I got a call from the oncology center at a local hospital looking for an on-site transcriptionist. I told the lady that I only work at home and asked if the main hospital had home-based transcriptionists. She told me that they outsourced their work to Medquist, and when I made a comment to the effect that Medquist is the Great Satan of medical transcription, she said, Oh, I know, we are quickly finding that out. Do not hesitate to badmouth Medquist at any opportunity. They are almost single-handedly responsible for declining pay, increasing production rates, and all the other evils that have fallen upon us over the years. As Medquist goes, so does the rest of the transcription industry. My belief is that hospitals should be *required* by JCAHO to hire their own transcriptionists, based on my experience working at home for a local hospital. We had several less-than-exemplary nurse practitioners and physician assistants who would dictate for their employers (admitting physicians and consultants). Most of us were experienced in radiology transcription and noticed that, when they referenced radiology reports, some of the things they said didn't make sense. When we checked the actual radiology reports, we found that what they were saying was either woefully incomplete or totally contradicted the radiologist's interpretation. They were incapable of putting the results in their own words and too lazy or medically illiterate to read the impression! Some of them also misinterpreted the information from a patient's previous medical reports. A few of them were so consistently bad at this that we provided example after example to management. They finally hired hospitalists (doctors) to do the dictation and increased our production rate by 10% (33% for radiology) to pay for it, but it was still a much better rate than what Medquist pays. MTSOs do not have access to a patient's medical history or diagnostic studies, and for this reason there is a lot of *correctly transcribed* medical misinformation that leads to serious medical errors and even death. If transcriptionists working for hospitals and anyone else concerned about patient safety would complain about the outsourcing of medical transcription (even to American MTSOs), we would all have good jobs with hospitals and good pay and benefits, and Medquist would have to settle for accounts with local clinics across the country. If enough people complained to JCAHO about hospitals outsourcing transcription, we could actually bring down Medquist and the other MTSOs and still work at home for hospitals anywhere in the nation. (http://www.jointcomission.org/)