Please pass the Kool-Aid

The only person who will ever tell you that professional networking isn’t important is the person who hasn’t engaged in any of it. That same person will tell you that being an association member, getting credentialed, and coming to ACE are a complete waste of time.

I feel sorry for that person. 🙂

Get out that broad paintbrush, folks, and pass around the purple Kool-Aid. If you don’t see the benefit of AHDI membership and/or the benefit of being credentialed and/or attending the AHDI annual meeting (also known as ACE) – Lea Sims feels sorry for you.

In my opinion, it’s statements like this that tell us how AHDI views nonmembers; i.e., not as potential members, but people who are too short-sighted to understand all that membership and participation in the organization will do for them, and the great benefits to be obtained from attending the meetings. People to be pitied because we don’t have the vision (i.e., we don’t like the taste of Kool-Aid).

Really – how has the majority of MT-dom survived without AHDI membership?? At its peak, AAMT membership comprised less than 1% of the total number of MTs that AAMT itself gave as an estimate (250,000). There are still many MTs who have never even heard of the organization, much less belonged to it. Don’t choke on the Kool-Aid or anything, but the numbers support the conclusion that if association membership isn’t a complete waste of time, at the very least it’s completely unnecessary. AAMT/AHDI has always had difficulty articulating the tangible benefits of membership. Is it any wonder so many medical transcriptionists don’t see the vision? When the organization itself can’t seem to point to the benefits of membership, how are medical transcriptionists supposed to see them?

Quite frankly, the organization has been battling a misperception by MTs, almost since the day it was formed. It seems that what many MTs want is a guild or a union – or they don’t understand the difference between a guild or union and a professional organization. Probably the most tangible benefits MTs seem to want are wage protection and health insurance, which would be what guilds or unions do, not professional organizations. Clearly, the benefits most medical transcriptionists want from a professional association aren’t anything that a professional association can (or should) deliver. There’s been criticism that those of us who don’t drink the Kool-Aid see only bad in AHDI and don’t see the good, so I’ll give this one to AHDI. Too many MTs simply don’t comprehend that the purpose of a professional organization isn’t to protect their jobs and wages.

Indirectly, a professional organization supports jobs and wages by promoting the industry and the people who work in it. And therein lies the problem for AHDI. In 20+ years, it has searched for that sweet spot – and never found it beyond the first several years the organization was in existence. In spite of deteriorating pay and working conditions for MTs, AHDI continues to try and convince us that it’s doing something to elevate the industry and those who work in it – all the while blaming those of us who don’t join for not supporting it and giving the organization a bigger voice. And feeling sorry for those who fail to see the glorious vision, which is not only insulting but completely discounts the many people who thought they saw the vision, contributed to it – and for a variety of reasons, didn’t feel it was worth their time and efforts to continue their contribution.

I understand that staff members at AHDI, as well as AHDI leadership, have to be all rah-rah about the association. What worries me is my impression that they actually believe what they’re saying.  As the saying goes, the road to hell is paved with good intentions.

What I see is a big disconnect between the projects AHDI spends its time on in an effort to promote the medical transcription industry, and the reality of what’s happening in the industry. In my opinion, AHDI has been struggling for relevance, and the name change from AAMT to AHDI is one of the more visible signs of that struggle. I see the current Health Story Project as another boondoggle, similar to the ASTM standards that AAMT poured so much time and money into. (And if you’re wondering “what ASTM standards” – my point exactly.)

This is a series of tweets (Twitter) from Lynn Kosegi, of M*Modal, live from the ACE conference that highlights some of the disconnect.

The Gerry she refers to here is Gerry Lewis, speaking at the recent AHDI annual meeting. I hate to disagree with someone with his credentials – but I’m going to go out on a limb here and disagree with some of the statements reported by Lynn Kosegi.

There has been no reduction in transcription services.

Hoo boy! Really? I have personally had discussions with HIMS managers at three large university medical centers and they all report a reduction of 50% or more in dictation/transcription following implementation of an EMR. They are all thrilled. On a personal level, I have lost – completely – two large orthopaedic practices that have implemented EMRs. They do NO dictation – zip, nada. If that’s not a reduction, I don’t know what is – and that’s just a small sample of what’s going on in this industry.

Not one MT has lost a job…

I’m sure there are plenty of MTs out there who can comment on this one.

No speaker is going to go to an AHDI meeting and tell the medical transcriptionists that their jobs are going away. But is that reality? The value of attending the ACE meeting is apparently to get thoroughly indoctrinated into AHDI’s vision. Pass the Kool-Aid and take a big swig – you’ll need it for these meetings. (Please note I have an overdeveloped skepticism of authority speakers and writers, one I developed acutely after being labeled as one myself while an AAMT member. I loved speaking at the meetings, but don’t consider myself an authority and frequently had a difficult time putting the necessary rosy glow on predictions for the future of the industry.)

From the AHDI website:

AHDI works to set and uphold standards of practice in the field of medical transcription that ensure the highest level of quality, privacy, and security of health information. Complete, accurate medical records are vital to increased patient safety, improved quality of care, and the seamless functioning of the healthcare system.

Here’s where that purple Kool-Aid really comes in handy: does AHDI (leadership, staff, members – take your pick or pick them all) not see the dangers inherent in putting medical transcriptionists forward as guardians of complete, accurate medical records? For patient safety and improved quality of care?

With or without a credential, that’s asking a lot from a person who likely has a high school diploma, is working at home, and never sees or talks to the patient – much less the practitioner who does see and talk to the patient – don’t ya think? Even if MT moved towards an hourly compensation environment instead of production, as Ava Marie George (president elect) suggests in a comment on my Facebook wall – I’m sorry, I just don’t think the healthcare provider or facility is going to agree with me that if I am in any way responsible for assuring a complete, accurate medical recordfor patient safety and improved quality of care – I need to be paid something comparable to what people with more than one post-secondary degree, years of training and a license to practice medicine make. I question the wisdom of making medical transcription more important by placing this kind of responsibility on the medical transcriptionist.

But wait! That’s where the value of credentialing comes in! AHDI sees mandatory credentialing for medical transcriptionists as a way to create a barrier to entry. And as you can see from the opening quote, anyone who doesn’t see the value of credentialing is to be pitied. In response to my prior post (Can you trust AHDI to represent the industry?), Laura Bryan comments:

…promoting credentialing to protect the industry from “would-be MTs”, creating barriers to entry into the field so that not just anyone has access to personal health information or the right to screw up a medical record…

This one has always been a hard sell for AAMT/AHDI. So hard, in fact, that they keep trying to make some sort of credential mandatory. So hard that they can’t get the members of MTIA, their business partner, on board. I keep hearing that MTIA members have agreed to give preference to credentialed MTs (and it’s included in the official AHDI list of accomplishments for 2009), but I’m not seeing it in the hiring practices. MTIA members give lip service to this without actually putting it into practice. (Does anyone remember the BMP? Yeah, it’s something like that.) If you want to move up to QA or some kind of management position, a CMT would probably give your ambition a boost. For the majority of MTs, however, there is little, if any, benefit to being credentialed. And frankly, if the people who hire medical transcriptionists and the people who contract for medical transcription services don’t show a great deal of interest, then there isn’t going to be a lot of incentive for the working MT to jump through those hoops.

There’s a lot of talk that the healthcare industry places great value on credentialing and that medical transcription has been somewhat invisible in that regard. This is kind of a catch-22 situation and nobody knows the answer. Would more employers require a credential if there were more credentialed MTs? Would there be more value placed on medical transcription if more MTs were credentialed?

Healthcare facilities are chronically strapped financially and looking to cut costs any way they can. To be quite blunt, the healthcare industry not only doesn’t think there’s much of value in medical transcription, but it also doesn’t really want to have to pay more to a workforce that is predominantly female, the majority of whom claim only a high school diploma and a certificate of completion from a medical transcription program. A credential that does not include the requirement for at least a 2-year college degree isn’t going to change that. (I would even argue that medical transcription is not a profession by definition. A career, yes – a profession, no.)

And what about professional networking? Here’s a newsflash: AHDI isn’t the only venue for professional networking. I haven’t seen much participation (if any) of the current AHDI staff or leadership in any of the medical transcription forums, so maybe they don’t realize that networking among MTs has been going on online for many, many years. Clear back in 1994, I voted on the charter to form the Usenet group (SMT). There was a tremendous amount of networking done there, and then subsequently on sites such as MT Chat. The regular contributors to those groups were some of the best medical transcriptionists I’ve ever known and I knew I could count on the word lists, grammar advice and medical information shared by Toni Mercandante, Barb Grow, Annie Ranieri, Ellen Drake and many others. For years, many vendors were active in the transcription forums, including SMT and MT Chat. Many MTs don’t see the benefit of joining an organization for networking purposes because they’ve been doing it online for years, and for free.

I want to address Laura Bryan’s comments about networking in the medical transcription forums online. Again, in response to my prior post (Can you trust AHDI to represent the industry?):

I have been treated far worse on the MT forums than I have ever been treated by anyone within AHDI. I find it curious that many of the people who participate in public forums and comment on the communication problems within AHDI (criticizing how they shut out comments, disregard member comments and opinions) are the very same people that have treated me and other advocates of AHDI in the very way that they find unacceptable. I don’t see AHDI’s critics setting an example that could be followed for improving the dialog. Do you really want to talk about shutting people out of the dialog? Just try posting in favor of AHDI over at MTChat!

I find this interesting on a couple of levels. I have allowed comments on my Facebook wall about this topic, without editing, deleting or censure. I accepted numerous “friend” requests from AHDI members in the last two weeks, presumably so they could read the wall and comment, should they so choose. I also don’t moderate or edit comments here at MT Exchange. The policy at MT Chat has been to lock threads when they get out of hand, but not delete or edit posts. In other words, these are all free exchanges of ideas and opinions.

Try getting that kind of free exchange in any AHDI venue.  Go ahead – ask if the comments at the official and semi official blogs are moderated. If you don’t already know, the answer is a big, fat YES. When AHDI had a forum – and they no longer do – it was heavily moderated. Apparently, even members couldn’t be trusted. Judging from Laura’s comments, there are people who prefer the moderation. It’s nicer – less honest, perhaps, but nicer. Like little sips of purple Kool-Aid.

The problem is, AHDI leadership (and staff, apparently) don’t “get” online networking. When they participated (and I use that word with reservation) at MT Chat on an official basis, they only posted to defend criticism of AAMT/AHDI. MT Chat is seen primarily as “anti-AHDI” because the majority of participants are critical of the organization. Why is that? Because supporters of AHDI, leadership in AHDI and AHDI staff don’t participate. Like the many folks who friended me on Facebook this week so they could read my wall or post a comment, they don’t introduce themselves into the community and participate in other topics. The only time we see them at MT Chat is when they jump onto the forums because they’re upset about something that’s been said about AHDI.

Have you ever had someone show up at every club party, just to sell Amway? They don’t participate in conversations, they don’t get to know anyone, they don’t contribute anything to the group – they see the gathering as a room full of potential customers, not potential friends or coworkers or people with shared interests.

This is not networking. This is more talking at people – selling Kool-Aid. The same people who say “you get out of it what you put into it” don’t seem to be able to translate that to online social networking. When your only contribution is to sell something – your services, a book, or purple Kool-Aid – you can expect the highly intelligent people who make up the majority of the online medical transcription community to call BS when they smell it. So here’s a hint for Laura: if you actually participated in the community, if you got to know people, and let people know you – then you’d be a part of the community, not just some AHDI rah-rah girl pushing purple Kool-Aid. People are much nicer and much more willing to listen to someone when they know them and have established relationships with them.

Finally, we get to the bottom of the Kool-Aid glass and see it for what it is. AHDI has problems finding relevance with MTs because it doesn’t bear any resemblance to the reality that most MTs work in on a daily basis. We’re not convinced that drinking the Kool-Aid gives anyone at AHDI any better vision of the future of the industry, or any better ability to direct its future. I don’t know about most MTs, but when I read some of the things written in a Kool-Aid induced euphoria, I am quite convinced that it doesn’t.

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11 thoughts on “Please pass the Kool-Aid”

  1. Interesting read! Thanks!

    But I have to agree with Laura about MT Chat. People on MT Chat can be cruel and harsh. I very rarely post anything there.

  2. Lisa, help me understand your problem with MT Chat. I reviewed your posts there. You asked questions and got some good answers. Aside from that, you’ve participated in two other discussions, both of which were very benign. What am I missing?

  3. Whoa folks – just a couple of points in response:

    1. When I tweeted what Gerry said during his presentation, I was doing just that…tweeting what he said. Those are in NO WAY my statements – thus the “Gerry” in the tweet. It is interesting that you don’t want to disagree with someone with his credentials – but you’ll disagree with me when I was tweeting him. Let’s be sure we know who is saying what and that you are clear in your post that you are disagreeing with Gerry – I was just the messenger. Social media is only useful if our communications are clear.

    2. Also note – that he was talking about a specific implementation. He wasn’t saying no MT has ever lost a job. He was saying no MT lost a job in those specific situations. So rule # 2 – Let’s be sure we understand context.

    3. I need to take exception with this statement “No speaker is going to go to an AHDI meeting and tell the medical transcriptionists that their jobs are going away. But is that reality?”

    You clearly do not know me if you think I will change my message to make it more palatable. To anyone. Did you attend my session? I clearly did, as I do frequently in my blog, say that transcription is going away if some changes don’t happen. I’m pretty sure it was me talking to MTs using the terms “hobby MT” and “Avon lady MT” as opposed to the Career-Minded MT. And you know what? Those MTs in the audience didn’t throw anything. No one from AHDI came out with a hook. In fact response was quite favorable. Do you know why? I didn’t rant about the hobby Mt without providing positive, constructive, suggestions for change. Did everyone agree with me? Good grief – I hope not! But did we have some great discussions after that? We sure did!

    4. Any organization is only as strong and as effective as its membership. So if people want AHDI to change, the only way to make that happen is to get involved. BUT – when you are looking for standards to support how cranial nerves should be typed, or when to use Roman numerals versus Arabic – where do you go? AHDI may have its faults (who doesn’t?), but it has also done a tremendous amount of good. If someone doesn’t like AHDI’s vision, get involved and change it. If someone doesn’t think AHDI is on track, get involved and help put it on track! Goodness knows I disagree with AHDI MANY times – and guess what – I’m out there talking about areas that I feel strongly about – and AHDI gives me a forum even when I don’t exactly agree with them. I’ve never been black-balled, I’ve never been refused opportunity to speak or participate, and in fact, AHDI has welcomed my participation with open arms.

    5. Moderating forums. You better believe I moderate M*Modal’s MT forum. (not mine by the way). Why? Because I want MTs who honestly want support, help, positive suggestions, to have someplace to go without being accused of being a “suit”, or a plant, or in general just slammed into the ground if they dare to say something positive. There are plenty of forums out there for those who want to talk about “speech wreck” and those who want to say to anyone who is happy, “well you must be a suit.” They won’t miss anything if they can’t do that on mine.

    So – lets all take a breath before we start dragging names through the mud, ok? Let’s talk about the things we think are wrong – but then lets have good suggestions for change too.

    I am up for open dialog any time at all. Anyone who knows me knows that. But don’t put words in my mouth and don’t make general statements that do not apply to everyone addressed.

    Lets work together to make things better – oh sorry, am I passing around the purple kool-aid by thinking we can make a difference? I don’t appreciate being lumped into one big giant kool-aid vat, but if that’s what you call good open discussion amongst passionate people who may or may not agree with each other – then I guess I’m wearing that purple kool-aid mustache with pride.

    Much appreciated!
    Lynn Kosegi

  4. I wasn’t specifically referring to my posts on MT Chat. I have received good answers recently. They were pretty rough on me a while back. Sometimes I think they are a little rough on new people.

  5. Lynn:

    1. I apologize if it wasn’t clear in your read of the post that I understood you were just the reporter; e.g., your credentials as anything other than a reporter were not significant to the discussion.

    2. When you tweet from a conference, you become a reporter. If the context isn’t clear, it’s because the reporting isn’t complete. Tweet complete – use those 140 characters to the best advantage.

    3. Thank you for sharing your experience. It differs from mine so perhaps the organization has changed in that regard.

    4. “Any organization is only as strong and as effective as its membership. So if people want AHDI to change, the only way to make that happen is to get involved. ”

    Been there, done that, have the T-shirt. And as noted in this post, there are others who share my experience. I think it’s valid to ask why MTs who were very involved in the organization – in leadership positions for years – have opted not to renew not only their membership, but also their credential.

    “BUT – when you are looking for standards to support how cranial nerves should be typed, or when to use Roman numerals versus Arabic – where do you go?”

    There are numerous credible references, online and off, as well as client-specific guidelines. As well as the very reference manuals where AHDI has copied, word for word, entire sections. As I construct the MT Desk style guide wiki, It has been enlightening to compare sections of the AHDI BOS and the AMA Manual of Style. About 90% of the BOS is nothing more than basic grammar and punctuation. If we’re looking for tangible benefits to MTs, this isn’t high on the list.

    I believe if you take a deep breath and read the post again, you’ll see I didn’t put words in your mouth. You’re only mentioned because you reported from the meeting using a public social network.

  6. From my point of view, Julie, the perceived value of attempting to engage in productive dialogue rapidly diminishes if the tone of the conversation inevitably turns angry and bitter with tangible overtones of personal animus directed at anyone who is seen as “pro-AHDI.” That has consistently been my experience at MT Chat, quite frankly. I don’t consider myself to be aggressive or combative when it comes to expressing a point of view; I did not go there to pick a fight with anyone. But that’s exactly what it felt like time and time again, that there were individuals who DELIGHTED in picking a fight, whose goal it was to attack and demean and condemn. I simply choose not to spend time in that sort of toxic environment. Don’t get me wrong, I visit MT Chat regularly to keep up on what’s being discussed. But I’ve been burned too many times and no longer believe it’s possible to carry on a civil discussion on issues there without it devolving into acrimony. To me that’s unprofessional and detrimental to the good of our industry.

    As to the issue of moderating comments on the AHDI Lounge blog, I respectfully disagree with your conclusion that having a moderated blog means AHDI doesn’t “get” social media. You can find a wide range of opinions represented in the Lounge, and by no means are they all complimentary to AHDI. We don’t allow comments that bash companies or individuals by name, have overtly racist overtones, or are simply mean-spirited. Does that involve a certain amount of subjective discretion? Of course. But we certainly don’t prevent visitors from expressing themselves candidly, even passionately, whether or not they are complimentary to AHDI. To me that represents a reasonable balance between a free-for-all on one hand and an AHDI PR machine on the other. The Lounge is neither. The same is true of the AHDI Facebook page, very little moderation takes place there either.

    Regarding your view of AHDI in general, Julie, you and I have been able to disagree agreeably over the years in that regard, and I’m confident that will continue to be the case. I respect your point of view and in fact agree with you about some of the problems with AAMT/AHDI over the years. I believe you are a person of good will and hopefully you feel the same way about me. I believe we can have diametrically opposing views about things and still maintain a civil and even friendly relationship. That would certainly be my earnest wish.

  7. I’m interested in your comment about comparing the AHDI BOS and the AMA Manual of Style. The AMA Manual of Style is for items for publication, not for business correspondence and notes. I hesitate to even get involved in this discussion because I, too, have been stunned into silence by some of the responses on MT Chat. In the

    But I’m really astonished to hear you say that basic grammar isn’t of tangible benefit to MTs. Why wouldn’t grammar and punctuation guidelines be helpful to working transcriptionists? What am I missing?

  8. Beth: The BOS is compiled from a variety of publication style guides and manuals. The AHDI BOS bibliography also lists the Chicago Manual of Style and the APA Publication manual, in addition to the AMA Manual of Style. These are all references for publications, not specific to medical records.

    Maybe my comment about basic grammar wasn’t clear. It isn’t necessary that MTs have the AHDI BOS as a reference for basic grammar. Basic grammar doesn’t change just because it’s being used in a medical context. There are other references that are better, IMO.

    Jay: What I find interesting in all discussions about MT Chat is the people saying what an awful place it is have used it to their advantage but apparently only remember what they don’t like about it. It all kind of reminds me of the whining I hear when I’m sitting at a blackjack table. You’ve pitched your services and products there. You’ve pitched AHDI webinars there. Hell, you used it as a launching platform for a whole new organization, and got the help and cooperation of many long-time members. It takes more than a little grit, IMO, for you to come here and say what a toxic environment it is. It served your purposes well enough when you weren’t an AHDI supporter.

    Yes, there is a decided anti-AHDI sentiment there but let’s roll out the whole truth: the forum has served many people well in selling products and services, getting answers to questions and networking with other MTs. I guess the “toxic environment” is tolerable if you’ve got something to sell.

    As far as the moderation at AHDI Lounge, let me make clear to other readers where I’m coming from on that.

    Jay posted a link to the AHDI Lounge here on MT Exchange. Blogging courtesy would be for the AHDI Lounge to post a link back to the discussion at MT Exchange. My comment was nothing more than saying there was a discussion on the issue at MT Exchange, and a link. It was never approved. And yet, AHDI and AHDI members and leadership felt free to take advantage of the open policy here at MT Exchange.

    Sometimes, moderating a forum or blog by not approving comments is as mean-spirited as anything said in an open forum – just more passive-aggressive.

  9. Beth, what I’m hearing Julie say is that basic English grammar and punctuation is basic English grammar and punctuation whether one is producing a term paper, a newspaper article, a letter or a history and physical. In the best of all possible worlds, “they are” is not going to become “they is” because it is a medical document. With that in mind, as she says, there are several other reputable options, including The Chicago Manual of Style that some of us had to buy in high school. In fact, an on-line subscription to that costs no more than the BOS the last time I looked. The BOS, as good as it is, cannot be the be-all and end-all reason for AHDI’s continued existance.

    As to why grammar and punctuation guidelines wouldn’t be helpful to working transcriptionists, please consider that probably the top tip for maximizing production on speech rec (i.e., how to break even and maybe even do better with editing pay versus straight typing pay) is “don’t pretty things up.” If what is said/recognized is understandable, then just leave it be and move on. More and more clients want strict verbatim, including poor English and flat out errors. Correct grammar and punctuation is fast becoming optional. From a client standpoint, it slows things down without adding value. What they want is fast and cheap. Like Marshall Field said, “the customer is always right” and “give the lady what she wants.”

  10. Julie, it was wrong of me to use such a broad brush in describing the atmosphere at MT Chat as “toxic.” I apologize. I believe there are lots of good people who post there and I’m glad you’ve kept MT Chat going. The site has accomplished a lot of good over the years and I’m sure it will continue to do so.

  11. Hi Julie: I appreciate the clarification. But I want to be clear as well that I was not objecting only to the reference to me, but to the references to others and to AHDI in general.

    We may not always all agree with each other – in my experience, positive growth and change never came from a discussion amongst people who all agree on every point. 🙂

    But nor does it come from including everyone in the organization in that brush stroke you talked about.

    Maybe the reason AHDI doesn’t bring the hook out when I speak – even when I don’t agree with them – is that I present my position AND the positive solutions that I think could help. Will everyone agree with me? No. Will AHDI necessarily support and adopt my suggestions? Maybe. Maybe not. That’s not the point.

    But the fact is that they gave me a venue which started a number of quite lively conversations. They reference my blog when it likely at times makes some AHDI folks cringe. And I appreciate that. Maybe because I limit my conversation to the topic at hand and don’t bring names into the conversation. In my experience, that seldom leads to a positive outcome. Maybe its because I never talk about a problem without presenting what I think might be a solution. I might not be right. But I try. Who wants to hear someone rant about “the Avon Lady MT” if she doesn’t also provide suggestions for improving the problem? Who has time for that?

    And about the BOS? I use it all the time and find much more there than basic punctuation and grammar. I have found it to be quite useful over the years and appreciate the hard work and effort that went into it. Kudos to the people who bring information from numerous sources into one point of reference. That’s a WHOLE lot of work.

    About social media and twitter specifically….twitter is not intended to be a reference in and of itself. It is not intended to be the means to provide the entire story. What it is intended to do is to provide small tidbits of information that followers can use to find more information. Ex: Someone who sees a quote from Gerry Lewis that interests them, or even makes them angry, can find the rest of his presentation online to learn more about his position. Anyone looking to twitter to be The Economist is looking in the wrong place.

    Twitter has been a huge help to me in drawing to my attention discussions, articles, and information about topics I care about. If I had to go out and do searches for all of the information that twitter brings directly to me, I could never do it. As with most tools, from social media to a garden hose, it’s all in how you use it…

    We all want the same thing here – more useful health information captured and disseminated effectively and efficiently – so I hope we can remember that we’re all on the same team.

    Thanks Julie – I appreciate the opportunity to converse and comment.


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