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CHOLECYSTECTOMY

30 November 2003

She told me I could call myself a real medical transcriptionist when I could spell cholecystectomy without having to look it up (nowadays I use a macro for it anyway!).

People frequently ask me if medical transcription is a good / easy / lucrative profession to get into. I'm the wrong person to ask. Like all of the jobs I've had in my life, I got into the field through the back door.

When I was growing up, I was fascinated by anything medical. I read all the medical novels for young girls (Sue Barton, nurse, Cherry Ames, nurse and their ilk), I watched all the medical shows that came on TV. I was fascinated by the terminology and I don't know that I ever actually imagined myself doing patient care, but I knew that I was definitely attracted to the field.

Math and science were never my strong suits, so I figured right from the get-go that I had no hope of becoming a doctor. And my stomach didn't like unusual smells (except for skunk--for some reason I am one of those rare people who don't mind the smell of skunk, when we happen across some black and white road kill somewhere), so I very quickly gave up the idea of nursing when I realized that it would involve human waste products. The blood and gore aspect of it didn't bother me at all.

So until I hit my 40s, my whole participation in the mecical field consisted of watching medical shows on TV and the occasional trip to the doctor.

Sometime in the 70s, I was working for a typing service when a veterinarian from Japan brought in some tapes of conferences he wanted transcribed. I cringe now when I think of the job I must have done on those tapes! None of us in the office had any experience doing medical transcription, but the boss handed me a huge box of tapes and a medical dictionary and told me to do the best I could.

Under the best of circumstances, the worst transcription is a conference you have not attended. You have no way of identifying the speaker, there is room noise to contend with, and you're lucky if you can produce any sort of coherent record when they are speaking about things you have a chance of actually knowing something about.

Add to that an entire vocabulary you have never encountered before--and an international panel who don't all speak with an American accent and....well, "horrible mess" doesn't even begin to describe it.

Let's say I didn't get rich from that project! I had to look up nearly every word (I was ok on "and," "the," and "a," but that's pretty much all!) and since I had never heard 90% of those words before, I didnt have a clue how to even start figuring out if this garbled word said by someone in a foreign accent was the word I was looking at in the dictionary. I worked on that job for weeks ...Tessie...that was his name. The guy who hired us. I guess Tessie was able to make some heads and/or tails out of what I typed, but as I look back now, with more than two decades of real medical transcription under my belt, I sure don't know how.

Later, I changed jobs and began working for a typing service which actually specialized in medical transcription, although I didn't know that at the time I was hired.

Ann, who ran the business, did all of the transcription but her fame grew and she got to be too busy, so one day she threw a tape at me. "Here. Transcribe that," she said, handing me the dictionary and telling me I would eventually learn how to spell "cholecystectomy."

Again, I didn't exactly get rich during the learning process, but I was being paid and Ann was there to help me when I was tearing my hair out trying to make out a word. She had started me with the doctor who spoke the clearest. He also had the advantage, for a novice transcriptionist (though it was the bane of an experienced transcriptionist) of repeating himself many times, so you got lots of experience learning his terminology--his field happened to be orthopedics.

He was so comfortable using a microphone that it never seemed to occur to him that someone might one day listen to all of his non-transcription moments. The best experience was not mine, but another transcriptionist who kept saying, as she was typing "he keeps clearing his throat. If he spits, I'm out of here." Then suddenly she leaped up, yanked the earphones out of her ears and shrieked "Ewwwww!! He DID!"

I've had physicians who blow their nose, fart, sneeze, eat, have conversations with people in their office, and I swear I've even had doctors who carry their hand-held dictation units into the bathroom with them. The transcriptionist hears it all.

I finally got comfortable doing orthopedics and began to consider myself a medical transcriptionist. That's when Ann suggested I share with her the early-morning typing for the local pathology lab. We had to go in at 6 or 7 a.m. and get all their transcription done before the office opened up. I was a medical transcriptionist. I could do this.

But that's when I began to realize that every specialty has its own language. Whenever you tackle a new specialty, there is a whole new terminology to learn, and you spend a lot of time back at the dictionary, trying to figure out what the heck they're talking about.

Pathology is fun, though. I found out, for example, that you have to type a report on anything which is removed from the body. Ann told me that her favorite report was on some guy who had somehow managed to wedge a doorknob up his anus. The best part of that report was that he had requested the doorknob back after the pathology report was dictated because "it was his favorite one."

You learn lots of weird things being a medical transcriptionist!

Over the next year or two, I rotated through pathology, cardiology, more orthopedics, general medicine and surgery and got pretty good at all of them. I even managed to be the only transcriptionist who could understand the Indian gynecologist who had his own pronunciation for everything!

Ultimately, I ended up as the in-house transcriptionist for ob/gyn, a job I really loved, though they had no place to put me and I ended up buildling myself an "office" out of a hallway closet, where the desk faced the back of the closet and my chair stuck out into the hall. I was at least in a great position to get to know everybody, because my "office" was directly opposite the break room and right by the nurses' station and there was lots of time for camaraderie.

As I said, it wasn't until I'd been doing this job for several years that I discovered there was a certificate that transcriptionists get, and high priced classes they should take...and that part of the training involves knowing things like medication doses and that sort of thing. I've absorbed some of that. I routinely edit the psychiatrist's reports when he makes a mistake because I've worked for him for more than 20 yrs and know his standard spiel, and know that sometimes his mind wanders. But I do not have, at my fingertips, the usual dose of non-psychotropic medications and wouldn't normally know a dictated overdose if it bit me.

Medical transcription is also changing, and it's very difficult to know whether to encourage someone to go into the field. While it's true that a good transcriptionist can make a good living doing it, there is also a move toward EMR--electronic medical records, which, in theory, will eliminate the need for transcriptionists. I don't see that happening until the current generation of older doctors dies off because there are still enough computerphobic physicians out there to resist modern technology. But as younger doctors move into place, those who have grown up in a computer age and aren't afraid of anything electronic, and as the technology continues to improve so that a physician in Pakistan can be understood as clearly as one from Chicago or Beijing, there may come a day when the medical transcriptionist will be just a footnote in a textbook of obsolete medical practices.

I think our position is safe for the moment, but, as with anything else, it's a continually evolvoing profession.

But at least I know how to spell cholecystectomy, so for my time, I could proudly call myself a medical transcriptionist, even if I did come through the back door.

Today's Photo

Tape collection

I decided this picture is appropriate to today's entry, so I'm leaving it up.

For more photos, please visit My Fotolog and My FoodLog


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Created 11/29/03