Who teaches Dictation 101? You may have to
Who teaches Dictation 101? You may have to
Get aggressive with your training
The orthopedic surgeon was in the middle of dictation when he paused and commented, "What am I trying to say? You know what I’m trying to say. Why don’t you just put it in."
Suddenly the transcriptionist at the other end of this dictation was expected to become both a physician and a mind reader. And the results , if not handled correctly, could have dire consequences for the patient and create a major problem for your medical records, data integrity, and reimbursement.
George Heymont, owner of Alert & Oriented Medical Transcription Services in San Francisco, says that orthopedic surgeon’s comment is just one of countless dictation blunders he’s come across. And it’s not even the worst. Sloppy and downright incorrect dictation skills are presenting a major problem that is not being sufficiently addressed in the industry, he and others say.
"We have a lot of doctors who don’t want to admit they are anything less than God, and you also have a danger because there are a lot of people in the medical work place whose English is faulty," he says. "They’re the products of the dumbed-down educational system and spell phonetically." Last year, Heymont says he saw a hospital contract that said that if such and such happens, the hospital "waves the write" to do something.
Another growing problem is the use of foreign-trained physicians and transcriptionists, Heymont says. Some native Asians have a tendency to switch genders in English, "so you get a 48-year-old man who had a radical hysterectomy," Heymont says. Some commercial transcription companies also are sending their work overseas where it can be done more cheaply. But Heymont questions whether someone unfamiliar with the nuances of English can do an adequate job.
The obvious solution is to train doctors to do better dictation. "But there’s no Dictation 101 in medical school," says Catherine Baxter, owner of Health Info Transitions in Houston, a transcription consulting company that works with hospitals. Not only do medical schools not teach dictation, but students also never learn what to document or even how to use the equipment.
Fixing the problem
The best solution, say Heymont and Baxter, is for medical schools to begin realizing the importance of good dictation and the potential consequences of bad dictation. In the meantime, here are their suggestions:
• Do your own training.
Sit down with residents early in their careers, and give them an hour or two of instruction such as how to access the system and how and what to dictate, says Baxter.
"At one point years ago, I was working with a group of podiatry residents who know nothing about anything above the ankles, but they had to do the H&Ps. It was hilarious. They’d try to tell what meds the patients were taking, but the patients didn’t know. The patients would try to tell the residents, and the residents would try to tell me in the dictation.
"Finally, I sat down with them and said Listen, if you don’t know the drug, find out from the patient what it’s used to treat and what the dosage is. And then just tell me what it sounds like, and let me figure out what it is. Then I’ll tell you for future reference.’"
It’s also helpful especially with foreign-born physicians to have somewhat formal discussions. Invite them in to meet the transcriptionists, show them how to access the system, and basically outline what they need to do. "They need to understand that the people on the other end of the [dictation] system are experts and want to help them," Baxter says.
• Develop aids for new physicians.
When she worked at a Texas hospital, Baxter developed laminated pocket-size cards that were given to physicians to instruct them on how to access the dictation system.
The right amount of documentation
The cards also were helpful in training physicians in the types of documentation needed, she says. Underdocumentation can hinder patient care and reimbursement, and over documentation is a waste of time for the physician and the transcriptionist, she points out. "If you’re in a clinic you don’t need an entire report; it will only cost more money," she says. "On other hand, if the patient is going to be admitted to an acute care hospital for outpatient surgery, the guidelines say you have to provide a complete history and physicial. In that case, complete documentation is required, and they need to know that. But you can’t assume they do know it."
Larger versions of the cards also were made and placed in areas where dictation was commonly done, Baxter says.
• Be aggressive.
Point out the consequences of bad, even dangerous, dictation to physicians or medical staff leaders with specific examples, says Heymont. "There’s still too much of an attitude of How dare you criticize a doctor.’ We have to overcome that."
Heymont is working with a publisher on a book he is writing tentatively titled Dictation Therapy for Doctors. He also hopes to develop a World Wide Web site containing dictation exercises.
The risks of bad dictation have to be exposed not only for the impact on medical care but also to reduce the amount of faulty data that can end up in data repositories, he says. "There is not currently an awareness that the data physicians generate has to be accurate. But if it isn’t, everyone is in trouble."
Catherine Baxter, Health Info Transitions, 6043 Beaudry, Houston, TX 77035. Telephone: (713) 728-4184. E-mail: [email protected]
George Heymont, Alert & Oriented Medical Transcription Services, San Francisco. Telephone: (415) 863-5992.
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