Medical transcription accuracy and accountability Part One

How did accuracy in medical transcription take a back seat? Why do medical professionals accept and sign off on reports that are replete with inaccuracies?

These are questions I've asked myself a lot in the last couple of months. You see, I spent years obsessing over transcription done accurately. Not just accurately transcribing what's dictated, but accurate punctuation, accurate grammar, and accurate style.

I came to MT from a background of general typing and transcription, where people actually read the letters and documents before signing or distributing them. For students writing theses and dissertations, and for professors writing papers for publication, the consequence of errors was either rejection or delayed acceptance. For attorneys, the consequences of errors could be even greater, and that includes errors in format and style. I've done transcription for all kinds of professional people and whether it was a letter, a document for court, a report, or an article for publication, they all read them and demanded accuracy. Even when there were no real consequences (no rejection by a judge, journal or graduate committee), they care because these documents are a reflection on them and their business.

My experience with medical professionals (read; doctors) has been quite different. After over 20 years, I still wonder whether they don't care or if they are just that trusting. Doctors sign off on reports and letters with the most awful transcription errors. I'm not talking style, format, grammar and punctuation, either, although there are plenty of those types of errors. However, while I'm reluctant to give up grammar and punctuation, style in medical reports has pretty much become an inconsequential distraction. The AAMT Book of Style is based primarily on the AMA Style Manual, and the AMA Style Manual is intended for articles being written for publication in medical journals, not medical records. While it might be challenging to distinguish a roman numeral from the letter I, nobody seems to know (or care) whether a grade or classification is written using roman numerals or arabic numerals. The bottom line is whether there are consequences to anyone as a result of style errors. Apparently not.

The bigger issue I focus on now is wrong, missing and misspelled words. Apparently, there aren't consequences for those in medical records, either; or at least, none that are severe enough to get doctors to read reports and demand that the words in them be accurate, and accurately reflect the intended meaning.

At this point I can't say with any degree of confidence that there are consequences for errors of any type. How do you hold anyone accountable without consequences?

Over the years, there have been a lot of arguments discussions about the decline in medical transcription, both in the quality/accuracy produced, and in the pay scale. It's a topic that's been on my mind a lot since I re-entered the MT world this year.

Is it the low non-existent entry barrier? I have a friend who is a vocational counselor and she's still shocked every time we talk about this. Virtually anyone can call themselves a medical transcriptionist and offer their services. Virtually anyone can start a medical transcription service and start soliciting customers. Even vocational programs for teaching medical terminology/transcription have no requirements or scrutiny. No license, credential, or even education is required. If accuracy is important, even critical, in these medical-legal documents, why has the low entry barrier  persisted?

Is it overseas transcription? In my opinion, that's only part of it. There were two things that opened the door to overseas transcription. The first was digitized dictation and documentation. Let's face it – without digitization and the internet, there wouldn't be an MT industry overseas. The second is the low entry barrier here in the U.S. (See the preceding paragraph.) The absence of credential or license requirements for MT practitioners here in the U.S. opened the door for anyone in the world to do the same thing people here in the U.S. were doing for years; i.e., saying “I are a MT” and going into business. Digitization was going to happen; there's nothing that would have stopped it. And honestly, who among us wants to go back to analog tapes and printing and delivering reports? (Not me.)

AAMT/AHDI tried for years to make the CMT credential meaningful, without success. In my opinion, one reason for the lack of success was that it wasn't tied to any kind of education requirement. AHIMA has been quite successful with its credentials, but all of these require a degree from an approved education program. As much as AAMT/AHDI has been American MT's favorite punching bag, I'm not placing the blame entirely on them. Almost everyone in the MT supply chain has some personal benefit from the low entry barrier. People already working as MTs didn't want to have to spend the time and money on an education, credential, and continuing education. In the interest of disclosure, I am/was one of those people. Unless my clients required it, I had no interest in it, and I'm not alone in that. People wanting to be MTs had no interest – they were looking for the fastest and cheapest way to get in on what was being touted as the best work-at-home opportunity out there. And the medical professionals seem to think it's just typing what you hear. All you need is someone who can type and maybe (and only maybe) a medical dictionary. Besides, someone with a credential or license costs more.

In that vein… put all that together and you come to what's really important to the doctors, clinics, hospitals, etc. who utilize medical transcription services: cost.

Going way (WAY) back to discussions in the Usenet group sci.med.transcription (SMT), when transcriptionists from overseas first started encroaching on the U.S. market, U.S. MTs pointed to quality issues when making the case for good-ole home-grown MTs. I didn't make myself popular by pointing out that anything that could be said about overseas MTs could also be said about U.S. MTs. Because of the low entry barrier, there were (and still are) a lot of really bad MTs here in the U.S. Any medical transcription service owner (MTSO) demanding accurate transcription can confirm that. Experience? Not an indicator of quality. There are plenty of MTs with little or no training or education who have confidently been pounding out error-filled reports for many, many years. Most of them are completely clueless about their lack of accuracy,  because nobody ever checked their work and/or held them accountable for it.

If you're going to get crap, it might as well be cheap crap.

Where cost is the #1 priority, and you're not getting what you pay for anyway, paying less to get essentially the same thing becomes a smart business decision.

Feel free to comment and discuss (respectfully, please). Since this is billed as Part One, you can expect Part Two, hopefully sooner rather than later.

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1 thought on “Medical transcription accuracy and accountability Part One”

  1. Per your comment about the doctors, I would have to say we are dinosaurs in this day and age. Most of doctors are in the thirties and forties and who knows if they even learned proper grammar. The schools are failing our children, but that’s another subject. (Part 3?)

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