Holy Crap! I've been waiting for this post. Glad to hear I'm not the only one immersed in colossal unintelligibility (is that a word?) on a daily basis. I also do MT from home and have pretty much resigned myself to the fact that the number of years one spends in higher education is inversely proportoinal to one's ability to speak coherently. I do transcription for an otolaryngology department at a teaching hospital and can vouch for the fact that 1st year residents start out speaking pretty much the same way you and I do. Each year they get progressively worse until they move on into private practice, at which time they begin speaking in a continuous, stream-of-consciousness, run-on sentence requiring temple-throbbing concentration to decipher!

Rachel, your blog is a breath of fresh air no matter what you choose to write about. I'm glad to have found your site (thanks Bill Whittle).

Actually that would have been inversely PROPORTIONAL. Yep, you are correct, most mistakes are typos;)

My dad was a surgeon, and I used to listen to him dictate.

I honestly had NO IDEA how he (I was unaware of the existence of medical transcriptionists) expected to be able to translate that later.

He didn't have marble mouth, but he'd fill in every pause while he mentally wrote the next sentence with "Aaaaahhhhhhhhh....". It drove me around the bend just to listen to (I'd usually find something to do in another room after a few minutes, I sometimes wonder if this was a deliberate parenting strategy), I couldn't imagine actually trying to sort it out into a neat little report.

Then again, I can't even have talk radio on in the car because the voices are too distracting, so I'm probably kind of a freak anyway.

I dated a MT many years ago. She never told tales "out of school", but I'll bet she had plenty. As usual, a witty, funny post, Rachel.

I too am an oncology transcriptionist, and two of my docs are marble-mouths. They also happen to be father and daughter.... Daughter is a nursing mother and I can often hear the breast pump wheezing away in the background.

On another topic... welcome back! It's great to see you back online whether you are ranty-ranting or not!

Lordy, Lordy.
At one time I proofread for a court reporting firm. The reporters took all technical terms down phonetically, or what they thought they heard phonetically.

I think this post of yours will be a godsend to attorney's trying to challenge a medical record's accuracy.

I don't know if it's because there's only an hour left in the work day, or because I used to type deposition summaries for a law firm, but this post had me rolling.

Incidentally, I've been thinking about doing medical transcription part-time while I'm in school. Just as a random aside.

I actually went through two years of secretarial school 30 years ago. One was expected to know spelling, grammar, and punctuation. In short, you had to make your boss sound educated. I never did any dictaphone work after school, but I had to type innumerable memos from written drafts for several people in my career. One guy was especially memorable for his incoherence on paper, and he was a member of his local school board. Yeech! To his credit, he was fully aware of his writing weakness and was appreciative of my efforts to get his points across.

I've always wondered what it was like on the other side of the microphone. As a physical therapist I dictate all my evaluations, and thanks to your old posts about wrist pain while transcribing, the one thing going through my mind as I'm talking is "Will the poor girl giving herself carpal tunnel syndrome writing this be able to understand me?" I always try to go easy on the MTs. I will write out the points I want to make ahead of time, use the pause button to minimize the umms and ahhhs, speak clearly, E-NUN-CI-ATE, and even spell weird medical terms that someone might not know. Doctors should know the importance of getting hypo or hyper right, but a lot of the docs I know don't seem to care after being on call for 18 hours.

My dad was a doctor in private practice (head of the office, no less).

His diction was so bad that the nurses actually pooled their money together and bought him a microphone and some automatic dictation software for his laptop.

My mom was a medical transcriptionist. When she was young she worked at Walter Reed Hospital in the early 50's, then stopped to raise two kids, then went back to it part-time at a local hospital in the 70's.

She did most of it on a typewriter. When I was cleaning out the attic after she died, I found an instruction manual from the mid-80's when the hospital transitioned to word processors. That was interesting to read.

She retired before they went to full-blown computers.

PaulT, you sound like a jewel. Any time you want to farm out your work elsewhere, give me a jingle. :)

Rickl, I'm old enough that I started my transcription career on a typewriter. At least it was electric. I thought I'd died and gone to heaven a few years later when I got my first dual-pitch scrunch-button correcting Selectric. Then came the electronic typewriter. And then, hallelujah, the computer.

Transcription on a typewriter required a completely different technique. Rachel, you think you have to listen way ahead now? Heh. On a typewriter, the consequences of not listening far enough ahead can mean retyping an entire page ::shudder::. Yes, I had to do that more than once. Oh, and then there were the carbon copies--actual carbon copies, not just the figure of speech used nowadays.

Okay, enough blog-surfing. Back to work!

I too am a transcriptionist working from home as an independent contractor for a small, regional transcription company in Glendale (near L.A.), California. Nowadays I do hospital transcription, though at times in the past I have done doctors' office stuff.

I honestly don't know what the statistics would say about who makes the most mistakes, doctors or MTs. I also know MTs who don't know "to" from "two" from "too." I know some QA people whose e-mails contain spelling errors, although their ears may be better than mine.

I used to work with one MT who typed "bowel duct" instead of "bile duct" for gallbladder-type problems, when the dictator had a southern accent. I even knew one MT who typed "heroine" instead of "heroin" when the patient had a drug habit.

I too wish the doctors would get the marbles (or other shit) out of their mouths before dictating. But the worst habit--to me--is when they chew anything while dictating, ESPECIALLY GUM. Because I can hear every damned chewing sound they make, and I hate them all. (I'll admit it up-front: I hate gum-chewing to begin with.)

People, when you chew gum, you're still making noise, even if you're not popping it. You probably can't hear yourself make disgusting squishy chewing sounds, but they're still there. Record yourself sometime and listen to the sounds you make. When you do that, it's as if you're doing them directly into the ear of the MT, because we have earphones in our ears.

I don't know why, but when people are in close quarters (in movie theaters, in classrooms, in line to pay for groceries or pay bills, etc.), they often break out the gum and start chewing like cows. I hate the smell, the look, and the sound of gum chewing. It's one reason why I'm happy to work at home rather than in someone else's office.

And it's pretty gross as well when you're slurping and chewing cough drops or hard candy. Also gross when you're crunching your rabbit food (raw veggies like celery or carrots).

To Paul, the physical therapist who is very careful with his dictation: Bless you. Whoever transcribes your work doesn't realize how lucky they are. I wish there were more like you. Since you're so considerate of the person transcribing your reports, if you ever need to find a new MT to do your stuff, you will have 'em waiting in line to work for you.

Well, end of rant.

I heard that Kaiser Hospitals used to teach their new doctors to dictate. I honestly don't know if any medical school has a course in dictating. I'm still friends with someone I knew as a teenager... he's a neurosurgeon, and he said something about having been taught how to dictate.

I think that part of the problem is that documenting their work is something that doctors are forced to do, because of regulations, and it also doesn't generate income for them--except in those cases where they are actually being paid to generate a report. Their doctoring skills DO generate money, on the other hand. At least that's my take on it.

And the doctors already spend so many hours on other things, that I imagine that dictating must seem to be one more pain in the patootie to them.

I do transcription for two hospitals which are clients of this transcription service. I've been in this field for nearly 20 years, and I've been working for the same MT service for over 10 years. Some of the native-English-speaking doctors are, frankly, worse dictators than some of the foreign-born doctors.

It's bad enough to be told that Doctor X "says the same thing every time," but to me that doesn't matter if I can't hear what the hell he's saying even the FIRST time. Duh.

I'm sure most of the docs you work with are fine, but I always remember this: SOMEBODY had to finish last in their class at medical school.

I've heard stories of doctors who literally dictate when they're on the toilet. Supposedly you can hear them flush, and probably can even tell if it's number one or number two. Gross.

Also, some doctors apparently dictate on cell phones while driving through tunnels... at least, that's what it sounds like.

Oh, yeah, and my distaste for chewing sounds is not ONLY because I personally find them disgusting... it's often harder to tell just what the dickhead is saying when he's trying to chew cud at the same time as dictate.

Any time a doctor starts spelling out stuff, I laugh my ass off. Most of the time it's WRONG, including when they spell out a patient name. One of the first things I learned when being trained on the job is to verify the spelling of any word the doctor tries to spell out.

I have one Asian doctor who practically sings/chants his way through a dictation, and he spells out a lot of words. But he's such a dickhead that he'd be easier to understand if he didn't spell things out, but rather took just a little more care to enunciate the words.

PaulT - you are the BEST kind of dictator imaginable. And believe me, the MTs you're working with appreciate it. Using the pause button is a HUGE FAVOR for us - I can't even describe how nuts it makes me when the dictator just sits there, breathing for 45 seconds. I can't fast-forward through it because my C-phone doesn't have sound when you forward. It is such a waste of time!!! Aghghghg.

And it's very beautiful to hear that you actually think about the human on the other end of the line. I'm sure the other MT's will agree with me, but often it really seems like the docs think they're dictating to a machine. It's bizarre! The ones I work with that actually talk to ME, I love love love them. One of the thanks me on every single note - he ends with "End of report, thank you transcriptionist." And usually bids me a good day or thanks me for all my work in general. It's extremely motivating to get that kind of feedback.

Pam - ohmyGOD I know what you mean about the spelling! It cracks me up. It seems to usually be a doctor saying somethign that's not common in his specialty. For example, my main expertise is in oncology so I know all the words. Sometimes when the radiologists have to say what chemo medication the patient is on, they get it so wrong it actually makes me laugh out loud. I literally LOL! Hahaha. "The patient is currently undergoing treatment with Adriamycin - A-T-R-E-O-M-I-C-I-N." Heh. I love it because it makes me feel smarter than a doctor. :)

The spelling is wayyy over the top. My personal fav is "The patient has a posse of symptoms." Um, do you mean PAUCITY? which is what I actually typed, and the in a note a few days later he actually corrected my spelling with P-A-U-C-I! Okay, you have to cut the guy some slack, English is not his first language but that was just too much.

They don't teach in law school, either.

Funnily enough, my "favorite authors" sound suspiciously similar to yours. Do you have the "audio gap king/queen," too? (The one that rewinds too much and could completely f'up the easiest of sentences?)

I have always maintained that if they actually LISTENED to what they dictated and tried to figure it out themselves, they would clean up their act. "Marblectomy of the mouth." Indeed!

And BTW, LOL!! That phraseology caused a coffee spill on my desk and the dreaded 'nasal enema.'

Yay. So glad you're back.

Sadly docs who are graduating now can barely power on a PC let alone enunciate.

I work with transcriptionists here at the hospital daily, as well as docs daily... the fact is if the power goes out neither can figure out how to turn on the PC again... so it seems we need to teach a lot of basics. Along with taking temperatures.

Hey Rachel--you forgot the part where even the very experienced oncologists consistently say "carboplatinum."

And last week I saw in some dictation done by someone else that the patient had shoddy lymphadenopathy. Shoddy indeed, when you've just been diagnosed with CLL!

Over 10 years ago, when I was working for a different MT service, there was this one resident doctor. He wasn't the best enunciator or the smoothest speaker, but he was very aware that there was a real human being who had to deal with his dictation... and he always said thanks for doing this dictation before he hung up the phone. He even sent our company a goodie basket for the holidays to show his appreciation! I wrote him a fan letter before I left that company.

His consideration more than made up for his shortcomings as a newbie dictator. He didn't have to do this, but he actually apologized when he knew he had screwed up. But to me, he was clear enough that I could nearly always tell what he was trying to say... or at least, I think I did.

At any rate, I will add my two cents to say that a little consideration by the dictator is MUCH, MUCH appreciated by the transcriptionist.

Rachel: My hat's off to you WRT transcribing oncology. I get some of it in the course of doing hospital transcription, but it seems to be a pretty difficult specialty... there seems to be a fair number of terms which aren't even in the word books yet.

Oh, yes: Before I did medical transcription, I did other forms of word processing, including faking it as a legal secretary. IMO, most attorneys are better dictators than most doctors... the attorneys are also getting paid for what they dictate, by and large.

One time I did some freelance work for an attorney who had been an English major before getting into law school. He was a dream to work for. He was even-tempered (not a screamer), and a good speaker and writer. If I made a rare mistake he caught it. He also appreciated the fact that my spelling/English mistakes were few, and the fact that I could keep up with a heavy workload.

One of the other attorneys, however, couldn't spell worth beans himself, and to top it off, he often had a word processor working for him who coudn't spell either (although she could type fast).

Once upon a time I was a paralegal and transcribed dictation all day long (estate planning documents). One of my attorneys liked to dictate while she drove. So there would be commentary on traffic and the occasional "hey! look at that dog!" thrown in for good measure.

Try dicephering their chicken scratch (shit) handwriting!

(15 year medical record coding experience here)

I just finished a cardiac catheterization report dictated by a guy who changes his mind and in general just sounds like a real idiot. In this report, however, he was crunching chips all through his dictation. All five minutes of it.

What a pig. I guess he was raised in a barn. He was obviously chewing with an open mouth. He sometimes smacks gum when he's dictating. But this time I got "treated" to a different sound effect.

I know that doctors are famous for thinking they're gods... but to me, they're mostly idiots and rude assholes.

Back in my sordid youth, I worked for a X-ray service company, and many were the times I'd be standing around in a radiology viewing room waiting to get into the darkroom to do my thing, and would listen to some radiologist dictate his findings he peered at the films (this being in the old days when X-ray images were pretty much all on film, rather than digitized as they are today for the most part).

Many of the doctors were pretty careful about their diction when recording their notes. But gawd, some of them were so mush-mouthed I could not believe whomever was transcribing their dictation could understand in a million years what the hell they were saying.

(BTW, I saw your reference to discography, and having had one, I instantly broke out in a cold sweat; talk about medical torture, it took five people to hold me down while they stuck that damn needle through my neck.)

Good god Rachel. First beverages out my nose and now an oncological transcriptionist! (I'm an NHL suvivor who knows how to use a semicolon; 3 operations, 5 months of CHOP and a month of rads.) Is there anything you can't do?

Lady Heather, doctors' dictation is bad enough. I'm GLAD that I don't have to deal with their handwriting! OMG!

Kick-ass post as usual. I'm a new MT of 6 months and there are times that I have this urge to drop my work computer from multiple stories, light the remains on fire, then dance on the ashes. I have the self-control (also known as laziness and fear of repercussions) not to so I just fantasize about it and that gets me by. :D

Chickwithbrain, don't kill your computer. All of us experienced MTs want to pull out our hair from time to time, and I'm sure I'm not the only one who cusses.

But we really like working at home. Things will get better as time goes on! You'll get used to it, and fewer of the assholes will cause you to want to kill the computer (that's like killing the messenger, anyway).

Sometimes I still wish I could pull out the dictators' hair, though!

My significant other is a newbie in this field, with about the same amount of experience as you (after completing an online course)... he's finding out why I cuss all the time when I'm working. ;)