Bill them any way! If a customer of mine has asked me to proceed with a project and at a later date decides to change to a more cost effective design, he gets charged for what I have completed to date. At least that's the law for custom fabricated components in Texas. I don't see why your work should be considered anything but specialized and custom work (you sure as hell can't use it for something else except it's original and intended use). It's not a popularity contest, it's business, their mistake should not cost you your time or money. (Oh my gosh, I'm starting to sound like my attorney, I'm gonna kill myself now!)

Aaahhh, attention to detail. It's a beautiful thing... but apparently in decreasing supply among the populace. Thanks for *your* attention to detail, Rachel (c:

You're making me VERY happy I chose a career as a graphic designer. I have this idea that doctors are more intelligent that the bulk of the population, or at least as communicative, and I'm not sure I could handle being fired repeatedly for telling them off.

You are a very patient person, Rachel. It must be all this no cussing.

Wow...I had no idea. So, I'm trying to figure out how this works. They dictate their stuff and decide at the end to not have it done...then why does it even get sent to you? I'm sure it's a procedural thing but it just seems odd. What a waste of time! I hate that.

Most doctors period in my experience period are complete idiots comma I would charge them anyway when they do crap like that comma

Rachel, what's the procedure for situations like that? Do the doctors truly object to being charged for transcriptions even though they don't decide they're unnecessary until after they've been dictated? That's crazy! I know doctors tend to have God complexes, but even God would understand his responsibilities in that situation. You type it, you charge for it.

On the other hand, I'm sympathetic to the transcriptionist who got fired for being too literal. Someone really needs to review these things, and I'd find it too nerve-wracking if I felt that I couldn't make any mistakes. Mistakes happen.

Do people in your profession really refer to their clients as dictators? That must lead to some amusing misunderstandings. Your reference to "thickly-accented Asian dictators" made me laugh out loud, because that phrase normally makes me think of Kim Jong-il and not a doctor who is going out of his way to enunciate clearly.

Kensington: Read what Rachel wrote again. The hapless transcriptionist didn't get fired for being too literal. She got fired for omitting vitally important words (like "no") from the material she typed. And I'm sorry, but "Mistakes happen" does not excuse that kind of blunder.

Heh. Your job sounds fun.

Frankly, my thickly-accented Asian dictators are easier to understand than 90% of my American ones, who just don't bother.

That sounds like a badly translated piece of North Korean government propaganda.

Rachel, I've been working for over 40 yrs, and people **always** find a way to make things more complicated.. :P

Rachel, you and your fellow transcriptionists seem to be the lubricant that greases the cogs that drive the juggernaught we know as modern medicine! Way to go!!!

ACK! Reminds me of being in court reporting school with teachers who, uhm, COULD NOT READ or lacked basic knowledge of just THINGS, in general:

"Serina Thompson, a principal dancer at the San Francisco Ballot ..."

"After years of brutal rule under the CHE-MER ROO-GEE regime ..." (Khmer Rouge)

"We thought we were agreed; evitably, we were wrong."

Things like that.

And I would sit there, trying to follow this at 200 wpm and just panic, going: "Do I write what I hear or write what is right? What I hear or what is right?!? Help me, Frankenberry, you're my only hope!"

Because I would go temporarily insane, you see.

Then usually -- and this is where it just gets so so sad -- as the precious seconds ticked by, I'd just write ... nothing. Because by then, about 53 more words had just breezed by in the midst of all my stupid angst about getting it right.

I swear, every day at that place was a struggle not to pee my pants.

The thing I hate the worst about transcribing stupid dictation is when they chew while dictating... especially GUM (which I hate anyway).

Gum chewers, IMO, are pretty much the rudest assholes on the planet, even when they're not popping it. The sounds they make when just chewing are disgusting too. Also the sounds they make when they're slurping cough drops or hard candy. Also the sounds they make when crunching what are probably raw veggies.

I don't know why, but whenever humans are sardined in together (such as in classrooms, on public transportation, while waiting in line for something, etc.), some stupid bastard inevitably pulls out gum and starts passing it around.

Some idiots think that chewing gum helps them concentrate better. That might be so, but for a lot of OTHER people, it totally destroys our concentration... especially when the chewers are too stupid to chew with their mouths closed.

I hate the sight, the sound, and the smell of gum chewing. I'm just glad that (1) not all of the goddamned dictators chew while dictating, and (2) the dictations average only about five minutes long, and thus are usually over and done within about ten minutes.

I've quit jobs in the past where my coworkers looked, smelled, and sounded like cows chewing cud... and kept on doing so, even after being asked not to.

My asshole father used to cram us all into the car for trips. Inevitably, because they knew that my mother and I hated it, my father and my fraternal twin sister would pull out some smelly goddamned gum, stuff their mouths with it, and proceed to chew as loudly and disgustingly as possible. Literally no escape... talk about feeling trapped.

So... I have no respect or liking for gum chewers. Frankly, when I was trying to date off the internet some years ago, I specifically stated in my ads that I didn't want any druggies, alkies, smokers, or gum chewers. Yecch.

Next to that, people who whisper into the microphone are just plain damned annoying. But the gum chewing, besides annoying the hell out of me, often interferes with the intelligibility of the dictation. I kid you not.

pbmaltzman:

Thank you. I was beginning to think I was the only one.

I like listening to my cats eating. But not people. Not at all. {shudder}

At least smoking is a relatively silent activity.

Ricki: I'm with you there. I don't like to listen to people eating, either. Yeah, at least smoking is relatively silent, although the last time I dated a smoker, my clothes and hair started smelling like his brand of tobacco.

Another horrendous thing about gum chewers: If you ask them to tone it down at all, most of the time they will redouble their efforts to be obnoxious... such as deliberately popping it in your face, or "chewing at you."

They think they're being oh-so-cute. But what they're too stupid to realize is that most of us who hate their habit would REALLY like to slap them upside their stupid heads... but we control ourselves. Some of us actually get a RAGE reaction.

You should be aware that there are LOTS of people who don't appreciate gum chewing and eating noises. We may be a silent minority, but there are more of us than you think.

Just google "hatred of gum chewing" or "dislike of gum chewing." Some psychologists have dubbed this a form of "soft sound sensitivity." There is a psychologist who works with folks up in the Pacific Northwest somewhere, and she runs a Yahoo group.

Yeah, I like the sound of cats eating better than people eating. Although I like meeting friends for lunch or dinner when I have the time and $$, some of my friends are rather noisy, and the eating part isn't that much fun. Fortunately, the talking and listening part usually is.

I have to say that I don't hate my job (medical transcription)... just certain aspects of it.

In order to strike a balance, I will admit that there are things about this work that I actually like... such as learning new stuff every night. I like the challenge of learning how to spell new stuff, and learning what those words mean. I like working at home in my own office, where things are arranged for MY comfort and ergonomics.

I also like being more or less self-employed... I have a "boss," and I've worked for him for over 10 years, as both an employee and an independent contractor.

I've had the experience with this boss of butting heads, but among other things I have learned to quit bitching so much and to count my blessings.

In this industry, if you work for a small company, sometimes you run into problems of cash flow. Some folks have had checks bounce. Well, my boss has never bounced a paycheck.

Also, every time he has upgraded the sound systems, we have generally gotten better sound, which I really appreciate.

I've also learned that I don't have to "love" my boss in order to respect him and work for him. I've also learned that I don't have to have pats on the head, and that being paid decently and on time is a form of respect and good treatment.

Hey all! I've been following this thread since yesterday and have been too buried to even come up for air. I'm going on vacation in three weeks so in addition to my regular workload, I am training/correcting some folks to cover me while I'm gone. That has really been exciting! Not really.

I have a handful of terrible docs and about 10 really good ones so I really should not complain but I just can't help myself. This one guy really hasn't a clue. He happens to be almost incomprehensible on a GOOD day but he dictates at least once a week while RUNNING on a treadmill. I'm NOT LYING!

Okay, I'm all for multitasking when appropriate, but dictating SOAP notes while gasping for air, pretty much eliminates the normal pauses for punctuation. Meanwhile, he is pounding his feet on the belt to the backround whirring of an overworked piece of machinery. That just makes my day. I'm sure he's a nice man but I really should have nipped that in the bud when it started and now it is probably too late to cry foul.

Happy Friday (back to work)
Deb

for some reason it strikes me as funny that these people are "dictators." Shouldn't there be some different spelling or something to differentiate between someone who is speaking into a microphone and someone who is invading Poland??

anyone?

anyway... want to hear a nasty joke about the word "dictate?"

Actually, the similarities outnumber the differences.

I'm so glad I'm not the only one who gets their knickers in a knot over dictators who chew gum. The most annoying (not the worst, just annoying) of my dictators is a guy who dictates for anywhere from 6-11 minutes. The actual amount of talking time is probably 1/3 of the total time. The other 2/3 is either dead air or him chewing gum, drinking, or slurping hard candy and I get to listen to the subsequent sounds of his happy sighs, hiccups, burps, and grunts. I try to play mind games with myself in order to get me through his reports by just slurping and burping my own coffee. If you can't beat 'em, join 'em. :D

For mhuete: We call them "authors," to diffentiate between they and the despots. Not that there's much difference in some. Heh.

I do legal transcription, not medical, and it's been my experience that most (MOST!) attorneys are linear thinkers and thus can dictate well. There are some (SOME!) that are just - not. They need to just type it out themselves. And I could only DREAM of billing them anyway for "oh nevermind" dictation. *sigh*

My pet peeve with this group of attorney authors (because I've worked for three different firms as a remote transcriptionist now) is that they feel they must dictate this report/letter/whatever at WARP FACTOR FIVE. If you do anything in a hurry, you're bound to get it wrong, so just slow the hell down, people! It's not a race. Well, in their case, it probably IS, but still. Sheesh.

Some of these wonder boys and girls even dictate (1) when they're using a cell phone and driving through a tunnel, and/or (2) when they're in the bathroom. I kid you not.

I've heard stories of other transcriptionists reporting that they can hear the toilet flushing, and also farting, groaning, and sighing noises. I bet they can also tell if it was "number one" or "number two."

How gross!

I think that there are higher proportions of English-as-a-second-language dictators in the big cities and along the coasts. If you live in the heartland and mainly do transcription for doctors who live in the heartland, consider yourself lucky.

I have a few dictators who sound like they just hopped off a boat from the fatherland (such as a Japanese guy with a very thick accent doing a cardiac bypass operation, or a couple of Middlel Eastern guys doing cardiac catheterization).

Some years ago, I was briefly back in Florida, and one of the local infectious disease specialists there (from India, by the name) would snort, grunt, sneeze, and cough his way through dictation. When I would transcribe his stuff, I always wondered what the heck you could catch from him if you consulted him. Tuberculosis?

I have one native English speaker, an anesthesiologist, whose procedure notes for epidural blocks are extremely hard to understand, even using a sample/template of his dictation. He just mumbles along at 90 miles per hour. I almost always leave at least one blank in his report.

I have an Asian gynecologist who'd be *much* more intelligible if he would refrain from spelling out words, and also refrain from sing-songing his way through the dictation. Did I also mention that he repeats himself?

Among *first*-generation immigrants, I find the following accents to be the hardest to understand, even after getting used to the doctor's peculiarities: Subcontinent Indian, Mexican or other thick Hispanic accent, Middle Eastern (particularly with a very deep, guttural voice), Armenian, Japanese, and Chinese.

Second-generation ethnic doctors usually sound fine, if they don't have much of an accent. They're a mixed bag; some are easy to understand, and some of them slur their words.

When I was still working in other people's offices, I worked at one place where several of the hospitals whose dictation we transcribed were heavily staffed with Asians. The native English speakers were definitely in the minority on staff at those hospitals. I remember, when working on those accounts, cheering to myself when I would get two native English-speaking dictators in a row.

I don't begrudge them coming here; I just wish they were easier to understand.

I've done both legal and medical transcription, and also faked it as a legal secretary for a time... from what I could tell, there was a higher proportion of better dictators among the lawyers.

I think it's partly because they directly derived their income from their writing/dictation, whereas for doctors, I think that most of the time it's something they're forced to do for documentation of their doctoring activities, which actually interrupts their hands-on doctoring function. Most of the time they don't directly generate income from the reports they dictate.

Just my two cents.

Ahhh... When I was listing the most difficult accents, I left off first-generation Filipino immigrants.

The same place where I worked and the hospitals were staffed with a majority of Asians, we had a bunch of Filipino doctors and dictators (also ran into some of these same doctors at other hospitals).

Some of these folks had been doctors in the Philippines, but licensing requirements meant that they could not work *as doctors* over here in the States--at least, not without re-doing a lot of their education.

In the past, I had read something which indicated that the Philippine government encouraged a lot of Filipinos to get a medical education, but at the same time it controlled how much they could earn as a doctor or other healthcare worker, which wasn't very much. So, for a lot of them, coming over here meant a big improvement in pay.

What some of them did for a living was to dictate discharge summaries for other doctors.

Only problem was, their accents were extremely strong and thick, in some cases nearly impossible to understand (and the sound quality wasn't always that good either). The reports would get done with many, many blanks in them.

That company had a Filipino immigrant who was a transcriptionist. The company decided to try him on the Filipino dictators, just as an experiment, on the theory that maybe he could understand their accents better than the gringo MTs. However--he wasn't able to understand them either.

If I get a very short dictation, and it is either cancelled or abruptly stops after only one or two sentences, it gets "shit-canned," and I don't get credit for it.

However, if I were to do a whole damned report, such as you are talking about, Rachel, and then the doctor says, "Oh, goodness, I already dictated this," I most probably would get paid for it. Because the way our software is set up, I would give a command when I was done transcribing and making sure the page breaks were correct, and that document would be sent over DSL to my boss's office, and then on to the client hospital.

Yeah, it *IS* irritating and beyond to have your work discounted that way...

Rachel, somehow last night I managed to post the same message three or four times. Thanks for deleting all but one copy of it.