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

The ESL nightmare: - What Id like to know is this: sm

Posted: Dec 26, 2009

All MTs (and I'm sure that would include Indian MTs, as well!) waste time and lose money struggling with ESL dictators. It would certainly seem to me that patients of these doctors are at higher risk for medical mistakes because no one, including their co-workers, is entirely sure what they heck those people are saying.

So why don't they simply dictate in THEIR OWN NATIVE LANGUAGE, and have that work transcribed by MTs who are also native speakers of that language? All these Indian doctors should be dictating in their native tongue, and then let THAT work go offshore, if need be! Spanish doctors should dictate in Spanish, etc. And American-English speaking doctors' work should be transcribed by English-as-a-first-language, American MTs. That way EVERYONE's production would go up, mistakes would go down, patient care would improve, etc-etc.

I've been wasting hours of my valuable time (not to mention all my work getting out of turnaround, and the doctor getting a veritable Swiss cheese returned to him), because I just can't understand what the frick this guy is trying to say.

While I share your frustration, since over 90% of my dictators - SM - sm

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- are ESL, there's no way that your proposition would result in fewer errors. Would you really want some MT in Mumbai translating Hindi into English before insertion into your medical record? Seriously?

Isnt Hindi-to-English pretty much what we get anyway, - whenever US dictation goes offshore? Seriously.

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Only if you don't know the difference between an accent and a different language. - nm

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nm

What I meant is, an ESL person reading a report in - English has to first translate in their mind

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before they speak. Just the same, the ESL person transcribing has to do something similar, only in reverse. Either way, I think it's a dangerous practice for something as sensitive as a medical record.

i complained of exactly the same thing tonight - Detesting most .....

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I was really doing ok and then had ESLs who dictate for American physician who speaks plainly and this blanky-blank was saying thinks like "The patient were ...." Used the wrong word each time and just makes a mess. It took so long to correct the baloney, costing me to slow down and lose money. I told hubby no use in all this and I agree with you. We are told NOT to change their dictation, to leave as it and IT IS NOT CORRECT in the least.

The ESL nightmare - notsonewbie

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Since the ESL docs are composed 80 to 90% of my work for an acute care hospital, I am not complaining. Otherwise, I would be out of work. I just slow down the speed, give blanks to the repeat offenders who have been told about the way they dictate. Repetition of work of the same doctor will make you more familiar with the way they dictate. What I do wish, though, is that these doctors take a course to reduce their accents. There is such a thing and they out of all professions can afford such a course.

I think all doctors should - be required

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to take a course about how to dictate in medical school. I know there is no such thing, but there should be!

I also think all docs should be required to do medical transcription for at least 1 full day so they understand what it is really all about. I think most of them don't even realize there is a human being on the other end that has to listen to all their mumblings, eating, peeing, driving, beeping machines, conversations, etc.

I would like to know the ratio..sm... - ESL

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between US doctors and ESLs.

Even ESLs have to stick to certain English terminology.

Interestingly, MOST of my ESLs are actually very good. - CrankyOldBroadOnTheBeach

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Most of them try very hard to speak clearly and properly, and I have nothing but the highest respect for a doctor who is practicing medicine in a language not his or her own. And most of them use near-perfect syntax and sentence construction; it's the creative ways they pronounce some of the words (putting the emphasis on the wrong sylLABle for instance) that throws me off. But I take copious notes on their quirks so the next time they hit me with that word, I'll know what they're saying.

My very WORST dictator is a native English speaker who can't be bothered to (a) speak directly into the telephone or (b) actually say all of the syllables in the words; he just "blurs" some of them out, and nobody has a CLUE what he's saying. I'll take just about any of my ESLs ahead of him, any day.

But, of course, there are the stinkers. The other day I had one of the difficult ESL docs trying to dictate QUIETLY in a noisy nurses' station, or something. I waited in vain for her to holler "SHADDUP!" at the yakkers, and wished she had taken herself to a hidey-hole to do her dictating....

So irritating for me to sit and try to muddle through - Sore spot

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when a dictator makes most things pleural, until you need it to be and then it is not, such as the patient has left leg amputations, high blood pressures,right arms and that is just for 1 patient. On reports that need pleural, not done, such as the patient mother. So very irritating to fix all this. Rather than hold in high regard, I think the vast majority should accept the fact they are not understood by most and have someone else dictate for them. I am just not amused in the least by dictators who pronouce the syllables wrong and cause me to lose money. I work on VR and straight and things that slow me down do not make me happy in the least. We were taught years ago to clean up a dictation only to be told now to leave as is? The dictators use the wrong verb, just leave? I put myself on fast forward and to be slowed down by people who stumble over medication pronunciation 3 or 4 times somehow is just not what I find to be a laughing manner.

Thanks, Cranky, for once again balancing out the hostile noise. SM - MissIndigo

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For sure, people who don't enunciate words clearly for ANY reason do slow us down; but if they were all good, line rates would drop as we sped up. So it's falacious to pretend the guy with a mouthful of hamburger is costing us money. And, of course, clear ESLs bring the average up the same as clear EFLs.

Look, guys, we all understand how some people feel about people from other countries. Some of my friends here in Georgia believe passionately that our country is and should be mainly made up of people who look, sound, feel, and act like them, who agree on their rules for living and share their religious faith. But this nation of immigrants was never, ever that way, and in these days when people flow around our planet by the millions every year never will be.

Those of us who find our world community of peoples fascinating and wonderful, and our country wonderful in its reflection of them, are fortunate--because transcribing dictation, regardless of where the clinician went to university and medical school, is THE job and ability to understand someone dictating through a slurp of coffee THE defining skill.

This won't change, and I strongly recommend trying to come to terms with it. Determining to take pride and satisfaction in being able to transcribe almost everything that comes along is a very effective way to get happy.

For those few for whom indulgence in dissatisfaction is too satisfying to give up, however, elsewhere await many, many forums where this sort of discussion is not cramped by limitation to talk of transcription.

Also in Georgia and do not care about those around me - Sore spot

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I do not see why I have to come to terms with someone who cannot speak good enough English when it costs me money. I can and do get through most of it gritting my teeth as I go. I do not care the color of your skin, your nationality, your faith, makes not one bit of difference to me. What I care about is how long it takes me to correct a person's English and slows me down so I am not making the salary I set for myself each and every day working. Clear ESLs versus English with mouthful of marbles? At least the English are not making pleurals out of every word.

LIne rates would drop as we sped up? - You talk like an MTSO-sold out?

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I really can't agree that ESLs are a good thing because they keep our speed handicapped and slow. You seem to be saying there should be a cap on our earnings and if some of our stumbling blocks were removed, it would be another excuse to lower wages yet again. Seems to me the more we typed the more profit for the company because the accuracy, TAT and reputation would be better. But I guess we see the result of that at Wmx, don't we? It appears you have bought into our company mindset that MTs don't deserve to make more than a certain amount, and when they do, we must devise a way to tie one hand behind their back and "level the playing field", again, and again, and again.

I am very disappointed in you that you are trying to tell us that ESLs don't cost us money - they DO cost every MT that struggles with them money (unless she's hourly). Have you become part of the corporate spin machine that tells us bad is good, poverty is riches, and VR is our friend? Corporate doublespeak doesn't become you. I used to have respect for your posts but lately I see you have sold out bigtime for whatever reason.

Don't deny our reality as "fallacious". We can't ALL be good at EVERY type of ESL, or some of the mushmouth Americans that are deliberately horrid. Telling us they don't cost us money and they are necessary to keep our speed down is hogwash, and we all know it.

I often wondered if it was a cultural thing - dictating in middle of zoo

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You know, it seems like some ESLs deliberately choose the loudest spot in the hospital to sit and whisper dictation. This is always a pain, especially when your headphones/speakers can't get any louder; and the next job you get at normal volume blows your head off. Alternating between whispering and shouting all day is enough aggravation all by itself.

I've got an American that blurs his words too, and I agree he is the worst. However, some of my ESLs are really bad as well (oriental Elmer Fudd, anyone?), and even though I can type them and eventually get some of their phrases into my expander, the added stress leaves me exhausted and wishing laryngitis and worse upon them so I could just get one lousy productive day for a change.

we say Asian - nowadays

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is there a reason you link culture and zoo in your post regarding ESL speakers?

?Looking for a reason to correct someone? - zoo=the background

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And what do we call Elmer Fudd nowdays, since YOUR job is to teach ME political correctness? Obviously I need all the education from YOU I can get. Please, oh please, let me run all future posts past YOU first in case I might make (in YOUR opinion) a mistake, oh great and perfect one!

I don't give a flying flip what "we" say nowdays. I was not intendng to offend anyone, but thanks for stepping up to the plate and getting offended anyway. Happy new year.

I still wonder what "culture" has to do with it - - oops

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Believe me. I don't think it's my job to teach you anything.

It's a respectability thing, keeping this board nice so - people will want to come chat.nm

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x

Because SO many ESLs tend to do it - no PARTICULAR culture

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CULTURALLY I question if some people feel more comfortable in a loud crowd vs a quiet room. I know many ESL docs (other types than "asian" BTW!) that deliberately pick a place to dictate that sounds like the middle of a party (there, is that more PC than "ZOO"?!?) and then they WHISPER. As if they are trying not to make too much noise and either be overheard by or disturb all the shouters, screamers and cacklers surrounding them. They seek out the same lousy dictation station every day, despite numerous blanks sent back to them marked "background noise" or "audio"!

Now, if I get a similar problem with an American doc, it is temporary because they will pay attention to the feedback and MOVE to a quieter workstation, so I am assuming they WANT to receive a decent report. Not so with ESL docs - no amount of feedback makes any difference - they head to the loud place like a homing pigeon! There are plenty of them that COULD get reports without blanks - and they DO get decent reports on the rare occasions that for whatever reason they cannot sit at their usual spot and are forced to find a better environment. However, receiving all their reports complete that day as a result of the change does not matter-tomorrow they'll be right back at the loud place getting blanks. So logic would dictate they care MORE about being surrounded by raucous people than they do the quality of their reports. They can't seem to notice or acknowlege the difference between "I can't understand your accent" and "I can't HEAR your dictation", and it appears they frankly just don't care either way, they will NOT make the effort to receive better reports.

So why not? Arrogance? Fear of small dark spaces? Indifference? Martyrdom ("I am ESL so I'll ALWAYS get blanks, its just my fate")? Utter selfishness "the world must accommodate to MY habits and deal with them"? I'm leaning towards this last one because how could patient care matter to someone that behaves like this?

If I was inhouse I would go find them, get them to come to my workstation, and ask them to listen to what I am hearing, and point out that WHERE I found them dictating is the problem. Then maybe I could make them see the light on an individual basis.

But since I'm remote, as long as they ignore all "background noise/audio" feedback, they deserve to waste half their work day filling in blanks, and their patients must wait longer for their reports. SO what do the geniuses do instead of MOVE and SPEAK UP - they STAT every freaking thing they read so they can hurry and get it back! This forces every other patient in the hospital to wait in line behind them! Inefficiency and subpar patient care is the price everyone pays to indulge their (EASILY remedied) idiosyncrasies.

I have found dictating from the work stations just - as noisy

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why does not someone answer that dang ringing telephone in the background that sounds like it is right under the microphone. What about their cell phone calls, they answer and talk while you are still waiting for their dictation to restart. How about all that clanking and sounds like boxes falling in the background, sounds like OR where they are dictating from, maybe taking the equipment down, setting up new? I hear the fire alarm going off in the background, they just dictate through all that. I have one ESL and I swear I believe he yawns just to yawn because every single dictation are several yawns and it seems a put on yawn at that.

Can only assume they have NEVER heard one of their own dictations - but they should!

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Yet instead of changing their behavior in the slightest, they think statting everything they do is going to make up for crappy audio files. I've never met a single American doc who sends every word out of his mouth stat like certain ESLs do. I know some geniuses that even stat dictations they are discarding - no, I really did NOT need to recieve "disregard, this has already been dictated" before I type Dr. Smith's ER patient that already been forced to wait behind 20 of your STAT "normal" mammos! Selfishness and stupidity - multiply this by 4 or 5 statting ESLs a day and its midnight before you can get to the ER patients from noon!

I have one - Exhausted

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An American doc (actually a PA) who seems to dictate reports for every doctor in the hospital.

He STATs EVERYTHING. It drives me crazy. He is a horrible dictator too. He talkes 100 mph and slurs his words. His reports always go back looking like they are swiss cheese.

The thing that bugs me the most, though, is that he STATs ALL his reports. I truly believe he thinks he is more important that anyone else on the planet. Every time I get one of his reports I literally feel my blood pressure go up and want to punch something.

What drives me crazy is - Exhausted

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when the doc repeats the same couple of words 3 or 4 times in a row. Date of admission is.....date of admission is....date of admissssssssion issssssss.

Ugh.

As far as the ones who can barely speak English and also talk like they have a mouthful of marbles, I have gotten to the point that I will relisten to a word or phrase 1 time and 1 time only. If I can't hear it after rewinding it once, it gets a blank.

I don't have the time to spend half my day trying to decipher what they are saying. Not typing means not earning. Most of the time, those blanks I leave go to QA and leave QA with the blanks still there because they can't figure it out either.

I am typing an ESL right now - who is currently...

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suffering from a runny nose, has no Kleenex handy (sniffle, snuffle, swallow.. yeah gross), is rolling a cough drop or something around in his mouth, and apparently has not slept in two days judging by the amount of yawning that he is doing (naturally without stopping dictating - just talking right through the yawn).

If I don't hear it the second time, I am leaving it blank. I call this a "patty melt note." Covered in Swiss cheese.

Ridiculous.

and who will translate these notes to English, - pray tell

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Just exchanges one time-consuming function for another.

ESL - tired MT

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I feel the same way. Only I think it is the hospital's responsibility not to hire these doctors in the first place. If even the patients and coworkers cannot understand them they are a danger to patient's safety and well being. What good is having a doctor whom you cannot understand. I do not want no foreign doctor that I can't understand treating me! I think they should go back to their place of origin, which are in countries with the greatest need for doctors. I think they are detrimental to patient and hospital safety.

My two cents - Alice

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I transcribe for some ESLs who have much clearer diction than some American-born English speakers. In this one part of the country, for instance, there seems to be a high percentage of slurring dictators, the kind who state an entire sentence that sounds like one long word. I sure can't deciper it.

All along, I've held to the opinion that docs should go through a training and QA process, and receive monetary penalties or hefty extra fees if their dictations are substandard.

It seems that all those big shots who make up the rules about accuracy in medical records just gloss over the fact that it all starts with the quality of the dictation.

My experience has been that there is a correlation between better hospitals - MissIndigo

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and better dictators, so to some degree this appears to be happening. Good hospitals by definition insist on quality patient records. What constitutes good records, though, has been what the dictators produce filtered thru MT function. That seems only sensible given the very high value of a clinician's time and skills. And don't forget, if it eventually could be done without us, you can bet they'd get our fingers out of their records tout suite.

Eventually? Front-end SR is here today. - looks like crap, nobody cares

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I've seen the result of them editing their own work with front-end SR, and the reports look horrible. It amazes me that all the things the client HAD to have (headers a certain way, etc.) are now completely ignored. Wait till some of those documents end up in court - totally unprofessional, misspaced, misspelled. They're cooking their own gooses by shoving us aside - let them reap it tomorrow.

So true - its the elephant in the room - Tuesday grouch

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Seems like docs with any self-respect would give a decent report to begin with, instead of expecting "typists" to clean up the mess. My thought is, if they have such sloppy dictating habits, doesn't that suggest they are sloppy in other areas of patient care as well? The worst bear watching...

Hope you're right, Looks-like-crap! Tuesday Grouch, - MissIndigo

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I've often thought I'd want to see the dictation of anyone treating me--beforehand. Where accents bother some people for various reasons, sloppiness is what makes me want to stay far away.

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