You hear it from staff and you hear it from patients. You hear it from pharmacists, insurance companies and lawyers. "I can’t read the doctor’s writing!” Doctors are renowned for their scribbled scrawl. But I have a better one: try typing 100 words-per-minute of English-defying medical terminology – straight from your doctor’s lips. This includes chart notes, hospital medical reports, referral and consultation letters, and legal correspondence to lawyers and insurance companies. Anyone who’s ever had surgery – knee, arm, gallbladder; been referred – to urology, neurology, gastroenterology; been admitted – to hospital, nursing home or care home; or had an accident or medical incident has had a medical report dictated by their physician outlining all the particulars. The people who transcribe these reports, documents and letters are your friendly, neighbourhood medical transcriptionists.
Medical transcriptionists, or MTs, are trained medical secretaries who keyboard all physicians’ notes, comparable to a legal secretary or court stenographer. It’s a demanding job that requires skill and accuracy, a curiosity of language and all things medical, and a sense of humour for all the quirks, bloopers and laughs that can accompany the work.
MTs work in medical centers, hospitals, laboratories, pathology services, insurance companies, government facilities and home offices. Dictation of reports can be via central recording stations where a doctor can pick up a phone anywhere in say, a hospital, dial into the recording centre and dictate the particular report; recorded onto mini or micro cassettes; or digitally recorded. Now there are voice recognition systems that transcribe directly into a document file without the need for physical transcription. This works well for a well-enunciated speaker – and that’s an oxymoron!
While medical transcription is a learned skill with terminology, understanding of medical systems and anatomy, and excellent English and grammar knowledge, with time and, again a sense of humour as you’ll see, it can be understood with a few rules and lots of practice. Medical terminology is a vast arena of Latin, French and Greek gobbledygook. With some curiosity and will, anybody can learn a few terms. Here are a few:
Many medical terms consist of a root word with a prefix and/or suffix. Common root words include tonsil, adenoid and gastro, which we all can recognize. Some basic suffixes are itis (inflammation), ectomy (removal of) and ology (study or knowledge of). Add the root word and suffix and you have tonsillitis, adenoidectomy and gastrology. There are hundreds of these simple combinations. More root words include hyster (uterus), cholecyst (gallbladder) and ophthalmo (eye). Put on your savvy suffixes and you get hysterectomy, cholecystitis and ophthalmology. Root words are also put together to form ridiculously long medical terms: otorhinolaryngology (science of ear, nose and throat); sternocleidomastoid (muscle of sternum and inner part of clavicle); and the ridiculous one pneumonultramicroscopicsilicovolcanoconiosis. Couldn’t they just say black-lung disease?
Prefixes like hyper and hypo mean over, above or excessive and under, beneath or below. So we get words like hypertension and hyperextension or hypoglycemic and hypocalcemia.
Then there are terms, medical or plain English, that make no sense at all. No matter how many times an MT types them they’re obnoxious and difficult and have a mind of their own. Whenever you swear you’ve spelled them correctly the red underline on the computer screen tells you not! These words just have to be memorized unless you can come up with some kind of verse or acronym – which is another whole can of words – to spell it right, hopefully the first time every time. Some of these include Pfannenstiel (type of abdominal incision) and xiphisternum (lower end of sternum or breast bone).
Similar-sounding English words such as accept and except, affect and effect can give even a good grammarian trouble. Words pronounced the same but with different meanings include perineal and peroneal or ilium and ileum. The perineum often gets torn during childbirth while peroneum pertains to the fibula in the lower leg. You wouldn’t want an ileostomy (artificial opening into the intestine) if you have ileitis (inflamed iliac joint). There’s prosthetic and prostatic; and dysplasia, dysphasia and dysphagia. So you wouldn’t see an urologist for your prosthetic valve!
Acronyms are easy to remember because each letter stands for a word: CT, MRI, GERD and AIDS: computerized tomography, magnetic resonance imaging, gastro-esophageal reflux disease, acquired immune deficiency syndrome. Over time some acronyms have become regular words no longer capitalized, like radar, which originally was RAdio Detection And Ranging.
Bloopers happen almost every day, either from the doctor or from the transcriptionist. Most are caught, some are not! The first example in the following pairs is the blooper:
Please see this patient for bilateral Cadillacs. Please see this patient for bilateral cataracts.
This patient is a prime rib. This patient is a primip [in first pregnancy].
X-rays of the vertebral column showed bunny fur formation. X-rays of the vertebral column showed bony spur formation.
Bronchoscopic exam revealed hemorrhoids. Proctoscopic exam revealed hemorrhoids.
Baloney amputation. Below-knee amputation.
See how much fun a transcriptionist can have? Imagine doing this all day! I just happened to find four fabulous MTs who do. The U-shaped office has five work-stations, one skookum printer and a room-width window. One MT is missing. There are steno chairs with a high back, low back, some use no back; soft cush, medium cush, one has no feelable cush – is that a word? (MTs always ask that question and Dr. So-and-So always makes up words.) The transcriptionists are ‘plugged in’ with headsets and have their foot to the pedal, coasting down the medical jargon highway. You’re not sure if you should interrupt to ask a question when their fingers are flying and eyes are on the screen. Surely they’re on a mission – getting to the end of the tape so they can flip it over, miss the first few words on side two because it’s always too muffled at the beginning, and rewind endlessly if it’s Dr. Blank. These MTs are poised and ready though. Taber’s or Dorland’s Medical Dictionary, The College of Physicians and Surgeons Directory and the handy Compendium of Pharmaceuticals and Specialties line the shelves (those who use the Internet); or are sprawled open with tattered edges (those who don’t). Here’s what I asked them:
Why do you do this?
/ls: The work is fast paced, you learn something new every day and even though banging on the keyboard may stay the same, the content always differs.
/lf: Not for the money! I enjoy working with words and solving puzzles.
/cj: I find the medical terminology interesting and I work with great people!
/jm: In the beginning it was to be involved in the medical profession. I thought it would be exciting to work for various specialists and it was.
What do you like the most about your job?
/ls: I like my co-workers the most.
/lf: Working through a challenge.
/cj: Feeling like you’re an important part of making a large clinic operate efficiently.
/jm: The camaraderie of the typing staff, some exciting dictation, thinking that you may be helping someone.
What’s your favourite word?
/lf: pneumonultramicroscopicsilicovolcanoconiosis (sure lf!)
What’s your least favourite word?
/ls: Maneuver, manouever, manever, maneuvre, – thank goodness for spell check, auto text, auto correct!
What do you like least about your job?
/ls: The aches and pains from sitting all day and staring at the computer screen.
/lf: Sitting plugged in for long periods of time.
/cj: Neck strain, illegible mumbling.
/jm: Sitting all day. The annoying quirks of doctors’ dictation, monotonous dictation. (jm also wrote the name of the missing MT)
Any advice to upcoming MTs?
/ls: Don’t get discouraged when you first start in transcription. Even after many years we still count on each other to transcribe a word that’s totally incoherent, even a simple word.
/lf: Learn to work with the tools available, the Internet etc. There are so many new drugs and medical conditions and the Internet is a great way to research.
/cj: Develop lots of patience.
/jm: Be patient, try different venues. Start off working for one doctor to gain more experience. Don’t do it!
There you have it, straight from the MTs’ lips. I feel like a pro! As to the missing MT, she’s too busy writing articles to be working today. And jm can say what she wants ‘cause we’re all buddies and she knows I’ll return the jibe —multiplied!