzzle aspect of the job--trying to decipher what that dictator is saying (even when he doesn’t know how to pronounce it himself), scurrying around the reference books and internet comparing conditions, medications, procedures, and filling in every last blank. I sometimes feel like I live for those rabbit trails because the hunt is such a satisfying part of the job.

Besides, as a newly single head of household, I needed a job that paid a living wage, offered benefits and security, and would not disappear anytime soon. Well, okay. . . so MT started to fizzle on me very quickly on many of those key points. I’m hoping that tumor registry will keep its promise as a “burgeoning field” so I don’t need to figure out another career in this lifetime.

My son has always been the left-brain guy of the family. Sesame Street had its place, but as a preschooler, he was the kid who would intently watch those PBS University math classes and blurt out the answers to things like, “What’s the acceleration of this car going down a slope of this angle for this far?” No surprise when his goal in life was to go to the best school for computer brainiacs because the kid spent over a decade hunched over his computer teaching himself how to write code, make websites, create games and music, and basically knock our socks off.

So he went off to school and got his degree, and what happens? First of all, 9/11 came along and destroyed a good chunk of the country’s technical jobs. (Aside: Thanks to Howard Dean's state and a major company then based there, a good number of post 9/11 computer programmers were offered free training and potential jobs as MTs as a means of vocational rehab. I'm not sure if that's still as cool as it seemed then, given the current state of affairs.) To compensate for all those computer whizzes who suddenly had no office to work from, companies started using crappy applications to throw together their own websites and quality became something they apparently decided they could live without. (The similarities are scary, aren't they?) Upon graduation, he learned that the wages were a fraction of what they’d been when he entered school, and genius was a commodity that mattered less than sheer production power--turn out sites fast and furious and focus more on selling ad space than anything. Suddenly, the thing he loved to do best had become a grind. As a web designer for a major paper, he was seriously bummed to learn that newspapers focus on “news” only as a means of selling ad space. He was crushed by the ethical conflict and knowing that his craft really meant nothing.

Parallel to all this, though, was another transformation--my reclusive little computer nerd was suddenly thrust in a school of his peers, many of them a decade or more older. He suddenly became a student of life, a very social creature, and started discovering there are more things in life than writing php in SimpleText or getting a web page to work the same in every browser. Welcome to that social awakening that comes when a kid heads to college and realizes he's not the center of the universe.

Partly as a way to cope with being a poor guy with too little income and partly because he was now interacting with some interesting people, he began to study things he’d taken for granted growing up--a student of living basically, living well, and becoming self sufficient. The more he learned, the more he realized he’d gone the wrong direction and now knows what career really resonates with his personality and beliefs. His new plan is to head back to school and become a doctor of Chinese medicine. I am astounded to find he can simply pour himself into his right brain with as much gusto and ease as he always put into the logic-based side of life, and I think the combination is going to make him amazing.

Honestly, I don’t know why it didn’t occur to me for myself years ago (the school has been in our back yard for years!), but I’m happy to stay my course and enjoy his journey vicariously. I figure this way, we have things covered from both sides.

What, me perky?

Jeanne Johnston — Thu, 10 Jul 2008 16:15:00 GMT

What a difference a week makes. Yes, the fates have flung me from negativity to contentment in just a handful of days. I don’t know whether to blame (or thank) the stars or the fact I’ve left the dreaded Computers in Healthcare course behind me, but I’m having a hard time getting my knickers in a twist over anything this week. This is about as close as I ever care to come to channeling that perky cheerleader type I always hated in school (minus the raspy voice), or perhaps even Carol Smillie, the BBC’s human equivalent to Prozac.

What’s my problem? I’m a blissful three chapters and one test into something I enjoy--word games. Latin, Greek, plain old English--doesn’t matter. It’s on to Medical Terminology and it could just as easily be Tetris for all the time I can spend on it. I think besides having a more interesting subject matter than Office 2003, the textbook is just excellent. It’s organized nicely, breaks things up with frequent exercises, and kudos to Elsevier for thinking clearly enough to counteract the sheer weight of the thing by putting it in a spiral-bound format. I was going to keep the thing pristine for resale and write all my answers in a separate notebook, but quickly heeded that voice in my head (which sounded an awful lot like Cybill Shepherd, telling me, "I’m worth it!") and decided to simplify my life, indulge myself, and just use the thing up. The book is even printed on good enough stock that you can erase cleanly and highlighter doesn’t bleed through to the other side. Add in the fact that it comes with a CD ridiculously full of silly little Flash games to help reinforce the material and it’s even better.

As I’ve admitted before, I’ve been through a Crappy School for medical transcription and have spent the ensuing years supplementing my studies to make up for it. I had pretty much aced the terminology module at that time and I live with this stuff in my job for what seems like a majority of my waking hours, so it should be easy. Though it is almost entirely review for me at this point, it’s still an ego boost to do well. Despite my supposed expertise at this point, by golly, I am learning some new things and it’s presented in a way that clearly shows how the words relate to the actual job. Many exercises are presented as medical records which you scour for answers and there are quite a few sidebars elaborating on various healthcare careers that make use of what’s being taught--definitely a lot more options than had ever occurred to me. Whether you’re looking for remedial work to supplement your own Crappy School experience or starting fresh, this is an excellent text. I can’t recall the last time I was even impressed with a textbook, and I’ve already reaped some benefits on the job just because the terminology is that much more concrete in my head.

Of course, give me a couple weeks and my neat handwriting and crisp corners may be a thing of the past, but I suspect my enjoyment will last through the final exam. With any luck, I’ll be so high on life at that point that I’ll be able to catapult a good way into my final prerequisite (pharmacology and pathophysiology) without getting bogged down. For now, "perky" is not such a bad place to be!

Tunnelvision

Jeanne Johnston — Thu, 03 Jul 2008 16:37:00 GMT

As the transcriptionist is the little guy who seems to be the first target in a hospital’s budget crunch or in an MTSO’s grasp for even greater profits, it’s hard not to get rather myopic and feel like THE target these days. Every once in a while, though, I get a reminder that it’s not just MTs who are facing big, bad changes these days. Case in point is my monthly fix from Placebo Journal, which is pretty much where good doctors go to get snarky about the state of medicine from their perspective, vent some frustrations, get silly, and I assume manage to stay sane another month. Now, transcribing four dozen reports or so a night, you get a good feeling for what they have to put up with. Yes, there's always a handful of docs who give you the feeling they’re a few years overdue for retirement, but the vast majority sound like they care.

At least, they must or they wouldn’t be able to muster such a dispassionate tone when so many of their patients seem to be noncompliant frequent flyers, and the vast majority are in the hospital almost assuredly because they refuse to do as they’re told. I'm not sure I'd have the patience to calmly repeat 20 times a day, “Quit drinking. Quit smoking. Lose weight. Take your medicines as prescribed. Use a condom. Don’t put things in there.” You just know that drunk is going to be back in two weeks needing a belly tap, the diabetic is going to lose a foot, the woman with asthma is going to be back on the ventilator because she won’t give up her cigs, and 20 people are going to trail in for pregnancy tests or penicillin in any given night because they’re just idjuts. That doctors can even have a sense of humor is amazing. I suppose that’s where the last guy comes in--the one who seems to have a knack for sleepwalking, slipping, and landing just so, so that assorted household items miraculously lodge themselves in his colon. . . every couple months.

Yeah, it’s a little hard to sympathize, knowing they make 1000 times more than we do, but consider how they earn it. Being a doctor is not about Medicine anymore. It’s about business. It’s about squeezing in 20 patients a day to keep your practice afloat. It’s about battling insurance companies to get services paid for in this lifetime (if at all). It’s about cookbook medicine--following strict protocols for every condition so that your hospital will be less likely to be sued when someone dies. It’s about Big Pharma controlling the drug supply (did you know they’re now trying to get OTC nutritional supplements outlawed so they can market them as brand items?) and their pushy pharmaceutical sales reps--which, thanks to the miracle of television, now includes thousands of gullible patients, eager to do the job for them for free.

You just know that most patients don’t get it. The proof of this lies in the response to a recent Reader’s Digest article, 41 Secrets Your Doctor Would Never Share, wherein two dozen doctors honestly shared their frustrations, regrets, disenchantment, and advice on how to be a better patient--and far from being grateful for the eye opener, many readers responded in a huff. It’s a shame, because there’s a lot of wisdom behind the statements shared.

In the old days, I resented the pedestal most doctors seemed to place themselves on, as though they were the wise, fatherly figures and we were children who should simply do as we were told, without question. Whilst I think it’s great that we now have a world of information at our fingertips and can now have a more educated say in our medical treatment, I think we’ve lost something important in the process. The masses are deciding that those years of study and hard work don’t count for much. Insurance companies are trying to dictate treatment. New technology means you have to churn more patients through, even though you don’t have time enough for meaningful interactions as it is. Malpractice involves more greed than legitimate complaints. I think there’s a good reason doctors commit suicide, nurture addictions, and probably divorce in far greater numbers than the general public. MTs certainly have earned the lifetime Rodney Dangerfield “I don’t get no respect” Award (acknowledging that there's a passel of clerks, coders, billers, and even nurses as close runners-up), but I don’t see the practice of medicine maintaining its appeal as a career choice, either, given that do-gooders are beaten down by the system and the guys in it just for the money would have an easier time becoming lawyers.

Of course, my sympathy will fly out the window next time Dr. Jones forces me to sit idly (I don’t make money if I’m not typing!) whilst he’s on another line for 20 minutes trying to cajole a salesman into giving a discount on his new Cessna, or Dr. Brown zips another young mother off for his routine, time-saving C-section. It is a good exercise to remove my blinders once in a while and think beyond myself, though--and in looking even further out there, I get the feeling that our problems aren’t even unique to the world of medicine. The business climate these days has generated a lot of negativity across social strata, and I think things are going to get worse before something revolutionary happens to change it.

So I don’t end on such a dismal note, I will veer off to my happy spot, wherein I finally meshed with my proctor and completed my Computers in Healthcare final last weekend. I’m in no way happy with the substance of the course (filler, fluff, and material cancer registry students couldn’t even access--yet were tested on), but it’s one more prerequisite behind me. I am once more gleefully cracking open a new text with fresh highlighters and enthusiasm, in the hopes that Medical Terminology gets me back on track. I work with these words every day--surely, this will be an easier credit, right?

Next time: Famous Last Words.

Empowerment

Jeanne Johnston — Thu, 26 Jun 2008 18:06:00 GMT

As always, I’ve been watching the MTs’ corner of the web with interest. Lots of interesting discussions about wages, speech recognition, offshoring, and the future of MT (or lack thereof) in general, as well as some fairly self-serving folks in particular. In the last year or so, there has been a move to market MT courses (and as always, some not terribly great ones) to capitalize on military spouses. We’ve seen the usual suspects (matchbook schools) and their hotel seminars, all the way to MTSOs trying to package themselves as philanthropists in order to curry favor and government money, all in the name of patriotism--a very overworked theme these days.

Honestly, the pool of mobile jobs is not that great and military families are a group that could really benefit from that option, even if the field is sinking faster than the Titanic. Utilizing a good school (do I need to mention M-TEC and Andrews again?) would be of paramount importance, to ensure one was up to speed and ready to fly solo because you really don’t want to have to stress about your job when you’re already having to deal with yanking your family around every couple of years. The right school means you don't need to suffer through some slave-wage "internship" because you graduate ready to dive into the deep end of the pool.

This has made me ponder how I got into the field--and mine is not a unique story, as I’ve found. It wasn’t really possible to pick up where I left off in my college career, so I spent the last decade of a lousy marriage trying to figure out how to support myself and get out from under the situation. After raising my 2.3 kids, it just wasn’t that easy to pick up and start over. I’d hardly even bought myself new clothes in all that time, wasn’t even sure I’d have transportation or a place to live, and the nearest vo-tech is an hour away, so naturally, I focused on something I could do from home. Crossed a ton of things off my list, from daycare (BTDT, not for me) to web design (my son is an expert and I’d feel like a fraud in comparison) to junk like Avon (I don’t even use the stuff) and even weird jobs like becoming a doula (I once wanted to become a midwife and this just seemed bogus). In this town, my artistic and secretarial jobs were not going to amount to more than piecemeal work and I needed a real income.

I kept reading that so many people were telecommuting, but where were these jobs? I spent months scouring the internet and found little more than MLM scams and very little of substance--certainly nothing that utilized my skill set, even my tenure as a division secretary in a university. That’s when I stumbled into MT, and the rest is history. In just a few months I was through a Crappy School (hence, my calling to spare others that same mistake) and was working. In less than a year, I was paying all my bills and in two, I had enough set aside to pay for a very good divorce attorney. Another year and the house was in my name and I had a new car--not doing too badly, but when you’re told you can have a raise only when you type faster and work harder, that glass ceiling comes up pretty fast.

In this short few years, I’ve encountered an awful lot of women (yes, women still comprise probably 95% of the MT workforce) in the same--or worse--boat. Many of them are so beaten down that they still don’t have much self confidence, but by the goddess, they’ve grabbed their bootstraps and kids and sent a bad marriage bye-bye. Others found themselves widowed or downsized, and even less prepared to cope. Even the young mothers (also a prime target for matchbook schools' sales pitches) looking for a viable second income for their families can find limited options. MT has been a lifeline to many of us--often the only thing that offered a real way out AND a legitimate career in the process.

But now what, given that this is no longer a career, but more of a sweatshop? To some, it seems very obvious that the big nationals are hell-bent on dumping their relatively “high-paid” US MTs in favor of speech recognition and offshore editors. The clients are being groomed to accept lousy quality and they won’t miss us because they’ll have lower expenses to show for it. I marvel that newbies can even make minimum wage when offered crap wages like 4-7 cents per line when I see veterans cursing SR and struggling to earn enough to live on-- but that’s the market now. The pink collar ghetto was always the lowest on the totem pole in this hierarchy, but now we’ve sunk off the radar. There are profits to be made and we apparently don’t register as much of an asset anymore.

Despite the cries of pro-family fanatics, women have always been nearly invisible in society. We’re still supposed to sacrifice our needs to churn out children and hold down the home front, but no one’s standing there with a fistful of money to help us do that, let alone make more of ourselves. There is no easy money helping us pay for good daycare, education, and living expenses, and there are countless women with next to no clue how to step out on their own and make something happen for themselves otherwise, especially if already limited by the options where they live.

MT is not set to keel over next week, but instead of being that big, inflatable life raft to self sufficiency, it’s becoming more like a flotation device that will barely serve to keep you afloat until you figure out which way to swim to safety. I’m not even 100% sure I’m going in the right direction myself, but I’m paddling as hard as I can--and I'm trying to impress upon my daughter that it's more important than ever to ensure her own self sufficiency now, because no matter how perfect your life is, it's a whole lot easier with Plan B safely at hand in case you should need it.

Online courses have opened up a whole world to people who previously had no options, but once MT is off the table what’s the next choice? I see huge numbers of you going into coding, but that can be a hard field to break into and not everyone is cut out for such left-brain work. What other field offers work and study from home, with hours flexible enough to manage without paying for day care? If the lowly transcriptionist goes the way of the dodo, what are the options for the next generation of women who need to find their own empowerment? What do you tell your sister to do when she suddenly finds herself head of the household and wondering where to turn?

Is that all there is?

Jeanne Johnston — Thu, 19 Jun 2008 15:51:00 GMT

Yes, I’m still studying for my Computers in Healthcare final, so nothing exciting (or dire) to report there--but I have been cogitating about the course in general and I’m curious to know if others have had the same, better, or worse experiences with this standard prerequisite for most healthcare courses. There are a couple alternate "schools" I had considered and I guess I'm just curious to know if anyone had a better experience in theirs. I do recall my son grousing about having to take a basic computer course to begin his degree (in digital media, at a school dedicated to computer brainiacs!), so perhaps this is just a cross we all must bear.

In a long preamble to the actual course, AHIMA informs us that since the class is taken by students in more than one course, “some” of the online coursework will be inaccessible to students in the cancer registry course and “some” of the test questions will pertain to these areas. Never fear, however--it won’t be many and it should still be quite easy to pass anyway. Mkay, that sounds a little odd, but I’m a sucker for a good reassurance, so plowed ahead.

In actuality, however, MANY of the sections had nothing whatsoever to do with the cancer registry side of the coin and HUGE numbers of questions pertained to this hidden wealth of knowledge. The coding students are apparently required to become members of AHIMA and thus, have access to the message boards and library that many of the lessons came from. Granted, in the final portion of the course pertaining to HIPAA and information security, many of these articles were reprinted so the rest of us had access, but in assessing the entire course I would say that almost three-fourths actually was irrelevant to cancer registry. Yes, it’s interesting to see how coding software works and no, I had no idea there were virtual shelves of dusty literature stockpiled in the AHIMA vaults, but really, what does all that have to do with the rest of us? And what the heck? The first module (one-fourth of the class) was spent getting us familiar with the message boards and online course format and how to navigate and post. That’s something that should be given as a free FAQ for anyone considering enrolling, not fleshing out a skimpy course! The way the online courses are presented, I know darned well most people probably have already taken the anatomy course and are also surprised that this information was not available beforehand.

I would humbly suggest that this course would better serve us--remembering that we’ve paid a hefty sum and want our money’s worth--by offering separate versions of the class to mesh with the specific courses of study it’s being required for. Utilize the modules with the word processing and database introductions and (yawn) security for everyone, but substitute more appropriate modules for the rest. It would be a lot more useful to know what software looks like for tumor registrars (yes, I know it’s probably similar--but not specific) and something else for the behind-the-scenes mumbo jumbo. Why not require us to become members of NCRA and walk us by the hand behind the scenes there to give us a leg up on mentors and resources? And fer cryin’ out loud. . . test us on things we really need to know. Half that stuff was from lessons I was instructed to skip over because they weren’t pertinent to my course of study and I simply had to guess at the answers. That just grates against my overdeveloped sense of what’s fair.

I dunno. It was just. . . lightweight. I suspect the course is also a prerequisite for other HIM courses and those students are even more bummed at what they need to learn. It would be far more valuable to have lessons more in depth about working with data in ways that we may actually encounter on the job. Biggest shock of all, perhaps, was that the actual hands-on part of the class involved Office 2003! That's amazingly outdated, as software goes. . .

Maybe I wouldn’t be such a whiner if the course was priced half as much as the others or if I hadn’t gone nuts last week researching software to better do my exercises (which actually proved totally unnecessary as they never went back to them!) *sigh* Well, I’ll just do my best to blow through the final and get back into the fun stuff.

As for my exercise in geekhood last week (LOL--as I know probably two people care), I did indeed install Leopard and with the new OS, Bento. I don’t see the latter as being quite powerful enough for serious database use in the big business world of brown-shoed squares (their FileMaker Pro is made for that), but WOW--it’s a blast! It takes those boring old tables of information and slaps a ton of Mac-style eye candy over it. My address book and calendar never looked so appealing and I’m going to be in danger of ruining my reputation as the black sheep of the family who can never manage a birthday card on time. I must have Virgo looming around my sign because I’m suddenly fantasizing about what I can catalogue next--recipes? books? movies? music? maybe a household inventory, complete with photos, or perhaps I'll finally organize and unload my stack of unused text and reference books I keep threatening to eBay!

Happily, though this computer course was not centered around the platform or applications I prefer, I can say that I am taking away some new knowledge that I’ll be able to apply everywhere. I just wish there was more of it.

Channeling Walter Mossberg

Jeanne Johnston — Thu, 12 Jun 2008 16:32:00 GMT

Still struggling to find a way to make my coursework doable on my Mac with the least contortions possible, I’ve spent the last week indulging my inner geek and trying on different software for size, and I have to say I’m enjoying it immensely.

My Computers In Healthcare course has presented more than a few challenges, not the least of which is that the text is written around things like Word 2003--absolutely ancient, in software terms. Granted, they mention frequently that students are not required to own M$ products and we can do the exercises using open source apps like OpenOffice (or any of its permutations--available for every platform out there). Now, last week I had slogged through all the chapters from Word to Access to Excel to Powerpoint, using my favorite of these, NeoOffice. This is basically a clone of OOo, except that it runs as its own application (OOo actually utilizes X11 and runs through UNIX, which can get a little tricky if you get confused by seeing that command line business.) It looks like the M$ Office applications. . . but as I discovered, there are occasional bugs in that a crucial button or function is missing here and there (hello, no one at OOo thought we might like to delete a record from a database?) I got through the exercises okay, but I knew it had been harder than it should have been.

I’m not sure why it took me until afterward to hit upon the idea of using the Mac counterparts I already had and simply saving them as Office-friendly formats. Rummaged around my hard drive and tried out my old iWork applications--which are so completely wonderful in comparison, it isn’t funny. Keynote versus Powerpoint is like comparing satellite HDTV to that 13” B&W set with rabbit ears that barely got four channels. It’s slick, it’s easy, it packs so much stuff in there that my mother (who didn’t do Ziploc bags until they came out with the ones with a zipper) could grope around it and look like a professional in the end. Likewise, Pages is Word to the nth degree--not just a WP app, but complete enough to do desktop publishing. Except. . . dang--Numbers is simply a spreadsheet app and I needed to be able to work with a relational database. It compares to Excel, but there was no way I could substitute that for Access. . .

So I flitted around the internet a bit and found the solution is Bento (lovers of Japanese cuisine will appreciate how cute and clever that name is), which is not just a database app from the makers of the old fave Filemaker Pro, but may be The Ultimate Database app. It syncs everything you’ve got into one place so your calendar, address book, iTunes library, iPhone/iPod, projects, event planning, and anything else you want to throw at it is in one cool spot. No fumbling around with formulas, queries, and awkward menus like I just learned in Excel--this is gorgeous, effortless, and powerful. Of course, I’m only able to vouch for that because I have no life and spent a morning watching all the tutorials. . . As I never got around to upgrading my OS from Tiger, I can’t even run the trial version yet. I had to throw some money at Apple and am awaiting my new Leopard installer this week so I can try it, but I have no doubt I’ll be paying to keep Bento around, even if I never use it for work.

In the meantime, however, how do I deal with this coursework? Well, much as I am loathe to install anything M$ on my computer, I decided just to bite the bullet and get the trial of Office 2008 and see if that didn’t make me see my homework in a little different light. Harumf--what a difference 5 years makes! It’s still a fairly ugly bunch of applications, but it’s nowhere near as basic as 2003. You can call up windows for tools, rather than just the mishmash of icons on the toolbar at the top of your window. You still have to run queries as a separate function, rather than filtering within the spreadsheet as you can do in the Mac apps (where you simply hold down a cell to bring up a menu), but it seems a little less clunky than what I’ve been working with. The jury is still out until I have time to go back and re-do all my exercises for comparison. In the end, however, I don’t see this as worth the price tag of over $300 because they chose not to include the most important part of the suite: Access! What the heck? In the end, it’s going to be cheaper to stick with my Mac apps and cough up another $70 for Bento, which I’ll use for everything IRL anyway, or continue plugging away with OpenOffice (FREE). Office 2008 without the database application is insane. I'm just glad I didn't buy the suite outright and then find it isn't complete!

I don’t know who decided that business applications needed to be ugly, boring, and soulless because keeping things cutting edge certainly makes the job easier to focus on, easier to impress people, and just more fun. If you're going to go utilitarian, it does make sense to use open source applications; I've encountered some pretty slick ones currently in use as ER and other hospital platforms, like Synapse EMR, which I believe was originally written by a doctor. The beauty of open source apps is that no one profits from their sale, only from providing support (ask Linux!), which means actual users can have a hand at developing products to maximize their usefulness, rather than software vendors who simply throw things together and make a fortune by endlessly correcting their problems. As a former accounting major, I do have a strange joy at plunking numbers into neat little boxes, but in the end, I really thrive on a 3D, Technicolor world. I don’t think I’m unique in that. Of course, in the end I’m going to wind up in a job that most likely will use the ugly, utilitarian, 2-dimensional applications because that’s what they do. I really have had a blast geeking out this week and playing with all the possibilities, though.

Life is just a B movie

Jeanne Johnston — Thu, 05 Jun 2008 13:51:00 GMT

Memory can be a fickle thing--or perhaps it's just the way my particular brain works. I apparently have a knack for picking out minutiae from any situation and applying it to myself. In fact, it often seems to be deliberately set in my path because it's something I need to learn. Case in point: An old song from the early '80s done by poet Gil Scott Heron, called B Movie. Now, I remembered this was political, from the Reagan era, but I didn't remember that it was seriously political the whole way (actually, a very relevant rap even today). What I took from it was one of those life-changing ideas that I actually have a hard time even finding in the spiel now--that life is like a movie script and we're just extras. (Hey, maybe I'm mixing Shakespeare in there!) You don't like the way your story is written? As the author, you have no one to blame but yourself. You cast costars you don't care for, a role or lines you don't like? Then change them!

This has occasionally been a touchstone for me. It took some years to work up my gumption, but I eventually rewrote my script to train for a new career (maybe I should make that "career," now I've found it's really just a job. . .), jettison a lousy marriage, and now to begin to recreate myself and perhaps recapture those lost years and get a do-over. When I became dissatisfied with the direction MT has taken and the feeling that the job security and my ability to support myself with it are crumbling away, I once again hearkened back to that concept and researched where I might take my skills again, to continue my story to the happy ending I desire--that I deserve, even!

I know I've been very vocal about the state of affairs in transcription, the fact that MTs have been badly served by the organization that was supposed to represent us, and you can't go anywhere online in MTville without running smack-dab into people even more angry and frustrated than I am. It is often jokingly said that the reason MTs never succeeded in unionizing is that they're too independent. You get more than a handful in one place and it's like herding cats--i.e. you just can't do it. It's an exercise in futility. At this stage of the game, it's not even worth attempting.

What remains when MTs as a group cannot change our future? We need to do what we've always done--look out for our own interests. Whining, complaining, and threatening to revolt do no good. At a time when veteran MTs are valued at the same substandard wages as rank beginners, employers can just laugh and invite us to be quick about our exit, if that's our wish, because there are misguided people eager to start at any wage to take our place, and clients are quickly learning to accept any quality as long as someone promises a quick turnaround time, so experience isn't even much of a bargaining chip anymore. Hardly a week goes by that I don't see some nitwit declaring they'd be glad to work for FREE, if it would help them get a foot in the door. (Thanks for helping to tamp those wages down, people. . .) So what to do? I know quite a few MTs--many of them veteran and highly respected small service owners themselves--who have stopped to look around, have seen the futility, and are making plans for another chapter in their own lives.

Rather than stand around with fists clenched, a lump in our throats, and a rising panic in our guts, maybe it's time for everyone to take stock of where they stand and where they want to be, whether next year or ten years down the line. Perhaps you're an MT who doesn't mind the spiraling wages or crush to move the work to speech recognition editing. Many of the SAHMs who were lured into MT aren't looking to support their families and just want to make enough for extras, so maybe the crap wages aren't an issue. Otherwise, perhaps there's something healthcare-related that would utilize your MT skills, or perhaps you have a yearning to get into something else altogether or build a hobby that you love into your next career. Surely, there's something that would cast you into a happier role, a starring role, rather than a bit player with the crappy lines.

Change is scary, but it can be revitalizing--and it beats the heck out of sitting there frozen like a deer in the headlights as the future bears down on you.

They always say time changes things, but you actually have to change them yourself. - Andy Warhol

Embracing illiteracy

Jeanne Johnston — Mon, 02 Jun 2008 11:54:00 GMT

Here I am, a week into my next class, Computers in Healthcare, a little mortified that I'm paying the same for this mess as it costs me for every other (more challenging) course—and perhaps even more because it's not as simple as I expected. I'm struggling with the weird contortions I'm having to go through to get all this MS Word-style junk to work like it's supposed to. Yeah, I expected I would learn a thing or two despite my supposed computer experience, but it's awkward and I don't know if it's because I'm using OpenOffice when the exercises are geared toward Word or because OO is made to emulate something that was goofy to begin with. Going step by step, that old mail merge isn't as effortless as it looks in the instructions because the wizard gets hung up in the middle without telling me why I'm not getting a “next” button. It should not take me two hours rummaging around user forums to figure this out (I had to create a database with addresses first, not just a document as they instructed me), but I guess that just heightens the satisfaction when you finally get something sorted out—nothing sticks with you like when you learn by doing.

Actually, I seem to be halfway through the course already and I would've been disappointed if it were all as simplistic as the first half. Boring as it was, there was some food for thought. A major chunk of the first quarter of the course revolved around things like email etiquette. First reaction was, “Who the heck needs to be told stuff like this? Surely, if you're 'net savvy enough to sign up for an online course, you're well past the point of needing to be told how to create and send an email, right?” I mean really—am I the only one too paranoid to just fire off a missive without running spellcheck to lessen the chance I'll look like an idiot? Does no one else obsess over things like the Blue Book of Grammar? I thought MTs were naturally obsessive about this stuff!

And then it hit me. . . accelerated by the horrible legacy of “no child left behind,” the dumbing down of America actually has created a generation or two of near-illiterates. I see it with increasing frequency on the online message boards and on the job—so-called “medical language specialists” who can't spell, don't understand homonyms or punctuation, or worst of all, seem to have learned a version of the English language by text messaging 12-year-olds on Yahoo. It is with increasing frequency that I see posts on message boards that curl my hair: "cn u help pls? im a new grad an i cant find a job i got high honors in my mt course....srsly iz hard co'z right now... i am havign hard time dealing with it." Not that long ago, such a ridiculous post would get an immediate smackdown by twenty veteran MTs for wasting people's time—never mind the lashing they'd get from QA, should they ever succeed in landing a job. Nowadays, however, any criticism of the obvious reasons that job search isn't going so well will be met with a huffy declaration that, “This is just a chat forum—I'm not at work and it's okay to let my hair down. Who says you have to be perfect all the time?!” Hm. I don't know about you, but either you know the rules of grammar and spelling or you don't; there's no turning common sense off at the end of your shift. It's like deliberately trying to sing off key—either impossible to do or it sets your teeth on edge to try. It's one think to use a more conversational vernacular on a forum or personal email and quite another to throw your brain out the window like it doesn't matter. (Word to the wise: What may appear to be a casual forum is probably monitored by employers scouting for potential hires—as well as applicants to steer clear of. Even with anonymous-looking user names, they can often recognize you.)

The scary thing is that I'm not just seeing this on “informal” message boards, I'm seeing it in emails at work. From graduates who are new hires to management who should be setting a higher standard, it is rare to get a communication with no spelling errors; even worse, more and more I see people lapse into chatspeak like, “pls help nd samplz... thx!” Ugh. Sorry, if you're too lazy to write a proper business communication, I bet you're just looking for a way to get someone to do your job for you, too. And puh-leeze—you advise someone, but you ask for advice. You need to get a grip on there, they're, and their and on to, two, and too. When someone who is paid four times what I am tells me their curiosity is “peeked,” it piques MY curiosity to know how they got the job!

Nowadays, the internet is full of passive-aggressives from Stepford who apparently think “niceness” ultimately trumps everything, including skills. Perhaps these people are a product of the 1990s (see the eBook on the dumbing down link), when Elizabeth Dole and the Dept. of Labor attempted to “determine the skills that young people need to succeed in the world of work,” wherein schools would focus toward the ideal SCANS (Secretary's Commission on Achieving Necessary Skills) résumé that would not focus on hard-core education. Instead, “personal qualities” like “responsibility,” “self-esteem,” and “sociability” were the criteria employers would be looking for. I guess this is when the three Rs and good old phonics went out the window and schools started passing kids to avoid “traumatizing” them by letting their peers be promoted to the next grade without them. Yes, why test students when they would feel so much better if you presented them with a nice merit badge for making an effort...

Flash forward to 2005, and what do the statistics show? Since 1990, the number of students lacking even basic reading skills has risen by a third, from 20% to 27%. Only 35% of high school seniors have reached a "proficient" level in reading, down from 40%. My own family has been frustrated by the inane practices of our public schools, wherein they now “teach to the test” and the yearly FCAT is geared more toward budget and bonuses than really educating kids to think, and with the lofty aim of ensuring students graduate high school with simply an 8th grade education (muscling out the students who don't conform and would just bring down the curve). My own daughter killed herself studying to be able to pass the GED and get out of high school early, only to find in the end that the test was written on a 4th grade level! I have quite a few friends who are college-level English professors and this explains their frustration with incoming freshman very well.

I, for one, am mortified at the state of literacy in this country. I find it especially ironic when these same lazy/inadequately educated MTs start whining about offshoring our work. I'm sorry, but in an age when students in Scandinavia, the UK, Europe, and Japan test so much higher than American kids, have a greater awareness of the world as a whole, and are held to much higher standards to graduate, what is the incentive to keep work here? To compete, we need to offer a better product for the money! Some may be surprised that even if they ace a medical transcription course, a lack of knowledge of basic English can still derail them on the job. Many dictators seem to go out of their way to utilize their word-a-day calendar or simply come from a background of a proper education. There are days you can look at the word help forums and see that over half of the terms people are stuck on are not medical words at all, but common phrases or colloquialisms.

It's depressing that literacy seems to have so little value now, that people would consider it a chore you only bother with when you're on the clock. The problem is by no means confined to the world of transcription, but the fact that MT revolves around language skills, it seems especially tragic to see the field devolve into the pink collar ghetto it's become. The world is geared toward the lowest common denominator, and I only have to go so far as an introductory college computer course to reap the benefits. *sigh* At least I'm not stuck in a classroom and can zip ahead at my own pace. On to spreadsheets!

Hello, I'm a Mac

Jeanne Johnston — Fri, 30 May 2008 11:33:00 GMT

Let me preface this by admitting I'm a snob. My family has used nothing but Macs and never will buy anything else. Heck, we've even got an original Mac Classic that still works--if you don't mind its quaint 8 Mhz processor and 512 KB RAM. Yeah, it might as well be Pong in this day and age, given that you'd need a garage full of them just to hold a basic browser now.

Mac's GUI is what Windows has endeavored to copy--so badly--from the start. In attempting to pretend to be "different," they simply managed to turn things sideways, set things contrary to what seems logical, and despite the fact that every "upgrade" has only compounded the problems, managed to market their mishmash to the brown-shoed squares who made it the standard in the business world. Forget that Windows is continually duct-taping patches upon patches and is prone to crashes and conflicts. It's beige, it's business, and business isn't cool, right? They've even convinced people that Macs are too pricey--despite the fact that they actually have a longer working life. Now with Unix humming along behind the scenes of OS X, it's even more stable. Like the Dyson, the Mac is not just hip, cool, elegant, and kicks ***, it's the best man for the job. Heck, you don't even need to pay for special software to play with the suits because there are perfectly good open source counterparts to MS Office for FREE in Open Office in several incarnations. I can do cool graphics and spreadsheets. Heck, even the US Navy decided long ago that Apple servers were the solution and are on their way to embracing Mac as the standard. I don't know about you, but when you're talking about nuclear warheads and global crises that might come up, do you really want to have to worry about that Windows Blue Screen of Death?

So what has me up on my high horse? Well, it's partly the mortification I suffer when I have to go to work and use a peecee. I hate everything about that workstation, and it doesn't even use Vista. I'm sure it's partly because I "grew up" on a Mac, but everything out this is counterintuitive. Nothing works the way it should and nothing is simple. Things I should be able to customize, I can't. I've been spoiled. But no, what's really got me irked is that I'm six chapters into my new Computers in Healthcare text and though they give a shout out to Mac OS and Unix, it's allll about Windoze. I suppose I'll end up learning something about those boring spreadsheets in the end, but holy cow, this is not going to be one of those classes that makes me rabidly enthusiastic. It should, however, go very quickly. /whine

On other fronts, did anyone happen to notice it's MT Appreciation Week? Apparently, those of us who got the obligatory pat on the back should consider ourselves lucky because I don't see anyone kicking their heels up. Even the the biggest and busiest MT forum hasn't mentioned it this year. It's usually good, at least, for one of those threads where people commiserate about how little recognition they got. It's kind of a sad commentary when even the MTs don't notice the occasion.

Lastly, for those of you who are wondering, I can officially verify that the 70s were indeed the decade of fine sleeping. Aside from dropping a very large piece of lumber on my foot in an attempt to break it, I did indeed succeed in setting up the new waterbed. I'm a little disappointed that it's more deluxe than my old one (this is almost waveless), but I broke it in by going comatose for 14 hours straight and have had to fight my daughter for it for the last week. Best $25 I've spent all year.

With advocates like these. . .

Jeanne Johnston — Sat, 17 May 2008 18:55:00 GMT

Here I am in my self-imposed spring break, trying to just be for a change, with a view toward hitting the books again this weekend. I'm finding that as always, the more you try not to think about something--anything--the harder it is to do. There's such a growing din of discontent in MTville it's rendering me incapable of harmlessly random thoughts. It's like I've caught an Andy Rooney virus and simply need to stew about something.

Case in point: The latest print issue of Advance, in which Peter Preziosi speaks for the Airheads--AKA The "Professional" Organization Formerly Known as AAMT, which should take a cue from Prince and just pick a symbol because their new acronym is just impossible to remember--once again pimps the party line by telling us that the sure-fire way to benefit the field of MT is to bust your hump and get your CMT certification because, golly gee, that alphabet soup and a better wardrobe is what will get you the respect of your employer, your dictators, and your coworkers. Heck, maybe it'd even make your sister-in-law think twice before dropping in for coffee during your shift. But wait--since Peter and his cohorts at MTIA have steered this ship to benefit the speech recognition vendors and AAMT dropped the "American Medical Transcriptionists" from the acronym, they've already declared that they now instead operate as advocates for the medical record and not the transcriptionist. It's all about EMR and SR now, baby. Except MT week is looming and this apparently calls for a flip-flop to claim they're advocating for us after all. So which is it? I guess they're hoping Lenin was right when he said, "A lie told often enough becomes the truth." As an MT, AAMT's claims of advocacy sound hollow indeed. I have a good feeling this is simply a matter of not wanting to give up the potential cash cow that certification offers. They've not succeeded in selling us the idea of the vanity title, though some of our Indian counterparts seem to think it will garner them acceptance. The organization is driven by the idea of selling us on their credential and their BOS, if not a membership. Without everyone on board for individual certification, how will they sell companies on the idea they should also be certified? Nothing else they've done seems to have hit the jackpot. Even that drive a couple years ago to lure in student members has not resulted in many of them staying on as full members, once they discovered how little that membership gets them (i.e. a very expensive lapel pin) and the realities that the organization simply does not want to deal with new ideas. Not that the old way of thinking is getting them too far. These people are the crew of their very own Titanic and as the water rises over all our ankles, they're busy congratulating themselves for jettisoning a few bothersome lifeboats because it gives them room to pack in another game of charades as the orchestra continues to play. To quote Peter: "So if you want to help advocate for your profession, to bring it more visibility and respect, become credentialed. . . The profession could really use your help." Is it just me, or is there a huge disconnect in the concepts of who's advocating for whom and what that really entails? Maybe the medical document isn't the great partner they thought it would be.

As the industry moves increasingly to SR and MTs are told they are now "editors," we find ourselves training the very technology that is replacing us, and at a cut in pay for the privilege. Veteran MTs are not valued when there are sloppily educated greenhorns happy to start at poverty wages. Even the clients are getting used to the idea that crappy transcription is all they'll get--but it's okay because it's cheap! It is fast becoming the norm that MTs with 20-30 years' experience are being hired at the same wages as those newbies and told they must "work their way up the ladder." Only--oops!--they're not talking raises, they mean that you work more difficult accounts with the dictators so awful that SR doesn't work with them, and the main option for increasing your pay is simply to work harder and faster. I know too many who are afraid to leave the nationals because they are at a rate of pay they will never see again and are already struggling to survive, at that. They have simultaneously put the production screws to us whilst redefining our wages with an eye toward 2-4 cpl as soon as they can get away with it. Honestly, is there another field where this kind of thing flies? What did MTs do to deserve an "advocate" like this?

I'm not sure why I'm harping on an organization I truly feel is history. Before I sprout Andy's gigantic eyebrows and launch into another silly rant, will mosey instead to my happy spot: My week has involved a revelation regarding my back misery, in which I suddenly realized the last time my bed didn't make me ache was back before the ex forced me to jettison the beloved waterbed and let him pick out an erroneously named "Beautyrest," which has been akin to camping on asphalt. A little tenacious sleuthing and I sing the praises of Craig's List, wherein I located a very retro full-motion waterbed for a mere $25 and should be floating blissfully by Friday night. The last bad vestige of a worse marriage will soon find a new home with some masochist or desperate cheapskate as I finally relish real lumbar support.

Add in the bonus that my daughter and I finally succeeded in getting far enough into the attic to fix the A/C as the FL summer hits and I am rarin' to get back into school with a clear head and fresh enthusiasm. I've finally received all the textbooks for my next AHIMA module. First impressions are that the computer course will be painfully simplistic and outdated. Since technology advances so fast that any new computer is outdated before you even break it in, I'm not sure how anyone can teach this as more than the basics. It appears that HIPAA is glaringly omitted, at least in the textbook. Hopefully, this class will be a breeze, as I'm still rather bruised from the anatomy & physiology course. Medical terminology looks to be fairly easy, though there's an extra text about pathophysiology that is kind of giving me palpitations because it appears to be an evil cousin to the A&P text. Pharmacology looks to be another fairly straightforward text and involves a lot of things I already deal with, so perhaps three out of four makes for pretty good odds on getting through intact. In light of the increasing grumbling amongst my peers and the knowledge that I need to race to get ahead of our "advocates," am feeling pretty motivated to dive in.

Call me La-Z-Boy

Jeanne Johnston — Thu, 08 May 2008 13:58:00 GMT

I suspect I'm channeling that lumpy old recliner with the floppy footrest that's been retired to the frat house. After surviving my work week last Thursday and with my A&P course deadline screeching up at full speed, I hit the books hard. Spent over 36 hours solid (yes, I napped a couple hours here and there) reviewing everything--the workbook exercises, then textbook exercises, the online lessons and all those little rabbit trails they link you to, the chapter tests, the word lists, and on and on in circles until I had anatomy coming out of my ears. It was a flashback to my college years, when we'd spend that last finals week pulling all-nighters in the hopes of making up for not paying attention in all those lectures, only with considerably less silliness and no chocolate chip cookie dough (Julie B's mom was the BEST).

The course was HARD--the hardest class I think I've ever taken. Still, for all the information to try to absorb in the chapters, the chapter tests were almost disappointingly sketchy--some only five to ten questions long. Surely, they were representative of what the final would be like, right? Twenty chapters crammed into 60 questions, so they would surely be hitting the highlights. This is a course taken not by med school hopefuls, after all, but geared toward coders, tumor registrars, and whoever else might feel the need to get a clue for their job on the periphery of patient care.

Holy cow. Big mistake right there. Whilst I was quizzing myself on organ systems and terminology, they were dredging up extremely specific questions about circulations, microscopic functions, and chemical bonds. What the heck? About four questions in and I was flirting with a panic attack because they gave me the wrong test. . . At the very least, they hit me with the gnarliest test in the arsenal. In the end, however, I persevered and made it through with just enough time to click my way back to the beginning and check my answers. Managed to trust my instincts on a couple that I shouldn't have and second guess a couple that I shouldn't have, but in the end, walked away with an A on the sucker. Not a high A--which in the past would've caused me about a week's worth of stomach upset and disappointment in myself--but in this case, it feels like I aced it.

Talk about relief. Bad enough I allowed myself to get sidetracked over the weeks and had to scramble so at the end, but even worse that my trip has been so public. Forget the tuition I'd have to cough up again if I'd failed--I would've had to slink back here to announce my failure. For someone who isn't crazy about the spotlight, this is a silly way to go about my studies.

So the lumpy recliner bit? That's what happened next. My brain wanted to come here and Woohoo! but the stress and lack of sleep made me feel like I'd had the stuffing knocked out of me by a couple of rambunctious toddlers and a semester's worth of frat keggers. I seem to recall getting groceries and surviving almost another week of work, but the brain is still not completely engaged. Spent a couple afternoons trying to find the perfect music video to convey my elation, but Devo's Whip It! has such a stupid video and I kept getting stuck on bagpipes, which I suspect not everyone loves like I do. Mostly, I found myself wandering off nonsensically into things like Shatner does the Beatles, which I couldn't explain away as remotely related to past or future jobs, studies, or healthcare forum in general, but good grief, it's hysterical. . . The gist of all this is that yay, I'm awfully pleased with myself, but lack the strength and discipline to convey it outside my head. I will probably need another week before the edges come back into focus and I'm firing on all cylinders again. With this in mind, I'm sure everyone will forgive me a few nonsensically mixed metaphors and general lack of coherence. Give me another week to clean the Doritos crumbs out of my cushions, replace that missing bolt in my frame (duh--no wonder my back went out!), and time for a good scrubbing and fluffing so I'm more presentable for Parents' Day.

Most silly of all is that it didn't even take me a day to ignore my promise to enjoy the break from studies and thoroughly deflate for a week or two to dive into the next course before I found myself sitting at the computer, looking for the best deals on my next group of textbooks. Any minute, I will probably be able to slobber over three classes' worth of tomes, with an eye toward starting the first class--computers, then medical terminology, then pharmacology. Sounds incredibly easy, given that these are things I've studied before and am immersed in with my job for the last few years.

Wait a minute. . . I thought anatomy & physiology was going to be a walkover, too! I think I'll give myself another week off, just to be safe.

Do or Die

Jeanne Johnston — Thu, 01 May 2008 15:20:00 GMT

My brain and my back are having an argument about which can give out on me first and after almost a two-week battle, there's still no clear winner.

After three months of study, I'm nearing crunch time on my first CTR course and I suspect the stress has simply gotten to me. Oddly enough, I sailed through school in my younger days effortlessly--rarely cracked a book, rarely bothered with homework (I was usually done before class was even over), and still managed to ace my exams and come out at the end with almost a perfect GPA. Same was true of my MT course--finished ridiculously fast and with few mistakes, though I have to admit at that point I was desperate enough to study like my life depended on it. (Actually, it did--the resulting job enabled me to toss a long, lousy marriage on the funeral pyre.) I recall feeling determined, but not particularly anxious. It didn't hurt that I had the luxury of spending 12 hours a day with my nose in my textbooks.

So what happened? I started this A&P course very excited to be back in school, but quickly took a bad turn. First chapters were great, but then I came up to that first exam. Didn't help that my sister-in-law had a heart attack and various other little family crises piled up at the same time to provide distraction.The material was killer--chemistry and all that good stuff I'd managed to avoid in high school and college--and I was suddenly freaking about a little test. How many questions would it be? How much of this incredibly detailed material would I really have to know? What happened if I really screwed up on it? The more I balked, the worse it felt. Test anxiety was a fairly strange thing to me. Even worse, the clock was ticking--only 15 weeks to complete the course, and if every chapter was this bad, how the heck was I going to hack it?

In the end, of course, I sucked it up, took the test, found it to be almost disappointingly short and easy, and rediscovered my old self and plowed headlong into the rest of the course like a fiend, desperate to make up the lost time. Of course, I also encountered logistical things I'd never had to deal with before because I am now working full time and still have a household to run (I'm sure I could run off on a heckuva tangent about the fallacies fed to us women about how we can "have it all," but I'll spare you all that particular rant for now). Yes, I can throw a case of ramen and institutional-sized bag of frozen vegetables at my teenage daughter and she's set for a week, but I've still got animals to depend on me, crud to vacuum, dishes and laundry to deal with, groceries to restock, and the occasional room to gut and totally redo (still not sure how last bit happened, but it ended up monopolizing my entire two-week vacation I'd so carefully saved up to devote to my studies). I found that I've been useless during the work week and my usual weekend catch-up activities in general still leave precious little time to focus. In the end, I've had to get ridiculous and devote entire weekends to devouring my course, lest I get tripped up at the finish line by running out of time.

So yeah, I'm finally at the point where all I have to do is study the crap out of this thing and pass the final--and yes, I'm finding that anxiety rearing its ugly head again. I have a suspicion that the deadline is going to save me from dwelling too long on the matter because it's bootstrap time. I just need to grit my teeth and "Just do it!" as those folks at Nike keep telling me--hoping that the shoes aren't a necessary ingredient because I prefer to go without. Unfortunately, I think the stress has found a way to assert itself anyway as my sciatica and deadhead vie for attention. I'm currently telling myself that once I pass this final (like that power of positive thinking?), my stress will disappear, my brain will start firing on all cylinders, my back will unclench, and I will have the luxury of a week or two before I head into the next module and start all over again. In the meantime, I think it's time to resurrect my motto and remind myself that failure is not an option.

Here's hoping I survive not only the final, but the next few months without a chiropractor or a wife, though I'm beginning to think the latter might bear some serious consideration.

Stress and then some

Jeanne Johnston — Fri, 25 Apr 2008 17:26:00 GMT

I'm happy to see another career-changing blogger here, but I can't decide if her narratives are more comforting (aha--someone who can empathize with me!) or just compound my anxieties. I don't know if it's the fact that I'm approaching the do-or-die portion of my A&P course or her most recent entry that made me have that dream where I find myself in the middle of the halls at high school on finals week, the bell has rung, and I can't even remember my schedule. . . I guess in the balance of things, knowing someone else is surviving the craziness is the bigger thing. Quite comforting, actually. It's kind of like when I shattered my knee and the best part of going to rehab was seeing how far other people progressed--or how pathetic some were (honestly, there was an old lady who even cried when they slapped the TENS unit on her. . . I LOVED that thing!)

Seriously, though, it's interesting to see that it doesn't matter what level education you're battling. Whether you're a rank beginner taking your first transcription course or going for a major degree, the stresses are the same. Carol points out great advice about picking a reputable school, and I agree fully that online degrees have come into their own, as far as credibility. Of course, there's a huge difference in the number of scam schools at the various levels. Medical transcription is infamous for those hotel seminars that try to convince SAHMs how they can make $60K/year working part-time hours of their choosing (ha!) if they just take this matchbook course. From what I see, the higher the credential, the more a school has to meet standards and accreditation. Many traditional universities have embraced online education and they're just not going to throw away their reputations by slapping up a course worthy of those late-night Sally Struthers commercials. Indeed, they have to meet the professional organizations' requisites before they can even offer a degree, or it's useless.

Coming from MT, I know very well how little accreditation can mean on the other end of the spectrum. The so-called standards simply were watered down repeatedly until they have no meaning. This makes it really hard to figure out where to get your education. The consensus amongst the majority of working MTs, editors, QA folk, and MTSOs is that if you simply pick one of THE two online courses (M-TEC or Andrews), either will pretty much ensure you're not just employable, but sought after. Many of their grads have multiple job offers before they've had a chance to breathe a sigh of relief at the end. In this case, oddly enough, I believe having a certificate from either online school maximizes your employability, at least when you're applying to nationals or other 'net-savvy MTSOs. Even that community college course--though it may meet the same standards (many don't come close)--will not register a blip on the radar when trying to break into the field. Unless that school has a great working relationship with local clients to help with job placement, you may hit a wall very quickly. Unfortunately, the trend is not to local, in-house jobs, but telecommuting, and even a great local school isn't likely to even get you an invitation to test for such a job without experience. Whilst a diploma from those two online courses is often a fast track to a job, any lesser course does not give the benefit of that kind of reputation. Besides actually giving you the best possible foundation to hit the ground running, I believe that reputation is a priceless benefit of choosing either school.

It was quite a surprise when I started looking into CTR. As the requirements for educators is so much more strict, there are considerably fewer options. I was shocked to see so few accredited courses for CTR, but it did narrow down the search quickly. More surprising was hearing that where I get my training isn't going to matter to employers, only the fact that I am or will be certified as a CTR. In rummaging around the job bank, I see that's true. In the ads, they all want CTRs with experience and certification, though they also list internships for new grads needing those hours before they can even take the exam.

It sounds like Carol's travels to her master's degree have similar considerations and stressors as far as the general educational concerns and integrating a career change into the family dynamics. As I find my own nose sore from pressing ever closer to the grindstone, maybe she'll pass some hints on the personal stuff, like how to get teenagers to pitch in and how to actually get dressed out of the closet instead of the laundry basket. *grin*

Wiki me what?

Jeanne Johnston — Fri, 18 Apr 2008 11:57:00 GMT

Ahhh, the internet is a wonderful thing. As a relative newcomer to transcription (i.e. I learned my job on a computer instead of a Selectric and never had to pay my dues in triplicate with carbon paper and Liquid Paper), I can't imagine doing this job without the web. As a book lover, I know there's nothing like a hard copy to validate an obscure term, but have to admit it's been ages since I've cracked that tower of reference materials hovering over my workspace. Having honed my online research skills, it's infinitely faster to simply hop on Google and zip to one of the countless trusted reference sites I've bookmarked. Every time a dictator says, "Oops--go back to where I said this and change it to such and such," I thank my lucky stars it's only a minor annoyance and not a real work-stopping event. You just tack things in as needed and off you go.

The internet pretty much provides all you need in terms of terminology, you can find tons of sample reports, message boards to pick the brains of you peers for that occasional obscure instrument, and now, the web has finally caught up with an MT Style Guide. For those of us who believe our so-called professional organization has devolved past its usefulness, this seems to be the final thing to render it obsolete, once it bulks up a bit and gains recognition.

So what the heck is a wiki? If you're familiar with Wikipedia, you probably understand the basic concept. A wiki is simply an online resource which allows users to add and edit content collectively, regardless of their browser or platform. You don't have to register to use the information, but you do to be a main contributor. Unlike Wikipedia, where just anyone can add information (or disinformation, as the case may be), this wiki is moderated in the sense that only approved users are able to add the main content and are generally very experienced MTs, MTSOs, and/or editors with that extra helping of anal retentiveness to make them perfect for the job. Any user can leave comments on a page, but the main content is entered by volunteer staff. If you're a veteran with a good working knowledge of style, you're free to volunteer for a section and leave your legacy.

It's been pretty much universally accepted that the official AAMT Book of Style is a counterintuitive mess, regardless of all the hype that comes with each new edition. I have to admit there are still few things I can look up in it easily. Nothing is where I expect it should be and it rarely goes into enough detail to answer my specific question. Theoretically, this should've been simplified for those buying the CD version, but noooo. . . the CD isn't searchable unless you knock yourself out making your own .pdf archive. To highlight the mismanagement of the official BOS, the third edition not only does not come with a CD, but they've failed to recognize the current state of technology and have no plans to offer it as an eBook, either. (We work digitally--how unreasonable is it to expect our references to be as accessible as everything else we do?) Not only that, but the new edition is rife with errors. Oops! Those were placeholders from the 2nd edition and they meant to go back and fix them. . . The capper is that having shipped the new book, they've immediately recalled them because there was some brouhaha about the cover and they have to have them redone. Hardly what I'd expect from anyone else who's declared themselves the ultimate professionals. (Yes, I'm still carrying a grudge over their Jan. 2006 edition of Plexus, which was devoted to the concept that AAMT members were professional and the bitter, unaffiliated miscreants loitering around MT message boards were so obviously not to be recognized as their peers. . .) To add insult to injury, we're talking about the "low, low price" of $70 for the privilege of owning this mess. Rather than actually improve the 2nd edition, they've simply repackaged it, leaving cynics like myself to assume it's more about stoking the cash cow than actually creating something worthwhile.

Of course, the official BOS is considered the default reference for many, if not most, employers. When a client's account specifications don't address something, this is what you use. Obviously, this online style guide needs to gain recognition before it can supplant the BOS. I'm doing my part to get the word out and I know there are countless grande dames of MT who are enthusiastically contributing. I know there are thousands of working MTs who have divorced themselves from AHDI and will probably be happy to embrace an open source style guide, as well.

As an entertaining sidebar to bolster my disdain for these people who seem to have no clue what they're talking about, I leave you with this: The AHDI I Love My Career contest. Heh. After promoting all the things that have rendered MT a piecemeal sweatshop, I guess they're a little confused about what "career" means. or maybe they're hoping if we'll all just put on our rose-colored glasses and say it enough times, we'll all believe it to be true. You almost have to admire them for their tenacity, no matter how silly reality makes them look.