Passage : Cancer Registry

I'll Take My Sunshine Where I Can Get It

Jeanne Johnston — Fri, 20 Mar 2009 11:54:00 GMT

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...(read more)

If You Build It, They Will Come ...

Jeanne Johnston — Fri, 14 Nov 2008 12:56:00 GMT

. . . at least, that's how it works if you're Kevin Costner. In my world, it's more accurately "if you take a vacation, they will ruin it." The "they" I refer to? Kids, of course!

My window of opportunity for time off appeared quickly, so at least I didn't have time to get too excited about it. First week, I had planned to take a couple days just to deflate. Otherwise, it wouldn't feel like much of a vacation, would it? A little background: My daughter has been hot and heavy with a boy across the country for months. Every week, I've been told they were socking away money, looking for apartments, and The Big Move was imminent--as in "next week," "next month." Never really came to fruition, so I guess I got immune to the threats.

So what does she do? Finds an apartment and makes plans to leave the nest immediately. As in less than a week. Forget the emotional trauma that entails--it meant we had the mind-boggling task of preparing her to leave the only home she's known here in the subtropics and land in soon-to-be-frigid Massachusetts. What Floridian in her right mind decides to introduce herself to the four seasons by plopping in the middle of winter? Sad enough she'd never even seen a proper hill before we went to Atlanta a year ago. Now, she's getting a real world education. This is a girl who whines about the cold when we dip down to 70. . . Ah, well--it's her karma now and I don't suppose they'll stay there forever. I don't even feel Florida is where we belong, even after 20-some years, so until I figure out where I DO belong, I shouldn't worry about calling the shots for anyone else. However, the main point of my rant is that this monopolized my first half of the vacation. Even doing her own laundry didn't spare me the lion's share of the work, and we ran around like the proverbial headless chickens--cleaning, sorting, locating boxes, and packing. I got to spend my Saturday driving her up to Tampa and letting her go through that gate--who knows, maybe for the last time.

Very sad business. . . until I got home and realized she'd left a mess in virtually every room of the house. It will probably take me weeks to pick away at it all, as I get the dubious honor of shipping her everything she left behind in dribs and drabs (starting with her computer, which was too heavy for carry-on and cost a cool $72 to ship!) I keep telling myself that this will be a good thing for both of us. She finally has to be an adult, get a job, pay her own bills, and (one hopes) set aside her WoW addiction for good (she claims it was merely the best way to stay connected with her man, and now they're in the same place, the game will probably become superfluous). I will also have to become an adult--or at least finally address the remaining post-divorce issues of self esteem and future relationships. Mommyhood, job, and studies have not left time for such things and I really need to hustle and face these demons, lest I turn around in 20 years and wonder why I did it alone. . .

So fine. I've survived this angst. The umbilical cord is stretchy and apparently does reach MA without undue pain or death, and hey--I still have a week of vacation!

Or not. At this point, my son takes over. He Who Is Never Ill announces he is not well. His foot is swollen and red and he's taking all the Chinese herbs his soon-to-be-doctor friend can throw at it. I have to go up there to step in. This is a guy who already lost a leg to necrotizing fasciitis and can't afford to fiddle-fart around. The foot looks bad to me, but he won't let me take him to the ER. Heck, he won't even let me wash that sink full of dishes because it's his mess in his (new) home and he's relishing the independence. Of course, as he's also just been laid off, he does not resist the offer of groceries or some Middle Eastern takeout. . . and when I finally leave (against my better judgment), he is promising that if the foot doesn't look better by morning, he will indeed go to the ER.

Natch, I get the call early. He's developed lymphangitic streaking up to his inguinal chain and his friend has taken him in. I get to spend the next week commuting an hour each way and keeping him company in the hospital. He gets his IV antibiotics, the redness recedes, the heat dissipates, the swelling relents, and they decide he can get a PIC line for outpatient antibiotics and go home.

In the midst of all this, of course, my vacation has vaporized, I'm living on maybe 3 hours of sleep each day because I'm still playing nursemaid, and I'm feeling more stressed than ever. I didn't even find time to read a book, finish my garden project, or even sleep in. Of course, my biggest plans for my vacation involved hitting my pharmacology course with a vengeance, and I ended up barely cracking a book. Here's hoping I can recover my stride and make up some ground now that I'm on the cusp of another weekend. I just need to find my own Shoeless Joe to inspire me on to complete my own Field of Dreams.

(OT: A shout-out to Jean R., who not only passed her CTR exam, but landed a job! Great inspiration!)

Beginnings and Endings

Jeanne Johnston — Tue, 04 Nov 2008 13:33:00 GMT

I'm not so sure the vacation is a success, except that I seem to be making up for being behind on my sleep. Maybe that's because it's still been a very stressful time. I'm still anxious for all the election hoo-hah to be over--and yet I jumped at the opportunity to stand in the sun all day to attend an Obama rally last Thursday. It was amazing in many ways, not the least of which was the demonstration of unity and power in our community. Whipped as I was at the end of the day, it was a much-needed infusion of optimism.

As today is The Day, I admonish everyone to get out and vote. Take your kids. Wear sunblock. Take plenty of water, if not a picnic basket (we voted over a week ago and missed those long lines, but standing in line with 12,000 people to see That One taught me something). Take the little old lady next door who can't drive herself. This election is making history and we should all claim our spot in it.

I find myself wondering just how the promised measures to discourage offshoring will affect our fields. I suspect it's too late to undo because the big nationals are already so established outside the US and are raking in the big bucks. Lose the rest of their "high-priced" American MTs and that would probably offset any penalties they might pay. . . On the other hand, I do believe sanctions will help stem the bleeding in general, as well as many of the other specifics for revitalizing US-based business. With GM's profits down 45% and Ford's announcement they're down 30% on the heels of the massive (and misguided) bank bailout, it isn't looking good for the economy. Will MT wages fall even further? Will they still be able to treat us like peons because we're so desperate for income of any kind? I hate to speculate, but I'm starting to think the survivalists might have the right idea. . .

As if this wasn't enough, I've also had family angst to contend with. For months, my daughter has been threatening to move across the country to join her boyfriend and become an adult. Suddenly, their plans came to fruition and I had only a week to gird my loins for it. As excited as I am for her, it was bittersweet to send her through that security gate to a far-off place, knowing I will hardly see her again. My kids and I have been joined at the hip forever, and my baby's flown the nest. Luckily, I got home and found she had left a disaster in almost every room of the house, so that took the edge off my sorrow. Bad enough when I don't have energy to keep up with housework, but it will be easier when I don't have someone working at cross purposes. (My kitchen counter has been crumb-free for days, and I am astounded at how many bath towels I have, now that they're not all in a damp pile in her bedroom.)

Sad as I am, this signals adulthood for both of us. She will finally get a job, go to school, and pay her own bills. (I suspect the toilet paper expense alone will be an eye opener.) I will finally be free to focus on my post-divorce reclamation of my life, start treating myself to luxuries (for me, this could be something as extravagant as new underwear. . .), and hopefully, put the hammer down on my CTR coursework before it kills me. I'm reluctant to look further ahead than that, but in general, am expecting to have to deal with an internship, certification testing, new job, a move, and (goddess help me) maybe even two-person sex again in this lifetime.

LOL--only I would fritter away a vacation fretting about things. Here's hoping tomorrow I feel a burst of enthusiasm and am ready to hit the future head on.

Now--go vote!

Career 2.0

Jeanne Johnston — Mon, 20 Oct 2008 11:52:00 GMT

How did you fall into your career in healthcare? In my case, I thought I found the perfect fit for my interests and abilities--and were it not for the current state of affairs, with the drive to wring greater production from us for less pay and shrinking benefits, I would have been content to stay put until I'm old and grey. That obviously being the case, however, I've started down this path--hopefully, toward a better-paying, more secure, more respected, and perhaps even more meaningful career. Much as I enjoy my job in general, I find the fact that cancer registrars actually can help define which treatments work and which factors predispose people to disease somehow more noble than merely helping to document a patient's bowel habits and pill count for the billing department.

Still, as I was already at an age where my kids were fairly self sufficient when I started MT, I've had even more misgivings about starting from scratch again. Do I have the strength? the brain power? the intestinal fortitude to start back at the bottom of the pile? This time around, I also have to work around a full-time job as I struggle to complete my studies, often a source of frustration and discouragement--and I'm not even counting the entropy that's overtaken my household anymore. Not like I have time or energy to entertain anyway, right?

Apparently, though, mid-life career change is all the rage. I got an invitation to enter a contest at site called Encore, which is apparently skewed toward baby boomers turning their lives inside out as middle age (ugh) threatens. Now, my first inclination was akin to when I get those AARP ads (OMG--those people start trolling when they see you turn 40!); as soon as I saw grey, I winced and closed the tab. In my head, I'm cruising along in my early 20s. I have more in common with my kids (who were born already older than I), and will probably never feel a connection with those people in the AARP flyers. It irks me to see Sean Connery looking paunchy and tired and songs I grew up with appearing as Muzak at the supermarket. After wasting half my life on a lousy marriage, I'm looking for the do-over of that misspent youth, not looking ahead to empathize with incontinence, laxative, and Viagra ads. . . Criminy.

After thinking about it, though, I decided it might be helpful to at least see what they claim to offer. It's not easy to decide to change careers, especially when you're talking about women who've played the thankless role of Mommy for 20+ years (we know that mommies in general make up the vast majority in the pink collar ghetto of medical transcription) and have no clue how to base a résumé on something employers don't respect. According to the site, "Encore.org provides news, resources and connections for individuals and organizations establishing "encore careers" that combine social contribution, personal meaning and financial security. People in their encore careers are helping to improve health care, educate the next generation, protect the environment and much more."

I haven't had time to investigate the site thoroughly, but I do note that they appear to offer educational grants, including one category specifically to provide "grants for innovative community colleges preparing people 50+ for careers in education, health care and social services." "Find your Encore" helps you figure out where to begin thinking about a new career, which might be helpful for those of us without much of a clue beyond, "I really need to make a change. . ." but floundering helplessly beyond that. If the site offers nothing beyond this, it might be worthwhile.

What I find most interesting is that baby boomers (we're talking the generation that helped end segregation and stop a war, remember) seem to be challenging and redefining everything as we go. Granted, our parents didn't have to cope with the same problems we do, but it would have been inconceivable 20 years ago to jettison a career you'd trained for and start fresh. Of course, "back in the day," respect between employer and employee was more of a two-way street than it is now. Perhaps in declaring ourselves unwilling to settle for something that doesn't satisfy our needs for financial security, acknowledgement of our worth, and some sense of purpose beyond the workplace, the paradigm will begin to change for the better.

That Which Does Not Kill Me

Jeanne Johnston — Fri, 10 Oct 2008 11:38:00 GMT

I've been looking forward to the time when I can stop grousing about the sorry state of medical transcription and focus more on my future in cancer registry. The last few weeks have brought incredible stress--some very up-close and personal (new account, new platform with a huge learning curve, endless conference calls and training modules, double shifts, dropping pay, rising bills, A/C leaks, car repairs, and an ex who's blown off alimony payments for six months without so much as a peep of explanation until I found time and energy to get my legal horses in order and sent the state of FL after him) and some off on the periphery, vying to be in my face because they'll affect me eventually (economy falling apart, an ugly election season that threatens never to end). With even less time to fit everything in and sleep the only thing that can give way to make room for the excess, it came as quite a surprise when I realized I may have already started the transition where it matters most--my head.

My new account has me transcribing more OP notes and procedures, and especially GI. As my mom survived stomach cancer a few years ago, this has been especially fascinating to me. As I transcribe these stories, I find myself thinking in terms of things I've been studying for the last few months--the specific anatomy, biochemistry, predisposing factors, patient's history, pathology, and prognosis. I've only rummaged through the SEER training site and have yet to get into the actual cancer registry coursework, so I play a little guessing game and try to pick out the things that I think will be noteworthy to a registrar. Eons ago (or so it seems) when I first researched registry and played around on the SEER site, I was amazed at how little of a patient's transcribed reports are actually germane. As an MT, I can usually see why doctors dictate what they do (with a few notable exceptions, often those zealous residents who throw everything but the kitchen sink in there, just to be safe), but from my little preview, a tumor registrar is going to discard most of it. If you're curious about whether cancer registry would mesh with your own skill set and interests, I highly recommend SEER to get a feel for what is involved. You can download their entire course as well as go through online exercises at will.

Mostly, I find myself fantasizing about the day my second career as a student will end and I will be able to confine my job to just 8-10 hours a day. Though there are definite benefits, working from home has never been a great goal of mine and especially having spent the last years sequestered save for the weekly grocery trip, I long for some human contact. According to this old article, over 50% of registrars work in the hospital setting and almost 40% work in state or regional registries. The main differences seem to be pay (hospitals paying less) and scope (hospitals tend to follow patients throughout their lifetime instead of a specific moment in time), and beyond that, I can't even focus enough to care. Anything will be a step up, as long as it involves better pay, job security, more compartmentalization of home and work life, and yes, even working with other human beings.

I'm still not sure what extra hoops I'll have to jump through in order to take my certification now that the requirements have changed. This will probably be a huge pain and extra delay, and given that the NCRA is already struggling to attract people to the field, I wonder how much further behind they will find themselves as far as recruitment goals. Still, given the enthusiastic endorsements of students who've blazed the trail for me, I have no doubt I will find it all worth struggling for--assuming I survive that long. Right now, I feel like a fetus who's been trying to will herself out of a very small orifice for a loooong time (yeah, I suppose I could've used a less-graphic turtleneck sweater analogy, but we're all medical people here, right?) and I'm looking forward to that moment when I can finally claim my own space in the big, bad world and see what's out there for me. I'm drawing on every scrap of optimism and sheer force of will I can muster at this point to get me there.

Send in the Cannibals!

Jeanne Johnston — Thu, 11 Sep 2008 12:43:00 GMT

It's become pretty obvious to me that MT has started eating her young. This is not exactly a new phenomenon, and I've railed for ages against the practices of entities like AAMT and the Crappy Schools that have made a career of marketing themselves for profit's sake, rather than for the betterment of the field of transcription. I think the disease is spreading, though. Everyone seems to want to ensure they get their share of the profits before the whole thing goes belly up.

The school approval process is a dud because AAMT chose to dumb down the criteria to allow more schools to earn it. Better money for them because more are willing to risk the hefty application fee for the process, knowing they stand a good chance of ending up promoted on an equal footing with the giants M-TEC and Andrews, but bad for the hapless newbie who thinks seeing a school in that list means they're all equal and invests all that time, money, and most of all, hope that this will result in a lucrative career. No, those are not the only two schools who can turn out good MTs--but the list is a mishmash, with no way to discern the level at which each school listed managed to qualify for the dubious honor. Like those top two, did they knock it out of the park and set the standard, or did they squeak by with the minimum criteria or even get special dispensation and fail to truly even meet them?

In my humble opinion, a good clue when picking a school is whether it even requires you to take a preadmission test before they accept your money. Those who are truly in it for the right reasons DO, not just for their benefit, but for yours. Do you have the skills necessary for MT? Do you perhaps need to spend some time getting remedial help in keyboard skills or basic English language/grammar first? As there is generally a finite time to complete a course, it's obviously best not to fritter that away trying to get up to speed on spelling, grammar, or learning to type. A legitimate school will test you and let you know that you will want to brush up on specific skills and invite you to return and try again afterwards, if it's obvious you're going to struggle with the material. They're not going to push all your trigger points for a quick sale, but are truly interested in seeing you succeed. If you want to factor greed in there, it reflects poorly on them to have graduates fail because they don't cultivate deals to funnel their grads into further on-the-job training; their grads are simply ready for the workforce and that word of mouth is their bloodline.

On the other hand, a red flag goes up when you see a course willing to accept your money NOW. All that is required is NOT a big enough desire to succeed, no matter how much you want to believe them. Ask yourself if that friendly come-on really indicates a desire to help you support yourself or if it's merely the ka-ching of the cash register they're interested in. You only have to get out your calculator and do some simple math to see why they would be so eager to accept everyone. . . It doesn't matter to them if anyone finishes their course at all or even if those who do manage to get jobs at the end. What matters is that they take in the most money possible with the least given out in return. Say a course costs $1500. Multiply by only 100 starry-eyed hopefuls a month (and man, you know they're snagging far, far more than that) by $1500 and again by 12 months, and you're talking almost a cool $2,000,000 (that's TWO MILLION) a year. Subtract a few homemade workbooks, maybe a dictionary (purchased with a nice bulk discount), a handful of people to answer the phone, run a basic website, and the profits are staggering. Bonus if you slap up a message board and can let the students "teach" themselves. Bigger bonus if you can sucker them further by helping to promote the school for you by letting them call themselves "partners." What's a $50 referral fee when you're doing all the work to bring them another $1500? It's multilevel marketing at its worst.

So you've got AAMT promoting everyone who wants in on their approval process AND anyone else who wants to buy ad space on their website--including schools that could never pass the approval. I'm sure that confuses enough prospective students to make it worthwhile. You've got bogus schools not only promoting themselves, but getting their students to do it for them. We also have more independent-minded folks who have opted to create message boards and website directories--ostensibly to simplify matters for those of us who might be looking for a clue, but in actuality simply following the crowd and looking for their piece of the pie. Just because a school or business is listed in such a place does NOT mean it is legitimate. It simply means that entity was willing to cough up the money to be included. Good or bad? It's apparently every woman for herself to figure that out. Caveat emptor is the law of the land now. By some miracle of osmosis, newbies should apparently "know" who's legitimate. If you're too ignorant and pick a course because it's affordable, you deserve what you get, I guess.

There are plenty of other ways to scam newcomers, starting with those self-described humanitarians who claim to offer undereducated graduates a way around the Catch-22 of experience. Without a proper education, you often aren't even allowed to test for jobs--or if you are, you're not likely to pass. Yet, no one will hire without at least a year or two of experience. What's a new grad to do? Enter the guy who tells you he'll give you that on-the-job experience. Of course, as you'll require massive mentoring and editing help, you're only going to be paid 2 cents per line, but hey--you'll have something to slap on your résumé! Are they filling a necessary function or just capitalizing on slave labor? If the school approval process works, why are there even graduates who NEED this kind of stopgap? Surely, completing an approved course means MTSOs will hire you, right? But wait, you say--there are nationals who hire grads of courses not considered great by the MT community at large, so how bad can those courses be? Again, consider the possible mutual behind-the-scenes back scratching, lower wages, and a need to find warm bodies, none of which reflect a measure of excellence. Beware, also, the MTSOs who have simply created a school as an offshoot. Occasionally, these might be legitimate, though limiting, because other companies might not see that kind of specific grooming as useful on a résumé. Worst-case scenario, it can be a way to simply get their work done for free, again benefiting you nothing but street smarts.

As a tangent, I think this all relates very well to the concept of how working in jammies is viewed as an integral part of MT, for good or bad. Of course, telecommuting and being able to work in ones jammies (heck, even NO jammies) is not necessarily a bad thing. It's not even noteworthy or relevant at all, but what IS bad is that it is specifically a concept being used to market the job to those stay-at-home-mommies who are having such a negative impact on our wages in general. Have jammies and baby? MT is for you! The very schools I gripe about above are the ones marketing specifically to this demographic. They don't care if these women are looking for a real career or just a hobby, they don't care if they even finish their courses or get a job--but in marketing this way, they are bringing in the MT hobbyists in droves and have impacted the legitimacy of MT as a true profession in the worst possible way. I think this has had a far greater impact than even offshoring, though cheap offshore labor and speech recognition are the nails in the coffin.

What is apparently very good for some individuals and companies has just been deadly to the field of transcription in general. I guess what really gripes me is that it's not just US versus THEM anymore. Many of the most egregious abuses, especially of potential and new MTs, are being propagated by people who come from within the field and were once newbies themselves. Forget honor amongst thieves, honor in general apparently means very little in the world today.

Dang. I really didn't expect to go off on another rampage this week. Having passed my terminology course with near-perfection, I should have been crowing! Onward now to pharmacology and pathophysiology, the last hurdle to my cancer registry management course proper. I look forward to the time I can "get off my high horse" (as I was recently described) and turn my back on MT with the rest of the cynics. Somehow, though, between my overdeveloped sense of fairness and vegetarian leanings, I doubt my old MT peers will be on my menu, even when I've managed to leave the field behind.

Be Here Now

Jeanne Johnston — Fri, 05 Sep 2008 07:46:00 GMT

My mom and I, separated by about 1500 miles, have settled into a little email routine wherein we are as content to touch base with such oh-so-non-newsworthy events as trash day, the arrival of the lawn guy, turning on the A/C, opening the house, and occasionally, even the results episode of some lame reality teevee show as we are with actual News. After surviving everything from illnesses, deaths, squirrel attacks, crack whore neighbors, loss of limb, and snarky teenage daughters, we've come to appreciate the mundane as "okay." As in, "Yeah, I really could stand to get a life, but at least nothing happened today." I like to think of it as cultivating those lessons Baba Ram Dass espoused many years ago, appreciating each moment for what it is. The main point is that we've made our obligatory contact and the other person can relax for the day, knowing that nothing untoward has befallen the other. No new IS good news.

This last week has been kind of a string of those not-so-special days. I think the high point was finally hanging up all my orchids and wind chimes that I'd taken down when Hurricane Fay threatened (no sense giving her projectiles to work with), and then the relief of knowing that Gustav--whilst he provided a lot more excitement in a shorter time than she did--wasn't going to make me take them all down again. I'm crossing my fingers that Ike isn't going to totally ruin my September, but for now I'm "being here now," happy to have survived almost another work week and ready for the weekend. Last weekend was a bit on the hectic side and I failed to meet my goal of finishing my course so I could study all week and take my final, but I'm just one chapter shy and may just make it anyway, if I pull a few all-nighters.

Even with my brain either halfway disengaged or at least focused on a ridiculously close horizon and my rationale that Ram Dass would agree with my savoring the moment instead of fretting about what I'm not getting done, I'm fighting a bit of guilt over my Lazy Libra-ness. . . My frenzy to get out of MT is stymied by the fact I do work full time (and on the worst possible shift), and I'm probably fighting old age, as well (that could just be the lingering back problem talking). When I studied to become an MT, being a student was all I had to do, and I was a fiend about it. Knowing what a disservice the femininists of the '70s did when they convinced us we could "have it all," it's still discouraging to experience first hand that you really can't. The only time we will really be able to compete on equal footing with men is the time someone figures out how to give us ALL wives. Until then, we (i.e. mostly women) get to figure out what part of our lives will suffer from neglect to make room to accomplish something more pressing.

I think part of my problem is that I have quite a few friends who are also scrambling to leave MT, and they've either chosen areas that require much less work to slip into or they're just infinitely better-organized than I am. I have one on the verge of being hired to become a police dispatcher (wow--what a great way to utilize those MT's ears!), another becoming a virtual real estate mogul (money aside, at least this one doesn't appeal to me), and another big MTSO who seems to do more world traveling now than ever before (some people just live right, I guess). The one who makes me feel most inadequate, however, is the Energizer Bunny of the group--not just a mother of two kids under five, but also running an online cross stitch business AND writing a novel (or six) in her "spare" time. But it gets worse. Failing to find a publisher who knew what to do with a genre like Mormon bodice-rippers, she's started her own publishing company. (I suspect the spectacle of Good Girls Behaving Badly will have a much larger audience than the mainstream publishing world grasps, so let me crow right now that "I knew her back in the day," before she starts making the talk show circuit and becomes famous without me.) The woman just started tearing into about 10,000 pages of editor's notes--we're talking a hands-on thinker with scissors and scotch tape here, folks, no crazy modern conveniences like computers--and I suspect she will meet her self-imposed timeframe and get it on the shelves this fall as planned. And her kids will still have clean clothes, her house will be neat, she'll still be churning out as many transcription lines as I do, and even her yard will be ready for winter. At least she has a husband who doesn't have to be hit over the head to pick up a dish towel.

So yeah, I've tripped over a little something this week in that woodsy path through my head and am feeling, if not discouraged, a little inadequate. At least I can take solace in the fact that at least nothing happened this week. Here's hoping when it does, it will involve a bright, shiny A on my terminology course and heading into my final prerequisite class.

Zen

Jeanne Johnston — Thu, 14 Aug 2008 19:19:00 GMT

Even before my life became this hectic, I always aspired to be more Zen. . . if only for a day. Everything about me is cluttered--my home, my calendar, and as a result, even my head. Add the resulting inner dialogue and the ability to crank out maybe 1500 lines a night, and I can't even write a simple email without tripping on the autopilot and spewing a novel in short order. My only saving grace might be that I'm a laid-back introvert in real life and am happier as an observer. I'm opinionated, but I suspect the keyboard is the vehicle that enables me. Stream of consciousness can be dangerous, unleashed!

I admire my friends who are such masters of pithy witticisms, but they know that no matter how much I aspire to learn the art of The Quickie, it ain't gonna happen. Oh, I get close, but the obvious effort it takes is still good for a laugh. The same is obviously true of this blog business. For someone who was reluctant to agree to the gig, once I get a burr under my saddle, it's hard to pare the resulting rant to a manageable size. Anything over a couple paragraphs and my daughter starts groaning, "Wall of text. . ." so I'm aware of the limitations of my audience. You may not have the attention span of today's youth, but you undoubtedly have work, school, and families cluttering your own lives and probably need more Zen, too. Yet here we are, mesmerized by the intertoob.

Zen isn't likely to happen anywhere for me, sadly. Now that my kids are threatening independence, I am enjoying the feeling of letting material things go to help them start their own households, but it's a constant battle to resist filling those spaces with something new. My goal is to lighten my load so that it will be less painful to pull up stakes and get the heck out of Dodge once I finish my training and start looking for a job. I don't care where, particularly. I just know that FL really isn't my choice and I'm dying to bounce back to a land of four seasons, though probably not tundra conditions like I left behind in the Midwest. Surely, a willingness to relocate can only help me succeed more quickly, and why not reinvent everything in my life at once? I've still got some stink to blow off after the bad marriage and besides--change is rejuvenating!

I can't even manage the clutter I have without always collecting more. I should be studying (just one more unit test and I can study for my Terminology final!), but I'm writing, I'm looking at every dumb link my kids send me (YouTube is E-VIL), staring at food porn, and organizing my own recipes into Bento (the cool database app I discovered back in my Computers course). This month, I'm also sidetracked by the Olympics--and to be honest, I don't think I'm really all that interested in tandem diving or beach volleyball. . . yet I'm watching.

In an attempt to analyze myself and perhaps fine tune my shaky self discipline, I even found myself watching motivational lectures for two hours today. This stroke story makes for a fascinating look at the brain, though I'm not sure recognizing that I lateralize toward the wonderful (if sometimes flaky) right helps me figure out how to buckle down. In fact, pondering the differences just led me back to YouTube because I knew there was a cool video that illustrated the Alan Watts lecture on the same dichotomy.

Mine is a wiggly and very cluttered world, and this is as close as I get to a quickie for now. Guess I will aspire to my ideals of perfection later when a space opens up on the itinerary. Better yet, maybe I'll just let myself enjoy the trip.

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!

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.

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.

More Than Just Statistics

Jeanne Johnston — Wed, 09 Apr 2008 15:00:00 GMT

Well, I almost let National Cancer Registrars Week slip by unnoticed. I had slapped it on my iCal back when I first noticed it a couple months back and I guess I figured that wouldn't be the only reminder I got. Sadly, it seems to get less notice than MT week, including on the National Cancer Registrars Association website, where there's simply a small, nondescript graphic and a link to adapt their own press release for a DIY promotion.

Seeing as how I've been waiting weeks yet to be approved for entry to the NCRA message board and never did get a reply about my newbie questions submitted to state and national membership heads, I find it especially interesting that the press release once again points out the need to recruit new CTRs:

“We must work together with our allies in the health community to ensure that we continue to recruit and train qualified candidates to enter into the cancer registry field.”

Ahem. That might involve some actual schmoozing with potential candidates, might it not? I guess they're leaving it up to all you CTRs to rope your bestest buddies into the field on an individual basis because I don't see a great push anywhere beyond lip service. Slick newsletters and apparent organization, but the followthrough needs a bit of work. I'm seeing more articles in Advance about registry, but that amounts to little more than dangling a half-eaten carrot if there's no practical information about how to join all those folks who loooove their job. Remember that you're recruiting people who have little or no clue and you need to take them by the hand to make them feel you're really serious about wanting them to consider the field. If there truly is a dire need for new bodies, you really want to be more aggressive about headhunting. I suspect working CTRs are too busy to make a hobby of playing Welcome Wagon for the good of the team.

As for festivities this week, I wonder if they're as universally pathetic as they are for MT week. I come from a world where a coffee mug is considered a major token of "esteem" from an employer and MTs who work on site often relate tales of offerings consisting of office supplies left over from drug reps or snacks quickly devoured by predatory residents--and these are considered fortunate because most MTs don't get any recognition at all.

Lest we feel too sorry for ourselves, however, I feel obliged to point out that I bet few of you were aware we recently missed Doctors Day on March 30. Yep, your favorite physician probably would have loved a token pat on the back because he's also dealing with quotas, bureaucracy, insurance companies, and patients who don't do what they're told. Some of these folks sound so weary as they dictate, I marvel that they do it as well as they do. Of course, it helps to not have to support a family near the poverty level, so we can only muster so much sympathy. (Hm. I wonder if I promote Placebo Journal if Dr. Doug would favor me with a free subscription. Love the gazette, but on an MT's wages I can hardly afford a subscription to the real deal. Regardless, I highly recommend it for many good laughs, if not some fascinating insight into the doctors' side of what we do.)

Heck, I think the problem is that there are just too many Hallmark holidays and no one's bought ad time in the right places to make ours stand out from the crowd--secretaries, auctioneers, customers, librarians, receptionists, third shift workers, golfers, principals, tourists, pirates, and all the others vying for attention in the next couple months. I guess that leaves it up to us to toot our own horns. On that note, I'll give a shout out to the 4,500 cancer registry professionals and CTRs I hope to join. Enjoy your week!

In Which I Wonder How I Got Here

Jeanne Johnston — Wed, 30 Jan 2008 14:57:00 GMT

I don't think anyone who is not a medical transcriptionist has a real appreciation for what the job entails. How many of us have had someone marvel at the ability to work from home and ask for a quick tutorial in how to get started?

"Gee, I've got a computer and a toddler, and I'd love to avoid paying for day care. I could do this, too! You just type what you hear, right?"

Ummm. . . in a word, NO. Although the field has lent itself to outsourcing and telecommuting, that does not put it on a par with an Avon gig. You need to commit yourself to space, a schedule, and be every bit as reliable and professional as if you worked on site. Even doctors-and certainly, hospital administrators-often fail to realize that it's a very important part of patient care, risk management, and even reimbursement. I've heard it said that an acute care MT needs the equivalent fund of knowledge to a third-year medical student. Not only do we need to be self-motivated and self-disciplined, our English skills need to be impeccable, we need to know anatomy, pharmacology, surgical instruments, disease processes, fundamentals of Latin and Greek, computer, keyboarding, and research skills, and possess an ability to understand myriad foreign accents (or just inconceivably poor dictators). We don't even get to specialize. We have to know it all and be prepared to handle everything from trauma to morgue. Whilst transcription is often viewed as something a typing monkey (or now voice recognition) could do and thus, is one of the first things to take a hit in a budget crunch, those of us who do it know better.

I was thrilled to discover the field, which offered a way to utilize my love of language and medicine and seemed to be The Perfect Career to take me all the way to retirement and beyond. I thought I had researched thoroughly and had a good sense of job security, as well. From the beginning, I saw there were people predicting gloom and doom because of everything from the advent of the personal computer to offshoring, but I noted there were many grande dames of MT assuring us that the field wasn't going anywhere. People have been predicting an end to MT for decades and it's still here. Surely, there will always be a need for transcriptionists, right?

A lot has changed in the past five years, though, and I see many of those same people admitting that it may well be time to move on. To my vision, the issue of offshoring has not helped wages, but it's almost a nonissue now that the industry has been overrun with software developers, speech recognition, simplistic EMRs, and more and more clients being sold a bill of goods wherein they believe they are saving money by having a physician playing hunt and peck around a keyboard in the exam room instead of dictating and waiting for the MT to produce a much more useful record of patient care. Even the transcriptionists' supposed representative organization has abandoned the practitioner in favor of the "medical document." Yes, offshoring gave clients a sense that they could save huge quantities of money and that has become the driving factor. It's been said that transcription involves three client needs: Speed, cost, and quality. Of those, it's only possible to have two. Naturally, cost is the one clients seem to feel is most important. All this has conspired to drive down MT wages to a point where it's getting hard to make a living. Wages that seem generous in Bangalore translate to well below poverty level here. Editing speech recognition may sound easier than straight transcription, but in fact it often involves almost as much work-double the production quotas for half the pay or less. With downwardly spiraling wages, I don't see the field attracting qualified MTs as the veterans retire-not when you can make higher wages for so much less work at your nearest McDonald's. No, transcription is increasingly becoming viable only to people with limited options or as a second income, and even independent contractors are beginning to complain that clinic work is disappearing to computerized record-keeping.

In pondering all this, I have come to the sad conclusion that medical transcription as we know it is marching along toward its demise. It's no longer a matter of keeping up with the technological changes, but of turning into a whole 'nuther animal entirely. Transcriptionists are becoming SR editors. Those sometimes-eloquent physician narratives are giving way to point-and-click EMRs. The profession I'd been so thrilled to find and proud to be a part of is starting to feel like it's built on quicksand, and I finally reached the point where I knew I needed to prepare for Plan B.

So what do I do with this head full of medical lingo? I could become a nurse, but I don't exactly have youth on my side there. I'd probably enjoy being an OR technician, but again, am I physically up to long hours on my feet or heavy lifting? I seriously considered phlebotomy or x-ray technician, and ruled out coding because I have a strong feeling it's a bit too "left brain" and requires a mindset completely opposite transcription.

Amid all my mental floundering, I saw it: That fateful letter to Advance by a woman who gleefully related how she took her skills as an MT into a new career as a cancer registrar. I paid heed to that "aha" voice in my head and spent the next couple months using my MT research skills to figure out exactly what this involved, and came to realize my name might be all over this thing.