Are Medical Transcriptionists The "Gatekeepers Of Grammar"?
Very thought-provoking blog post by Chad Sines at omniscribeonline.com regarding medical transcriptionists' attention to/obsession with grammar:
Why do we as MTs feel that we are the gatekeepers of grammar? Isn’t that a faulty view of our role?
We are fighting a battle that no physician/facility really cares about. In practice we have allowed so many style variations in templates that our QA spends the majority of their time checking style instead of critical patient information.
Now I am not saying that grammar/style is irrelevant, but I am saying it MUST not be how we define ourselves. It should be secondary except in cases where it honestly affects patient safety.
Feel free to weigh in with your thoughts.
Jay Vance, CMT
AHDI Lounge Administrator/Moderator
As the author of the BOS, one might think I would take exception to Chad's comments, but I have to say that I fully support his assertion that in our zeal to be the comma police of healthcare, we have lost site of our true value to the process - identifying and alerting the system to truly critical errors in the record, those that have the potential to result in misapplied information and/or wrong care decisions. Chad's example of the group of MTs who celebrated their ability to recognize the scandalous use of a contraction in the record while overlooking a glaring clinical notation is alarming. How many MTs in that room didn't recognize the error because they don't have the clinical understanding to identify it? Are they experts in EXPRESSION only? Are we really admitting, "I have no idea WHAT I'm transcribing, but I can sure tell you where the comma goes"? Clinical accuracy should come first. By all means make it technically beautiful with the right applicaton of style and expression, but at the end of the day, if we hang our professional hats on that value, we have no one to blame but ourselves when healthcare continues to view us as secretaries. :(
And before anyone dings me, that should say "lost sight of" not "site of"....my fingers flew faster than my brain.
As one of the responders to the original "MTSO to Walmart", I would like to clarify something. The grammatical errors were glaring in the article. Given that it was written in a non-medical fashion, it made the English errors all the more obvious.
For my part, patient safety is, has been and always will be the bottom line in this business. While I pride myself on identifying and correcting grammar mistakes in dictation, the primary focus of transcription is catching errors in dictation and bringing them to the doctors attention when necessary. Working in a diagnostic radiology, this happens almost daily. We catch errors from findings to impressions frequently and flag them for correction, as well as lumbar levels dictated as cervical levels, etc. It is also our primary responsibility to be fluent in medical terminology and anatomy and physiology in order to KNOW when a body part is dictated incorrectly, as well as being able to differentiate sound-alikes such as ileum and ilium, perineal and peroneal.
Now let's talk about a real issue, like the egregious medical terminology mistakes speech recognition makes that are found to be acceptable. Mistakes that would have gotten us fired or sued in the past.
By the way the example of the MT's given is referred to as Groupthink.
As a member of the QA Best Practices committee, I wholeheartedly agree with Chad's assessment of the article. This is why we now have only critical and noncritical errors listed and have taken grammar and punctuation almost completely out of the picture. Lea, we do not have the luxury of making things "technically beautiful" any longer--did we ever? In all my years in a QA role, I have rarely seen an MT respond to feedback regarding a critical error. Most have a forest/trees problem and will argue on and on about why this sentence was changed, why this punctuation, why, why, this is the way I've always done it, etc. But tell them they transcribed an incorrect medication or dosage within this feedback and you get nothing. I caught the moot/mute error in that article immediately, but Chad's right--who cares??
I agree that it is not for us MTs to beautify documents but make sure they are accurate and reflect what the healthcare professional wants to say. It is important to realize that while grammar is important, it is even more important to get the vital details captured without any mistakes.
Perhaps we should ask why we've come to see being the comma police as our role.
Could it be because that was the focus of QA for years?
Could it be that because that was QA's focus it impacted our ability to advance in pay within our organizations? One can always find enough little dings to keep someone from getting a raise (BOS as weapon).
Could it be because for years our ART/RHIT/RRA/RHIA bosses wanted us to just sit down, shut up and type and didn't want the gals in the typing pool to question the God-almighty doctors about anything because that would be disrespectful and "uppity"?
Things happen for a reason. You tend to take the roles that are modeled for you and are open to you. So why, again, are we surprised that we've ended up here?
I guess I am sitting here wondering about what seems to me an obvious question ... if we agree that Chad's article is timely and important then why is our organization pushing "BOS Boot Camps", when by our own admission much of what is in that BOS does not reflect the things that today's clients think are important in the medical record these days?
If MTs are being told by their clients/employers that much of what is in the BOS is no longer important enough to spend time correcting why is our organization still making use of the BOS mandatory for its credentialed schools? And, if we are going to make that a necessary teaching tool for these schools why isn't it being rewritten to more accurately reflect what the clients are actively instructing their MTs to do when editing those SR-generated draft documents?
Nae
I don't think anyone is suggesting, Nae, that this is an either/or proposition. Actually, I would disagree that "much of what is in the BOS does not reflect the things that today's clients think are important," because that would be to generalize and paint the entire BOS with a sweeping and dismissive brush. Whether our clients appreciate and notice the accurate expression of information in the record does not negate our obligation to apply good standards to how we capture that information. Throwing out grammar, punctuation, and style is a slippery slope, and I would argue that it wouldn't be long before the absence of our good editing skills would draw someone's attention. They take them for granted, yes. But throw them all out with the bathwater, and I think we'd start hearing about how sloppy and "unprofessional" our work product has become.
I think we're just saying here that we need to recognize that we can't hang our hats solely on "good style" alone. We can't raise a fist at the use of a contraction and turn a blind eye to the clinical inaccuracy in the record that may impact care decisions. Both are necessary, but of the two, clinical accuracy can't be sacrificed for style.
Also, the BOS most certainly DOES address what we're seeing in the SRT editing space when it comes to applying BOS standards with a too-strict rule of thumb. You'll find our recommendations and guidelines about that in Chapter 28.
-Lea
Yes, most of our clients have had chapter 28 pointed out to them ... it didn't change their minds one bit about what they will and will not pay us to do. I think you are probably fighting an up hill battle with that one and the folks writing the pay checks (the clients) unless of course we have some sort of secret plan to make the machines recognize and correct grammar and verb tenses by themselves :)
Nae
I can assure you that the intent was not to say that grammar and style are irrelevant or not worth knowing. Everyone of us should be seeking more knowledge and attempting to better ourselves. The point that I thought was clear was that grammar and style are not the most important issue and should not be the first thing we look at. The content is more important than form but like Lea said, it is not either/or.
What I personally find odd about how many MTs approach written text is that their eye seems to go first to the unimportant, quite possibly at the sake of what should be critically important. If we as MTs are reading a report and we are eyeballing grammar or style before properly analyzing the content, I feel we have lost focus and need to check ourselves. Should our eyes not instinctively go to the labs values, the diagnoses, the vitals, etc before we even allow it to entertain a comma, homonym, or subject-verb issue? After all which is most likely to risk the patient's health?
Chad
Let us see how these statements are applied to the new RMT/CMT exams in 2011. Put the emphasis where it belongs as mentioned above. Having recently sat for the CMT I was dumbfounded at the content. I studied for a long time on the so called issues of "clinical accuracy" only to be inundated with grammar/punctuation. Shall we get out of English class and on with Transcription please?
My thoughts exactly! It seems to me that AHDI has focused more on grammar/punctuation in the BOS and on the credentialing exams! So it makes sense to me that MTs have also focused on grammar/punctuation.
Nae, I'm not sure how you're reading chapter 28, but the whole point of that chapter is to encourage organizations adopting SRT to be less prescriptive about style in areas where those issues are deemed not to compromise clinical clarity in order to realize the productivity gains that will make their SRT adoption worthwhile. We provide guidelines in that chapter for approaching each style issue contemplatively. If the engine can't be trained to make the edit, the physician can't be trained to modify his dictation to avoid the conflict (not likely, to be sure), and it's a style issue that has no bearing on clinical clarity, we encourage organizations to forego the standard and keep SRT editors productive by focusing on only those things that truly need editing.
As for anonymous above, we'll still be evaluating style on our new exams....FYI. Recognition alone is not the goal. Recognition and correct expression is what we're evaluating and likely always will.
Feel the need to defend the BOS a bit (I'm biased, I know), but there is ONE chapter on grammar in the entire BOS and ONE chapter on punctuation. On the new RMT blue print, there will be ONE objective on grammar and TWO objectives related to punctuation. It's not the first time I've heard or seen a sweeping generalization that the BOS is a "grammar and punctuation" text. Those are only two of MANY elements of style and standardization of expression, many of which do contribute to, and exist for the purpose of communicating, clarity in the health record.
I, too, was a responder to the "Walmart article," and I feel the need to point out that to the best of my knowledge, the expectation of correct grammar, syntax, punctuation, and word use has NOT changed in business or professional writing for publication, which the article was. It was NOT a medical record and the criticism of the article has NO bearing on what should or should not happen in medical reports. The fact that many feel the need to defend this kind of sloppy writing in a business publication only underscores, for me, that many MTs just do not get it. They don't recognize what is or isn't a critical error in a published article (and "mute" vs. "moot" IS a critical error in this context), and they don't recognize what is or isn't a critical error in a medical report. As far as the BoS, I only wish the guidelines on SR editing were as clear as Lea purports. Chapter 28 is one big waffle of "well, we can't really do it the old way, but we can't really abandon the old rules, but we can't really expect MTs to follow them, but we can't say they aren't important...." I am part of a committee that is wrestling with the QA standards we will apply to SR reports, and we have found the BoS nearly useless in this regard.
I am so tired of this brainwashing that AHDI is trying to do. I have recently taken an SRT course and I almost could not make myself finish because I was absolutely appalled at the quality of the dictation and especially by the documents produced by the software. How is that we are held to such high standards while the SRT software can "guess" at both medical and English words and that is somehow acceptable?
I am scheduled to take the CMT exam next week after being told ad nauseum by AHDI that my 20+ years of transcription is essentially void without credentialing. I specialize in Diagnostic Radiology. I suspect I will have forgotten the training I do not use everyday. I think I'll save myself the $200.00 and cancel my examination. I am too much of an independent to feed into this bullying anymore.
Am I the only one who is worried about a doctor who bases treatment decisions for a critically ill patient on vital signs typed incorrectly into an H&P from 5 days ago rather than on the current vitals on the monitors?
Am I the only one who is worried about a doctor who relies on lab work typed incorrectly into a consult from 5 days ago rather than actually checking for current lab reports from the LIS in the chart? I do wonder what his dictation sounds like when he reads those lab results off into a report, though. Faster than a speeding bullet? Nah, he knows they're too important to get right to dictate them like that, right?
Is old, regurgitated data really critical or should one be looking at data directly from the source?
Am I the only one who is instructed to put in headers for admitting/discharge diagnoses and preoperative/postoperative diagnoses even when the doc doesn't bother to dictate them or the diagnoses either?
Well, in this case, his idea of critical and mine are different again. I wonder what his definition is? I can't provide it if I don't know and he doesn't tell me.
I passed the CMT exam in January 2010, and honestly did not think the grammar and punctuation elements of the test were a big deal. I remember feeling that the medical knowledge required by the test was quite sophisticated, and the practical transcription component (which is a BIG part of the test) was very realistic and even, at times, fun. Grammar, punctuation, and spelling are part of the basic skill set for a good MT, right? If you are not good with language and not primarily a "word person" then you will not enjoy or excel in this field.
I agree with the poster about quality of dictation. Doctors should be held to a higher standard of dictation. Eating, chewing gum, speed talking through common phrases and garbling measurements is not sufficient anymore. Especially with the advent of SRT, which will simply "type" any word that "sounds similar".