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

A little rant from me today. - Rant Lady

Posted: Mar 07, 2013

So, I got chewed out by QA because a doctor dictated a lab value INCORRECTLY! It was a genetic lab value, not your normal CMP, CBC or anything like that. He DICTATED the value and I TYPED the value. The dictator stated that this was a normal value. He was quite clear in his dictation and I typed what I heard.

QA got all over me and said that lab value was incorrect, and not normal, so regardless if he dictated it, I should have flagged it. I told her it wasn't a lab value I had heard of and his speaking was very clear, so I had no reason to think it was wrong. She told me that if I wasn't familiar with a lab value, it is MY JOB to look this up! I mean, for real? It is MY job to check behind the doctor to make sure that HE knows what he is doing, while all the while not getting paid a dime for my research time?

This industry has gotten crazy, to say the least!

To me this sounds - like yet another

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"take this job and shove it!" moment which are becoming more and more the norm rather than the exception. So now we (minimum wage peons) are now supposed to know all lab values, drug doses, ranges for studies, etc. Yeah right.

I have been getting the same thrashing, with - the changing of words to

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from what the dictator dictates to be be gramatically correct. Since when?? We have always been told to type what the dictator states, NOW they are changing it and pouncing on every grammer word to make sense. I type what the doctor says. If he is wrong, start there? I dont have time to go back and back and back to check.

I hear ya, Rant Lady! - OHMT

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Doctors go to school for many years to learn all that stuff. Most of us have attended a one- or two-year course. Remember the days when the doctor was ultimately responsible for the information on the report? But now they've made it OUR responsibility to make sure the doctor hasn't made a mistake. Seems a little backwards to me, especially when we're talking about an obscure lab result.

Don't get me wrong, I take my job seriously, and if the doctor says to give 100 mg instead of mcg, and I know the dosage should be mcg, I'll flag it. But I do think it's ridiculous that they expect us to know as much as (or more than) a doctor who has had years of schooling and training (and the paycheck to show for it).

Ranting - BTDT

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It has always been the job of the MT to research and confirm things that are in question. I've probably been an MT a lot longer than you, and no one ever told me they'd pay me extra for my research time. Hey, you might actually learn something. I know I'm in the minority, but refusing to do things that are part of your job because you don't think you are paid accordingly is a bad attitude. I bet 99% of the US work force doesn't feel they are being paid well enough to do things they may not necessarily consider to be part of their job. FYI, I'm now a QA person and I don't feel that I should have to correct stupid mistakes left by others, but hey, it's my job.

Just a question.... - sm

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How was she supposed to know it was in question? The doctor clearly dictated it. I am pretty sure it is not our job to question the doctors, as they are the ones making the big bucks and have the education. Do we question diagnoses and treatments as well? Obviously, if you know something is questionable, you flag it, but otherwise you could spend all day just looking things up because you are not an expert in them. I am pretty sure we don't get paid for that. At least I don't.

I'm also pretty sure - that if we took on

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second guessing everything that was in a report, we would be told not to. This is what the original post was about, not knowing a few basic values.

99% - of the

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work force aren't getting paid what they should for doing their job, but that was not what the poster was ranting about. FYI, I shouldn't have to have a QA person fix mistakes that aren't mistakes or fix my mistakes wrong, but it happens. My job isn't to research everything the doctor says to verify he is correct. My job is to type what the doctor says and if it is an obvious mistake, I flag it.

QA - Me

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Well, technically, it is your JOB, as QA, to correct the mistakes of MTs, regardless of how "stupid" you find them. My job is NOT to correct what a doctor says, when he says it clearly. If the speaking was garbled and I couldn't understand, then yes, I should look it up, but otherwise we are supposed to type what we hear. It is not my JOB to be fully educated on rare lab values, medications, etc. and have more knowledge of this than the doctor does. That is ridiculous!

You are incorrect - sm

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Flagging an obvious error on the doctor's part is done as a courtesy by the MT. We are not required to do this. We are supposed to type what they say. We do not have the education or the backing to dispute or question what a doctor dictates.

Most doctors specialize in one field. MTs have to work ALL fields and all specialties. To assume that we should have knowledge of every single lab value, every single disease, every single medication is insane! If a person was strictly typing for a genetic clinic, then maybe it would be more realistic that she should know the values, but we type for ALL clinics. Even a doctor doesn't have to have that vast of a knowledge base, why in the world should we? Your post implies that an MT should be even more educated than a doctor, give me a break!

yeah well the rest of the world - gets paid by the hour

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and no I don't mind doing a little research, but I also have to make a living. If I was paid by the hour, I imagine I'd spend more time researching than I do. You have to strike a balance.

I've been an MT for a very very long time too - Sort of Disagree with you

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It has always been our responsibility to get down on paper what the doctor says accurately. It is not our responsibility to "fix" his dictation, and we should not. In fact, we are doing him a service when we catch mistakes. Of course we do need to make sure we are typing what he says accurately which occasionally is going to require looking something up, but it is NOT NOT NOT our duty to spend exorbitant amounts of time researching something; certainly back in my hospital days when I was being paid by the hour, it would have been frowned upon to spend a lot of time doing research, not only because of the cost to the hospital but because of TAT. I will not spend any more time on my dime doing research than I would have been allowed to do when I was being paid by the hour by the hospital. That being said, of course it is necessary to keep current, and that does require looking things up from time to time, or confirming what you think you know but are not sure. Also, our wages have gone down, down, down. Back in the day when I started working at home for 12 cents a GROSS line, the research time was factored in the cost, but now-a-days, it is not. I can't afford to spend much time in research and neither can anyone else. If the hospitals/doctors want cheap transcription, they are going to have to fill in the difficult blanks.

You are right about that. Our job description has - changed right along with

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our pay. We no longer have the time to research like we use to. I still research, but within reason. I will not spend 15 or 20 minutes doing research for a report that I may be lucky to make $5 to $7 bucks on if that. If I cant get it in the first couple of tries and I have made at least one or two attempts to google or open a word book, I put a blank and move on. No one has that kind of time anymore when all you're making per line is 4, 5, or 6 cents and in some cases 3 cents.

We are now only being paid to edit and proofread these documents and thats it. Of course we still do our best to assure accuracy, but the days of spending 10 and 15 minutes on research are over.

Job description changed - BTDT

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I completely understand what all of you are saying in regard to being paid for what you produce. I agree, that spending a lot of time researching cuts into one's income. I can remember (as many of you probably can as well) when a day did not go by when we had the opportunity to learn something new by doing a little research, or giving an "ear" to a co-worker. It is fine to leave a blank, that is honest. I QA on site for one facility and I can only judge by the work I get back; much of it is carelessness and much of it demonstrates that they just did not want to take the time to figure it out and it does get frustrating because I know that they know better but just didn't want to be bothered. It is not just MT, it is the work ethic these days that bothers me. How would you feel if you went to the grocery store and the checker only rang up half your groceries or the courtesy clerk quit in the middle of bagging because they "weren't paid enough" to handle large orders? Who told you that you were only being paid to edit and proofread; I haven't seen that in anyone's job description lately. I'm not trying to put anyone down, but QA gets it from all sides too. Personally, I don't think I get paid enough either, but I do my job and do it well.

"Who told you that you were - only being paid to edit and proofread"..sm

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You ask, "Who told us we only get paid to edit and proofread?" I think the line rates speak for itself. Suppose you are one of the ones who only make 3 cpl and you only managed to produce 200 lph, you would only make $6 dollars per hour, if you made 4 cpl at 200 lph you would make $8 per hour, there are a few of us who are lucky to make 5-6 cpl per hour which at 200 lph would average $10 to $12 per hour. Of course thats a lot better than $6 and $8 and many of us probably edit more than 200 lph, but if we spent the time casually researching like in the days of old 200 lph is probably the best we could do.

Personally, I dont have issues with QA even though I refuse to spend a lot of time on research. I have been told by management and quality coaches to not spend too much time trying to fill in a blank. Fortunately for me (and Im sure many others) I have been doing this long enough that I can get by with very little research.

If you think research time is factored into those line rates than no offense, but I believe you are sadly mistaken. You also have to think about all the clerical work that goes with our jobs such as adding CCs, looking up correct patients when doctors enter the wrong medical record numbers and whatever else the account profile requires of you.

By the way, most companies require that you produce - enough to at least average...sm

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minimum wage. Do you honestly think someone making 3 and 4 cents per line has time to spend doing a bunch of research? Especially if they only have a couple blanks. I dont think so. Bottom line, not only do they have to make rate, but they have an hourly dollar amount to maintain in order to keep their job. Sorry, but its a dog eats dog world and people have bills to pay and mouths to feed. No MT I know is going to purposely send a report through to the client with a bunch of blanks thats of poor quality, but nobody in their right mind is going to spend 20 minutes on research when all they are being paid is 3 and 4 cpl.

It was not in question. the doctor clearly dictated it - and said it was a normal value

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I'm with the OP. If it's not a value I'm familiar with, I don't look it up if the doctor clearly states it. That is one of the reasons I ended up leaving what was to become Nuance. For 4 cpl, I edit what the doctor says. If I recognize something as incorrect I'll flag it if I can, but if it is clearly dictated and I don't recognize it...it's on the doctor, not me.

just curious... - sm

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was the value something like 4 vs 40, 8 vs 18, vs 80? Numbers can be very difficult to hear, and if you are not familiar with the lab value it can be easy to mistake the number. If I didn't know the normal range for potassium, for example, I could easily hear 30.5 instead of 3.5.

No, he said normal at 3 and normal was like (21-50) - NM

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x

there you go... - sm

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It's more than likely that he said normal at 30. Not 3. You HEARD 3. It doesn't mean that he SAID 3. Just because he said "normal" doesn't mean you heard him correctly, right?

He said 3 and QA confirmed he said 3. - sm

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The whole issue was that I should have known that wasn't the proper value. According to her, he meant to say a whole different test was performed and THAT value was 3.

wow. Your QA must be part of the psychic hotline - sm

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just curious - do you recall what the doc said the value was for? And what QA said the doc meant?

You "heard" normal at 3. Doesn't mean that's what he said. - nm

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It was never a question of what I heard, QA heard the same thing. - nm

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x

why are we quibbling? - QA is wrong

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you are not responsible for looking up every lab value to find out if it's correct. That's just all there is to it.

changing lab values - on the other hand

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It is danged if you do, danged if you don't. (I'd like to use usual word for "danged" here, but I am not sure it would be allowed.) I do leave blanks in lab values when it is very very obvious that the doctor has mis-dictated, and danged if QA doesn't come along and fill in the wrong value! How I wish I could back to work in the hospital where my judgement was trusted, not to mention being paid for my time when it did become necessary to do a little research. Things are not good for us, but it is worse for the patients.

I've had the same - happen to me! nm

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!

I worked clinical hem/onc for 28 years... - Still old still cranky

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So believe me, I know my hemoglobins and hematocrits, and can tell if they've "flipped" the values. Nonetheless, my former team lead told me, in this and any other similar case, don't change what they said, but flag it as a possible discrepancy and send it in that way, because on the less-than-1% chance they're right and I'm wrong, guess who's going to get thrown under the bus; hint, it will NOT be the doctor. I remember a very clearly-dictated metoprolol dosage of "500 mg" and I said no freaking WAY, the patient would be in the ICU if not already dead, I flagged it and QA said "Good catch!"

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