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Absolutely ridiculous!! I just got chewed out by QA - sm

Posted: May 07, 2012

for putting potassium was 216. She said patient safety is an issue here. I said ok. I mean with the crap pay I get, they cannot expect me to memorize normal values in anything!! That is what QA is for, for one thing. For another, if that is what the dr said or even what it sounded like, that is on HIS shoulders!! What a crappy job to have!!

No, that is not what QA is for - Ayn

[ In Reply To ..]
I'm sorry QA "chewed you out" - there is always an appropriate way to give someone constructive criticism. But, yes, that is part of our job as an MT - to know normal ranges for at least the common lab values, of which potassium is one.

QA's job is to check on things that are flagged as a question/blank by the MT. If that is what you did (questioned that value and flagged it for QA), then that is their job. But, it is not QA's job to find all these errors after the MT has typed & submitted the report and it is most certainly not QA's job alone to memorize all the things the MTs don't want to remember.

If any doubt when transcribing (i.e., what you hear doesn't jive with what you know, either from your own knowledge or other info in the report), you should have researched the lab in the patient's record if you have that capability or flagged it for QA to research.

Yes, it is the doc's responsibility as well when he goes to sign/finalize the report, but that does not lessen the responsibility of the MT to catch errors, discrepancies, inconsistencies, and out-and-out errors that are dictated. That is the definition of our job -- we are not just typists.

Too bad - they do not

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pay us for all our knowledge and the responsibility of getting it right. I agree MTs should know normal lab values and flag report for anything questionable.

Very true - Ayn

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Yes, it is very discouraging to see our salaries dropping & dropping as we are expected to know more and more, and fix more and more of both poor dictators & SR, learn multiple accounts & specs, etc.

What really irks me at my current position is that everyone is paid the same line rate across the board, no matter what your experience and/or your abilities/quality/skills.

In this case, SM, too bad they don't have the power to fire. - You are totally wrong in all statements. SM

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This is a very basic lab. You ARE absolutely supposed to know that while normal range varies a bit from lab to lab, it will be somewhere around 3.5-5+.

Also, between initial training and some time on this job you should have further understanding, such as that while a low potassium may just lead to a recommendation to eat more veggies and take a multivite, elevated potassium can kill, that it often results from kidney failure and can lead to cardiac arrest. Elevated meaning over 5.5 or so! If your guy had dictated...8 your eyebrows should have flown up into your hairline.

We all are far, far more ignorant than knowledgeable about what's in these reports. What is so shocking and inexcusable is your insistence that total ignorance of the most basic elements of your job is justified. It's not.

I agree with you - Last night I had a doozy

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I had a whopper last night. Don't know what the doc was thinking but he dictated Coreg 500 mg twice a day. As tired as I was, a red flag immediately shot up in my sleep-deprived and overworked brain, I put a blank for the dosage and a comment in the QA box, and off it went for QA.

I think it comes with experience but once certain lab values and drug dosages are drilled into your brain, after awhile, no matter how tired you are and going on "auto pilot," those outrageous levels/dosages just jump right out at you (thankfully, lol!).

Yeah, gotta agree with above poster. - anon

[ In Reply To ..]
Memorizing lab values, approximate dosages of meds, what conditions meds are used for, etc. are exactly what is expected of you. I shudder to think what a report would be sometimes if I just typed "what the doctor said." You're the last line of defense for what goes into the record! You are not a typist! And yeah, the pay is crappy for many right now, but that doesn't change the fact that the job is an important one.

Training - Old MT

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If any MT in the world thinks a potassium in the 200s is anywhere near acceptable, they haven't had proper training or aren't paying attention to most of the reports they're typing.

Of course, you aren't expected to know EVERYTHING, but you are expected to know that you don't know. A quick Google or look in a lab reference book would have given you a very clear picture that a potassium in the 200s is off the wall.

THAT BEING SAID, if this was an ASR report and the dictator said 206 [or whatever it was] for 2.06 and you missed it, it's still on your back. It's easier forgiven, though, what with this ASR catastrophe and us trying to catch all these stupid little things that are huge. It sounds to me, though, that you just typed what you heard and went on.

Take your lumps. Now you know that if you ever see or hear a potassium in the 100s, something is wrong.

Agree with OldMT - You live and you learn. - you probably typed what you heard or

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read it in the ASR as he was dictating and because it lined up with what he said, you didn't catch it.

I have been doing this for 10yrs - and while I am

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Familiar with most of the labs and medication dosages, I'll be the first to admit, I DO NOT CITE them off the top of my head. So I disagree with all this memorizing crap, you know them because you have typed them for years.

I agree that it was a critical error, but everybody makes mistakes or at least has at some point in time. I am sure this is one she's likely never to forget with the way you guys came down on her whether her attitude was poor or not, you all were beating up on her self-esteem as if trying to make it seem like she should be able to recite dosages and lab values off the top of her head and have them all memorized.

Like I said, I'm familiar with most, but that came from 10yrs of typing, not because I sat down and memorized them all.

I agree, but - I think the reaction

[ In Reply To ..]
would have been very different if she had accepted responsibility, rather than blaming QA for not reviewing every report or the company for not paying her enough to care. I do agree with what you're saying though. Folks really did pile on and shouldn't have.

While I will agree with you that - we should not have to

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site lab values off the top of our heads, we should still be able to look them up if needed. Even if the doctor was saying 2.16, that is a critical potassium level. That is pretty important.

The biggest issue to me is that when she was reprimanded for her mistake she comes to vent on an MT forum instead of just realizing she made a big error and really may want to watch that in the future. Instead of an "Oh goodness, I can't believe I did that", she is upset with QA.

On a positive, anyone in the hospital with access to the chart would have known that was way off and not even a possible potassium level.

WhileIAm, of course I memorized all the basic ones in the beginning, - then reinforced and picked up others. NM

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x

It's a shame no one else thinks this job is - important except us SM

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and i agree with everything you said. I am old school, and I know what is expected of me. In fact, I feel almost compelled to produce a quality report. It's too bad that MModal actually docks pay for too many blanks to QA, I assume regardless of the reason? I don't work there. What are MTs supposed to do with that? Guess? Absolutely not. How does anyone in upper management reconcile this practice? I am really curious..does this docking of pay with more than 5 percent to QA include reports with discrepancies in lab values, med dosages etc?

includes everything - even bad sound

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Does not matter if doctor error or bad audio... you are docked for over 5%.

Probably should have been 2.16. Google potassium - levels. Sometimes the

[ In Reply To ..]
doctor will dictate lab values without dictating the decimal point.

Instead of saying "two point one six" they will say "two, one, six". Working on VR you have to slow down when you get to lab values and medication dosages, because it can be easy to miss.

Very true - and I think a big difference

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between editing and typing. Constantly have to be thinking critically when editing--it's coming fast and furious and it's easy to just let something like that fly by.

link for lab values - loa

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I'm not going to rag on you. Sounds like you have gotten enough of that today. Keep your chin up. :) Here's a link for future reference that I go to if I need to check normal lab values.

http://www.student.med.umn.edu/wardmanual/normallabs.php

Can'[t believe - anon

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She's not going to look it up, she doesn't think it is her job!

I can't help bu think this post was a setup - to make a point

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I wonder if a QA got this kind of response or attitude from an MT and then posted it to the board to get reactions from peers.

I guess my suspicion comes from the belief (perhaps mistaken) that no real MT would claim that it was not their responsibility to know lab values, and then post it to an MT board looking for support.

Welcome to the reality world of MT - mt

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You'd be AMAZED (or DISMAYED) to know how many MTs have that attitude and would be dumb enough to think they'd get support by (b)ragging on an MT site.

I remember very clearly a lively discussion with a gentleman on another forum over 10 years ago when his attitude was, "I don't get paid to think." :D

MTs like THIS - MT

[ In Reply To ..]
are a big part of the reason we are paid crap wages. An MT worth her salt (and any kind of positive pay) would know that putting in a value of 216 would create a patient safety issue.

Your attitude sucks. Your work ethic sucks.

QA is not there to be your reference file.

IMO, get over yourself and go find a job where your attitude won't be noticed or harm anyone.

totally agree - stirring the pot

[ In Reply To ..]
I thought maybe this was a pot stirrer too, but I am with you - OP has a bad attitude and if they truly were any good at their job, regardless of this mistake, they would ACCEPT the criticism, learn from it and remember that it is all about patient care. QA and the physician's themselves are not there to do your job for you. If you don't like your job, then QUIT!

another lab test site alphabetical - anon

[ In Reply To ..]
Agree with all of the above posts, you are absolutely required to know common lab values or look them up. That value would be impossible actually, the patient would be dead far before that value. This is an alphabetical list: http://www.healthcare.uiowa.edu/path_handbook/

This is a shorter one I printed out and kept handy until I had memorized most of them: http://www.mtworld.com/tools_resources/lab_values.html this site has a lot of other good links as well.

Better be thorough... - CYA

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http://www.amazon.com/Mosbys-Manual-Diagnostic-Laboratory-Tests/dp/0323057470

Make sure you're well acquainted with all 1264 pages...just in case one of those MDs misspeaks.

It is getting to the point of absurdity what a number of just-above-minimum wage workers are "expected" to know. Heaven forbid you send it to QA...there goes your bonus for the quarter.

We are not responsible for what doctors do under their licenses - they are. If they dictate incorrect values...that SHOULD come back to haunt THEM...not us.

I typed a report a couple of weeks ago where the dictator clearly stated that the patient was allergic to drug "XYZ". Then, a couple of paragraphs later, they went on to clearly state that the they were GIVING the patient the drug they just said the patient was allergic to. I could send it to QA all day...that wouldn't have fixed that problem. I flagged it for the hospital to see.

Come on... - For reals?

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I would really REALLY not want to work for the company that would punish me for flagging a K+ of 216 or not notify the client that a med appears on the med list and the allergy list.

simma down WMJ - Simma down

[ In Reply To ..]
We know, we should strike and that would handle that problem, right?

I'm with ya OP - sm

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We are not doctors, pharmacists or anything of the like. This job does not require that we know the correct lab values or dosages of anything. We type what is dictated otherwise we would have some pretty fancy credentials after our names and wouldn't be sitting behind a desk typing all day LOL! That, my fellow transcriptionists, is what the doctor, PA, RN, pharmacist or whomever dictates/signs the report is required to know. I have never ever in 24 years memorized any lab values and have never been required to. Seriously you guys? Call it whatever fancy term you want to inflate your egos, but you are bonafide TYPISTS for crying out loud - just like me. You are not MDs, PAs, RNs or PhDs - it's not OUR job to know as much as a pharmacist or physician! It falls on them, NOT US, if something is amiss. It is not our burden to carry if they misspeak or whatever and it affects patient care. They are the ones who are responsible, not us. You people are so holier-than-thou. Wow, is all I can say.

Go ahead - start the bashing, I wouldn't expect anything less from a bunch of nasty, egotistical people hiding behind a keyboard :)

Amazing - anon

[ In Reply To ..]
After 24 years of being an MT and you don't know a potassium of 200+ is not right? You are wrong, wrong, wrong.
A "typist" types what she hears, a transcriptionist does know these things. How do you produce a quality report if you don't? QA does not listen to every report to make sure everything is correct. If they did, there would be no need for transcriptionist.

ok I'm shocked - slave wages

[ In Reply To ..]
takes a bit to shock me but I'm shocked. I was sure you were being sarcastic, and you weren't. 24 years and you don't know potassium ranges.

Thank you! sm - OP

[ In Reply To ..]
I expected the bashing, too, so skipped over the rude replies, which were most of them..not real sure since I did not look too closely. It is so true. If we got paid much better or even treated with respect, it would be different, but still there is no way I am even going to try to memorize normal values for all labs:)))

So after all this you're intent on being shockingly bad - at your job AND feel you deserve respect? Wow. NM

[ In Reply To ..]
x

Not only that, but more money too. I do not get it. - Wow. No message necessary

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a

Wow. - I was feeling bad for ya

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with the way everybody piled on you, but now not so much. I'll bet most of us here have been caught on a critical error at some point in our careers, and we learned from it and moved on. I'm guessing that's what your supervisor expects from you too -- it's too bad you're too busy blaming everybody but yourself. I don't mean this as rude or mean or ganging up on you, but you are compromising patient care, and that's not a cool thing to do. There are plenty of other fields that don't require you to do more than what you feel you're being paid for.

it's not about memorizing normal values - sm

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It's up to you to perform due diligence. If someone dictates "two, one, six", how would you now how to transcribe it without quickly looking up the normal values? Numbers are tricky.

and this is why you will not be able to survive - the MTQuake

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Because you are a typist (and a poor one at that apparently). As to the poster with 24 years experience and never memorized a lab value- then I daresay, you aren't really an MT either. But you seem fine with being a typist. It's just sad that typists will no longer be required.

No one meant you had to memorize all normal - labs, but you should SM

[ In Reply To ..]
know basic chemistries, etc. That is part of the job of being a competent MT. I have been in this business a long long time and I know what my responsibilities are. It's a work ethic and I always tried to do my best on all of my work. Perhaps you haven't been in this business long enough to know that we used to be paid for our abilities and were respected for our knowledge. It must be different for those who came into this business being disrespected and paid minimum wage, but I can't change something that is ingrained in me because I am now paid so poorly. MTSOs have put us between a rock and a hard place IMO. They have managed to exploit us to the point that many good MTs cannot stay in the business. They want 100 percent quality and knowledge for a minimum wage job now. You are so very wrong that we are just typists who type what we hear. The thing that upsets me the most about all of this is the company that docks pay for an MT who has the knowledge to know something is wrong and flags it. It is such a mixed message but I am wondering now if it is because of MTs like the OP who think they should just type what they hear and expect QA to have the knowledge. Punishing all of us for the behavior of others.

Agree with you - sm

[ In Reply To ..]
As a former CMT (for what THAT'S worth, LOL), and someone who typically maintains a 99.8% to 100% QA score on random QA checks for years now, I know the normal ranges for lab values and (hopefully!) would have caught this potassium level error and flagged it. The value is so outrageous as to be inconsistent with sustaining life. STILL, where do you draw the line? How much am I supposed to know, really, and what guarantee is there that I meet that standard? What if a doc dictates the wrong brand of surgical retractor...should I know that, too?

I've bragged about my depth of knowledge for a long time now, and I know it's substantial. I know how to research things, and I produce reliable documentation, but MTs aren't even required to have a high school diploma. There's no consistency in our training and no reliable measurement. I'm not a licensed healthcare worker with rigorous state/federal controls, and my willingness to continue to improve my skills is voluntary. The CMT has negligible value and isn't recognized outside the MT field anyway.

IMO, I can't be held responsible for verifying every word dictated. I'm not on site, and it's not my job to police MDs.

I once described (arrogantly) to my dentist what I do for a living, and his response was, "Well, you seem intelligent and all, and I'm hoping you underwent some training to do this correctly, but who's watching YOUR back?"

If only the part about it not - falling on us were true

[ In Reply To ..]
You type something wrong in a report and that physician gets sued, there is a good chance you are going to be sitting in court. It does and has happened. The patient sues the doctor and wins, and the doctor turns around and sues the MTSO and wins if it is your mistake.

I guess that is why some companies are requiring their ICs to carry general liability insurance. I can sure understand why now.

I've never sat down and tried to memorize labs, but over years of working in the healthcare field, you just kind of learn them via research, the same with meds.

I am now starting to understand why the doctor I used to work for used to call in on transcriptionists constantly, even having some banned from typing his charts and why the one I work for now started typing his own charts and eventually went to a point-and-click system.

If we knew all the things the doctor's know, - mtms

[ In Reply To ..]
then we should be the doctor and not the MT. If I'm not sure about something, I definitely leave a blank and don't guess. We should not have to memorize all this, otherwise we would be the doctor.

Yes, it is....sm - Old Woman

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our responsibility to know normal lab values, medication dosages, and disease processes, as well as cancer staging and a wealth of other information in order to produce a competently transcribed medical document.

If you find this beyond your capabilities or your desire to learn and if this job is so crappy to you, then you might want to consider another field. Medical transcription is not for everyone, and while it is no reflection on you if you aren't cut out to do it, it is a reflection on you and the even the entire industry to produce work that is substandard and even dangerous to patient care.

I find this whole thread quite enlightening and very telling. - see message

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The OP made a mistake that most any MT could make. We have all been there at one time or another QA caught it. How many details in her report have they NOT caught that endangered patient care? And she thinks she should make more money? Hmmmmm. Why? Like some posters agree, we are not RNs or MDs. This is probably a mistake that she will not make a gain. To say that this is "absolutely ridiculous" speaks volumes about what she perceives her job to be. Is she saying that if she made more money, she would be a better MT? Really? How?

Some MTs feel it is their job to know these things, and do. They feel they deserve more money for that knowledge. Perhaps they are right. The fairness of it all is probably somewhere in between, but I would not call QA being "absolutely ridiculous" in either case.

We have all made mistakes in reports...sm - Old Woman

[ In Reply To ..]
from time to time, myself included, whether from fatigue or lack of knowledge. Chances are the doctor who dictated this report just slapped his/her head and got a good laugh at the MT's expense.

I am guessing that the OP in this thread is someone who either did not complete any kind of formal training for this job or just plain does not care. Even the other poster who claims 24 years of experience and does not know common lab values is likely the same type of MT. These kinds of MTs is one reason, among others, that our pay rates have deteriorated over the past several years and the reason why MTs who are worth their salt and deserve more cannot get more.

My Daddy always said "You might grow up to be a ditchdigger, but be the best darn ditchdigger you can be."

MT reaction to QA - oaf

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While you may not think it is important - it is. Just tell QA you are terribly sorry and learn from this -mulling it over will get you nothing but a headache! QA is just doing their job. You should question things that are out of line and leave a blank - a 216 potassium is off the charts. Just apologize, learn from it and move on.

Her attitude sucks...but I get it. - Nony

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No, that's not what QA is for, etc. blah, blah, as everyone else has bashed.

But, I will be the first to admit that my work ethic has changed along with my pay. I no longer spend more than 1-2 minutes researching ANYTHING, whereas I used to research something until I found the answer. Of course, over the years my knowledge has increased so I have to do less research nowadays, but when I do, it's very minimal effort. Really, I don't get paid enough to make it worth it to me to spend more than a few minutes looking anything up. BUT, if I question something or honestly just don't know, I WILL DEFINITELY flag for QA. I won't just let it go out with questionable info.

Attitudes will suck when employers cut pay in half, raise quotas, and not be flexible in scheduling (as mine has done to me in just the last month).

And really, it does sound like she was doing SRT/ASR and it matched what she heard so she didn't even think about it...or she's really QA masquerading as an MT looking for some kind of support here. Either way, it's wrong.

Researching....sm - Old Woman

[ In Reply To ..]
I agree that an MT should not spend more than 3 minutes researching a term or value for a report. I, too, used to spend a lot more time researching, but in order to maintain my daily production rate, I have cut down on that time spent looking up things I don't know.

However, what I DO do is maintain a comprehensive research library, mostly in my Favorites, in which I can easily access those terms, etc., that I have trouble remembering or are new terms to me or to the field of medicine. I find this cuts down on my research time as I can quickly click over to Favorites, find what I need, and go on about my business of producing a quality report. If a web site does not display the term I am looking for, then I change the name in my Favorites file to reflect that. I have files within Favorites for the different medical disciplies as well as common lab values, radiology findings, names of towns and facilities related to my accounts, etc. If I change companies or accounts, what is no longer germane to my situation can easily be deleted.

you don't have a leg to stand on this time - slave wages

[ In Reply To ..]
Usually I'm the first to side with the MT but not this time. You may not know all the lab values by heart but the basic electrolytes, BUN and creatinine you should have an idea of normal range. Surely you see them dozens of times each day.

Even if we don't know them by heart we should - bmtevr

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have references that are easily seen for such things that do not take any time to see, i.e., flipbook, etc.

seriously not your job? - laughing

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I am cracking up!! QA is paid a LOT LESS than MTs!! It your JOB to look up normals if you do not know them and to flag if it is really out of the norm, that is your job.

I get less pennies a line than you and you expect me to do half your job for you...nah, do it yourself. We fill in blanks, type of the hard dictators when MTs decide not to work the reports. So many MTs abuse QA - get a grip!! Quick picking on QA who has more experience than you do and gets paid LESS as you are supposed to know your job!!

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Pinging in and out. Getting booted off. Losing reports. And what slow reports are coming through are all wrong...wrong patients...wrong data in ASR. I knew when I read that email a couple of days ago that they were going to update the client's database and apologized for any inconvenience this might cause, we were in for trouble. So predictable. Thanks MQ. All I want to do is WORK! ...

Nov 23, 2011

So I send resumes to about 20 places yesterday and I get responses. They say they only pay 8 cpl, but their test is ridiculous for a pathetic 8 cpl. Forget it MedInk!!! ...

Dec 30, 2011

I am currently doing a doctor who actually spells out "N-O" whenever he says the word no. I'm ready to scream. ...

Nov 03, 2012

One of the docs upset because many of us are leaving the word "and" out of one of his sentences so we got an email instructing us to make a note of this. Never mind that he dictates at the speed of light on a speakerphone, we need to be sure we get every single little word. Heaven forbid anyone should ever tell these docs it is their responsibility to slow down and make sure they are understood. ...

Jan 08, 2013

I sat here for 2 hours waiting for work, and I finally have a few reports. Now the sewer just now backed up for the 3rd time in 2 weeks. ARGHHHHHH!!!! I have had the plumber out twice already and still owe for one visit! I make way less than minimum wage most days and am having to depend heavily on my retirement account (I'm only 56). Feel like everything is raining down on me! I also had to call a wrecker the other day because I locked myself o ...

Sep 05, 2013

Is it just me or are a lot of you making minmal wage? ...

Sep 05, 2014

As if speech rec can't get more annoying and stupid. Working on a report that had Progresso for progressive over!! ...

Feb 14, 2015

My team is required to be signed into a conference in Spark when working our account. That is not a bad thing, in fact it is quite educational because I am seeing just how ridiculous everything is. The account is verbatim, you only type a heading if it is dictated. Someone is worried that the doctor said Procedure for a heading naming the procedure and then later used procedure when beginning the real procedure. That MT was worried about getting dinged if she changed the ...

Jun 03, 2010

Talked to the recruiter 2 weeks ago tomorrow (Friday, after her postponing the interview on Wednesday), she was very nice was told the paperwork would be send Fed Ex after not receiving it was told the gal in fhe office was out and would be sent later, and of course based on a "background check" etc -- with training to supposedly start 06/14/2010 -- I have since accepted two positions and if I were an MT, I would be VERY leery of this company -- a month to start is ridiculous especially wh ...

Jul 28, 2010

As with most of you, my pay from Medquist has taken a total nose dive ever since ASR went to 85% while at the same time cutting our transcription rate down for ASR from 70% to 60%. That's a 40% pay cut!!! I've had to take another job elsewhere to try to make ends meet. Besides that, our health benefits are the absolute worst and get worse every year. Can anyone ever remember any kind of cost of living raise? I used to make $36,000 annu ...

Nov 29, 2011

What is wrong with these companies! That type of transcription is a minimum of $1.00/min!! You have to look up so much drug terminology and who knows what the audio quality could be like. I can't believe they have the NERVE to offer $.07/A LINE!! And as usual, they are targeting the "newbies" who they can take advantage of, rip off and pay slave wages to - they are right up there with that other company who posts jobs for general transcription - the name of which escapes m ...

May 30, 2012

are there any MTSOs who hire part-time weekdays? I'm looking for something M-Thurs or Tues-Friday with morning hours (7 a.m. to 12 p.m.). I realize most larger companies require weekend work, but I have family commitments (sick family member) that interferes with my ability to work weekends. ...

Apr 13, 2014

This is soooooo ridiculous, my blood is boiling. The doctor dictated: "Continue vancomycin and will obtain a vanco trough and further dosing recommendations." I get it back as a minor error. She changed it to: "Continue vancomycin and we will obtain a vanco trough . . . She's acting like he put a contraction in there such as we'll. That's purely a judgment call. No wonder we're getting emails complaining about our high ra ...

Oct 14, 2014

Up to now, I have hardly ever run out of work but the last 2 weeks it has become steadily more and more and here I sit on a Tuesday morning with no work. I hope to God we are not losing this account because it is an awesome account. I cannot sit here and work all day as I have a second job that I work also. This is truly killing me!! Might as well go back to bed ...