Hi-Ho Silver … Away!
I have worked Sunday through Thursday for years. It has become a routine that fits me comfortably, giving me a weekday off to run errands, take the in-laws to doctor visits, handle my husband's business. For that one day of my work week there is a lesser level of stress that I enjoy. Hospital staff is minimal, requests for stats or finding lost reports fewer. The office staff for the MTSO I work with are off as well and there are minimal interruptions.
It is not all "mai-tai's and Yahtzee" on Sundays. For our primary clients Sunday has become the dumping ground for every dictator on staff who is behind ... often, as was the case last Sunday, a month or more behind and obviously driving the billing department into a frenzy because they cannot bill without the documentation; the wasteland for problem dictators, those who dictate 30-minute long consults resulting in a report that is only half a page long; 18 blanks in a 3-minute dictation because the dictator has never learned to use the dictation equipment properly and keeps cutting himself off; the dictator who speaks (and reads) so little English that I am often transcribing the report while hunched almost double over the keyboard, shoulders around my ears, straining to hear the voice of the interpreter who is standing behind him and repeating everything he says ... it sounds silly, but on Sundays I often find myself, like the Lone Ranger, shouting at my dog (named Willow, not Tonto ... sort of spoils the dramatic effect), "Hi ho Silver, away!" On Sunday, it is up to me to get the job done, no matter what. The ever present pressure of TAT must be met regardless of any issues that may occur to slow down production.
So there I was last Sunday, wading though a massive file of op notes, perched on a heating pad because the arthritis chose that day to make itself felt, and there they were, over 30 reports in a row, with same dictator ID number, and all with that distinct, liquidy sound; a wavering, sort of shimmering splintering of sound that is the tell-tale giveaway of a cell phone call. A surgeon who was a month behind documenting procedures already performed, upper GIs and colonoscopies, and dictating as fast as he could. The Olympics and children playing were clearly audible in the background, with not a single "canned phrase or normal template to be inserted" in the lot! If the Olympics had been in Australia the guy could have been dictating while snorkeling at the Great Barrier Reef with a trail of medical reports bobbing along behind him. It could have been a little mini-vacation for me, I would almost feel the warmth of the sun on the dictator's back through the voice file; the up and down motion as the waves pushed him on toward the next coral formation behind the school of parrot fish in front of him. Unfortunately, the Olympics are in China this year and, rather than a mini-vacation, these files that had the same sound quality of bad Chinese opera being warbled from the top of the Great Wall in a "whisper voice" were a far cry from those awe inspiring, jaw-dropping sound of the 2008 drummers of the opening ceremonies.
As an MT it always takes me back when a client blithely assures us that "our dictators are not allowed to use cell phones to call in dictation" It is impossible to disguise a cell phone call into the dictation system, although I have listened as some dictators attempted to disguise it by rattling x-rays into the speaker or slamming file cabinet drawers. Cell phone lines have a uniquely distinct sound, different from the everyday sort of tinny chatter and static that any MT who has worked offsite is used to hearing. After years on the job any MT can, with unerring accuracy, immediately identify a cell phone dictation ... despite vehement client denials to the contrary.
Poor sound quality slows down production, instead of passing through 1 or 2 sets of ears (the MT and a QA) it ends up going through 3 or 4 sets, resulting in late charting, multiple blanks and twice the cost in labor to produce a single report, yet clients passively allow their dictators to get away with it ... all the while patting the MTs on the shoulder and assuring them, "yes, yes, we know the sound is terrible, we will tell them not to do it again," or, (my personal favorite at the moment) "this will no longer be an issue once we have our new speech recognition system installed." The expectation that software will miraculously "hear" through poor sound quality any better than a human ear is something I often chuckle about while I am adjusting the ranger mask over my eyes in the vain hope that the eyes will somehow "see" what that dictator is burbling under the water better than the ears can "hear" it.
The MTSO I work with once spent 6 full weeks documenting in every possible way the dictation habits of a dictator that were so utterly foul, coupled with his preference for using his cell phone to call in the reports while sitting at railroad crossings, she felt compelled to take several weeks of his routine daily dictation to the hospital's Risk Management Officer. They agreed that there "might" be a problem with the quality of his medical documentation habits. A meeting was set up with the physician, one of the hospital's lawyers, the MTSO. The physician walked in, sat down, punched "play" to relisten to the first of those dictations, irately announced that was not him dictating (even though every person sitting in that room clearly recognized the voice and the patients as his) got up and left the room ... the meeting was over. To this day he still dictates and has not made a single effort to change anything in the way he goes about the process of dictating.
That was a lesson in picking what MT battle to fight that I have never forgotten. I learned that for as long as cell phones will fit neatly in the pocket of the busy physician nothing is going to keep them from keying in the report line numbers and that the energy spent throwing books at the Dictaphone is wasted effort ... but even Tonto's legendary patience as the "go to" guy, the one expected to perform the grunt work for the masked hero, did snap sometimes and I have to admit that last Sunday, after keeping the derriere in the chair 2 hours longer than I should have (with the resultant stubborn aching of arthritis)I would have cheerfully handed this dictator the scooper and the bucket and let him handle his own shoveling duties as Silver pranced across the dictation lines.