Understanding the Language of Medicine

I mentioned before that I was hoping to take off a few months when I moved to Idaho.  I was actually hoping to take off about 6 months. I thought I wanted that time to just get used to living in a new city, especially so far away from family and friends.  I had been working just about nonstop since I was 17 years old, so taking an extended “vacation” sounded like the perfect thing to do as I adjusted to Western living.  Joe still marvels that I got our entire belongings unpacked and our house organized the way I wanted it in less than 2 weeks.  Well, when you have no phone, no car and no TV, what else is there to do?  I do love to organize things to the point of almost being obsessive about it, so those 2 weeks I had a ball figuring out where to put things.  I am very lucky that my husband does not care how I organize. I just need to let him know where everything is (and then usually have to remind him from time to time where to look). 

Almost to the day that I got everything in its proper place and ready to just relax and enjoy, I got the call from Joe’s office that they needed help, and thus began my local service in Idaho.  Of course, I could have said no, but I really don’t think I could have gone 6 months without working.  When you love what you do, and I have for most of my career, it really is hard to stay away.  Working for Joe’s office was also a great way to get to know his co-workers, some of whom are still my friends to this day, so it was definitely a win-win situation for me. 

I have also found it interesting how different physicians can be in their dictation habits.  There were 5 docs in this practice when I first started.  Fortunately they were all pretty easy to understand, so it was not too much of an effort to get settled in to their style of dictating.  A couple of the physicians did sinus surgery, and that would include CT scans of the sinuses.  The one doc was very organized and methodical in his dictations.  He went through the findings of each sinus in the same order every time, and it got to a point where I could almost transcribe ahead of what he dictated.  The other doc was the complete opposite.  He was very unorganized which came through in his dictations with jumping around the sinuses and often losing his train of thought with things like “The ethmoids, no wait, the frontal, no, go back to the ethmoids or did I mean the maxillary, yeah, the maxillary….”  It was kind of like putting a patchwork quilt together each time I transcribed one of his scans.  

I constantly emphasize to my students that it is so important that we have a good understanding of what we are transcribing.  This doc was a prime example of that, because I was able to put his reports together in the right order with the right information under the correct sinus area.  That paid off, too, because one day he caught me in the hallway and thanked me for making sense of his CT scan reports!  MTs don’t often get compliments or thanks for their work, so that was a moment I will never forget.  

One of the other docs (the one who also dictated on CT scans and was wonderfully organized with his dictations) was also usually very long-winded with his chart notes.  He would also dictate letters to insurance companies when payment was denied or there was some type of error or difficulty with a patient’s documentation.  I wish I had kept at least one of those letters because he had such a great way of more or less telling these insurance people they were utter idiots but without actually saying that.  These letters were almost always at least 2 pages long, but I so enjoyed those dictations.  You would think transcribing insurance letters would be the epitome of boring, but not so these letters!  I often have wondered if any of the recipients of those letters really got what this doc was really saying to them, but I would venture to guess they never did. 

Over time, this practice opened an office in Elko, Nevada, and I eventually did the transcription for that office.  Joe and one of the docs, along with a few medical assistants, would fly down to Elko once a week to see patients down there.  There was also a PA (physician assistant) who ran that office full-time, and it was his dictation that I started to do on a regular basis.  It was also my very good fortune that this PA was one of the nicest guys I ever had the pleasure to work for, because there was a time when I made a mistake that could have resulted in one very severe tongue lashing or quite possibly losing the account. 

I’ll talk about that next time, along with those handful of opportunities that came my way that I was hoping to have avoided but wound up being great experiences for me, both personally and professionally.  In the meantime, I hope all of my readers have a very Blessed and Happy Thanksgiving.  It sure seems to be early this year, but I guess that means more time for Christmas shopping!  Enjoy your day and your holiday!  

A Quick Look Back

Sometimes the writing part of my brain decides to vacate the premises.  That is apparently what took place for the entire month of October.  I’m really not sure where that month went, but it is on my calendar, so I know somehow it did not magically disappear into the time space continuum.  We are pretty settled now in our new surroundings, although I still don’t know what happened to my shoes.  I have looked in every box I can think of where there might be shoes, but they either went the way of the trash or the donation box. I sure hope they went to the donation box, because they were good shoes.  Well, when you work from home, your shoe wardrobe consists primarily of tennis shoes, hiking boots, and maybe dressy flats for those rare times one must dress up for dinner out other than McDonald’s.  Looks like there may be some shoe shopping in my future.

I would like to backtrack a bit to my first service when I lived in Ohio.  I never did get it to the point where I needed subcontractors, although I suspect had I not moved to Idaho, that may have happened.  At least back in the early 1990s, there seemed to be plenty of transcription to be done as physician offices were not outsourcing quite as much as they seem to do today. As I stated in an earlier post, my first client turned out to be my main and busiest account.  He did endoscopic carpal tunnel surgery for about 90% of his practice, and on postop days, he would see close to 100 patients.  It was really just a matter of his checking on incisions, which would only take a few minutes at most, but there were some who wrote into the local newspaper complaining about the fact they would schedule an appointment for 8 a.m. and find out that 5 or 6 other people were also scheduled at 8 a.m.  When you schedule 6 people at the same time, you can see how the day can build up to almost 100 patients in one day.   He did have to dictate on all of those patients, and he did not use any type of macro, surprisingly, so it was all straight dictation for each and every patient. 

When I look back on that particular account, I probably could have charged him 25 cents a line, and he would not have cared.  Money just was not an issue with him as long as I returned dictation in 24 hours, which I did, even working on Saturday morning to get his Friday dictations completed for Monday morning.  Not too long after my move to Idaho, I found out how he was able to handle that many surgeries—well, obviously he did not do 100 surgeries in one day, but he did a lot of them, easily determined by the postop day appointments.  As it turns out, the man was dabbling a bit in drugs to keep him going into such long hours!  He apparently was even seeing patients at his home in order to accommodate everyone.  As far as I know, there was never any harm that came to any patients from their surgery or their followup, so that was a good thing, but needless to say, I was absolutely floored when I learned of this news about my #1 client!   Timing is everything, since none of this came to light while I was working for him. 

As I mentioned in an earlier post, I did also have some p.r.n. accounts, which usually came in very sporadically, but there were those occasional days when everyone called me on the same day.  The income from those days was very nice, but I can tell you that sitting at your desk typing from 9 in the morning to midnight is not a fun way to spend a day.  The main lesson I learned from that is to not take on more clients than you can handle all by yourself.  I should have planned out in advance how much work I could manage in a day to keep up with 24 turn-around time should everyone call me at the same time, and I did not do that.  I figured that would never happen, and when it did, it was exhausting!  Thankfully, though, those long days of transcribing into the wee hours of the night did not occur too often, so it did work out okay. 

By the way, when I did start to work from home, this was a little before computers and Word or even Word Perfect for Windows.  I had a word processor which looked a little like the picture below, working in DOS and using 5-inch floppy disks. 

  I thought this was such a cool piece of equipment, so much better than a typewriter!  I guess we have come a long way.  I even had to use hard copy reference books for researching with no internet or electronic references.  I still do use my hard copy references on occasion.  I guess I’m old fashioned, but sometimes I just prefer to have a real book in my hands where I can make notes or highlights.  I have also embraced today’s technology though, and have never resisted it, at least not too much.  It was hard to let go of my service in Ohio. I worked really hard to build it into a pretty good service and felt very proud of what I accomplished in a few short years.  As I closed it down in July of 1994, I got excited about not working for several months, but that was not to be  and was not something I even wanted. I just did not realize it until I was faced with saying yes to a new life in Idaho and a new career that would take me from local service to a national service and on to becoming an MT educator.   There are a handful of things I never wanted to do or felt I could even do well if the opportunity ever presented itself, and of course, all of those situations did come knocking on my door, and I’ll tell you all about it hopefully before the month of November gets away!