I was speaking of change, wasn’t I?

This weekend, I am completing some changes being made at MT Desk and MT Chat. There are also going to be changes involving MT Reference, but the impact will be felt less. Some people have received e-mails about the changes, some have seen my post at MT Chat. It’s a huge change, however, and I want to make sure as many people as possible are aware of it.

MT Chat is a discussion forum for medical transcriptionists. Originally, it was part of MT Desk. I imagine the owner at that time had good reasons for making it two different names and websites, but after a lot of consideration by me, I feel it’s time to marry them back together and put the whole kit and caboodle under one roof.

Changes at MT Chat

Regular users at MT Chat will feel the change most acutely. This is a very big change for anyone who participates regularly there.

Because the software that runs the wiki at MT Desk includes a forum, I’m going to be making MT Chat a read-only forum and ask that everyone start posting in the MT Desk forums. The look and feel of the wiki forums is very different from MT Chat. However, it’s still a forum. And the plus is that if you’re already a registered user at MT Desk, then you are able to use the forums without a separate registration and login.

The forums at MT Chat will remain available for people to view while I move the most-viewed posts to the articles section of MT Desk. At some point, MT Chat will just be redirected to the forums at MT Desk.

If you are a registered user of MT Chat and you have logged in at any time this year, you will be manually added to MT Desk. When that happens, you’ll receive an e-mail asking you to validate your registration at MT Desk; once you do, you can set a password and you’ll be good to go. If you registered at MT Desk with the same e-mail you used at MT Chat, you won’t receive an e-mail.

Changes at MT Reference

The directory listings at MT Reference are being moved to the new directory at MT Desk. When that’s complete, MT Reference will be forwarded to the directory at MT Desk, and it will be effectively closed.

Changes at MT Desk

The wiki software at MT Desk has been upgraded to better handle all these changes, and the forums and directory have been added.

The biggest impact is to registered users who have never logged in or have not logged in recently. Those registrations have all been suspended. Suspended users can log in but most of the functions allowed active users have been suspended. If you log in and you cannot post in the forums, suggest a link for the directory or comment on a wiki page, most likely your registration is in this category. All you need to do is send an e-mail through the MT Desk contact form or to the MT Desk admin, requesting that your account be reactivated. If you use the contact form, please provide the e-mail address you used for the registration. If you send e-mail, please use the e-mail account you used for your registration.

MT Desk is temporarily closed to new registrations until MT Chat is closed. You can still view the wiki pages, the directory and the forums if you aren’t logged in, but you won’t be able to post anything.

There is an internal messaging system at MT Desk that allows registered users to network with one another privately. However, this feature is only available to regular forum users. There’s been a lot of complaints about spamming going on through private messaging at MT Chat. Once a user has established himself or herself as a trusted user, they will be allowed access to this feature.

Registered users will have full access to their personal bookmarks feature, which allows them to create a list of favorite websites. There is also a mini calendar.

Why the changes?

In spite of the big change for MT Chat users, having everything at one site is much better for everyone. It means I only have one site to administer. It also makes people more aware of what is available at the MT Desk reference and style guide. There isn’t a lot of cross-over between the two sites, even though they were originally the same site. There is also some confusion, with people e-mailing me about MT Desk when they actually mean MT Chat. It also seems there are a lot of MT Chat users who aren’t even ware of the style guide at MT Desk. Having everything together gives me a better opportunity to complete the style guide and start working on additional services to offer medical transcriptionists at MT Desk. MT Reference is also an oft-overlooked resource in the medical transcription community. Even though these sites all share links with one another, my research shows there isn’t much crossover between them. I hope by integrating them all, everyone will make better use of the available resources.

I’m excited about these changes. I hope everyone embraces them and participates and provides feedback. So – see you at MT Desk!

It all apparently started with this article at Advance for HIM, Big Transcription… which got picked up and posted at the AHDI Lounge… which generated a lot of comments… which got Chad Sines thinking, so he wrote a blog post, Style Over Substance… which again got linked at AHDI Lounge.

Whew! And now, of course, I’m going to write a blog about it, because it seems my comments at AHDI Lounge never quite make it to publication – plus, I am going to be a bit long-winded.

So what’s the big deal?

The big deal is the English errors made in the original Advance for HIM article. Chad Sines seems to think MTs need to cool off a bit and pay more attention to the substance of what’s said and stop picking on the errors.

What struck me as off was that the comments seemed to suggest that since this MT made “glaring” errors, the substance of the article was not worthy of reading. The author apparently was to be shamed and discarded as seemingly irrelevant simply because of “mute” versus “moot” and other simple oopsies. While reading the comments I was almost yelling “WHO CARES??? Get off your pedestal and listen to the message!!”

Here’s the thing for me: there’s a reason for those big fat books on the shelf called “dictionary” and “Gregg Reference Manual” and that slim but oh-so-potent “Strunk & White.”

Errors such as mute instead of moot can certainly be overlooked – but as is obvious from the discussions at these websites, they’re distracting. It’s the equivalent of watching a period movie set in the 1800s and seeing an airplane fly across the sky in the background. Suddenly, you can’t pay attention to anything but the airplane, in spite of the fact that it’s a few seconds of a 90-minute film and a relatively minor event. And if you’ve ever watched TV or a movie with someone in the TV/movie business, you’d know that these types of errors are very obvious to them. Errors in spelling, grammar and punctuation are distracting and detracting for most readers, whether it’s a fiction novel or a professional journal – or a medical record.

If the Big Transcription article had been a blog post or a post in a forum or some other type of casual venue, errors could be written off – the author was tired, in a hurry, etc., whatever. But this isn’t a blog or a forum post, it’s an article in a professional publication that is widely read by everyone in the health information management chain. Is Advance for HIM no longer running articles past an editor? Or are the editors no better than the author?

Moving on, Chad compares this to the medical transcriptionist’s obsession with grammar and punctuation while overlooking glaring errors in the medical record.

The article in question isn’t a medical report. It’s a regular column published in a professional online magazine. By any publishing standard, the grammar and punctuation should be correct. Asking a group of people whose daily bread is the written word to ignore them is like asking a production assistant to ignore the airplane flying across the sky in a movie set in the 1800s.

The discussion at AHDI Lounge takes a turn in that direction, which then raises the question about Book of Style Bootcamps. Lea Sims defends the BOS as something other than a grammar and punctuation manual.

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.

This really isn’t an either/or. There are few – very few – instances where clinical accuracy would even have to be sacrificed for style. Correct me if I’m wrong, but proper grammar, punctuation and spelling  are not exclusive of accuracy of medical terms and terminology. I can think of many instances, however, where improper punctuation, grammar and spelling have impacted the clinical accuracy of a record.

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.

The BOS is not about clinical accuracy of the medical record. It is about style. No big surprise there, given the title of the publication. As part of the MT Desk online style guide wiki project, I’ve been through the Book of Style for Medical Transcription with a fine-tooth comb. It’s a style guide, not a laboratory values reference or a word list or an anatomy guide, or anything else that would guide a medical transcriptionist to recognize accurate clinical documentation. Let me just open this book at random in some of the sections  and give you some examples – you tell me if this helps medical transcriptionists identify clinically accurate documentation. I’m going to identify Section 2, Chapter 4 (Grammar) as the ONE chapter Lea identifies as being devoted to grammar and Section 2, Chapter 6 (Punctuation) as the ONE chapter devoted to punctuation – everything else is fair game.

Section 3 is devoted to Measurement & Quantitation; i.e., numbers, percents, proportions, ratios and ranges, units of measure. I see how to decide when to use arabic numerals, Roman numerals and ordinal numbers. I don’t see any explanation of the clinical use of these numbers or how to determine whether or not what’s being dictated is within the accurate range. And oh look – there’s an entire section on punctuation when expressing numeric values in the record, covering days and times, among other things. Lots of clinical significance there. There’s another section on how to form plurals, use of numbers in proper names, use of numbers at the beginning of a sentence….

Section 4 is devoted to Specialty Standards. Surely, there’s something in this section that would help a transcriptionist make decisions about a clinically accurate document. Let’s see… commonly encountered elements in the periodic table and their symbols, how to write chemical compounds, how to write chemical names and concentrations… nothing there that would help me make decisions about whether or not the dictation was clinically accurate. The Pharmacology section devotes an entire page to the FDA approval process; while interesting, not especially helpful from either style or clinical accuracy point of view. As long as we’re being obsessive-compulsive about the little things, we could start a discussion about the clinical importance of capitalizing brand name drugs and not capitalizing generic drug names. There’s a section on the different DEA drug classes, but there’s only a short list, given as an example, of some of the drugs in that class. And while I would say it’s useful for an MT to know the forms of administration of a drug, as outlined on page 302, what would be helpful insofar as the clinical accuracy is knowing which drugs are administered by each method – but that information is missing.

I could go on and on, but you get the idea.

The Book of Style for Medical Transcription is a style guide. It may have only one chapter devoted solely to grammar and one chapter devoted solely to punctuation, but that doesn’t mean the rest of the book isn’t full of instructions for grammar and punctuation and (gasp again!) style as applied to the medical record. What it is not about is what drugs are administered by inhalation and what drugs are tablets, or what laboratory ranges are normal, or what diagnostic studies might be performed on specific parts of the body, or to rule out a specific diagnosis. In other words, it has nothing whatsoever to do with clinical accuracy. As the self-claimed author of the BOS, Lea Sims surely knows that.

The Book of Style does what it’s supposed to do – other than general grammar and punctuation, it provides a framework for how to format the terms found in medical records. The terms themselves, the anatomy, the physiology, the pharmacology, the diagnostic studies – in other words, the clinical aspect of the medical record – are not the purview of a style guide. For one thing, it would take several volumes to cover the amount of information required to ensure the clinical accuracy of a document. The medical transcription school an MT attends, subsequent training, reference manuals, quality assurance, etc. – those are the appropriate venues for ensuring that a medical transcriptionist has the information to assess the clinical accuracy of the document. And I’m not even going to climb on my soapbox (again) about the dangers of attempting to make medical transcription more important by claiming that MTs are or should be responsible for the accuracy of the medically relevant portions of the record.

As far as I’m concerned, the bottom line concerning the errors in the Big Transcription article is that this is an article by a transcriptionist, in a professional publication for health information management professionals, and therefore it represents – or should represent – the standards of the industry. Starting with the transcriptionist who made the mistakes and ending with the editor who didn’t correct them, it’s a poor reflection of the kind of skills a medical transcriptionist brings to the table. Really, if MTs can’t demonstrate that they know the difference between they’re/their/there, moot/mute, or any number of other common English language errors, how can anyone be confident that they have the ability to protect the clinical accuracy of the document? I recognize that nobody is saying the English language component isn’t as important as the clinical accuracy of the document; however, my opinion is that we have to view this in the broad spectrum. You don’t trust someone with advanced skills – and the clinical accuracy of a document is certainly an advanced skill – when they can’t even demonstrate mastery of their native language.

Payments can be made by Paypal or by check. Order will be shipped when payment is received.

	Vera Pyle’s Current Medical Terminology, 9th Edition Like new condition Price: $10 SOLD
	Vera Pyle’s Current Medical Terminology, 8th Edition I actually have 2 of these. One was misprinted – the cover is on upside-down and backwards. In every other respect, the book is perfectly acceptable. Please specify which book you want. Price (each): $10 Pending Sale
	Vera Pyle’s Current Medical Terminology, 7th Edition This book is like new, with very little cover wear. Price: $10
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	Elsevier/Saunders The Surgical Word Book, 3rd Ed. (Tessier) This book is like new and is the latest edition. Price: $25 Pending Sale
No Image	The Surgical Word Book, 2nd. Ed. (Tessier) The newer edition is available above. This book is more worn, with some water staining, the cover is more worn, and the pages are yellowed. Price: $2 Sold
	Dorland’s Illustrated Medical Dictionary, 30th Ed. Includes CD with spell-check software (I’m not sure what), never opened. The latest edition is 31st; this edition is a steal at this price. Price: $25 Pending Sale
	Dorland’s Illustrated Medical Dictionary, 28th Ed. This book is more worn and an older edition. Price: $5
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No image	AAMT Book of Style, 2nd. Ed. There is a newer edition of this book. FREE – Shipping only CLAIMED

Am I the only one who thinks that if AHDI had done a good job in layout and design, we wouldn’t need lessons on how to use the book?

I was doing some research for updates to the MT Reference Style Guide this last week and discovered why people may need lessons on how to use the book.

There are confusing discrepancies and contradictions between the text and the samples.

I’m interested to see how they address that in a webinar.

If you have the book, look at section 10.3.9 Money (pp. 246-248).

For numbers less than one dollar, use numerals; spell out and lowercase cents. Do not use the decimal form. Do not use the dollar sign ($). Do not use the cent sign (¢) except in tables.

EXAMPLE:
8 cents not $.08 or 8¢

20 cents not 20¢ or $.20

It then notes an exception for tables and moves on to:

For amounts over one dollar, use the dollar sign ($) preceding the dollar amount, and separate dollars and cents by a decimal point. Do not use a decimal following the dollar amount if cents are not included.

EXAMPLE:
$1.08
$1.20

$40 not $40.00 (unless listed in a column with other amounts that include cents)

Are you with me so far? Stay with me while we cover ranges in money values (bottom of page 247).

For ranges, repeat the dollar sign or cent sign, but do not repeat the word forms. Use to instead of a hyphen with a dollar-sign or cent-sign forms.

EXAMPLE:
$4 to $5 not $4-$5.

10¢ to 15¢ not 10¢-15¢

I had to read this about 20 times to figure out that NOW there’s an exception to the “do not use the cent sign except in tables” instruction at the bottom of page 246. Because apparently, it should read: “do not use the cent sign except in tables and ranges.”

I’m starting to understand why a webinar might be necessary.

Moving on to the top of page 248:

Use to with word forms.

EXAMPLE:
4 to 5 dollars not $4-5 dollars.

10 to 15 cents not 10-15 cents.

Wait a minute. Back on page 247, it says we use the dollar or cent sign in ranges. Why are we spelling it out now?

I hope they cover that in the webinar.

More confusion on page 248:

Do not use the possessive form with compound adjectives.

EXAMPLE:
a 2-dollar bill.

Again – why are we spelling out the word dollar? According to the instructions on page 247, amounts over a dollar use a dollar sign ($).

I’m confused and this is only 3 pages. I’m beginning to wonder if 2 hours is enough time to explain everything.

In contrast, I refer to section 4 of the Gregg Reference Manual, which clearly states:

An isolated, nonemphatic reference to money may be spelled out.

two hundred dollars
nearly a thousand dollars
a twenty-dollar bill
like a million dollars

That might provide some clarity to the examples used – if there was an explanation in the AHDI BOS. But there isn’t. And why should you have to refer to both books to get some clarity?

Of course, this could be just a sales pitch for the book. Attendees are advised that they should have a copy before they attend the webinar. I wonder if AHDI-West gets an affiliate percentage of the books sold as a result of this webinar.

The bottom line is that because the book is in print and not electronic format, it can’t be changed. The solution – give a webinar and charge people $45 to learn how to use the print version of the book after they’ve paid $50 (members) or $70 (nonmembers) for it. I hope you don’t mind making notes in the margins – you’re going to need them. Alternatively, you can pay $30 a year to get the electronic (searchable) version. I’m also wondering if they’re going to do a webinar on the electronic version or if there are plans to update it to clear up any errors or confusing text and examples.

I’m thinking I need to spend more time on the MT Reference Style Guide so MTs have a free, searchable, updated style guide that is comprehensive and complete. Shameless plug: Feel free to participate in the style guide creation. Your comments and feedback on the content is welcome and appreciated.

First, I’m changing this to a single-person industry blog. My personal blog can be found at Juliew8. I’ve also included a link in the blogroll. The microblog is my Twitter feed. If you are on Twitter, please feel free to follow me.

If you have a blog relating to the medical transcription industry and you want it included in the blogroll and/or the feed, please use the contact form to send me information. I don’t guaranty that I’ll include every blog but I do guaranty I’ll at least go take a look and decide.

The old MT Exchange will be available until I decide it doesn’t need to be any more. You can access it here or click on the link in the blogroll. However, I have shut it down for all new entries and made it read only.

If you have other useful links, please submit them here or at MT Reference.

I hope everyone has a very prosperous and safe 2009. Thanks for your patience in the changes that have been made here in the last year.