A community of 30,000 US Transcriptionist serving Medical Transcription Industry

Nightmare still going on....... - Pitbullmom

Posted: Mar 24, 2011

From Western region - got e-mail from "interim QA" yesterday with attachment which was "normal lab values per KB Benchmark."

Third paragraph of e-mail said the MT should be ever vigilant for punctuation errors and errors in dictation of lab values by docs. Said if doc was in error in dictating the lab value and the MT transcribes it, IT IS THE MT's FAULT ! Does this person have a Napoleonic complex or what ? It is now expected that we must constantly check these dictated lab values to make sure there is no error ? Please pinch me and wake me up ! Thanks.....

Who wants to work some more for free? - Nutz!

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That is crazycrap, man!

Welcome to the crazy QA world - The Gods must be Crazy

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My head simply spins from all the corrections I get from the QA staff. Do they get a bonus or on a quota or something for correcting the MTs? Any time I'm proofing the ASR or typing something, I think about how many other ways it could be said and still be correct. Sure enough! The QA person "corrects" it to the other option I did not choose, for no good reason like following one of our standards, guidelines, ADHI, or anything else, but just to change it. If a doctor clearly states a wrong lab error, I usually leave a blank (which by the way is counted against MY INCOME - NOT THEIRS). However, what if the patient really had an abnormal value - who are we to read their minds? We're simply following "doctors' orders."

Thank you, thank you, thank you..sm - digiti minimi

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How true. I was told during training to use the "100,000" canned headings they have before all else. Every heading I picked, they would change it. no matter what the dictator named the heading, it would be changed by QA.

Been doing this forever. Last audits were 100% - no name

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Got a QA audit yesterday (just one) that had TWO CRITICAL ERRORS. I must really be getting worse at this? Of course, it put me below 98%. I hate QA with such a passion. They are more stress to me than the bad ASR and low pay --- and that is saying something.

Shouldn't sweat the small stuff - MME

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I do QA and, even the Q probably won't want to hear this, if the error doesn't change the meaning of the sentence or is ambiguous, I leave as is. (Unless verbatim, but even that is subjective now). I just flag out the big corrections. If a QA is picky, they have the ability to correct without it showing as feedback, like ASR. As there are poor MTs, there are also poor QAs. Unless its a big error I would just ignore it, its just a QA on a power trip.

Soon 98% will not be good enough, it will be going to 99% accuracy with any lab value, age, date, ADT or other number errors being considered automatically critical and failing the whole report. I'm not sure what they mean by failing, but I'm guessing that now you can still get a critical and stay at 98% on a long report, but soon that won't be possible?

I'm guessing these changes will take place during open enrollment.

And I ask again, are our ILPs held to this and future vise grip strangle holds? sm - veryoldMQMT

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I say, no of course not. And I still see no change in the accuracy of reports that have been sent to clients. This is an affront to me, and should be to all true MTs that this kind of work would be sent. Are ILPs QA now? Like I said, before I give myself a heart attack I am going to stop.

Yes, ILPs do QA - MME

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They do not QA US work, obviously, but the ILP work does go through one or two levels before it gets to me. It's just as bad. 80% of the time I have to correct the QA corrections. Those that say that ILPs are better than us because their English is better because they were occupied by England is spouting a bunch of bull. If that were true, how come most Indian doctors can't speak proper English. And those are doctors, while the ILPs are pretty much housewives.

Sorry, I'm just upset when I see presumably US MTs stick up for the people who are threatening our jobs. Even if a lot of the ILPs are good, why would you want to spread that around and lower the minute chance that a client will say, I hear the Indians aren't that good, lets stay with USA.

99% on the Spheris side - mom2huskies

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I have been told that MTs on the Spheris side of MQ now need to have 99%.

funny how the new line requirements were Spheris too - NJA Queen

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Just saying, who exactly bought who? Spheris payroll, Spheris line requirements, Spheris office in Tennessee...

So let me get this straight - CyberlandMT

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Are you saying QA has the ability to change something in a report that an MT has done without notifying the MT??? That is wrong on so many levels. For one thing, if the QA happens to be wrong and the client complains, who does it fall back on?

QA changing things - Wendi970

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So...you think QA needs to get your permission to correct mistakes before sending to customer? It would be best to send with errors rather than touch your piece of art? If the QA person is incorrect, everyone knows who is to blame. DQS records whether the MT or the QA made the error. If you see a correction you believe is an error, just report it to your CCM and/or the QC.

Wendi970 - CyberlandMT

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No need to get snippy with me. We're both on the same side. Right? I did not say I think QA needs permission to correct mistakes before sending to the customer. However, I do believe QA needs to inform an MT of such, whether it be in feedback or a note to the QAC to pass on to them. Otherwise, how can we possibly know that a correction has been made? You say DQS records whether the MT or QA made the error. How do they do this? I know keystrokes are recorded. Is that what you mean? I only thought the number of keystrokes were recorded...not the actual type of keystroke it was. As in, they can actually tell when someone types the letter N? Not being sarcastic. Trying to understand it.

changes by QA - a1typist

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I understand your concern regarding changes being made to a legal document without notification to the transcriptionist. In my own experience, about 10 years ago, a clerk in the hospital made a change to the content of a report I typed and somehow or another it got back to me and boy was I livid (it was not correct). I went round and round with my supervisor at the time, but in the end we are without any control over what happens to a report once it leaves our desk. I am not saying that we do not make mistakes, but we should at least be notified of these for learning purposes wouldn't ya think!!

changes by QA P.S. - a1typist

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That is also my concern when we are dealing with the fact that we cannot copy and paste anything to save to compare to QA'd reports. How can you tell if what they are QA'ing you on is what you really typed? Just a little concerning.....

CyberlandMT - Wendi970

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I am an MME. The DQS system (even though you can't see it) can tell whether the MT transcribed or the QA transcribed. Also, as I'm sure you've noticed, the MME's name is always below the MT's name in DQM. Actually, I believe if you go into your daily files and click on the QA feedback function, you can see how it looks when the MME corrects anything. Sorry - did not mean to be snippy, just seems like QA gets ripped apart a lot on here. We are just doing what we're told like everybody else - and we only make 3 cents per line for the work, so it's not like we enjoy looking for mistakes. Most MMEs do not bother with corrections other than filling in blanks as we are struggling to make a buck too and don't want to take the extra time unless it is imperative.

reply to cyberlandMT - a1typist

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Actually, I do not have major complaints with QA. Only time I have had problems is when you ask for a raise, then quality coach goes looking for reasons and it would be really nice to be able to see what you actually typed compared to what they are saying you typed....I have had the personal experience of having reports changed by clerks at the hospital end without anyone's permission....and complaining to me nowhere even though I could prove it was done! I actually was not trying to denigrate or put down MMEs or QAs....they gotta make a living just like the rest of us, which by the way is getting harder and harder over the last 10 years at Medquist!

please, can we have more like you? - n/m

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nm

Just a question - sm

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I agree with you about leaving the stuff that doesn't matter alone. I am questioning the part of changing without leaving feedback. Um, I don't want anyone changing my reports without letting me know they changed my reports. That is wrong. What if you are wrong and the report comes back on me? You should not be changing reports and not providing feedback to the MT regarding the changes. That should not be an option.

what I mean - commas and very small typos

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If I change something that is questionable, is a significant error, or something that you may not have known/learned from, I leave feedback. For mistakes like missing a comma, A versus AN, missing a THE, pleural/singular grammar (was versus were), or other small obvious typos, the ones where you smack your head because they were made in haste, I change without feedback. Nothing that really changes anything.

Doesn't matter - sm

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You shouldn't be changing anything in my report without me knowing about. Don't care what it is!

Lab Values - Old MT/ExQA person

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There are lab values that are incorrect, and we should have enough knowledge to know that if the doctor dictates sodium of 120, and the patient has no problem with hyponatremia, then something is wrong. Same with any value that wouldn't match a disease. It's something we gain through experience on the job if we're paying attention.

I agree with the lab value mark-offs IF it's obvious it's incorrect. If the value falls within the range that fits the patient condition, there's no way we would know if the dictator made a mistake.

Even with being an old MT, I should not be held responsible for knowing ALL diseases and lab values. - noname

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At a minimum wage, even though I do as much as possible continue to try and learn and read up on new terms,etc., how can we possibly be expected to do this and become diagnosticians? Now, granted if I were to see that ASR had put in white blood cell count 300,000 and the patient was not being listed as septic then OF COURSE we should know that. How many of us truly have a lab value sheet next to us that shows what normal is on every single lab value? I have a vast amount of books I still use, in addition to researching terms. Of course, we are not paid for this any longer. I resent the above poster exQA saying we should have that kind of knowledge without the true whole picture of a patient, for which we are not always given a total complete history on every single report.

quite frankly, with computer generated reports taking the place of MT anyway, who is going to be held responsible then. Of course, it is going to be on the nurse and the doctors themselves.

Enough with the scare tactics. It is disrespectful to all of us who remain loyal and dedicated to being excellent MTs.

Like poster above, if you have been doing this - sm

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for a while you should have a general knowledge of normal lab values to go along with diseases, just like you should have a general knowledge of medication dosages. For example, I had one the other day that said Plavix 75 mg twice a day--which I knew was incorrect and therefore did not transcribe. At least they sent a list of normal lab values. It is no different than catching the doctors dictating discrepancies in dates, ages, gender, etc. We are required to catch those.

And are u the doctor to change the dosage he dictated? sm - veryoldMT

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Absolutely, we are NOT supposed to be changing dosages or lab values to what we say we "know" is correct and the doctor dictated it wrong. Did u actually change that above poster? Leave a blank, I don't think I see the title M.D. (or MD, whatever) behind our names. CMT does NOT make you a doctor! Like poster below, if this is the case then by golly they better be changing a whole lot in the realm of titles duties and pay to go with it.

Here, Here veryoldMT - cyberlandMT

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I'm already sick to death of what all I'm required to do for free. Trying to second guess a doctor's garbled speech on something as important as a lab value is not something I ever intend to do. They definitely need to take responsibility for their own patients. I sometimes cringe when I hear dictation that is so horribly off...and know that I would never ever have that physician treating me as a patient. If I question something, I don't care how many times I get dinged, or how much money I lose, I simply will not take it upon myself to guess. Of course, the real issue here is the company trying their level best to reduce us all to making less money (by routing to QA... with submissions over 5% etc.)

I did not say I changed the dosage, I said ai - sm

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did not transcribe it. I referred it to QA who left a blank also and sent it to the client. I don't "guess" at what they mean. If it is incorrect or questionable, I do not transcribe it, I refer it to QA. After doing this for 30 years, I do have some knowledge of normal dosages/values etc. of commonly used medications and lab tests. If it is something I am not familiar with, I look it up.

MTs are not responsible for dictator's errors - LK

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The QA people can spout off all they want, but MTs are NOT responsible for the errors dictators make. If something is questionable and the MT can flag it or blank it, that's great, but it is not up to the MT to catch doctor's medical errors. The dictator is responsible for what comes out of their own mouth. If we are being required to edit medical content, that puts the MT into a whole different realm, and there better be pay and education that warrants that. It's certainly not there now.

Nobody Said to Edit Incorrect Values - Old MT

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Nobody is suggesting that we CHANGE what the dictator said to what we think is correct. We're saying to flag it, whatever your protocol for that is, to the client or to QA. I have a very old Mosby's Diagnostic and Laboratory Test Reference that never goes out of style, save for the newer labs tests aren't in there, and it's been a life saver. It takes no longer to look something up in there than to look something up for drug dosing.

Really, I don't need the book that often. Anybody who has been doing acute care for even just a year knows the normal values for the basic labs. Something weird, like genetics and stuff, no. But you should know your basics, like the electrolytes, LFTs, TSHs, cardiac enzymes--stuff that pops up a lot in hospital dictation.

We all make mistakes now and then, but if your lab errors are chronic, then some more researching needs to be happening on your end.

Don't disagree, but that wasn't my point. - LK

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What I felt was wrong was the OP's statement that QA told her that the MT is responsible if the doc dictates an incorrect lab value and the MT doesn't blank it or flag it. Sure, an experienced MT will catch many or even most of these, but it is NOT the MTs ultimate responsibility to ensure that everything the doctor dictates is correct.

By the way, you said "if your lab errors are chronic, then more researching needs to be done on your end." I thought we were talking about the dictator's lab errors here! How about the dictators being a tad bit more careful about what spews out their mouths, rather than MTs being paid on production having to constantly stop and look things up because the dictator is lazy and sloppy?

There is no way on earth you can check to make - kt

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sure lab values are correct without access to the lab reports in the chart. However, an MT should have a general knowledge of "normal" lab values, medication dosages, etc. and know when something is totally out of whack. Just like MTs, doctors make mistakes too and sometimes misspeak. At least, that is how I was trained many moons ago. If you are not sure, you refer it to QA with an explanation. If they decide to send it through with what was dictated or blanked, that is their choice.

Nightmare - Wendi970

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You are educated in your field, right? So would you not be able to determine that, for example, a dictated potassium value of 130 would be incorrect? If you are an MT, you should definitely at least know normal values for most common labs. This is what that crazy 'interim' QA person meant.

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