i robot. not! - career step · ity of the medical transcriptionist to ensure accurate...

In This Issue

In I, Robot, Isaac Asimov’s fa-mous collection of science fic-

tion stories, he explored various fac-ets of robotic technology and how it might affect humanity. In Asimov’s stories, robots were governed by laws designed to protect humans, but events in the stories often went awry because of strict, unwavering robot obedience, devoid of human under-standing and judgment.

I am reminded of these stories every time I field a phone call from a student who is upset because some-one said that medical transcription-ists are being replaced by voice rec-ognition software—because it’s the same idea.

Developers and salespeople of the VR technology are, understand-ably, proud of their invention and en-thusiastic—perhaps overenthusiastic—about its abilities and applications. Of-fice managers whose main concerns are to keep track of per-sonnel and cash flow of a medical office, and even doctors who don’t really understand what happens to their dictation between the time they speak it and the time they see it in the patient record, are excited with the prospect of a machine to take over the task of medical documenta-tion without expecting a paycheck. So, the salespeople pitch to doctors’ offices and a VR system is purchased (against a very large price tag) based

I Robot. Not!In a presentation given to the

8th Annual International Confer-ence on Critical Thinking and Edu-cation Reform, Summer 1987, Mi-chael Scriven & Richard Paul put forward these simple ideas:

1) A set of information and belief generating and processing skills, and 2) The habit, based on intellectual commitment, of using those skills to guide behavior.

Volume 13 | Issue 4 | JULY/AUGUST 2010

Intuitive Research . . . . . . . . . . . . . . . 2

Dealing with the Gray . . . . . . . . . . . . 3

Ergonomic Topic . . . . . . . . . . . . . . . . 4

Stepping Up Recipe . . . . . . . . . . . . . . 5

Student Spotlight . . . . . . . . . . . . . . . . 6

Dear Susan . . . . . . . . . . . . . . . . . . . . 6

Forum Report . . . . . . . . . . . . . . . . . . 7

Graduate Spotlight . . . . . . . . . . . . . . . 8

Notable Notes . . . . . . . . . . . . . . . . . . 9

Share your Career Step Experience . . 9

Work Smarter Not Harder . . . . . . . . 10

Stepping Up Challenge . . . . . . . . . . 10

Speech Wreck . . . . . . . . . . . . . . . . . 11

Moderated Chat Schedule . . . . . . . . 12

on the idea that a machine is superior to a human, that a computer program will deliver perfect compliance and accuracy sans the hassles and expenses of dealing with a person—the same pitfalls explored in Asimov’s stories.

As trained professionals in the medi-cal transcription field, it’s easy to see the error in these assumptions. Why is a computer unable to handle the entire task of medical transcription? On the surface the task appears simple: to accurately turn spoken words into a text format. This seems like it would be appropriate for a computer program, right? Well, no, because the task is really much more than just robotic typing in response to audio. Trained MTs use uniquely human abili-ties to make decisions, read context, ac-cept variation, and understand meaning. Medical transcriptionists leave out all the ‘ums’ and ‘uhs’ as well as comments the

doctor makes to his kids or passing colleagues that have nothing to do with the report; MTs follow verbal directions and dictated backtracks to correctly insert in-

formation spoken out of order; MTs also can work with charts and lists if neces-sary, inserting headings and subheadings as needed; MTs organize and rephrase at times. In short, trained MTs ensure that what shows up in the patient’s medi-cal report reflects what is meant, not just what is said. This demonstrates critical thinking—a uniquely human ability. The cold, hard fact is machines lack the ability to think critically.

"Trained MTs use uniquely human abilities to make de-cisions, read context, accept variation, and understand meaning.”

Continued on pg. 3

2 JULY/AUGUST 2010 STEPPING UP

The Human ElementIn this issue we approach the

notion that despite technological advances, tools, and gadgets, the human element is indispensable in all things, including our world of medical transcription. In the articles, you’ll read about uniquely human capabilities like problem solving and judgment calls, how to research intuitively, and how to understand acceptable variations.

You’ll get a humorous peek at doctors’ personalities in the Forum Report. Speech Wreck clearly shows what happens in the absence of the human touch. Ergonomic Topic touches on the physical benefits and pitfalls of transcription editing. Finally, enjoy the More Than Nuts & Bolts Pie featured in the Recipe Box.

As the future continues to arrive, it’s important we are open to change and continued learning with regard to technology. It’s also important to recognize and cherish our unique abilities that no computer has—our human capacity to care and laugh, sympathize and empathize, and take pleasure in a job well done.

Intuitive ResearchBeyond the Boundaries of a Machine

In the last Stepping Up issue, you may have noticed that we

talked a lot about technological devel-opments that affect the medical tran-scription field—electronic medical records, home office equipment, and speech recognition software. All of these things have and will continue to change and evolve. There is at least one thing, however, that remains the same. Even with these advances in technology, it is still the responsibil-ity of the medical transcriptionist to ensure accurate transcription. Why? Because, as the previous articles have noted, analyzing context, critical thinking, decision making and, there-fore, researching are all beyond the abilities and boundaries of a machine.

Several years ago, an MT would lug out a 10-pound medical diction-ary and thumb through it in order to look up unfamiliar terms. Today we don’t have to deal with a clumsy, over-sized book on our desk, but we still have to investigate unfamiliar terms and other areas of possible inaccuracy. While we don’t want to get bogged down heavily researching every report, it’s important for the transcriptionist to know both when and how to research, without invest-ing a lot of time yielding fruitless results. Becoming this type of

report might seem like a complicated sentence that lacks understandability. You may be very tempted to shrug it off as part of the learning process and just plow ahead, transcribing words that don’t necessarily make sense just to avoid receiving the dreaded “significant omission.” After all, you do just want to hurry up and start working already!

Don’t give in to the temptation of ignoring report context that you do not understand! While you will likely never fully understand every

single phrase in every report you transcribe, some reasonable action on your part right now, while work-ing your way through your medical transcription or editing program, will pay off generously in the future. Take the example mentioned above, in which you, a student, are faced with a report that has a lot of unfamiliar terminology. If you invest the time and effort right now into looking for diagrams (Google Images is often a great place for this) that will help with understanding the referenced anatomy and for sample

intuitive researcher doesn’t happen overnight, though!

When you know a word is incorrectly used or you can’t quite understand the drug dosage that is dictated, researching is the obvious thing to do. Instances like these are the starting point for becoming an in-tuitive researcher. When faced with these situations, you quickly learn to use a dictionary site to double-check the meaning of a word and to tap into a favorite pharmacology resource for correct dosing information. As you gain more experience, you will start to expand your researching methods, checking sounds-like sites in case the dictator was simply mis-pronouncing the word, and locating manufacturers’ sites to find accurate information on the latest medications.

Then there are times when researching may not seem like the best—or should I say, “easiest”—ap-proach. Especially as a new student, you be bombarded with terminology you are likely seeing and hearing for the first time in your life. Just about every sentence in a medical Continued on pg. 4

"...analyzing context, critical thinking, decision making and, therefore, researching are all beyond the abilities and bound-aries of a machine.”

STEPPING UP JULY/AUGUST 2010 3

Continued from pg. 1

It is thus to be contrasted with: 1) The mere acquisition and reten-tion of information alone, because it involves a particular way in which in-formation is sought and treated; 2) The mere possession of a set of skills, because it involves the continual use of them; and 3) The mere use of those skills (“as an exercise”) without acceptance of their results.

If you apply these defining state-ments to contrast and compare hu-man medical transcriptionists and computer software, it’s easy to see the strengths of the human transcription-ist.

Medical dictation presents a great

deal of variation in speech pattern and voice modulation, accents, regional dialects, etc., from doctor to doctor; although VR software is advertised as having the ability to “learn” a par-ticular person’s speech habits, this is limited and requires time and patience on the part of the person speaking to train the machine. Also, the “training” accomplished for one person’s voice doesn’t help the next person who uses it. The machine, therefore, doesn’t really have a habit, or an intellectual commitment that guides behavior, like a trained human transcriptionist does;

all it has is the ability to acquire and retain information.

There is a very large task of mak-ing sure the information makes sense. A machine cannot take verbal cues, apply them to the constructs of the language, make logical allowances for variation, draw correct conclu-sions and accurately convey meaning. Again, there is no real processing of information, only the application of acquired skills as an exercise with-out (and this is the important part) acceptance of their results. A ma-chine doesn’t know, nor does it care if it makes a mistake. In contrast, a person, especially a well-trained pro-fessional in the field, accomplishes all this naturally and instantaneously. And a person cares.

Ironically, it is also human nature to defend a decision, especially if a significant investment has been made. Medical offices that convert to a “com-plete” VR system are very motivated to implement it and the office person-nel work very hard to turn the excite-ment into reality. Some medical offices seem to be an acceptable fit; they have fairly modest demands and repetitive documentation needs, so after a period of adjustment involving changes in the doctors’ habits and a likely dip in productivity, the VR system settles in as an acceptable, although not supe-

rior, option. Other office and hospi-tal settings are not conducive to the limitations of a VR system at all; the reality in this case is the office must now work with a system that requires a great deal of adjustment, may very well put more demands on the exist-ing office staff as well as the doctors, and does not really work any better than their old system—and they’re still making payments. Some offices grit their teeth and make it work; oth-ers realize the system is good for a first draft and hire MT editors; some offices simply give up and call back their transcription staff.

Technology will continue to de-velop, of course. Perhaps someday our lives will resemble the pages of science fiction stories in our easy use of computer intelligence designed to enhance our daily existence. Keep in mind, however, that as thinking, feeling, analyzing human beings, we are irreplaceable. No technology ap-proaches the unique abilities of a per-son. Just as Asimov’s stories illustrate, the human component is vital to the success of any endeavor involving the welfare of people—like medical tran-scription. Remember this, and value yourself. We are not robots; we are so much more!

- Jill McNitt

CS Student Support Team

Dealing with the GrayChoose Wisely

Do you remember that scene from Indian Jones and the

Last Crusade, when the bad guy takes a drink from the wrong cup and in-stantly mummifies and the old knight says stoically, “He chose poorly”? Well, when speaking to students who are anxious about acceptable variations, I feel like many of them worry so much about having it exactly right that if they transcribe something “incor-rectly” then they too will be instantly mummified (or worse!) for having chosen poorly.

It would be nice—really nice—if the world of medical transcription was black and white. It would be a dream come true for many MTs if there could be a universal handbook, an industry standard, that all doctors’ offices and hospitals everywhere must follow, that spells out well-nourished should always be hyphenated and distention should always be disten-tion and not distension and A1C should always have a capital ‘C’ and never a lowercase ‘c’. Unfortunately,

as it goes with anything involving the English language, there are excep-tions and acceptable variations to any given rule.

Often students worry and fret and stress over not having a black and white rule. They worry about dealing with the gray and making that leap of judgment, concerned that they may get it wrong. We say, “Enjoy the freedom!” The grayness is

Continued on pg. 5



Ergonomic TopicMedical Editing Pros and Cons

We’re all familiar with the pitfalls of straight tran-

scription—the wrist pain, the numb-ness, the tingling, the NSAIDs, the wrist braces, the quest for the per-fect keyboard and mouse—the whole bundle of symptoms and treatments surrounding repetitive stress injury associated with typing a lot. As men-tioned in recent issues, the best thing to do when faced with injury like this is to rest and heal, but of course, this is not a viable option if you depend on the keyboard to make your living. Expansion tools like Shorthand and Instant Text are life (and wrist) savers in this arena be-cause they allow you to produce many lines with fewer keystrokes. Medical transcription editing is similar in that the editor uses specialized software to zip through many lines, quickly mak-ing any necessary corrections along the way—not typing every word. Let’s explore this from an ergonomic standpoint.

Fewer keystrokes means fewer finger movements and fewer oppor-tunities for the tendons to irritate the tendon sheaths running through the small, enclosed area of the wrist called the carpal tunnel. Less irrita-tion means less inflammation, less swelling, less pressure on the blood vessels and nerves sharing this finite

space, resulting in less numbness, tingling, and pain. We’re all for fewer keystrokes! How does a medical editor work with fewer keystrokes? The secret is in the software and the built-in short-cuts.

For instance, speech recognition software will often produce text that is not formatted correctly, with mis-placed headings and numbered lists that appear in a paragraph. Without editing software, you’d have to place your mouse, hit Enter, then perhaps space and add proper punctuation. That’s a lot of keystrokes, not to men-tion the time wasted by taking your

hands off the keyboard to place and click the mouse. With editing soft-ware, all you need to do is hold the right or left arrow button to place the cursor, then strike a combina-tion of keys (like CNTRL + N) and the subsection is created! There are many shortcuts designed to do any-thing you’d ever want when navigat-ing a document, making corrections, and creating formatting—all of them much less labor-intensive than tradi-tional word processing. An experi-enced editor can edit twice as many lines as an experienced transcription-ist working straight transcription, with fewer keystrokes.

The medical transcription editor is vitally important to ensure the accu-racy of medical documents originally produced by a machine. Using the ed-iting tools is a great way to put the finest aspects of technology to work for us while keeping the human ele-ment alive and well.

- Jill McNitt

CS Student Support Team

reports (www.mtsamples.com is just one of several sites to offer samples) to help fill in some of the blanks--and then you save these sites to your favorites in an organized manner and perhaps add the unfamiliar terminology to your word list-- the next time you come across a report involving cardiac catheterization, you will have already done the leg work in researching and will know exactly where to look.

As you have repeated exposure to common procedures, anatomical

structures, surgical equipment, and drug dosages, you’ll find that your gut feeling starts to kick in. Even though you may not know exactly what the usual dosage is for Syn-throid, you will find a little red flag appears in your mind when you hear a dictator say, “Synthroid 50 mg per day,” being relatively certain that a dose of Synthroid 50 should be in mcg and not mg. You will then automatically proceed to your favorite drug resource to verify your suspi-cion, flag the report for clarification, and then continue on with transcrib-

ing the report, all in a matter of seconds!

Though researching is certainly a skill that needs to be developed, over time you’ll find that it becomes second nature to know when and how to research. We are, after all, intelli-gent creatures who go far beyond the boundaries of a machine.

- Heather GarrettCS Skills Assessment Team


More Than Nuts & Bolts Pie

Ingredients2 (9 inch) prepared graham cracker crusts*6 tablespoons butter1 (7 ounce) package shredded coconut1 cup chopped pecans1 (14 ounce) can sweetened condensed milk1 (8 ounce) package cream cheese, softened1 (16 ounce) container frozen whipped topping, thawed1 (12 ounce) jar caramel ice cream topping

Directions1. 1. Place butter in a medium skillet and melt over medium heat. Add coconut and pecans, stirring to coat.

Sauté until coconut and pecans are lightly toasted, about 5 minutes. Set aside.2. 2. In a large mixing bowl, whip together condensed milk and cream cheese until fluffy. Fold in whipped

topping. Spoon 1/4 of cream cheese mixture into each graham cracker crust. Drizzle each with 1/4 of caramel topping. Repeat layers with remaining cream cheese mixture and caramel. Top each pie with coconut and pecan mixture. Freeze overnight.

*For a twist, use a chocolate cookie crust instead. Sprinkle chocolate chips and drizzle chocolate sauce on top in addition to the caramel.


Original recipe yields two 9-inch pies

not a thing to be feared! Embrace it! Use that wonderful decision-making organ called a brain to muddle things out for yourself ! You see ballottable or ballotable and you’re frustrated because it’s different from report to report. After doing some research, you find that there really are two spellings and they are both acceptable within the industry. Your power of reasoning kicks in and says, “Well, if the industry accepts both, then I can use either one in my report. If they key has the other spelling, so what! I know what I have transcribed is also correct. Because both are used, I won’t get counted off for this on the final exam.” It really is that simple.

Punctuation is another area that casts a big gray shadow over our idyllic black and white world. Many students feel like they have to be grammar experts to make the judgment calls on what’s right and

wrong when it comes to punctuat-ing a sentence. You transcribe a report putting semi-colons between laboratory data. The key comes back with periods. You wonder if you did something wrong. The truth is, especially with punctuation, there is more than one way to correctly present the information given. The comparison tool in the course simply provides one example of how to format and punctuate. It’s up to you to judge if what you typed represents a true error that changes the mean-ing, or a difference in style that does not change the meaning.

Remember: we’ve given you the training. You know what’s right, what’s wrong. You know how to re-search. You know how to make sure a site is a trustworthy resource. Trust your training. Trust your instinct. Trust that you know, ultimately, what’s right, what’s wrong, and what is left up to your own personal preference. Remember the great big

rule of thumb: if it doesn’t change the meaning of what’s being dictated, then you’re fine!

There are many things that are difficult about being an MT, like which pair of slippers to put on when you go to work in the morning. All joking aside, even with top-notch training there are certain intangible traits that are difficult to “train” a person to do but are crucial to gain-ing and maintaining success in this field. Learning to handle style issues, exceptions, and acceptable variations is one of those intangible traits. If you can grasp that concept, the MT world is your oyster, or as the old knight says approvingly after Indiana Jones picks the right cup, “You chose wisely.”

- Chelsea PyleCS Skills Assessment Team

Student SpotlightShaindy Grinberg

Hi everyone! I want to thank Career Step for giving me

the opportunity to introduce myself to all of you and, of course, for the wonderful education. You may have seen me on the forums as notthetype--hello to all my study buddies!

I was born and raised along the Eastern coast of the US. After grad-uating from high school at 16, I at-tended a teaching seminary, planning on making teaching my career. I en-joyed teaching, but after 4 years, my husband and I decided to move abroad to a foreign country. Realizing that it would be hard to teach in a language that I was not fluent in, along with expecting my first child (born when I was in middle of FOMS), I started to investigate other options. I have al-ways liked science and medicine, but being a doctor/nurse was out of the question because to me, family comes

first. Someone mentioned medical transcription to me, and the more I heard about it, the more I was con-vinced that this was the job for me--a job that was both interesting and flex-ible with regard to family life

I started Career Step in June 2009.

I completed the first few modules (getting stuck in Keyboard Kinet-ics with a slow typing speed; this has gotten much better). A week later I moved overseas with my husband. Af-ter a nice break, trying to acclimate to a new country, along with getting my phone and internet set up in a differ-ent language, I got back into Career Step. I was not working at this time and did not have many distractions. I was able to put a few more modules under my belt before my son’s birth in September. After an even longer break, I resumed Career Step, now with a baby keeping me company.

At this point, I began to get dis-couraged about finishing. While the first modules had been hard, I had been excited about starting and could not wait to actually transcribe. By now, however, the excitement had worn off somewhat. I still had not ac-tually gotten to the transcription, and the course was just getting harder. I started spending more time on the fo-rums looking for some motivation and help. I soon realized that I was not the only one feeling discouraged and oth-ers were having trouble in the same places I was. I found myself jump-starting my day with a visit to the forums. I also found that I could help others because other people were hav-ing the same questions I had struggled with, and I could provide the answers. I started clinics and began my own study buddy group to help myself and others get through the practicum.


Dear Susan...Dear Susan,

Are we really responsible for correcting the doctors MEDICAL errors? I understand being responsible for grammatical errors, but this seems unreasonable. How about dosages? I noticed in report #4102, for example, the doctor prescribed cephradine 500 mg q.i.d. for paronychia of the left 2nd finger. I know that the usual dose for skin infections is actually 250 mg q.i.d. The dose of 500 mg q.i.d. is only prescribed for more serious infections such as lobar pneumonia. Anyway, please advise!!! This seems like the DOCTOR’s responsibility to know what he/she is prescribing!!!!!

Signed,Frustrated

Dear Frustrated,

Our job is not to change the dictation; rather, it is to type as dictated and ask for clarification on anything that throws up a red flag.

The kinds of errors we should be catching are the “slip of the tongue” errors—on page 2 he says the xyz test results are negative and on page 6 (and after he’s been interrupted a zillion times during the dictation) he says that “based on the positive xyz test results” he is recommending abc. THESE are the kinds of things we are expected to catch, not that he used Vicryl when we think he should have used nylon, or prescribed X drug instead of Y drug and our drug book doesn’t

mention that it can be used for this. It is not our job to second-guess the doctor’s treatment of his patients. We are NOT doctors and

we have NOT seen the patient. However, we absolutely DO flag when a patient is listed as allergic to a drug and then later in the report a different brand of that

same drug is prescribed. We ARE supposed to know these and notice what has been dictated. A lot of this knowledge will come with time and repetition and working as an MT on a daily basis.

Hope this helps!

- Susan Tuckett, CMTCS Student Support Team

Continued on pg. 12


A Funny Thing Happened On The Way To The Forum

Doctors are people too!Sometimes their personalities shine through, even while dictating. Here are some examples, taken directly from the forum:

#1 “Hope you enjoyed your flight with us today!” This was at the end of a recent dictation . Just made me snicker .

#2 That’s funny! Once, after a surgery report, the doctor said, “Thank you for joining us today. Join us again next week when we continue to take out more gallbladders!” I wasn’t expecting that, and it made me laugh so hard!

#3 I have this one doc who

sounds really nice . He occasionally sings parts of the report in an Elvis mimicry . Cracks me up every time .

#4 I love when I get one that has a sense of humor. The other night I had one that after he said the patient’s name, which was Wilbur, he repeated it as “Wiiilllllllbbbbbuuuuurrr.” I assume it comes from a movie or a show but I can’t figure what.

Anyway, it was funny.

#5 Mr . Ed, the horse!

#6 Too funny! I’ll share my doctor funny for the week. I have a doc who is the absolute worst doc to transcribe. The man never dictates a complete sentence. Anyway, at the end of the report he says “Please send this incredibly brilliant note to...” Methinks he’s fond of himself.

#7 At the end of a report today, the doctor dictated, “I have talked with the patient about smoking . In fact, I am going to send him upstairs to the clinic today and have the surgeon sew his lips shut so he cannot smoke .”

This totally threw me off for a second . This doctor dictates while the patient is in the room with him, so you could hear the patient and his wife’s response laughing and protesting . Made me crack up!

#8 [This] is a report w/ a letter to the referring doctor. “Thank you for referring whoever this is.” I laughed so hard my tummy ached. I wipe the tears, start working again, think of that...then burst into laughter all over again.

#9 My MT friend told me that one of her doctors was dictating a report about a child and said “Both he and his parental units” then he stopped and said, “Both he and his parents” . . .

She thought he had been watching Coneheads too much lol .

#10. For over 10 seconds while this doctor was collecting his thoughts, he hummed Jingle Bells.

#11 . This was funny . Last night, the radiologist was dictating an exam and he says, “History of OSA . I have no idea what OSA is but that’s what they wrote as the reason for the scan .”

I had a good laugh over that . I even said out loud, “OSA is obstructive sleep apnea, silly .” LOL

#12 LOL ~ Kind of nice when you realize they are only human, huh?

#13 That’s awesome . Things like that make me smile while I’m working . This morning I had a doc speak specifically to me,

“Transcriptionist, . . . . . . Thanks and have a good day .” I loved it; it just reminds me that some do think about us and respect what we are doing on the other end .

#14 A little kid’s voice: “Oh no, I am recording. Stop!!”

I suppose the doctor’s little one got a hold of the recorder...

#15 Oh how funny! :) Times like this are what I think will keep this profession fresh and human . These aren’t just voices on a sound file - they are real live human beings who just happen to have a very important job .

I’ve had several people tell me that they couldn’t imagine doing MT for a living because they need the human interaction too much . We get human interaction - it’s just that the human on the other side of the sound file can’t talk back! It sounds like the perfect setup to me!

#16 The other night a doctor said, “This is Dr. XXX dictating an ER report, while eating peanut M&Ms, I apologize.” I laughed so loud when he said that!

#17 The other day the physician gave me a chuckle . . . . .he was describing a Past Surgical History and was trying to list herniorrhaphy . He tried 4 times to pronounce it, then laughed and said “oh, heck, he had a hernia repaired!”

#18 I love it when doctor’s throw in a little humor to break up the monotony! It lets you know they are still human!

Continued on pg. 8

#19 I had one this morning where the doctor dictated, “She had a bone marrow,” and then dissolved into giggles until he had me giggling with him and not even knowing why he was giggling yet and then he corrected himself to say, “She had a bone density scan this morning .” Not really all that funny, but to hear this guy giggling was great . He is always so serious when he dictates .

#20 I think my funniest one was when I first started transcribing for my FAVORITE provider (thank goodness I still have him) and he was doing a physical examination on a woman and got to the GU part of the exam and was going through the

list and spouted of, “Testes:..Oh my gosh, where did testes come from?” and then went on asking me to PLEASE not put that in there.

#21 I had one that made me laugh today .

In the middle of an adenosine stress test report the doctor yells out, “Did you have any chest pain with this? . . . yeah, okay, that should ease up now .”

Then he goes on to calmly dictate “The patient had some chest discomfort with . . .”

#22 That reminds me of one of the urologists I type for. He ALWAYS dictates with the patients in the room, which

can be good or bad at times, depending on the situation, mostly a good thing...

Anyways, he’s dictating all about the followup with this patient and says, “He was taking PDE5 inhibitors for his erectile dysfunction but decided that he no longer wants treatment for this.” THEN, you hear this weak, feeble voice in the background holler out “I’m 80!”

I about fell out of my chair laughing!

- Jill McNittCS Student Support Team



Graduate In The SpotlightDarlene Hoggatt

I live in a little mountain town of approximately 1,000 people,

so job opportunities are limited. I first heard about medical transcrip-tion when a friend of mine mentioned that she was doing medical transcrip-tion from home and really enjoying it. Then, approximately 6 months lat-er, another friend said she was look-ing into medical transcription. She had found a repu-table school and suggested I look into it too. She brought the Career Step books by my house, and after I looked at them, I was hooked. I have always loved anything medi-cal. Whether it’s CPR training, home health care, or nursing, I have pursued them all at some point. When I saw the books, I thought, “This is right up my alley,” so I talked with my husband

and enrolled with Career Step just a few weeks later.

I thought the Career Step pro-gram would be a cinch—little did I know! After listening to my 400th transcription report, I began to won-der if I would ever finish. One year

after enrolling in Career Step, I fi-nally took the fi-nal exam and fin-ished the course. At that point, I began looking for employment. Af-ter submitting numerous applica-tions and taking multiple pre-em-ployment exams

(some of them as long as Career Step’s final exam), I became discour-aged. I will never forget the speed-typing tests, the 48-hour long tests, and the tests that had 8 different tran-scriptions--each 1-2 pages long. I will

also never forget the letter that I re-ceived after taking one 48-hour long test, that informed me the company I had tested with was not hiring at that time. I had passed their test, they just were not hiring!

Two months later I found out that our local hospital was looking for a back-up medical transcriptionist. I applied, and just like that, I was hired. Currently I only work when the regu-lar medical transcriptionist is sick or on vacation, but I am getting experi-ence in a field I love.

Career Step is only the first step. Hang in there. Be creative in get-ting your foot in the door. Take the part-time opportunities, and above all, don’t give up!

- Darlene Hoggatt


Share Your Career Step Experience

Love Career Step? It’s easier than ever to share your Ca-

reer Step experience! We’ve just intro-duced two programs that help you tell others about Career Step and reward you for helping them succeed—choose the program that’s best for you!

Personal Referral ProgramThe personal referral program is a re-naming of Career Step’s historic af-filiate program. This is the right pro-gram for you if:

•You plan on mainly promoting Career Step to your family, friends, and associates.

•Most of your efforts will be through word-of-mouth or other per-son-to-person tactics.

•You don’t have an independent website. (If you have an “affiliate web-page” through the old program, this does not constitute an independent website as it is hosted by Career Step, but you will continue to have access to

Career Step Personal Referral and Affiliate Programsthis webpage through the personal re-ferral program.)

The personal referral program provides you the opportunity to earn generous monthly referral bonus-es based on the number of individ-uals you refer who enroll. Participa-tion in the program includes a unique code and webpage that will allow Ca-reer Step to track your referrals’ en-rollments. You will also have access to downloadable marketing resources to help you promote the Career Step pro-grams. For more details or to apply to the Career Step personal referral pro-gram, visit http://referral.careerstep.com/.

Affiliate ProgramThe new Career Step affiliate program has been developed to provide website owners the opportunity to promote Career Step programs to those who are interested in the growing health-care industry. This is the right pro-gram for you if:

•You plan on advertising Ca-reer Step on your own independent website(s) to an audience that matches that Career Step demographic.

•You plan on advertising online through banners and text links.

This new affiliate program is ad-ministered through the ShareASale affiliate network and offers generous commissions based on monthly lead volume. The program includes ban-ners in all standard sizes with cus-tomization available. For more details or to apply to the Career Step affiliate program, visit www.shareasale.com/shareasale.cfm?merchantID=25156.

- Amy KendallCS Marketing Team

Notable NotesNew Student Support Team Member

Rebekah Hutchins, Pharmacy Technician Program

We are pleased to introduce Rebekah Hutchins as writer, designer, and all-around awesome queen of Career Step’s soon-to-be-released Pharmacy Technician program. She says:

“I am from the great state of Texas; Austin, to be exact. I proudly graduated from the University of Texas (Hook ‘em Horns!) with a degree in Spanish. I became a Certified Pharmacy Technician during my freshman year of college, and since then, I have worked in three different pharmacies in two different states over the course of nine years. I also taught high school for four years, working at pharmacies several times a month and full-time in the summers.

Joining the Career Step team gives me the opportunity to combine my love for pharmacy and my passion for

education by supporting students who want to learn the skills necessary to be successful as a pharmacy technician.”

Welcome, Rebekah!


Work Smarter not HarderYour Humanity, Your Final Exam

The human mind is an amazing machine that cannot be repli-

cated. As a medical transcriptionist, using the mind’s ability to reason and focus on context is critical in pulling together an accurate medical report. There is no computer or machine that can reason in this same manner. To ensure accuracy and improve your overall results while taking the Ca-reer Step final exam, it is important to implement this unique human ability, primarily through two proofreading techniques.

The first of these techniques is to read the report out loud in your own voice. By doing this, your brain can hear extra and omitted word mistakes that a computer cannot detect. As you read the words out loud, the sentence will not sound correct to your ear if there is an extra or omitted word in-volved. At that point, you should go back and listen to the sound file specif-

ically at that section, adjusting the au-dio speed as necessary, to verify if the word is stated and then retracted by the dictator, if you possibly confused the word with a dictated punctuation mark, or if there is a dictated word that you missed initially as you were transcribing the report. Once you’ve identified the error, you are able to correct it.

The second proofreading technique is to read through the report carefully, focusing on definitions of the terms included, constantly asking with your human mind: “Does this make sense?” This approach allows you to detect contextual errors that are critical and costly on the final exam grading be-cause they often affect the medical meaning of the report. For example, if you are proofreading an operative report about a cholecystectomy and you read the transcribed sentence, “The patient’s leg was prepped and

draped in the usual sterile manner,” your human reasoning would alert you that this does not make sense. Since this type of surgery involves remov-ing the patient’s gallbladder, the doc-tor would certainly not need to prep and drape the patient’s leg. Again, as the transcriptionist, you should go back and listen to the sound file specif-ically at that section, and most likely, you will instead hear, “The patient’s ab (slang for abdomen) was prepped and draped in a sterile fashion.” That definitely makes a lot more sense! By implementing the amazing reasoning capability of the human mind, your transcription skills will be much more accurate, and you will see improved results on your final exam.

- Mary Louise Arango

CS Skills Assessment Team

Stepping Up ChallengeAcross2. The “A” in Al5. The “R” in SRT6. The “M” in EMR9. An old popular brand of dictating machines10. A scaly mythological creature and popular speech recognition software program

Down1. A popular word expander program3. The “V” in VR4. Not hard but ___ware7. Has more portability than a desktop8. Not a bike pedal but a ___pedal


Speech WIf you have ever had the pleasure of working with speech recognition technology, you likely have learned that

speech rec engines make some rather absurd mistakes! Here are 10 things you probably didn’t know about speech “wreck” engines…

Note: “SR:” refers to what the speech recognition program interpreted the dictation to be. “D:” refers to what the doctor actually dictated.

SR: The pelvic mass is palpable in the patient’s right eye .D: The pelvic mass is palpable on the patient’s right side .

reck

1. They failed Anatomy 101...

SR: The patient last worked as a hoarse breather .D: The patient last worked as a horse breeder .

2. Being sympathetic, they understand that on some days even just breathing seems like work...

SR: She does not like the side effects of the kids .D: She does not like the side effects it gives .

3. They also understand that having kids has consequences…

SR: Plan: Distrust of support curds .D: Plan: Discussed supportive care .

4. They have unwarranted trust issues with cheese…

SR: Low neutrophils, high tomatoes .D: Low neutrophils, high eosinophils .

5. But they do love their veggies…

SR: Later on it baked diarrhea .D: Later on, a big diarrhea .

6. Speaking of food, they should never throw a dinner party… EVER…

SR: mood, mood, good, mood .D: [no actual dictation, just the doctor clearing his throat]

7. They just want everyone to be happy…

SR: She is very cheerful and unhappy .D: She is very tearful and unhappy .

8. Although they seem to suffer from mood swings…

SR: She has had very little pee intake funny .D: She has had very little p .o . intake, if any .

9. Luckily, they have a good sense of humor…

SR: quit typingD: quetiapine

10. And finally, they have big plans to take over the transcription industry…

Stepping Up is published bimonthly by Career Step for its students, graduates, and client partners .

This newsletter is produced for electronic viewing and print . The electronic version is available to all current students and graduates at no cost . Print subscriptions are $25 for a one year and $40 for a two year subscription .

Career Step Quality Medical Transcription Training

4692 North 300 West, Suite 150Provo, UT 84604

Phone: 800-246-7837 or888-657-5752

Fax: 801-491-6645Email: SteppingUp@careerstep .com

Website: www .careerstep .com

Jill McNitt, Editor-in-ChiefChelsea Pyle, Associate EditorHeather Garrett, Associate EditorAlesa Little, Layout Editor


Moderated Chat SchedulePlease join us for Career Step’s Thursday moderated live chat room sessions. The topics vary weekly and include course-related topics, industry topics, and employment issues.

1st Thursday of month, 10-11 am Mountain, Industry Topic/Guest 2nd Thursday of month, 12-1 pm Mountain, Student Support team 3rd Thursday of month, 12-1 pm Mountain, Skills Assessment team 4th Thursday of month, 12-1 pm Mountain, Graduate Services team

5th Thursday of month, TBA, wildcard topic when applicable

When I started BAC (Basic Acute Care), I began tracking my productiv-ity. Suddenly, the reports were flying by (well, not that fast!). Instead of checking my email, getting a drink, typing, hav-ing a snack, talking on the phone, typ-ing, and playing with my baby, I was now typing and typing and…typing! I found that timing myself really helped me get more done. I felt accountable to the timer and kept trying to get more done in less time.

My biggest secret for success, I think, is my rewards system. I feel that when I do something signifi-cant, I deserve a reward. Even if it was a small one, like a chocolate bar or going out for lunch for finishing clinics, I worked hard and earned it--and never underestimate the power of a reward! In one week I did the last 30% (!) of BAC for a big prize--a silver bracelet!!

- Shaindy Grinberg


i robot. not! - career step · ity of the medical transcriptionist to ensure accurate...

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