Tuesday, October 2, 2007

I only typed one report today! It got crazy really early and I wound up catching up on some housework. It was a nice day off, although, a little more hectic than it usually is with my structured "work" schedule. Wow, that's pretty weird. I haven't had a job since I was a mom, and I never thought I would say things were calmer when I was working!

House is coming on and I'm pretty tired so there will be more tomorrow! Oh, and I'm out of books. Someone, please leave me a suggestion!
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4 comments:

Cheryl said...

The Honor of the Blank - The Horror of the Guess. By Cheryl J. Blake

Most medical language specialists have been taught from their earliest training to fear the blank; the evil blank…the awful blank. The blank that is to be avoided at all costs. The accepted practice of making transcription blank-free as a marker of accuracy has done more harm than good to the industry of medical transcription. We are here to demystify and give honor to the humble blank.

A blank is a valuable tool. The virtues of the blank must first be weighed against the evils of the guess. The first thing you must learn about the blank is that it is far more preferable than the guess. The guess is the evil entity. Guessing will hurt your accuracy much more than a blank will. Guessing is dangerous in many ways:

1. A guess will pollute the ears and eyes of the proofer/editor into believing something that is not there.

2. A guess will potentially be left in a report at the final tier because it “looked” correct.

3. Guesswork costs valuable turnaround time. One cannot trust the work of a transcriptionist who guesses, thus every word must be listened to in real time. An MT who guesses will never be placed on blanks only status, simply because their work is not trustworthy. The research to fill the blank must be done on the back end rather than at the transcription end because the MT failed to do this research him or herself.

Now, let’s look at the blank in its own right.

There are different kinds of blanks. We’ll go through these one at a time.

1. The inaudible blank: This kind of blank will never be able to be filled, no matter who listens to it. It is caused by a skip in audio transmission or static. No amount of repetitive listening will fill this blank. It must be left blank at all times. The one exception to this would be the partially inaudible blank, but cannot be used at the beginning of training. There are tools to help one figure out what they hear in a partial blank, but will be discussed in future chapters.

2. The contradictive blank: This blank is to be used when a dictator has made an error. Either the dictator has confused rights vs. lefts or medications or dosages have been dictated in more than one way in the same report. This blank must be left and flagged for confirmation and clarification by the dictator. It is the duty of the MT to ensure that he/she has read the report to ensure that no contradictions exist. Should there be a conflict of this sort, a blank must be left or patient care will suffer.

3. The unobtainable information blank: This blank is useful for flagging doctors’ names that cannot be found as well as locations that, after proper due diligence and research, have been unobtainable. Future chapters will discuss tools for finding this information.

4. The “I tried everything and simply cannot figure it out” blank: This is the blank that we want to encourage. When an MT hears something but cannot ensure with absolute surety that what they think they hear is what they actually hear, it is time to leave a blank. It is time to use someone else’s ears and eyes to help fill this blank. In order to give the proofreader the best possible opportunity to hear this blank, you must leave a blank without a sounds-like. There are tools to help you figure out this blank, but until your training advances, a blank is the only remedy.

Now that you understand the purpose of the blank, hopefully you realize that blank-free transcription should not be something to fear. It is a tool to be respected. It is not to be taken advantage of, though. There is a delicate balance between doing your own work and sloughing it off on the proofer. You must do your own research to test your thoughts on what you think you hear.

“Due diligence” qualifiers for a guess to be turned into a blank.

Every blank is a guess until it becomes a blank. The process one goes through should determine its potential “blankhood”. The process goes like this:

1. You hear something, but you cannot be sure. The dictation reads as follows;

“ She also has had imbalance and difficulty walking and requires a cane. She saw Dr. John Jones about this and describes having (GUESS: Candela 3 positioning) (ACTUAL: canalith repositioning) exercises performed, which she describes having a very bad reaction to with severe imbalance and dizziness,”

Both terms may sound correct, but only one is actually correct. How do we determine which one is correct? We look at the context:

candela (cd)
kancde-l^

The SI unit of luminous intensity, 1 lumen per m2; the luminous intensity, in a given direction, of a source that emits monochromatic radiation of frequency 540 × 1012 Hz and that has a radiant intensity in that direction of 1/683 W per steradian (solid angle). Syn: candle.

The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.

The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration.

In reading the text of the transcription, only one of these is correct. The use of “Candela 3” in this case is an example of a dreadful, unqualified, absolutely not well-thought-out guess.

When we read the report, we know we are not talking about candle intensity. We are talking about balance. Should the MT have been unable to find canalith repositioning in his or her reference material, a blank should have been left. To have placed Candela 3 in this report was incorrect and dangerous. It reflects on the accuracy and trustworthiness of the transcriptionist. Obviously, this transcriptionist did not read the report he/she was transcribing, or would never have left candela in place for canalith. It is fair to say that no research had been done.

The offense committed above is commonly known as “Fitting a square peg in a round hole.”

The “lazy” guess: This is an inexcusable offense of neglecting to leave a blank, as it is insidious.

Dictated: “She has a strong family history of stroke.” The dictator speaks rapidly and with accented speech. You hear: “She has a _________________ family history of stroke.” You cannot make out the word between “a” and “family”. You decide to transcribe it as, “She has a family history of stroke.” A terrible crime of omission has been committed. It is inadvisable and strongly discouraged to “make sense” out of a sentence if you cannot hear a word. A blank MUST be left in this situation or patient care will suffer. You do not have the right to place or take words out of the dictator’s mouth.

The nonsensical guess: This type of blank reflects pure carelessness on the part of the transcriptionist. Obviously, if the dictated sentence had been listened to and read, such a guess would never have been placed.

Dictated: “There is a good chance this will regress.”
Transcribed: “This would be chance less this will regress.”

Does the transcribed sentence even make sense? Not at all. This guess is a crime of the highest order. The transcriptionist cares so little for the health of the patient whose life he/she has in his/her hands that a nonsensical guess has been made. The MT did not perform any due diligence, primary of which is READING THE REPORT FOR CONTEXT. If it doesn’t make sense, do not try to make it make sense. A blank is called for.

October 3, 2007 at 11:03 AM
Debbie said...

Hi Brigy! Cheryl leaves a comment about blanks. I'm leaving a comment about my favorite show, House. I may be very strange, but I think Dr. House is a sexy old sourpuss! Love that show. But great column, Cheryl. :)

October 3, 2007 at 9:06 PM
Briget said...

Wow, Cheryl, thanks for that! I am learning more and more every day about those blanks, I'm trying to find that balance you talk about between knowing when I don't know it, and doing real research and trying to come up with it. There's a lot of balancing that goes on in medical transcription.

Debbie- I agree about House. I think he's right most of the time, maybe I'll be a grouch old sourpuss one day too. But, I am a Jersey Girl and I LOOOOOOVE Princeton so that makes the show even better for me! I hope to take one class there someday, just to say I went!

October 3, 2007 at 10:39 PM
Cheryl said...

Guess what? My stepdaughter is propmaster for "House." We don't get Fox up here anymore so we'll just get the whole season on DVD soon.

Cheryl

October 4, 2007 at 10:37 AM

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