Medical Transcription: "Specialized Secretarial Work?"

If an MT is an indepedent contractor, essentially running their own business, then the reports should be prepared in as complete a fashion as possible, i.e. correction of errors grammar, left/right errors, etc.. etc.  If an MT is an employee and the company the MT works for requires strictly verbatum transcription, then the MT is not a medical language specialist or a transcriptionist, but a word processor typist.  Of course, compensation is reflected as appropriate.

I'm not sure how an MT doing critical thinking and transcription being 100% automated are mutually exclusive.

If you're working in McDonald's and you burn the fries.... do you serve them?

If a typist in the typing pool at a large insurance company (ummm, technically she/he is the one "transcribing") sees an error and takes it to her/his boss.... does she get a change in title? A raise?  A "thanks, great job"?

We transcribe medical records.  If we see something inaccurate we flag it (I'm usually against "fixing" it).  And life goes on.

Years ago on sci.med we had discussions about calling the police on a physician based on something typed in a medical record?

Risk Management? Nosy neighbor?  Vigilante?  

Our job, while not an easy one, is a simplistic one.

Listen to the words.  Put them on paper according to given protocol.  If the doctor says, "The patient has sores on his feets."  Well, sorry, it's just not rocket science to type feet.

If you hear, "Pain in the perineum."  It's part of the vocab list for that job to know if that's accurate or not.  But that STILL doesn't make it rocket science.

I'm saddened to see the pay rates for MT have DECLINED while the pressures often increased, but that still doesn't make us a risk to patients or physicians.  I'd like to just see a description for medical transcriptionist that fits everyone who does the job... you know one that says more than "Listens. Puts it to paper. Delivers." :)

"Last week I advocated for a "National Verbatim Transcription Day" in order to call attention to the risk management role MTs bring to the table as part of our skillset as we routinely "clean up" after our dictators.  I think we do this partly out of concern for the patient, partly because the client's account specifics call for it, and partly because we're just wired that way.  But according to Julie, MTs shouldn't be taking on this responsibility at all, either voluntarily or as part of our job descriptions.

I'd like to know what you think about this.  Do you consider medical transcription to be in a category of its own, one that cannot or should not be compared to other industries, as Julie does?  Will there be or should there be an ongoing risk management role for medical transcriptionists in order to ensure accuracy in medical records?"

The words "risk management" are repeated several times.

IMHO, this sounds to me like the question of an MT's role in risk management is being brought into question. Perhaps my reading comprehension is down with this cold, rainy May weather.  The thread on MT chat shows similar interpretation by other MTs as well.

Regardless of whether it's a matter of semantics or not, "account specifics" are not determined by the MT; however, the MT is expected to follow the rules for whatever account they are working on. Different specs for different accounts. This is not risk management. This is clerical skill..and of course it requires thought. It requires concentration. But the MT does not determine what those specs happen to be - the client does. (Tell me what other clerical jobs do not require thought, concentration, or thinking skills.)

Ultimately, it is the client (doctor, hospital) who determines what level of accuracy is acceptable for his/her facility. Is it acceptable for a degreed nurse to click the wrong drug on an EMR? Is it acceptable for the doc to sign off on an SR-generated document that clearly regurgitates the RN's error? Is it acceptable for an MT to type as dictated that same error thinking it is a valid med (no access to patient chart)? It is the MT's fault it did not get caught?

The client has to be the one to determine what level of error is acceptable. Cheap errors (poorly skilled MTs - and there are plenty of them - foreign transcription, SR & EMR errors) are a lot more palatable than expensive ones.

MTs perform a secretarial/clerical role in the world of healthcare. Nobody said it wasn't a valuable role that deserves to be well compensated when done well.

Chris, I disagree that the point of my post is to re-hash some old discussion about whether or not MTs provide some degree of risk management service.  The broader and much more critical question is whether or not human MTs are even needed as part of the healthcare documentation process if we DON'T provide some type of critical thinking intervention while we're transcribing/editing.  Because the rest of the healthcare community can't have it both ways.  They cannot say, "You're just a typist, just type what you hear (verbatim) and we'll pay you accordingly," but then turn around and say, "Here are pages and pages of account specifics which you have to follow and "clean up" after the doctors."  Whether you call it "risk management" or not, if transcriptionists are expected to exercise critical thinking and at times change what the doctor dictates in order to adhere to account specifics or to avoid a dangerous medical error, that's not verbatim, and neither speech recognition nor any other technology can duplicate that process.  

So again I say, the question is whether or not the process of healthcare documentation as it exists in this country truly requires the services of skilled medical transcriptionists, and why or why not?  To get tangled up in semantics would be to miss the true point of the discussion.

Of course medical transcription is "secretarial" by nature. Sure it's specialized - its focus is specifically on transcribing MEDICAL records. The jump from doing legal to medical transcription isn't too far. The skills are the same. The jump from a purely medical secretarial position is even less.

Your blog isn't really about whether MT is a secretarial position though. It's the same old question about whether MTs should accept a greater role in risk management and if they do, should that role require mandatory credentialing.

Tell me, which of the MT training programs out there TEACH MTs to be risk managers of medical records? Catching and flagging a L/R or other discrepancy is, perhaps, by definition, some slight form of risk management.This is purely common sense for most people. If an account is not verbatim, flag it. If it's strict verbatim, transcribe as dictated and move on. The "author" of that document is responsible for its content. We are to transcribe as accurately as possible with the data we are given.

I did a job search for "medical secretary" and in several of the ads across the country, transcription experience was necessary, medical terminology was necessary, and mostly, EMR use was necessary. MTs may just have to go back into the secretarial realm to maintain employment.

I did a job search for "medical transcription" and in none of the job requirements did it mention anything about risk management experience.

Bambi said, '...At this juncture in my MT career, I really don't care what I'm called.  I want paid.  I have no formal MT education.  I was a damn fine typist in high school, who was intelligent enough to use a dictionary, ask questions, and get the job done.  As an MTSO, give me a bunch of THOSE kinds of people and watch me grow my business with those magnificent medical "secretaries." '

I say, "Applause, applause, applause!"  :)

B

I do think that medical transcription is its own industry and if it was so easy than everyone would do it.  Part of the work that I do does require total verbatim transcription and sometimes the broken English with ESLs drives me nuts.  Truthfully, if I went to see these doctors and they spoke to me the way they dictate, I would get up and leave the examining room.  What good is having a large amount of education if you cannot even communicate properly via the written and spoken word?  I would believe that if clinicians are dictating their records in a subpar manner that it could affect insurance compensation.

Good questions, Jay.  I, however, agree with Jules.  As I sat in a physician's office last week, patiently waiting while my medical doctor input my information into her computer, thus creating my record, then handing me a print out of what she did so I could ensure the accuracy of what she had input.  Was *I*, the patient, going to take credit for the accuracy of my medical information?

When I used to hire MTs and found trained MTs difficult to come by, I was often heard to say- "Give me a good secretary and I'll make an MT out of her."

I still believe that.  

I also remember mentoring for a short time for a school for MT and realizing one of my mentees would never, EVER make it as an MT.  I wanted to let her know that.  I wanted to tell her she really WOULD make more per hour at Wal-Mart because as an MT she'd just not cut it.  Of course, schools are businesses and in the business of charging for education and thus I was asked to keep my mouth shut....and I did.

I do not personally believe you can standardize transcriptionists.  The job title encompasses more (or less) depending upon the environment.

When I taught my daughter to transcribe, it consisted of "here's your vocabulary list, study it."  I answered questions she had but never really formally taught her anything more than giving her that list and being available as a mentor and reference guide.

I honestly feel trying to INFLATE the job of MT to something it's truly not, will in the long run culminate in the further demise of the job title.  MTSO's are not going to incur more costs to have the really "good" MTs, instead they will try and work out the kinks with the "okay" ones.  We're not going to see salaries increase and for goodness sake why would we be held for liability of patient care when we have no direct patient contact or involvement.  

At this juncture in my MT career, I really don't care what I'm called.  I want paid.  I have no formal MT education.  I was a damn fine typist in high school, who was intelligent enough to use a dictionary, ask questions, and get the job done.  As an MTSO, give me a bunch of THOSE kinds of people and watch me grow my business with those magnificent medical "secretaries."