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


Style Guides and the Craving for Conformity - Briana


Posted: Feb 14, 2012

I made a comment regarding the need to recognize the differences between both the processes and the reasonable expected outcomes with respect to the preparation of:

1.  Working trade documents - such as the medical record.

2.  Materials for publication, whether in journals or books.

The comment is here:  http://forum.mtstars.com/378004.html

I'd like to expand on what I said by first making two observations that I believe are highly relevant to this issue:

First, the human being is hard-wired to strongly prefer that which is "familiar" to that which is "different".  Without belaboring the issue, innumerable studies have shown, for instance, that we tend to identify with people who are similar to ourselves.  The reason, of course, is that de facto such people are "familiar" to us.  The phenomenon is found in many other areas as well - even physiological studies showing differences in metabolic rates when subjects are given tasks to perform with visual images of "familiar" versus "unfamiliar" scenes.

Similarity is but a stand-in for familiarity, and conformity is but a continuum scale for similarity.

Absolute conformity ----->relative similarity -----> Nonconformity

POINT:  People who have power over such matters have great difficulty resisting the temptation to require greater and greater levels of conformity, because "differences" arouse anxiety in the primitive brain. There are many people who find any deviation whatsoever to be quite "jarring" to their sensibilities, and these people unfortunately often wind up on the committees that create specifications of one kind or another - such as "style guides".  The reason they do so is because it is in their nature to gravitate to positions where they have a degree of power over "nonconformity" - the power to narrow gradations of "difference" to zero (they hope).

But, for a given situation, there are differences that are important, and those that are not.  It is, perhaps, one measure of mental health and maturity to be able to differentiate between them.

Which comes to my second point.  There are differences and there are DISTINCTIONS without any (real) difference, by which I mean a difference that has a measurable practical impact on any other outcome.

An example from the Web might help illustrate this point.  Colors on the Web are often represented by numeric values for red, green and blue (or RGB).  A particular color, for instance, might have the values of 157 for red, 16 for green and 235 for blue.  Let us say that a "different" color has the values 158-16-235. 

But, is there really a difference between the colors, or is this a distinction WITHOUT a difference?  Here, the purposes for which the color is being used must be considered.  If we are representing this color to be viewed by a human being on a computer screen, the human eye is utterly unable to distinguish between these two RGB specifications.  For our purpose, then, we do not have a difference, but a mere distinction without any (real) difference.  On the other hand, if we were doing commercial design work of certain kinds, the difference might not be a mere distinction.

The drive for conformity carries with it all manner of costs, both direct and indirect, and the greater the degree of conformity demanded, the more rapidly those costs mount up.

And this is why we have something that is referred to as "tolerances" when we design things.  If you required a machine shop to manufacture a case for your product, you COULD specify dimensional tolerances down to any decimal point you wished - if you want to PAY for it.  But be aware that both more expensive machinery and a higher level of machinist skills will be required.  These are direct costs. 

And these direct costs to manufacture your case would only be the start of what you'd pay.  There would be a higher number of rejects, for instance, and that in turn would increase your cost of both materials and labor. Reworks would raise your labor costs. It would be more costly to perform quality control tests on your gear, and hence those costs would rise. There are other indirect costs that could be impacted as well.  Every one of these costs will be reflected in the price you pay that machine shop for each and every case they deliver.

Now, imagine the shop floor with piles of rejects waiting for the scrap metal dealer.  Other piles are awaiting rework. The pile of "accepted" cases grows slowly - and at a cost of $25.60 per case rather than $2.80 if they were built to reasonable tolerances.

And now suppose that all of this was utterly unnecessary because cases built to a much less stringent set of specifications would have worked perfectly well, and the cases built to your extreme tolerances are not DISCERNIBLY any better, or more desirable, in any PRACTICAL way.

"Style guides" - when treated as such - become specifications, and every individual specification carries with it both direct and indirect costs, and the opportunity for "failure".  It would seem important, then, to insist that there should be some demonstrable practical value in each and every specification, or else question the reason for its existence.  Certainly, we should be unwilling to pay any unnecessary costs associated with specifications that amount to "a distinction without a (real) difference".

 

 

 

 

 

 

you lost me - sm

[ In Reply To ..]
The good news is, I think with a few tweaks to your verbiage, you could quite easily write the Medquist (now MModal) Marketing e-mails... Whole lotta round about talk and not directly to the point, clear, and concise.

I'll post a Cliff Notes version when I get a minute. - Briana

[ In Reply To ..]
I keep forgetting this is a generation of sound-bites. Thanks for the reminder.

oh really... - got issues?

[ In Reply To ..]
A generation of sound-bites huh? NO, I THINK NOT. I am pretty certain that I top you in age by at least 20 years. Take a hike, Ms. Bully.
I should have said "culture". My bad. - Briana
[ In Reply To ..]
But whether "generation" or "culture", it's obvious that my original post challenged your attention span, and for that I apologize.

Incidentally, unless you're in your 70s, you don't top me in age by 20 years. I can't think why that's relevant, but now you know.
not talking chronological age, hun. - but you earned my thumbs down.
[ In Reply To ..]
Arrogance is not a virtue, too easily confused with sma'assm.
Neither is ignorance & hostility. - Oy vey..........
[ In Reply To ..]
NM
I see your thumbs down and raise you - a thumbs up. sm
[ In Reply To ..]
If you can't follow the conversation, go sit at the kids' table instead of playing with your food. The adults wish to talk.
lol - it was a figure of speach!! lol - thank you, made my day!
[ In Reply To ..]
.
Not encouraging an MT can't spell "speech" correctly... - nm
[ In Reply To ..]
x
LOL - wheres_my_job
[ In Reply To ..]
nm, just LOL

Briana - Letitia

[ In Reply To ..]
Do you have to make yourself feel big by belitting others? You need therapy, hon.
You again? - nm
[ In Reply To ..]
x
Letitia - sm
[ In Reply To ..]
Calling someone you don't know "hon" is what's belittling.

Why the "hon" - wheres_my_job
[ In Reply To ..]
more internalized sexism displayed by MTs - sweetie, hon, all ways of infantalizing women in the workplace. Hey, anything to help drive wages down!
Here's the hon - xxx
[ In Reply To ..]
Well, someone has to add some sugar.

Style guides - Mg

[ In Reply To ..]
Could you repeat that please?

Sure. - Briana

[ In Reply To ..]

"A foolish consistency is the hobgoblin of little minds, adored by little statesmen, philosophers and divines." - Ralph Waldo Emerson


Every "specification" or "requirement" in the production of anything costs money, both to implement and to enforce.  As such, the specifications we use should be those that matter, and not those that bring no demonstrable benefit to the product - merely for the sake of "a foolish consistency".


 

Briana - Nick

[ In Reply To ..]
Whatever meds you're on, change the dose.
Doesn't get much more infantile than this, "Nick". - sm
[ In Reply To ..]
A better question might be to ask just how many personalities you have on this forum, and are all of them this nasty?
Jeez, what is WRONG with you people? That was - an interesting and intelligent read! (sm)
[ In Reply To ..]
(FOR A CHANGE!)

Up until the time I started reading Briana's posts, I was starting to think most MTs were a bunch of knuckle-draggers.
Yep, most ARE. - Reader
[ In Reply To ..]
You are correct: Most MTs ARE knuckledraggers! It wasn't always that way, however -- back in the 80s and 90s they were smart coookies! Now they're just as ignorant (or more so) than the average Joes off the street.

Briana's posts are erudite, insightful, informative, and entertaining! She is one of a kind and a REAL asset to this board. I look forward to reading more from her!

Bravo! - Briana

[ In Reply To ..]
...and here I thought I was the only one that regarded the BOS as a Bunch Of S.... Good for you! Keep it coming.

Style Guide, have you heard of... - justme

[ In Reply To ..]
The customer is always right, whoever signs your paycheck is right, and professionalism?

I follow my clients' instructions to the letter (including such things as 1 space after a colon or 2 (as they are paying for my services) and adhere to the BOS, even sending my clients copies, so they are aware of why I transcribe certain items a certain way, and I have more work on my desk than I know what to do with, with a waiting list for new clients.

Briana - Curious

[ In Reply To ..]
Do you have delusions of being a professor or something?

Dear Just Curious - Briana

[ In Reply To ..]
I've never suffered from that particular delusion but I suppose it could be cultivated.

If you should ever suffer from the delusion of wanting to learn something, let me know and I'll give it a whirl...

thats funny - nutti

[ In Reply To ..]
because if I came to you to learn, my two professor parents would equate that to joining Jim Jones. LOL

It's not delusional if you could actually do it - wheres_my_job

[ In Reply To ..]
do we think so little of ourselves as MTs????

Sarah Palin couldn't have said it better - wheres_my_job

[ In Reply To ..]
All the negative posts re: Briana's musings, remind me of what they said of Sarah Palin - that she was "intellectually incurious." She wasn't interested in learning anything, incapable of taking on a new viewpoint or perspective...just the same old same old mass of unconsidered opinions and lazy thinking swirling around in the old noggin' you betcha etc...

No wonder there are no MT unions...that would take an act of the imagination and a curiosity about how the world works, labor history, etc...and apparently...people just like the same old same old...style...of being an MT...intellectually incurious....conformity...narrow tolerances...intolerance for new ideas...there's a symmetry there, between the insane "style guides" and the insane "style" of working conditions and wages we suffer...or specifications...are set so narrow...instead of wide tolerance wage-wise, say, 4-10 cents a line, we have a very narrow tolerance paywise, that is 4 cents. That's it, no raises, no shift differentials, ever.

Hmmm...

Now, THIS is good. - nutti

[ In Reply To ..]
There is a reason SP isn't in office, and it is not because of she is an intectual giant. LOL

I understood and liked your post. It points out some - of the reasons we humans are such sheep! (sm)

[ In Reply To ..]
I have the same issues with all the "style guide mania" that has become the norm in the MT field.

Especially when, such as my company for instance, the MTSO tells you an account must be verbatim, then sends you "warnings" because the verbatim report you just typed wasn't in the King's English.

OR, on the flip side, they dump reams of style instructions for each account on you, expect you to read and memorize them, and yet when you follow them, and change an "a" to an "an", or insert a comma or a semicolon where it belongs, in order to keep a sentence true to the meaning the doctor intended, you're written up for THAT, too.

Never mind that the doctor can't remember whether the patient is a male or a female, or whether or not they were allergic to penicillin (he prescribed it, anyway!), we just better be sure we follow their random and useless "style guides" to the letter.

WHO ARE YOU?????????? - wheres_my_job

[ In Reply To ..]
Dear Briana,

That is the best thing I have ever read on MTStars - it also ranks *quite highly* on my list of best things I've ever read, period (and I read a lot of different things). Oh thank you, thank you, thank you for feeding my brain with something intelligent, in a work environment close to devoid of anything resembling intelligence (human or artificial or extraterrestial).

Sincerely,

MT on her way OUT of MT'ing.

reading - ha

[ In Reply To ..]
That reading list and social circle must be very limited.

wow - wheres_my_job

[ In Reply To ..]
have a nice day too :)

I love this board!!! - Happy MT Robin

[ In Reply To ..]
Most of the time, anyway, I love this board. Here we have a woman who posts generally very interesting, sometimes very funny, extraordinarily well written posts for what I am assuming is her pleasure and then ours. Can't imagine why she would do it if she didn't like it.

The best part of all of this is she gets attacked!!!! This right here is why no union (not that I would ever want one, mind you) would ever, EVER work in the MT field. It doesn't take hardly much at all to have us turning and eating our own young.

Here's a really good suggestion. Since Briana always posts under the same name, if you don't like the her essays, DON'T OPEN THE LINK!!!

It is call the dumbing down of the - MT profession. nm

[ In Reply To ..]
.

Our profession is why we eat our young? - Happy MT Robin

[ In Reply To ..]
Not sure what you mean by your statement.
Not sure, but... - Thoughts
[ In Reply To ..]
That wasn't my post, and I don't presume to be a mindreader.

However, I think I can follow the logic there: MT has been so dumbed down that intelligent posts such as Briana's intimidates most MTs. Feeling insecure, they go on the attack, viciously assaulting the messenger.

If that is off the mark, then hopefully I will be corrected in short order. :)

@Happy MT Robin - You hit the nail squarely on - the head! MTs are a cannibalistic lot.

[ In Reply To ..]
<- Nonlinear ->

people - thinker

[ In Reply To ..]
I read the first para of this stuff and I asked myself, who has time to write all this? The answer came when I see how much attention and amniosity these posts are causing. Then I formed a distaste for such. And, yes, I am a learned person, blah, blab. Do you care? Geesh, I hope not. I bought that life at Wally years ago. Just a FYI. They're still on sale.

I don't understand all the animosity - sm - NYMT

[ In Reply To ..]
I just read through all the comments (yeah, I should be working, but we all know about procrastination), and am astounded that such a well written essay should raise such ire! For some reason, I sense a lot of defensiveness, as if fear is driving the negative comments. But fear of what? Independent thinking? Total anarchy in the absence of Standards? Not being able to function without someone to micromanage every move they make?

I enjoyed the read very much, and see your sensibilities as refreshing and a touch of sanity in a world where we're expected to be more robots than people. Take the humanity out of what we do and get VR. I'd like to see what would happen if they had to rely on nothing but VR for a week!

no - its her delivery that rubs people negatively. - not the message

[ In Reply To ..]
Even as satire, these writings come off as more a know-it-all, look-at-me, I'm better than you, arrogant design through a way-overdone attempt at creativity that only serves to drown out the point of her posts and any chance of being taken seriously.

And she hoggs the whole board pretty much every 2 - 3 posts with this babble that gets old real fast. She has done this before only her attack was much worse in the response to criticism, went away either banned or fed up, and now to our (THIS is sarcastic --->) overwhelming delight...what's that Elton John song? The B is Back.

I might add - she visits no other forum here for the sake of MT-ing, just the main board to editorialize.

I like people like that... - wheres_my_job

[ In Reply To ..]
know-it-all
look-at-me
I'm better than you
arrogant

maybe it's just self-esteem and confidence? I love to read editorials, I love to hear other people's opinions, especially when they can present a reasoned argument. With humor as an added bonus! Not seeing what the negativity is about - don't like it, don't read it. Or maybe...you realize you yourself could step things up, and take a more cohesive view of things...reason things out...instead of just being at the mercy of the MTSOs, and let THEM reason things out (pay cuts, loss of benefits, etc).

Isley Brothers: "Fight it/fight the power"

I agree, it was her delivery and not her message - DM

[ In Reply To ..]
I actually enjoyed some of her posts until she went over the top. Since she hasn't been dominating the board again today, I'm guessing she has been banned. Of course, I could be wrong.

NYMT - Old Pro

[ In Reply To ..]
I read her, too and think she is plenty smart with a lot of good things to say. If she could just balance that with a little kindness and a little less condescending attitude, I think she would be more accepted. Again, she is plenty smart and has a great message--unfortunately it sometimes gets lost with the layer of attitude. JMHO.

Thoughts... - Bravo

[ In Reply To ..]
That was VERY well done, Briana! You raised several salient points.

I think the *COST* factor should get EVERYONE'S attention! Time is MONEY, and how much TIME is wasted over minutiae that have absolutely NO bearing on patient care?!

A couple of additional points come to mind:

You wrote: "People who have power over such matters have great difficulty resisting the temptation to require greater and greater levels of conformity, because 'differences' arouse anxiety in the primitive brain. There are many people who find any deviation whatsoever to be quite 'jarring' to their sensibilities, and these people unfortunately often wind up on the committees that create specifications of one kind or another - such as 'style guides'. The reason they do so is because it is in their nature to gravitate to positions where they have a degree of power over 'nonconformity' - the power to narrow gradations of 'difference' to zero (they hope)."

Very true, but I think there are a couple of other things at work here as well. There is an old adage, "Absolute power corrups, and absolute power corrupts absolutely." Many who seek out these positions crave power just so they can throw their weight around and "lord over" others. Serving on a "standards" committee such as HL-7, the BOS editorial board, etc. allows them to carry "weight" and have additional "stature," which in turn feeds the ego. Also there is RELEVANCE. Once formed or hired to address standards, a committee or employee(s) will then need to PRODUCE something in order to justify their being on the payroll. Frequently this manifests as pages and pages of unnecessary material ("overkill").

I look forward to reading more input from you!

~A Lateral Thinker~

I bravo you Bravo - wheres_my_job

[ In Reply To ..]
"lateral thinker" - I'll have to remember that. Sounds better than "swampy headed" (my preferred moniker so far) :)


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