Suits will immediately appear to tell you this is not happening, - that I am obviously making stuff up. Posted: Aug 7th, 2015 - 2:18 pm
...you decide.
On what I call "training accounts," those where MDs are able to secure contractually lower transcription costs by reading a few inconsistencies into documents in order to help train MTs, there are a few common test elements you can be on the lookout for. The training courses routinely sent out by HR, "It's All About the Numbers," or whatever, those elements are likely the things you will be tested on for the subsequent few weeks (any company has to be able to say they offered training for the things they expect you to know). It means nothing that they do not pay you for these trainings.
You will likely be told you are needed on a particular account because someone quit or there is a hole in coverage on one shift or the other. In all likelihood there isn't. Conversely, in some situations the account only runs OOW from time to time as they bring new people on to "train," leaving the regulars to duke it out in competition for work.
Generically speaking, there are a number of items you can and likely will be tested on:
Left/right inconsistencies.
Dermatology reports: Size of defect 7 mm, length of closure 7 cm. (Get in the habit of googling all measurements, just type in ? cm = inches or ? mm = cm and hit enter. In the example, is 7 cm likely given only a 7 mm skin defect)? NOT. Blank it, as you really do not know whether the mm or the cm is correct!
Grams to pounds especially with regard to infant weights.
Pounds, height, and an out of whack BMI (I have a BMI calculator saved in favorites).
The gravida, para statements, gravida 5, para x-x-x-x whatever. (Make sure you know what all those para numbers mean and whether they are possible given the number of pregnancies the patient has had—and if she is currently pregnant, how that factors into this calculation).
Percentage statements not adding up to 100%. (Examples I saw of misstatements were in sleep center reports by the most mush-mouthed fast-talking MD imaginable in the small WA account. Others appear in percentages of neutrophils, basophils, etc., in a white blood cell count). I saw these in the largish CT account also.
In GI reports you will be tested on your knowledge of the tract – descending will appear on your speech document when the MD is clearly saying ascending. (Which is it? What is it attached to)? Blank it.
Sometimes hemoglobin and hematocrit numbers are switched up.
Diagnoses that are inconsistent with the lab values stated.... hyperkalemia versus a lab value that would represent hypokalemia.
You might see Apgars stated in the plural but then only 1 value dictated.
Catching subject verb agreement is HUGE, not only because you are likely being tested, but also because the MDs have TERRIBLE grammar, but I know you already know that. If the subject has an AND in it, it takes a plural verb form, etc. We seen is never correct. We saw is.
Which words are always hyphenated, which are only hyphenated when used as adjectives?
I was once expected to catch how many leaflets in valves of the heart (of course they really wanted me to mess up consistently so they could justify firing me; they might not go to this length for many of you). The pulmonary valve has left, right, and anterior cusps. The aortic valve has left, right, and posterior cusps. The tricuspid valve has anterior, posterior, and septal cusps; and the mitral valve has just anterior and posterior cusps. These are the CLINICAL lengths to which the company went to trip me up).
Lab values that are clearly out of whack with the expected reference ranges. CK or CPK versus creatine. Glucose level off the chart but no diagnosis of diabetes?
Therapeutic medication levels.
Serum alcohol levels. Docs will say blood alcohol level 2-8-3. This is not typed 283. This would be typed 0.283. Examples ad nauseam.
Simple spelling errors = serosangeneous versus serosanguineous.
they're, their, and there
There are countless other inexplicable inconsistencies. They might purposefully read in a statement saying the patient did not have this and then turn right around in the next paragraph and insert that they did.
Doctors leave off medications in the lists they itemize but then talk about 2 or 3 more before signing off.
Doctors dictate a medication allergy, then prescribe the generic of it to the patients upon discharge.
Doctors complete 2 or 3 additional procedures not listed on an operative report.
I once saw so many sedating medications in such lethal combinations that I laughed out loud. Obvious trap that I did not fall into. (Obviously before he got a lesson in subtlety).
Doctors ascribe the incorrect ICD code or procedure code to the procedures they are dictating.
Famous lack of "pluralization" (is that a word)? of stuff that is clearly BILATERAL or having more than one. Examples: PA and lateral are views plural, not a single x-ray. MRIs is more than one study if it was conducted both with and without contrast.
By the same token, words for which the plural form is always used (adnexa are).
Copy capitalization in MeDICal devices if TRADEmarked that way. (Don't know how or when this got started in the WA account, but it seems to be the valued tradition now). But not so with medications. Utilize some trusted medication resource for capitalization rules regarding medications. I use Saunder's).
Especially with the smallish WA account, there are a multitude of templates utilized fairly routinely (it is how and why it is such a good account). Without exception, these have errors that have NEVER been corrected in all the years I've worked it (many). If you just plug these templates in without proofing them, you are dead. Correct each of these templates just one time, save it into a WordPad document (free software which can be opened as you work in WORD), label it with the number of the template for that doctor, and always plug YOUR VERSION in when that MD asks for it. If you get dinged by some QA audit for anything on it, go back to your version immediately and correct it for the next time!
Google anesthesiology groups in ________, WA. Click them open, save these as favorites.
The smallish WA account has a bunch of midwives—they have their own website from which to obtain correct spellings of names.
They have an orthopedic group and almost all this account's staff orthopods are in this group.
They have a separate site for nurse anesthetists.
They have another site just for their residents.
Their find-a-doc site is invaluable.
The smallish WA account's hospitalists and cardiologists and many other specialties are all members of a nearby group practice/clinic. Look these up and bookmark these sites as well.
Make a file folder on your desktop and add anything that you had to look up even once, paste it there.
Example of one of mine:
MDs dictate Chad Swaims, PA-C
this is really William Chad Swaims, PA-C (I verified this with Healthgrades.com and a couple of other registries).
sounds like Swims or Swimms
Signature line misspelled IN THE SYSTEM as Williams C. Swaims, PA-C (with the s on the William)!
Next time I hear swims, I can quickly locate it in my little file, and pretty soon I have it memorized.
Oh yeah, NEVER EVER BELIEVE ANYTHING a doctor spells out for you. BIG RED FLAG. Famous example in the WA account is
A Talon device for esophageal stricture. A T.A.L.O.N. is something completely different. Stuff like that.
Is any of this stuff what an MT normally does? Yes.
Is some of this stuff beyond the scope of what an MT should be expected to do? Yes.
The company hopes to get the most bang they can out of the pennies per line they pay you. Soooo, this stuff IS expected, or at least it has been of me.
Here's the thing. When you've typed doctors for as long as I had been transcribing these accounts, these inconsistencies stick out like sore thumbs. (These doctors do not typically make bonehead errors). Suddenly they got stupid overnight? Right.
So, by taking experienced MTs off familiar accounts, you are not as apt to catch as many inserted errors (and they can avoid paying out anything over minimum wage). Since they are dummy documents to begin with, they don't really concern themselves with patient safety so much as they like to let on. They just want to keep you on your toes as much as possible and cost you as much money in the process as possible and call it "training" amongst themselves over the conference table.
It is all fodder for FIESA.
--
Respectfully,
Tam
On what I call "training accounts," those where MDs are able to secure contractually lower transcription costs (or something) by reading a few inconsistencies into documents in order to help train MTs, there are a few common test elements you can be on the lookout for. The training courses routinely sent out by HR, "It's All About the Numbers," or whatever, those elements are likely the things you will be tested on for the subsequent few weeks (any company has to be able to say they offered training for the things they expect you to know). It means nothing that they do not pay you for these trainings.
You will likely be told you are needed on a particular account because someone quit or there is a hole in coverage on one shift or the other. In all likelihood there isn't. Conversely, in some situations the account only runs OOW from time to time as they bring new people on to "train," leaving the regulars to duke it out in competition for work.
Generically speaking, there are a number of items you can and likely will be tested on:
Left/right inconsistencies.
Dermatology reports: Size of defect 7 mm, length of closure 7 cm. (Get in the habit of googling all measurements, just type in ? cm = inches or ? mm = cm and hit enter. In the example, is 7 cm likely given only a 7 mm skin defect)? NOT. Blank it, as you really do not know whether the mm or the cm is correct!
Grams to pounds especially with regard to infant weights.
Pounds, height, and an out of whack BMI (I have a BMI calculator saved in favorites).
The gravida, para statements, gravida 5, para x-x-x-x whatever. (Make sure you know what all those para numbers mean and whether they are possible given the number of pregnancies the patient has had—and if she is currently pregnant, how that factors into this calculation).
Percentage statements not adding up to 100%. (Examples I saw of misstatements were in sleep center reports by the most mush-mouthed fast-talking MD imaginable in the small WA account. Others appear in percentages of neutrophils, basophils, etc., in a white blood cell count). I saw these in the largish CT account also.
In GI reports you will be tested on your knowledge of the tract – descending will appear on your speech document when the MD is clearly saying ascending. (Which is it? What is it attached to)? Blank it.
Sometimes hemoglobin and hematocrit numbers are switched up.
Diagnoses that are inconsistent with the lab values stated.... hyperkalemia versus a lab value that would represent hypokalemia.
You might see Apgars stated in the plural but then only 1 value dictated.
Catching subject verb agreement is HUGE, not only because you are likely being tested, but also because the MDs have TERRIBLE grammar, but I know you already know that. If the subject has an AND in it, it takes a plural verb form, etc. We seen is never correct. We saw is.
Which words are always hyphenated, which are only hyphenated when used as adjectives?
I was once expected to catch how many leaflets in valves of the heart (of course they really wanted me to mess up consistently so they could justify firing me; they might not go to this length for many of you). The pulmonary valve has left, right, and anterior cusps. The aortic valve has left, right, and posterior cusps. The tricuspid valve has anterior, posterior, and septal cusps; and the mitral valve has just anterior and posterior cusps. These are the CLINICAL lengths to which the company went to trip me up).
Lab values that are clearly out of whack with the expected reference ranges. CK or CPK versus creatine. Glucose level off the chart but no diagnosis of diabetes?
Therapeutic medication levels.
Serum alcohol levels. Docs will say blood alcohol level 2-8-3. This is not typed 283. This would be typed 0.283. Examples ad nauseam.
Simple spelling errors = serosangeneous versus serosanguineous.
they're, their, and there
There are countless other inexplicable inconsistencies. They might purposefully read in a statement saying the patient did not have this and then turn right around in the next paragraph and insert that they did. (This is not a speech engine generated problem).
Doctors leave off medications in the lists they itemize but then talk about 2 or 3 more before signing off.
Doctors dictate a medication allergy, then prescribe the generic of it to the patients upon discharge.
Doctors complete 2 or 3 additional procedures not listed on an operative report.
I once saw so many sedating medications in such lethal combinations that I laughed out loud. Obvious trap that I did not fall into. (Obviously before that MD got a lesson in subtlety).
Doctors ascribe the incorrect ICD code or procedure code to the procedures they are dictating.
Famous lack of "pluralization" (is that a word)? of stuff that is clearly BILATERAL or having more than one. Examples: PA and lateral are views plural, not a single x-ray. MRIs is more than one study if it was conducted both with and without contrast.
By the same token, words for which the plural form is always used (adnexa are).
Copy capitalization in MeDICal devices if TRADEmarked that way. (Don't know how or when this got started in the WA account, but it seems to be the valued tradition now). But not so with medications. Utilize some trusted medication resource for capitalization rules regarding medications. I use Saunder's).
Especially with the smallish WA account, there are a multitude of templates utilized fairly routinely (it is how and why it is such a good account). Without exception, these have errors that have NEVER been corrected in all the years I've worked it (many). If you just plug these templates in without proofing them, you are dead. Correct each of these templates just one time, save it into a WordPad document (free software which can be opened as you work in WORD), label it with the number of the template for that doctor, and always plug YOUR VERSION in when that MD asks for it. If you get dinged by some QA audit for anything on it, go back to your version immediately and correct it for the next time!
Google anesthesiology groups in ________, WA. Click them open, save these as favorites.
The smallish WA account has a bunch of midwives—they have their own web page from which to obtain correct spellings of names.
They have an orthopedic group and almost all this account's staff orthopods are in this group.
They have a separate site for nurse anesthetists.
They have another site just for their residents.
Their find-a-doc site is invaluable.
The smallish WA account's hospitalists and cardiologists and many other specialties are all members of a nearby group practice/clinic. Look these up and bookmark these sites as well.
Make a file folder (in WordPad) on your desktop and add anything that you had to look up even once, paste it there.
Example of one of mine:
MDs dictate Chad Swaims, PA-C
this is really William Chad Swaims, PA-C (I verified this with Healthgrades.com and a couple of other registries).
sounds like Swims or Swimms
Signature line misspelled IN THE SYSTEM as Williams C. Swaims, PA-C (with the s on the William)!
Next time I hear swims, I can quickly locate it in my little file, and pretty soon I have it memorized.
Oh yeah, NEVER EVER BELIEVE ANYTHING a doctor spells out for you. BIG RED FLAG. Famous example in the WA account is
A Talon device for esophageal stricture. A T.A.L.O.N. is something completely different. Stuff like that.
Is any of this stuff what an MT normally does? Yes.
Is some of this stuff beyond the scope of what an MT should be expected to do? Yes.
The company hopes to get the most bang they can out of the pennies per line they pay you. Soooo, this stuff IS expected, or at least it has been of me.
Here's the thing. When you've typed doctors for as long as I had been transcribing these accounts, these inconsistencies stick out like sore thumbs. (These doctors do not typically make bonehead errors). Suddenly they got stupid overnight? Right.
So, by taking experienced MTs off familiar accounts, you are not as apt to catch as many inserted errors (and they can avoid paying out anything over minimum wage). Since they are dummy documents to begin with, they don't really concern themselves with patient safety so much as they like to let on. They just want to keep you on your toes as much as possible and cost you as much money in the process as possible and call it "training" amongst themselves over the conference table.
It is all fodder for FIESA.
So, for the sake of fun, let's all agree that I am completely off base, crazy, or some other adjective. The info I provided here will help someone on some future account, maybe even the one referred to here, and I will sleep better tonight on my now minimum wage 20 hour per week nonchecks.
And maybe I am not so far off base as believed.
Reply By Email Options
Complete Discussion Below: (  marks the location of current message within thread)
|
