It is inspiring to hear these words from your superior...

I just wanted to take a moment out of the day to recognize [Manang]'s EXCELLENT WORK on two of our tougher doctors, Dr. Xxx and Dr. Xx. She types them like a pro!! It is so nice to have someone who is very dedicated to professinalism and perfection on tough ones like these two.

Thank you and have a great evening!

That's from one of my QAs that was emailed to me last night.

Then my boss made this offer:

I am considering completely pulling over Xxx or Xx for you to type since you seem to do very well with them both. That way, you should not continue to have the problem with light days etc. Right now another company has been handling those and the plan is for me to slowly transition them over here anyway. Which one do you like the best? You would still be hooked up to the other docs, but the doc you pick here will be your priority as you will be the only one working on it for the short term anyway. Eventually, I will get someone else on them for backup, etc. Until then, you will have to let me know ASAP if you are not going to be able to finish their load. I am going to look a the numbers and make sure the one you pick does not exceed the commitment you have made on a line basis so we can ensure coverage…. Just let me know!

That offer was in an attempt to solve my dilemma when I would spend several hours here without a file to transcribe, primarily because of the 3-hour difference in time from where my clients are (California). I have been asking my boss if I should work on additional accounts to fill in this vacancy, as I spend my early morning hours working on leftover files from the previous day.

I really think that my employer is VERY VERY ACCOMMODATING and is indeed CONCERNED with her employees.

My superiors (from employer to the QAs) have been very supportive and they know when to listen and really gives answers.

I think I would really want to grow in this team.

Guidelines for OB report etc.

Obstetrics and Gynecology is a clerkship in a class all its own. You are usually caring for young, healthy patients, have a fair amount of responsibility, get to do procedures on your own, do deliveries, and participate in some surgery. In addition, in this clerkship you'll rarely have trouble making a diagnosis. Patients usually present appearing pregnant, feeling pregnant, and smelling pregnant. Yep, you got it - they are pregnant.

As in most other clerkships, you'll start of with an orientation: "Welcome to OB-GYN. In this clerkship you are graded on technical skill as well as knowledge. Therefore, when you are delivering babies, you are not to drop them." You'll also get a brief demonstration on scrubbing and sterile gown and glove techniques. While this works well in theory, you'll soon discover that occasionally from the time the mother is transferred into the delivery room to the time you have to be in position to catch the baby, there are often only a few seconds - not much time for perfect sterile technique. If, as you are racing to the delivery room, you should happen to spill a glass of water and get your fingertips wet, you will probably be considered sufficiently "scrubbed." Almost without exception, though,, there IS time to wear a gown, gloves, and mask with a fluid shield. Plan for this each time you are part of a delivery and it will become second nature. This is a part of OSHA (Occupational Safety and Health Administration) regulations that have been mandated for your safety Don't take unnecessary risks - it isn't worth it!

Some general advice for OB

Tips: Get to know the nurses working during your shifts. They are typically your lifeline to deliveries and a fantastic resource. Let them know that you would like to do the cervical checks, but remember not to check a pt after SROM without asking your intern or resident. Be sure to give the nurses your pager #. If they like you, you will be called when things start moving, if not... NOT.

Carry a standardized copy of each type of note . Since many of the cases in OB are relatively routine, the write ups are fairly standard - this includes admission notes, delivery notes, postpartum notes, and discharge papers. The residents will be impressed with you if you do this. See the attached Copy Me! pages or use the format used by the residents in your rotation.

As in surgery, practice your knot tying. OB-GYN's tend to be less forgiving when a student asks to do some suturing and hasn't at least practiced tying knots. If you don't know how yet, ask! The residents will be happy to show you how. The one-handed tie is used more often in OB relative to the surgery rotation.

Sites

Tucson

University Medical Center Students divide themselves into 3 groups, in which they spend 3 weeks on OB and 1 _ on GYN and 1 _ on GYN-ONC. Call is approximately every fourth night depending on the number of students on the rotation. Hours are approximately 6:3OAM-6:30 PM on both services. On OB, you are in clinic every morning and on Tuesday through Friday afternoons (Tuesday and Thursday afternoons are spent at the St. Elizabeth Clinic-Bring a Spanish/English dictionary if you are not bilingual). Basically, you will spend all day in OB Clinic, unless you are on call, then you are "on the deck" admitting patients and catching babies. Don't check cervix without intern being present. On GYN, students are in clinic in the afternoons, with the rest of the time for surgery, rounds, and studying. Generally speaking, at UMC you'll see a lot of high-risk patients on OB. Don't expect as much direct involvement in surgery as you had, or will have, in general surgery. You will learn more by showing interest. You will get less deliveries than in Phoenix but if you pay attention, you will get to do a lot. On GYN-ONC you pre-round, round with residents, scrub for the surgeries and do clinic (pre-op, follow-up, oncology).

The residents/interns are for the most part very good and really enjoy teaching. The main complaint at UMC is there are fewer deliveries than other sites, but most students get to do 2 to 8 on their own. Be assertive! UMC usually affords students more GYN experience than the other sites, so students usually become proficient at the pelvic exam. It doesn't hurt to ask the Thomas-Davis and Cigna attendings if you can assist if things are slow. Many times they will let you do the delivery if their patient doesn't mind.

Phoenix

Maricopa Medical Center- While doing OB-GYN at Maricopa, you may be confused for the entire 6 weeks, but when it's over, you'll realize you have a great deal of confidence when it comes to examining women and delivering babies. This place is a baby factory! You will have the opportunity to deliver many babies on your own, repair several episiotomies, and assist on all kinds of GYN surgery. The best piece of advice we can give is to be assertive (can you see a theme developing?) - they really do believe in "see one, do one, teach one." Also, don't, whatever you do, cross the nurses. They have the power to make or break the rotation. At Maricopa you'll work hard. Twelve hour days are the norm. Call is every 3rd to 5th night for 8 calls in six weeks. You can count on going without sleep, but the post call team tries to go home by noon. You may want to review clinical GYN in your "spare time." Be aware that the long hours leave minimal time for studying. In addition, those of you wishing to work with a Spanish-speaking population will have a terrific opportunity to do so at MMC. All in all, Maricopa is a great place to learn "hands-on" OB-GYN. The experience, confidence, and skill you'll gain are well worth it. It your goal is to deliver lots of babies... this is the place. Dr. Glen Kishi is a very enthusiastic teacher and a valuable resource.

St. Joseph's Hospital and Medical Center - As the residencies are combined, the MMC and St. Joe's experiences are similar, although it tends to be a little less hectic here "on the deck." The main difference is the droves of private attendings that care for patients. Many of them will be more than willing to let you catch their patient's kids. Others are less receptive. Again, be assertive. The worst that can happen is that they'll say NO! Call is the same as at Maricopa but students make their own schedule. The clinic experiences are much more limited at St. Joe's that at the other Phoenix sites. There is however, plenty of opportunity for GYN surgery.

Good Samaritan Regional Medical Center- GSRMC is a regular baby factory. It's not unusual for a student to deliver 10-20 babies in 6 weeks. The rotation is split between L&D, GYN, Clinic and subspecialty. Call is every fourth to fifth night, and you must do 8 nights with a couple of weekend days. Students make their own call schedule here, as well. Call nights take place in L&D and are extremely valuable. This is when you'll catch most of your babies and assist in C-sections. Some students have commented that it is easy for a student to be "ignored" when on L&D and on-call, because there is so much going on. The nurses here are great about waking you up to check on patients - but you have to ask! Assertiveness is important. Tip - check the triage board (there are TV monitors to do this with) and anticipate when a normal patient is coming up to L&D, then SNAG IT! It might pay to follow the second-year resident around as well. For some reason this is not encouraged, but this is where you'll work the ER, do some cross-cover and maybe watch some high risk OB. You will meet with your personal preceptor once a week. You will attend lectures (which are excellent) and conferences with the residents almost every afternoon. The evaluations of the students are often short and generic. An honors grade is difficult, but possible. GSRMC has a lot going for it - the residents are friendly, the teaching is outstanding, and the food is plentiful. Just be ASSERTIVE!!!

OB Exam

The final is an NBME exam which is challenging, but passable. Get in as much studying as you can, using lecture notes, handouts, and the books you may have. You may actually get the day off before this exam. The department is changing the required text for the rotation and will likely have it to borrow as they did with this year's book.

Pearl Books OB-GYN
Obstetrical Pearls, A practical Guide for the Efficient Resident (Benson). ESSENTIAL. READ THIS BOOK BEFORE YOU START THE ROTATION. The hours it takes to read it will be invaluable!! Borrow or buy it. An excellent practical guide to being on the OB-GYN rotation.
PRE-TEST - Obstetrics and Gynecology Great overview of OB-GYN. Helpful for the NBME exam.
NMS and Board Review Series were also helpful for exam preparation and NMS can be borrowed from the OB office.

Copy Me!

OB/GYN history and physical

H&P for Labor and Delivery, actual format

ID/HPI: Patient is a 24 yo. G2PlOOl African-American female with an EDC of 07/05/93 by U/S (07/06/93 by L.M.R) Gestational Age is 39 3/7 weeks. Patient presents with uncomfortable contractions since 06/30/93 at q 10 minutes. Patient presented to triage today with painful contractions (ctx's) q 4'. Patient denies any SROM (spontaneous rupture of membranes), bloody show h/a (headache), epigastric pain, edema, visual changes, N/V/ F/C. Patient intends to bottle (vs. breast) feed. Pediatrician is Dr. Moreno. (Optional: Birth control method used during conception, pregnancy was planned/unplanned) (You may add a paragraph here describing any significant complications during the pregnancy)

Prenatal Hx: First prenatal visit on 01/05/93 at 16 weeks gestation. Patient received prenatal care at the office of Dr. Mary King. Ultrasound was performed at 18 and 24 weeks and demonstrated a singleton fetus without abnormalities. Patient was diagnosed with a yeast infection which resolved with administration of Metronidazole ointment on 3/23/93.
Labs: Blood Type A pos, H&H 14.3/41.9 on 5/25/93.
Antibody screen neg., G.C. neg, RPR non-reactive,
Chlamydia neg., Rubella reactive, Pap smear negative,
HBsAg neg., Glucola 89, serum AFP not performed.
Amniocentesis not performed.
OB Hx:
(1) 1990 - S.V.D. of an 8# 4.5 oz. male at 40 weeks gestation, without
complications. Midline episiotomy performed.
(2) Current
GYN Hx: No history of abnormal Pap smears. Denies any history of STD's (you will want to specifically ask patient if she's had chlamydia, syphilis, gonorrhea, HPV, trichamonas or exposure to HIV)

PMH : Denies Asthma, DM, HTN, Immunological deficiencies, Cancer
Allergies: NKDA
Meds: PNV (Prenatal vitamins) with Fe 325 mg QD
Past Surgical Hx: Appendectomy, 1988, St. Joseph's
Hospital, Phoenix, Arizona
Fam Hx: Maternal grandmother with Breast Cancer, otherwise no significant family history. Denies fam Hx of DM, Immunological deficiency HTN, CHD, twins, mental illness, stillborns, or congenital or chromosomal anomalies.
Soc Hx: Denies TOB, Denies ETOH, 1 cup coffee QD. Patient is married x 3 years. At Maricopa always ask about hx of sexual abuse. Drugs.
ROS: Denies chest pain, visual changes, HA, edema, N/ V/F/C, calf pain, back pain.

PE: A WDWN African-American Female with apparent discomfort during contractions.
BP 11 6/71 HR 77
HEENT No thyromegaly
Breasts: Not engorged
Lungs: CTA Bilateral
Heart: Sl and S2 normal, without murmur, gallop, or rub
FHt 38 cm. Leopold's with vertex position. FHT's 150's and reactive.
Ctx's q 4-5 min.
VE: 6/80%/O (that's 6 cm dilated, 80% effaced, 0 station - always ask a
resident or nurse to check after you)
Ext: No edema, calf tenderness. DTR's 2/4 bilat patellar (Don't forget DTR's!),
no clonus.

A/P: TIUP 39 3/7 weeks with ctx's x 1 day and no SROM.
(1) Admit to L&D with monitoring
(2) Expectant managemnt ( you'll write this ALOT)
(3) Consider artificial rupture of membranes (this is not
always indicated)
(4) Discussed with Dr. Montis

Prenatal H&P - Initial visit

This H&P is similar to the one above, with the exception that you won't be as rushed as you are in Labor and Delivery. The HPI is essentially the same - you may want to ask the patient about things like low back pain and constipation (iron in prenatal vitamins is a major culprit), visual changes, vaginal discharge, and head aches. In the Gyn history, ask about age at menarche, information about menstrual periods (length, regularity or lack thereof, days of heavy/light flow). You will also want a more complete sexual history, including number of partners, whether they are "men, women, or both" and STD's. One way to elicit accurate information about STD's is to ask, "Have you ever had any bumps, rashes, sores, ulcers, etc......" Under Social History, get information about occupation. Your physical is much more complete, and the clinic may have a form for you to fill out. Make sure and find out the pregestational weight. You will be performing a pap and pelvic on the first visit. You will also want to perform a thorough breast exam, as many women receive their primary care at these visits. Remember DATING (of the pregnancy, that is) IS KEY! ALWAYS recalculate dates on every prenatal visit, even if gestational dates are listed in the chart!

Copy Me!

OB/GYN delivery Note
OB/GYN Post partum note

A controlled spontaneous vaginal delivery over an intact perineum (or midline episiotomy anesthetized with 5% lidocaine) of a viable male/female infant, weight 6 pounds 1 0 oz, apgars 9/9. Bulb suction on the perineum. Clear amniotic fluid. Spontaneous expulsion (or manual extraction) of an intact placenta with a 3VC (3 vessel cord make sure there are 3 vessels in the cord - a 2VC is associated with abnormalities 18% of the time). Cervix, vagina, and side walls inspected and intact with no tears appreciated.

Episiotomy repaired with 3-0 vicryl. EBL 300 cc. No other complications. Blood type is A pos. Rubella reactive. Delivered by Joseph Montes, M.D. and Mary Falls, MSIII.

NOTE: Certain residents/attendings prefer different formats. Refer to your OB/GYN orientation packet for different formats.

Post Partum Note

I.D.: [Age] [Race] Female G- P - - - - estimated gestational age-
This is a regular SOAP note, but you need to pay special attention to:
Level of uterine fundus (in relation to umbilicus)
Is the uterus firm (i.e., contracted down)?
Lochia (this is the postpartum bleeding) - quality and quant.
Episiotomy - intact? edematous?
HCT
LE edema/tenderness (for DVT's)- review Homan's sign.
Rubella status, Blood type (Does the mother need Rhogam?)
f/u care and discharge instructions (ask your resident)
Ask about contraceptio, breast/bottle feeding.

Source: http://studentaffairs.medicine.arizona.edu/TheBook/obgyn.html

Line production

I recently posted about what could be the realistic line production for a newbie like me...So far, I am averaging 500++ lines per day, but my back and legs and hands are really crying...

Still I want to set a goal, but while I have set it at 1000 lines (at least) per day, I am not sure that is realistic.

But this is the jump:

FRom day 1 to day 5 my production increased from a bare 200++ lines to 400++ lines.

On my first week I made "Total Records: 100 and Total Lines: 2187" (mainly due to "gettin to know my dictators" stage and finding the right matches for me to come up with a pool that will fill my time and not leave me waiting here indefinitely for a dictation to download).

On my second week, with dictators pretty much established (though I still had new ones added to my pool for another 2 days and so I had to orient myself with their styles), my production rose to "Total Records: 156 and Total Lines: 3031 lines."

We will see if there will be improvement in the next weeks as I get a firm grip of my dictators' styles, and do less of researching for vague/unheard terms.

Somehow I have made improvements with my autotext and templates/macros to make transcribing easier, but still, when I am about to reach my daily goal of 600 lines, my hands are already stiff and slow, and my eyes are strained, my back and legs feeling numb...

Maybe I should relax a little bit. Anyway, I did not mean for this to be a major income source, but only to push myself to study more about medicine, to be able to save some for a possible USMLE, to help pay the bills, to raise money for buying a second-hand car, to be able to buy gifts for my husband, to be able to send some money to my Nanay...

Maybe I should start working on my garden...work there from 5:30 am to 10:30, take a break, have lunch then start work at 11:00, stop at 5:00, cook supper, work again for another 2 hours (if I would not be too tired by then), hit the sack at around 10 or 11 at night...

Somehow, this extra feature of counting lines in the software that I am using is making me obsessive-compulsive in reaching a certain number of lines...But hey...I should be wary. I might end up with CTS if I am not careful.

What QAs look for in a transcription (How can an MT get out of QA stage?)

I started my MT career as an MT, primarily just knowing how it is on the client's end, but not having any knowledge on how it is to properly address the MTs (correcting them, giving suggestions on researching techniques and hoping to get them out of the need for QA). I decided to do transcribing itself not only for higher net pay, but also to avoid having bad relations with the MTs and my boss. I searched for a new employer to start anew, willing to learn every level, before I finally (I hope) embark on setting up my own business (or an option is to do some marketing and receive commissions).

I found this series of posts at a forum very helpful.

-----

I am new working for a company and I want to make life as easy as possible for me and for QA. I try very hard not to leave blanks and spend a lot of time researching before I leave a blank. What is really expected by QA? What would you consider a good employee versus a bad one? Do you get paid for anything that comes through QA? Do you QA all work or just certain MTs?
I'm just trying to get some insight into a world unseen to me.

----

QA procedures differ from company to company.

We do full audio review for two weeks on new MTs, new accounts, MTs assigned to accounts new to them, and accounts on which we have received customer complaints. If the MT is performing at 98% or better after two weeks, the account is released from QA; if not, we continue with review until we see improvement.

MTs are reviewed randomly once a month on 5% of their work and are given a score of accuracy.

We provide instructions for each account which include account specifics and client preferences.

QA editors are paid per line. They are not assigned to specific accounts. They do jobs in order that they come in.

My advice to you is to find out what your company's QA policies and procedure are and exactly what they expect from you.

First and foremost, you need to know whether your company adheres to a particular style guide, such at the AAMT Book of Style. Some companies use their own style guides which are usually an adaptation from the BOS.

Secondly, clarify your account preferences, i.e., does your dictator prefer verbatim transcription, etc. If you don't have the account specs in writing, get a copy. (You never know when you might need these to defend yourself.)

It would also help if you could see a QA worksheet that shows the point system your company uses to determine your QA score. For instance 2 points for a medical word error, 1 point for an English word error, 2 points for an omission, etc. If you could get a copy of this list, you would know what types of mistakes we are looking for.

Next, proofread, proofread, proofread. Most errors can be avoided by taking the time to proofread. I realize we are paid on production, but proofreading is a step that cannot be omitted.

Regarding blanks, as many of the other posters have said, I would rather see 10 blanks than 1 guess. NEVER, ever guess at medical terms. I follow the 5-minute rule for blanks--search all your resources for 5 minutes, then leave a blank and move on. (This applies to editors are well.) If the audio quality is horrendous, don't waste time trying to figure it out. Leave a blank and let your manager know if the audio is consistently poor. Sometimes the dictators are using a bad phone or a bad phone line or they need to adjust their handheld settings. Your manager or customer service people can handle those issues.

And also, as others have stated, develop a system to record all of the feedback, corrections, and blanks that are sent to you so that you can refer to the feedback and review it frequently during the first few weeks/months.

Lastly, develop a good relationship with your QA staff. Most of us are willing to answer questions and help out if we can. Hopefully your QA editors will provide clear, constructive feedback that will help you continue to grow as an MT. I realize that some editors enjoy their perceived "power" and are hard to get along with, but most of us enjoy the teaching aspect of our jobs and are willing to do what we can to help.

If I were your editor, I would appreciate your professionalism and your concern about doing a good job. Good luck.

-------

For those considering of making the shift from MT to editing/QA, here were some tips given:

Tests vary a lot and can include a little bit of everything ("sound-alikes," English/grammar, punctuation, AAMT style, terminology, anatomy, etc.) For example, the test may consist of several sentences that contain errors, and the instructions are to find the errors and correct them. I have taken a few tests that were very extensive and tested every possible aspect of editing, while others were very brief. I actually appreciate the tests that are more comprehensive because it shows me that the company places a high emphasis on finding qualified people. (I took a test recently and the test itself contained two errors. I decided they probably wouldn't be the most quality-minded company to work for!)

Personally, I like editing much more than transcribing. I think I am just more cut out for editing/proofreading than I am transcribing. I genuinely like the challenge and I like the teaching aspect of the job. In addition to working in QA, I also teach part-time at a college, and I try to incorporate a "teaching mindset" into the feedback that I provide for MTs.

I always had a difficult time making any serious money transcribing on a production basis because I spent so much time looking up obscure words, reading articles and proofreading my work. And now, even though I work on a production basis doing QA, I have found that I can make a lot more money.

Another thing to consider is your wrists. I was starting to have the classic tingling and wrist fatigue. I'm sure switching to QA saved me from carpal tunnel. (Now my eyes are tired at the end of the day, but my wrists don't hurt!)

-------

I found these helpful. so right now, my first aim would be to be out of QA, then I will slowly work on my production.

What QAs look for in a transcription (How can an MT get out of QA stage?)

I started my MT career as an MT editor, primarily just knowing how it is on the client's end, but not having any knowledge on how it is to properly address the MTs (correcting them, giving suggestions on researching techniques and hoping to get them out of the need for QA. I also partly used the AAMT, but I am not inclined to follow every guideline they have, which are, to my point of view as a doctor, ridiculous.). I decided to do transcribing itself not only for higher net pay, but also to avoid having bad relations with the MTs and my boss. I searched for a new employer to start anew, willing to learn every level, before I finally (I hope) embark on setting up my own business (or an option is to do some marketing and receive commissions).

I found this series of posts at a forum very helpful.

-----

I am new working for a company and I want to make life as easy as possible for me and for QA. I try very hard not to leave blanks and spend a lot of time researching before I leave a blank. What is really expected by QA? What would you consider a good employee versus a bad one? Do you get paid for anything that comes through QA? Do you QA all work or just certain MTs?
I'm just trying to get some insight into a world unseen to me.

----

QA procedures differ from company to company.

We do full audio review for two weeks on new MTs, new accounts, MTs assigned to accounts new to them, and accounts on which we have received customer complaints. If the MT is performing at 98% or better after two weeks, the account is released from QA; if not, we continue with review until we see improvement.

MTs are reviewed randomly once a month on 5% of their work and are given a score of accuracy.

We provide instructions for each account which include account specifics and client preferences.

QA editors are paid per line. They are not assigned to specific accounts. They do jobs in order that they come in.

My advice to you is to find out what your company's QA policies and procedure are and exactly what they expect from you.

First and foremost, you need to know whether your company adheres to a particular style guide, such at the AAMT Book of Style. Some companies use their own style guides which are usually an adaptation from the BOS.

Secondly, clarify your account preferences, i.e., does your dictator prefer verbatim transcription, etc. If you don't have the account specs in writing, get a copy. (You never know when you might need these to defend yourself.)

It would also help if you could see a QA worksheet that shows the point system your company uses to determine your QA score. For instance 2 points for a medical word error, 1 point for an English word error, 2 points for an omission, etc. If you could get a copy of this list, you would know what types of mistakes we are looking for.

Next, proofread, proofread, proofread. Most errors can be avoided by taking the time to proofread. I realize we are paid on production, but proofreading is a step that cannot be omitted.

Regarding blanks, as many of the other posters have said, I would rather see 10 blanks than 1 guess. NEVER, ever guess at medical terms. I follow the 5-minute rule for blanks--search all your resources for 5 minutes, then leave a blank and move on. (This applies to editors are well.) If the audio quality is horrendous, don't waste time trying to figure it out. Leave a blank and let your manager know if the audio is consistently poor. Sometimes the dictators are using a bad phone or a bad phone line or they need to adjust their handheld settings. Your manager or customer service people can handle those issues.

And also, as others have stated, develop a system to record all of the feedback, corrections, and blanks that are sent to you so that you can refer to the feedback and review it frequently during the first few weeks/months.

Lastly, develop a good relationship with your QA staff. Most of us are willing to answer questions and help out if we can. Hopefully your QA editors will provide clear, constructive feedback that will help you continue to grow as an MT. I realize that some editors enjoy their perceived "power" and are hard to get along with, but most of us enjoy the teaching aspect of our jobs and are willing to do what we can to help.

If I were your editor, I would appreciate your professionalism and your concern about doing a good job. Good luck.

-------

For those considering of making the shift from MT to editing/QA, here were some tips given:

Tests vary a lot and can include a little bit of everything ("sound-alikes," English/grammar, punctuation, AAMT style, terminology, anatomy, etc.) For example, the test may consist of several sentences that contain errors, and the instructions are to find the errors and correct them. I have taken a few tests that were very extensive and tested every possible aspect of editing, while others were very brief. I actually appreciate the tests that are more comprehensive because it shows me that the company places a high emphasis on finding qualified people. (I took a test recently and the test itself contained two errors. I decided they probably wouldn't be the most quality-minded company to work for!)

Personally, I like editing much more than transcribing. I think I am just more cut out for editing/proofreading than I am transcribing. I genuinely like the challenge and I like the teaching aspect of the job. In addition to working in QA, I also teach part-time at a college, and I try to incorporate a "teaching mindset" into the feedback that I provide for MTs.

I always had a difficult time making any serious money transcribing on a production basis because I spent so much time looking up obscure words, reading articles and proofreading my work. And now, even though I work on a production basis doing QA, I have found that I can make a lot more money.

Another thing to consider is your wrists. I was starting to have the classic tingling and wrist fatigue. I'm sure switching to QA saved me from carpal tunnel. (Now my eyes are tired at the end of the day, but my wrists don't hurt!)

-------

I found these helpful. so right now, my first aim would be to be out of QA, then I will slowly work on my production.

Setting goals as a newbie MT

In a forum I frequent, I posted this:


What is the realistic goal of # lines/day for a newbie?

How fast usually is the rate of increasing production (say, an increase of 200 lines per day more than the previous production shuld be achievable in how many days/weeks/months?)

Accordingly, how much should the increase in pay to accompany such increase in production, and also increase in quality (i.e., getting out of QA stage)?

Thanks for the info.

To which another forumer answered:

Too many variables to say. Your own base of knowledge and the clarity of your dictation will have a big impact on what you do. If you need to be spending many many minutes replaying fuzzy dictation and/or searching for unheard of words, drugs, etc. in all your references and online, it can really eat up a large part of your day and cut into your production. Also, the familiarity you have with your software will have a lot to do with how fast you crank out files, too.

I won't even comment on the pay because you usually stay at that post-newbie level for quite a long time as a search will show. The companies pay what they want to pay. If you don't like it, you pretty much have to move on. Good luck!

then I replied:

When I was applying, I have seen companies outlining pay based on productivity based on certain ranges, like 400-600/day at 0.05 cpl, moving up as one improves. I have read that some companies require MTs to make 1,200 lines/day to qualify for benefits. I have read MTs making 2000lines per day, and recently there was a post of making 15,000 lines per pay period.

I am getting confused as to what is realistic. I was not sure if those 15,000 to 20,000 lines per pay period were meant to be sarcastic.

I have set a goal for me to reach at least 1000/day to 1200 lines /day, to achieve a pay equivalent to $9/hour on an 8-hr period basing on my current pay level. Right now, having started learning about a new software and quickly learning to utilize its features, I have jumped from 200 plus lines to 600 lines per 8-hr workday within 5 days. This increase is mainly due to the autotext feature, but I think my initial entry of new autotexts for new accounts also slowed me down. Neverthelss, I can foresee this investment of time having its benefits of escalating my production once I have all my autotext and macros etup for all the 10 accounts (mostly ESLs, multi-specialty clinics) I have. Will it be realistic for me to even set my goal to, say, 2000 lines/day?

Plus, though I started at an entry level, I have received feedback from my QAs that I am doing a fantastic job, that my medical terminology is excellent, and that I am very skilled (I have 7 years of previous hospital/multispecialty non-MT job aside from a medical course which included 2 yrs of basic medical sciences plus 1 year of clinical sciences)...and that some of my work (where I left no blanks) needed no change, so, modesty aside, I am predicting I might get out of QA in a matter of few months if not few weeks...I have been observing (through the software feature) that my most of my transcriptions are delivered to the client within 2 hours upon my submission to QA.

I am just trying to arrive at what I should expect that is fair both to me and to my employer, although right now I am very very pleased with my company's system, and would not ever wish to get to the point of hopping to another company (which I might do if I think I am not being paid fairly)...I may sound dumb to you, but I really have no idea...your input will be highly appreciated. Thanks.

Another newbie posted:

That is a lot to chew on. I am about to begin my first job as a recent grad. I am interested in what software your using. I need to buy something. Thanks for the misc. info on line production also.

I emailed her with this:

thought I'd email you in case you didn't read my reply...

The software I use is provided by the company. Nowadays, I think most companies have their own platform, so I would suggest you don't buy a software yet, as some companies require their MTs to buy their software once hired. I also suggest before you sign any contract, verify if you have to purchase/rent anything from the company. I think it is very unfair to us, and they profit not only from their clients but also from MTs. Our pay is not at all decent enough. They should consider that with this business they don't even have to pay for internet, office, telephone lines, etc. A company that requires you to purchase hardware and reference materials is a no-no in my opinion. The internet itself is a very useful tool for researches.

If you want to familiarize yourself with the autotext, I suggest you do something like the following:

I wanted to print the autotext that I have made so far with the sofware I am using. However, the program does not have such a feature (I wish they will come up in the next version), so per dictator, I made a listing of autotext. Some of the "codes" I made were meant for short words such as "hs" to be converted automatically to h.s., to "tpci" to convert automatically to "The patient is coming in." In wanting to customize my autotext to a particular dictator, I wanted to print them accordingly (per dictator). What I did was, while transcribing and using and adding new autotext (which makes me slow at this initial period), I would also make a table in Word of such, The Word automatically corrected my codes by capitalizing the first letter, which I did not want it to do. So I clicked on the help button in Word, and asked how to remove that feature. I then learned that it was the autocorrect feature. I realized it can be used the same way, to build macros and autotext, if you happen to be working for a company that does not have such a software that helps MTs increase productivity. From what I have read, such Word autotexts can be imported into software provided by the company, if they do have addressed that concern.

Honestly, I still don't know at this point if I will be able to achieve that. I am giving myself one month to familiarize myself with all my accounts and prepare macros and templates and atutotext, hoping that I will indeed reach at least 1000 to 1200 lines per day, or more, without having to have a 100 wpm typing speed. I only have 45-65, and I doubt that that will change. I can type faster if I am typing my own thoughts, but not when I have to listen to a dictation and pause and type and play and listen and pause and type.

Right now while still getting acquainted with the autotext I have made and trying to create a method for me to organize my approach in typing for certain dictators, I am making barely above 400 to less than 600 lines per day, sometimes working more than 8 hours in a day.

Sample Endocrine transcriptions by ALT

Among my accounts, this is the most interesting and fascinating...

HISTORY OF PRESENT ILLNESS: The patient is 59-year-old woman who was diagnosed with hypothyroidism in October xxxx. She presented with fatigue and weight gain. She was started on Synthroid 0.2 mg once a day. At the time, her TSH was 35.04. Repeat laboratory testing in December showed a TSH at 0.07 and her dose was reduced to 125 mcg. Her repeat thyroid function tests in February showed a TSH of 0.16. She is currently complaining of continued fatigue, total weight gain of 25 pounds since October, difficulty losing weight, cold intolerance, and dry skin. She takes her medication in the morning with her other medications but no supplements. She waits for an hour before eating breakfast. She was apparently started on a generic preparation, developed the rash to this, but is now on the brand Synthroid. She has never had any previous thyroid disorder, no history of nodules or lumps in her neck. She has had no compressive symptoms. She has noted a significant increase in the size of her neck, but this is in the area below her chin.

The patient also had her estrogen level reduced about 1 year ago. She had been on 2 mg daily since 1982 when she had a hysterectomy. The dose was cut in half to 1 mg about 1 year ago. She believes some of her symptoms began at that time as well, particularly the dryness and reduction in temperature.

PAST MEDICAL HISTORY:

Hypothyroidism, diagnosed xx/xx.
Postmenopause, on HRT.
Depression, on Wellbutrin.
Urinary incontinence.
Hearing loss requiring hearing aid in the left ear.
PAST SURGICAL HISTORY:

Hysterectomy with ovaries intact in xxxx.
Hemorrhoid surgery xx years ago.
Breast augmentation.
Pregnancies, x, with x children.

ALLERGIES: Unknown, except for the generic thyroxine.

FAMILY HISTORY: Father died at60 with heart valve problems. The mother is 88; she is recently diagnosed with hypothyroidism and osteoporosis. She has 2 brothers, age 53 and 57; they are healthy. She has 4 children, 27 through 40, who are also healthy, no diabetes, no other tyroid disease, cancer, or heart disease in the family.

MEDICATIONS:

Synthroid 125 mcg daily.
Wellbutrin 150 mg SR daily
Detrol LA 2 mg daily.
Estradiol 1 mg daily.
Bextra 10 mg as needed.
Super B-complex with flaxseed supplement.

SOCIAL HISTORY: She is originally from California. She is a retired puppeteer. She is married.

HABITS: Nonsmoking. Consumes 1 alcohol a day. Caffeine none.

REVIEW OF SYSTEMS: General: Overall, the patient feels well, but she is very unhappy about not being able to lose weight. HEENT: Negative. Cardiorespiratory: Negative. Gastrointestinal: Negative. Genitourinary: Her symptoms are controlled with Detrol. Endocrine: Amenorrhea, cold intolerance and dry skin ; she has never had an elevated glucose. She had a bone density scan done many years ago and has lost 2 inches in height. She is not following any diet at this time, but is contemplating on a weight-loss diet. She did look into Madura. She exercises 5 times a week, going to Curves for 30 to 45 minutes. Musculoskeletal: She has some osteoarthritis. She is on occasional Bextra. Vascular: She has had varicosities, and some end-of-the-day edema in her ankle. Neurologic: She occasionally can feel some numbness in her feet. Hematologic: Negative. Psychiatric: Her depression has been under good control.

PHYSICAL EXAMINATION: General: The patient is a healthy-appearing 59-year-old woman. She is no apparent distress. Vital signs: Blood pressure 126/70, pulse 64 and regular. Weight 159 1/2 pounds. Integument: Cool and dry. Normal texture, smooth and some old stretch marks on her abdomen, nothing new. Hair: Normal in distribution, no hirsutism and balding. HEENT: There is no Cushingoid appearance. There is increased soft tissue under the chin in the midline, but no supraclavicular increase in fat or subcervical fat pad or facial cheek fat distribution. EOMI PERRLA. Normal eyes and nose. There is no periorbital edema. Oropharynx is unremarkable. Neck: The thyroid gland is small with no nodule. Lymph nodes: Negative. Chest: Clear to auscultation on anterior and posterior. COR: Regular rate and rhythm. No murmur, gallop or rub heard. Abdomen: Soft, flat and normoactive bowel sounds. No hepatosplenomegaly and nontender. Extremities: No edema. Neurological: Cranial nerves intact. DTR is 2+/2 with normal sensation and motor intact.

LABORATORY DATA: From October laboratory testing included a normal CBC, a chemistry panel with a fasting glucose of 75.

IMPRESSION:

Hypothyroidism.
Recent low TSH.
Fatigue.
Cold intolerance.
Postmenopause on estrogen.
Abnormal weight gain.

DISCUSSION: At this time we will recheck thyroid function test to see if the dose needs to be adjusted. I discussed with her the lag in time for normalization of thyroid function once the dose is changed, as well as the lag in time for clinical symptoms to improve as well. Autoantibodies are supposed to have been drawn today to see whether or not this is consistent with Hashimoto's thyroiditis. We will recheck her estrogen level as well. I am reluctant at this point to increase her estrogen to help relieve some of her symptoms until the thyroid level has been completely normalized. We will also order a bone densitometry at this time as it has been many years since she had one.

We briefly discussed weight loss, dieting, and exercise principles. She is going to work on this on her own and is contemplating on program at this time.

We will have her return to the office in 3 months. We will contact her concerning her laboratory results.

******************

HISTORY OF PRESENT ILLNESS: The patient reports that she was recently diagnosed with pituitary adenoma in June of 1999 when she presented for an annual Pap examination. She had galactorrhea of both breasts at the time. Her prolactin level was checked and it was high at 100. An MRI was done, which demonstrated a 5-mm pituitary adenoma. She was started on bromocriptine; however, she had a poor response in her prolactin level. This has been switched to Dostinex 0.5 mg 2 times a week. She has been on this since then. She reports good control of her prolactin when she is on the Dostinex. Her results will go down to below 10. Her menstrual cycles are also regular when on Dostinex. When she was originally diagnosed, she was on oral contraceptives. Her menstrual cycles have remained normal on this. Birth control pills were discontinued, and she had irregular cycles until she was placed on the Dostinex. She had a lack in medication last year due to a change in the insurance. During that time, her prolactin level increased to 190. Her menstrual cycles were also irregular at that time. Recently she has gone off the Yasmin to become pregnant. Her last menstrual cycle was on February 20th, which was at the end of the last pack of Yasmin dose. She has not had a menstrual cycle since then, but has had a repeated home pregnancy test negative. She missed Dostinex for 1 week while she was traveling on spring break, and attributes the irregularity to this, too. She has been back on the Dostinex for 1 to 2 weeks. She has had repeated MRI throughout the year. I have a report from the most recent one, which was in 5/04. The pituitary tumor measured 78 mm. It was in the right aspect of the gland and it showed no significant change from prior MRIs. She reports that the size does vary on MRI between 5 to 8 mm. In addition, she has seen an ophthalmologist on a regular basis and has never had any problems with her visual field. She has never had any symptoms such as headache or change in vision. She has no galactorrhea.

PAST MEDICAL HISTORY:

Pituitary tumor.
Hyperprolactinemia.
No surgeries, no fracture or injuries.
Gravida 1 para zero, 1998.

ALLERGIES: None known

FAMILY HISTORY: Her father is 46 and had a brain aneurysm a number of years ago. Her mother is 40 and is doing well. She has 3 siblings, all well, ages 7, 18 and 20. Her maternal grandfather had prostate cancer and a stroke. Her maternal grandmother had glaucoma. There is no thyroid disease, diabetes, endocrinopathies, or pituitary tumors in this family.

MEDICATIONS: Dostinex 0.5 mg twice a week. Multivitamins daily.

SOCIAL HISTORY: She is originally from xxxx. She is married. She is currently working as a substitute teacher and recently graduated.

HABITS: No cigarettes, no alcohol, 1 caffeine a day.

REVIEW OF SYSTEMS: General: Overall, the patient feels well. HEENT: Negative. Cardiorespiratory: Negative. Gastrointestinal: Negative. Genitourinary: Negative, except for as in history of present illness. Endocrine: She is complaining of hair loss at this point in time. Her weight has been stable. She exercises 30 minutes 3 days a week. Musculoskeletal: Negative. Vascular: Negative. Neurologic: Negative. Hematologic: Negative. Psychiatric: Negative.

PHYSICAL EXAMINATION: General: The patient is a healthy-appearing 24-year-old woman. She is no apparent distress. Vital signs: Blood pressure 120/72, pulse 72 and regular. Weight 182 1/2 pounds. Integument: Cool and dry. Normal texture and color. Palms were dry. Nails are normal. Hair: Normal in distribution, no hirsutism and no hair loss noted. HEENT: No Cushingoid appearance. EOMI PERRLA. Normal eyes and nose. There is no periorbital edema. Oropharynx is unremarkable. Neck: The thyroid gland is normal with no nodule. Lymph nodes: Negative. Chest: Clear to auscultation on anteriorly and posteriorly. Back: No dorsocervical fat pad. [5:23] COR: Regular rate and rhythm. No murmur, gallop or rub heard. Abdomen: Soft, flat with normoactive bowel sounds. No hepatosplenomegaly, no stria and nontender. Extremities: No edema. Neurological: Grossly intact. DTR is 2+/2 with normal relaxation phase, no tremors. The visual fields were intact to confrontation.

IMPRESSION:

Microprolactinoma.
Irregular menstrual cycle.

DISCUSSION: The patient probably has a prolactin-secreting adenoma given the degree of elevation of prolactin and the size of the tumor being under 1 cm. It has responded well to Dostinex when the patient has been on the medication. We will check prolactin level. At this time, it may be mildly elevated given the fact that she has not been on the Dostinex regularly in the last months or so. We also will check a serum pregnancy test as her menstrual cycle is late at this point in time. She will continue on the Dostinex at this time. Should she become pregnant, it will be discontinued and she will notify our office. I have recommended that she wait a total of 3 months prior to getting pregnant off of the contraceptive pills. She is to keep track of her cycle, and from the day that her cycle is due, she will need to begin her pregnancy test until she resumes her period or the test is positive. We will also check other pituitary functions at this time, including thyroid, IGF-1, and gonadotropins, and estrogen.

I would like to thank you for having referred this patient for evaluation and I have requested her to follow up with us in 3 months. She is to call us if she becomes pregnant. Please let me know if you have any questions or concerns regarding her.

I love the software that I am using to transcribe dictations

My present employer has partnered with [EMR service] to facilitate the smooth flow of work from the doctors to them, with a good distribution of accounts to the several MTs (including me), back to QA, then delivered to the clients, without worrying about filing and archiving. The [EMR service] prives those services; my employer only worries about transcription per se and anything related to it: hiring MTs, assisting and communicating with her MTs.

The dictation files can be pulled in by the MTs, and work on them only while online. I (MT) have no way (or have not found a way and not planning to) to store the dictation files in my computer to work on it offline. When the MT does not work on those files right away, the company has the option to pull them back in for the others to transcribe. This way, TAT is ensured, and contingency measures are taken care of in case an MT suddenly has an emergency. One MT has 6-8 accounts to transcribe, but there are 2-3 MTs assigned to a particular account, in case an MT goes on vacation or is sick. Good contingency measure.

I love using the [software]in that templates are already there, dictator-specific, as prepared by my employer and, of course, approved by the client. (Client has the option to type in the template themselves or just dictate it so the MT can choose from the different templates.) MT has the option to check demographic data from the database or enter those as dictated. Employer builds a database of doctors and associates to facilitate easy CCing of reports, and if there are new associates to add, MT can add that to the database; no need to look for and to enter addresses and all everytime that associate comes in for CCs. Autotext features enables MT to enter such codes as "tpic" to mean "The patient is coming in," or the code "rsmb" as "I reinforced multi-self breast examination, daily calcium needs, and regular exercise," so that by building up my autotext during my initial weeks for such "canned" (de-kahon) sentences/reports/paragraphs will eventually maximize my production and the overall production of the company. The [software] also has the Spellchecker, which not only has a central database like the addresses of the associates, but an MT can also add a new term/acronym/abbreviation there . Before final submission/uploading for QA, spellchecker is run again automatically. Comment box is separate. When empty, the QA is notified as such, and when there are comments, QAs also are automatically notified.

I can also check my lines transcribed or the actual # of lines delivered, any time! I can check from and to any point in time. The counting is done automatically. In my first week of transcribing using this system, my one-week production was 2187, of which 2032 were delivered. It is so motivating to keep track of how I am improving daily with my line count. My productivity from day 1 jumped from 200/day to 500/day on day 5, and only because I kept adding doctors/accounts to my list, from an initial 3 dictators to 11, and I guess that is enough to keep me busy during the day (I won't have to waste time waiting for dictations). As soon as the doctor start their day and start seeing patients, they dictate right away, I get the files right away and work on them one by one and check them back in, usually within 20 minutes for a 1-2 minute dictation.

I am about to enter my second week, and without additional doctors to get used to and to build my autotext for, I am foreseeing a jump in my productivity, hopefully to at least double my initial production.

From the MT's point of view, I love using this [software]. It is soooo user-friendly. It is easy to use, and best of all, my employer DID NOT REQUIRE ME TO BUY THE SOFTWARE nor to have high-speed internet connection ([EMR service feaures are sooo flexible!). When I was looking for a new company to work for, most of them required their MTs to purchase their software, which is BS, if you ask me. Companies save a lot already on overhead costs, not having to provide a working environment with computers and telephones/internet lines having shouldered by the MT themselves. Some even ask the MTs to purchase their own pedal and/or lease their computer! Well, I certainly don't need additional computers. We have a total of 4 computers at home now! Almost one for each member of the family. We are just saving money or wait for some "donations of parts" to build another one. We always have a use for thrown away keyboard, modem, CPU, etc. My hubby only buys the second-to-the-latest computer parts that are critical for upgrades like the motherboard, DVD player/burner, video card and audio card, etc. So I don't really need unnecessary expenses for those.

I cannot speak for the company/QA and the client itself, but I can imagine how efficient and simple the system is, given that this [EMR service] can configure several dictation hardware for the client's end, who have the option to enter the data themselves or just dictate. If they just dictate, which they usually prefer, MTs have work to do. Filing is made easy and taken care of by the [EMR service], not on the shoulders of the MT company nor the client, and I am pretty sure a back-up system has been addressed by as well.

I can only think that if I do get enough experience as an MT, I might embark on my own MT business and use the same [EMR servcice] as well, or, I am exploring with my employer the possibility of marketing for my company, offering this service to the doctors around here in my state, getting commission (say 1%) for all clients I introduce to the company, and taking direct responsibility for doing QA on these accounts and direct personalized communication with the clients to keep them in our client database and in my account.

If I also find the motivation to practice here myself (these cases I am typing just gives me some kind of high that I feel like I am working as a doctor myself! Reminds me of those days when I used to manage patients. It also gives me the motivation I need to review things that might be useful for the USMLE so I just might take up those tests to be licensed.), then I am pretty sure that when I do practise here as a doctor, I will use this [EMR service]for my dictations and even recommend it to others.

So I'd say, a lot of headaches will be taken care of if an MTSO will go for this [EMR services]. Your focus, as an MTSO, will be on the transcription itself. The [EMR service] takes care of everything else. My employer even told me that this [EMR service] sometimes add to their pool of clients (she mentioned that to me when I asked about the possibility of incentives for marketing for new clients). Doesn't that sound too good to be true?

Sample IM, SNF transcription by ACU

SUBJECTIVE: Mr.xxx has multiple questions and problems.

He states that his ears may be full of wax. He uses a liquid but he still feels that he has some problems there.
Pain in his knee, especially over the patella, also when he puts pressure on it, such as kneeling. He has left knee pain when he flexes his leg at times, but this is intermittent and none of these are disabling.
He needs a refill on medications.
He also requests a complete physical examination.
He has some various reactions when he takes his blood pressures. He gets anxious, and his blood pressure stays elevated.

OBJECTIVE:

General: This is an alert and orient male aged 57.

Vital signs: Blood pressure 148/84; retake is 150/84; temperature 98.4; pulse 78; respiration 16. Weight 222 pounds. Height 5 feet 11 inches.

Skin: Warm and dry.

HEENT: Cranium is normocephalic and atraumatic. Ears have increased cerumen bilaterally.

Chest/Lungs: Clear.

Heart: Regular rate and rhythm.

Abdomen: Soft.

Extremities: No peripheral edema.

ASSESSMENT: Hypertension, obesity and hyperlipidemia.

PLAN: Refill hydrochlorothiazide and lisinopril. Add atenolol 25 mg 1 tab daily to the regimen of hydrochlorothiazide and lisinopril 40 mg. He is also taking Zocor 20 mg, and he will return for a complete physical exam. Also, the patient's ears were irrigated, and he was advised regarding his ears.We will follow up.

********

SUBJECTIVE: The patient presents with a complaint of low back pain. She states that she is feeling much better. Emotionally she is in therapy. She still has a great deal of problems with family, etcetera, but it is definitely better. Regarding her complaint of low back pain, she was seen by Dr. XXX. She is taking medications. She still has sacroiliac discomfort, and we discussed this with regard to therapies.

OBJECTIVE:

Vital signs: Blood pressure 170/90; retake 160/90. Temperature 98.6. Pulse 64. Respiration 12. Weight 228 pounds.

Skin: Warm and dry.

Cranium: Normocephalic.

HEENT: Benign.

Neck: Supple.

Chest/Lungs: Clear.

Heart: Regular rate and rhythm.

Abdomen: Obese and nontender.

Extremities: There is no peripheral edema. The feet were examined, and they show no lesions which may be aggravated by her diabetes.

ASSESSMENT:

Diabetes mellitus, non-insulin dependent.
Obesity.
A case of chronic heart disease with status post coronary artery bypass graft (CABG).
Hyperlipidemia.
Hypertension.

PLAN: The patient's chart is not available at this time. She will return for a complete physical exam in 2 weeks, but she is having laboratory work done. We have not done this in quite a while. She is having SMA 20, with repeat UA, CBC, TSH, HbA1c in 12-hour, microalbumin done. Her medications are atenolol and lisinopril plus the medicines which I do not have listed. She will bring all her medications, and hopefully we will find her chart prior to her being examined.
********

SUBJECTIVE: XXX is here for medication refill and also have her lipids evaluated. She is feeling well; there are no specific complaints at this time.

OBJECTIVE:
General: The patient is a 54-year-old white female, alert, oriented, and in no distress.
Vital signs: Blood pressure 140/80; temperature 98.6; pulse 97; respiration 16. Weight 167 pounds. Height 5 feet 3 inches.
Skin: Warm and dry.
HEENT: Benign.
Neck: Supple.
Chest/Lungs: Clear to auscultation.
Heart: Regular rate and rhythm.
Abdomen: Soft.
Extremities: No peripheral edema.

ASSESSMENT:
1. Hyperlipidemia.
2. History of fibromyalgia.
3. Lactose intolerance with irritable bowel syndrome.

PLAN: New prescription for Vytorin 10/20. She will get #30 to try, and then if no side effects such as diarrhea, she will get the 90-day supply. If that is not covered by her insurance, we will order Zocor. We need to follow. The patient is asked to return in 3 to 4 months.

**********

SUBJECTIVE: Mr. XXX is here for followup. He complains that he is getting severe back spasms upon rising from bed or even getting out of his chair at times. It may last 3 to 4 days where he is incapacitated. He has had at least twice in the past month, and before that he had this several times during the month. He failed to make any mention of it. The patient had no history of trauma; it is just moving from one area to another, or arising from a sitting position.

OBJECTIVE:
General: This 84-year-old gentleman is alert and oriented in no severe distress
Vital signs: Blood pressure today was 130/60, temperature is 97, pulse is 60, and respiration is 14. Weight is 190 pounds. He is 6 feet 3 inches tall.
Skin: Warm and dry.
HEENT: Benign.
Neck: Supple.
Chest/Lungs: Clear to auscultation.
Heart: Regular rate and rhythm.
Abdomen: Flat and nontender.
Extremities: There is no peripheral edema at this time.
Musculoskeletal: On examination of the spine, there is some muscle of the right lower lumbar area, but it is not tender. I am not certain if this is a normal finding in this gentleman's case. He is muscular in general.

ASSESSMENT:
1. Hypertension, with history of atrial fibrillation, diabetes mellitus, osteoarthritis, spinal stenosis, hyperlipidemia, and glaucoma.
PLAN: He has Vicodin for the severe pain. He has several conditions definitely predisposing him to these problems, one of which is his arthritis, and the other is his spinal stenosis. I will discuss this more in the future. We will follow.

*********

SUBJECTIVE: The patient is here for a review of her blood pressure and to review diabetic standing. She is doing quite well. Her only problem is that she is having difficulty with sleeping.

OBJECTIVE:
General: The patient is a 52-year-old white female. She is alert, oriented and in no distress.
Vital signs: Blood pressure 130/68; temperature 97.6; pulse 88; respiration 20. Weight 166 pounds. Height 5 feet 2 1/2 inches.
Skin: Warm and dry.
HEENT: Benign.
Neck: Supple.
Chest/Lungs: Clear to auscultation.
Heart: Regular rate and rhythm.
Abdomen: Soft. There is no mass nor tenderness.
Extremities: There is no peripheral edema. The patient denies any sores on her feet or any other significant changes.

ASSESSMENT:
1. Diabetes mellitus.
2. Hypertension, controlled.
3. Hyperlipidemia.

PLAN: We will continue to monitor. The patient is to return in 6 weeks or as necessary.

*********

SUBJECTIVE: Xxx presents with the complaint that she has had chest pain, which is oppressive, as somebody is sitting on her chest, and difficulty in getting her "ear". She says that she gets pain in the right arm and also cervical spine pain when this occurs. There is some difficulty with the history. This is because of the nature of the problem and also of the patient's prohistorian as well. This has occurred in 4 episodes, which is disconcerting. She also has abdominal pain; it is a chronic pain, which keeps her from employment. She also a right upper quadrant pain. Whether this is GI or cardiovascular remains to be seen. She was taken to the emergency room and they gave her a clean bill of health and sent her home a week ago.

MEDICATIONS:
1. Naprosyn.
2. Vicodin.
3. Voltaren.
4. Prozac.
5. Tylenol.
6. Some medications for her eyes.

She is not to take Voltaren and Naprosyn at the same time. If she does, she may have stomach problems from that. She shakes her head no, she is not taking both medications.

OBJECTIVE:
General: This is an obese 53-year-old asthenic female, alert, and in no distress at this time.
Vital signs: Blood pressure 120/90; temperature 98.6; pulse 76; respiration 16. Weight 232 pounds. Height 5 feet 1 inches.
Skin: Warm and dry.
HEENT: Benign.
Neck: Supple.
Chest/Lungs: Clear to auscultation.
Heart: Regular rate and rhythm.
Abdomen: Rounded, obese and nontender.
Extremities: There is no peripheral edema.

ASSESSMENT: Chest pain, etiology secondary to psychophysiologic reaction versus esophagitis versus cardiovascular complications.

PLAN: Repeat electrocardiogram; have cardiology re-evaluate, and consider an upper GI and esophagram to rule out any esophageal problem. I will treat the esophagus at the present time with mild antacid medication and possibly proton-pump medications to prevent her symptoms, and then await referral to cardiology. We will follow.

*******

SUBJECTIVE: He has no specific complaints. He has some concerns about his skin as he was a surfer and exposed to the sun. However, we examined him last year and again this year, and we will evaluate the skin areas. He has physical examination a year; he is gainfully employed, and he is a hardworking gentleman. There is a history of asthma, but he has been asymptomatic for some time. The patient is a nonsmoker, and drinks alcohol only very socially. There is no family history of chronic disease. His parents are in their 80s, living and in good health.

REVIEW OF SYSTEMS: He denies constitutional symptoms. He has gained 5 pounds over the past years. He has no fever or night sweats.
Thyroid or throat: He denies visual or hearing difficulties.
Respiratory: He does not complaint upper respiratory infections or chronic cough, etcetera. He denies shortness of breath or chest pain. There is no cardiovascular symptoms of fatigue, palpitations or chest pains either. The asthma has been asymptomatic for a long time.
Gastrointestinal: He denies nausea, vomiting, diarrhea, and constipation. There are no changes in bowel habits.
Genitourinary: There is no history of dysuria. He has occasional back aches in the past, but has been asymptomatic over the past years or so.

OBJECTIVE:
General: The patient is a healthy-appearing, good-looking 6 ft 4 in 43-year-old Caucasian weighing 187 pounds.
Vital signs: His blood pressure is 120/80; temperature 97.2; pulse 64; respiration 16. Weight 187 pounds. Height 6 feet 3 1/2 inches tall.
Skin: Warm and dry. There are no lesions of note on his back or elsewhere.
HEENT: [2:40 hyro-per-cream] normocephalic, atraumatic. Pupils round and equally reactive to light, accomodation and distance. There is increased cerumen in the right ear which will be lavaged. Contaminants were localized on the left but not on the right. Nares slight congestion. Pharynx benign.[02:59] No oral lesions.
Neck: Supple. No bruits, thyromegaly, or retinopathy. No restriction in motion.
Chest/Lungs: Symmetrical. Lungs clear to auscultation without adventitious breath sounds.
Heart: Regular rate and rhythm. No murmurs, friction, rub, or gallop.
Abdomen: Flat and nontender. No masses. No hepatosplenomegaly. No tenderness noted. There is no hernia, either ventral or inguinal.
Genitalia: Circumcised male without penile [3:24 sl circumferential?] lesions.
Rectal: Prostate is normal in size and shape, flat, nonindurated. Stool is negative for occult blood.
Musculoskeletal: Spine has no asymmetry. No paraspinal muscle splinting.
Extremities: Intact. No clubbing.
Neuro: Cranial nerves are grossly intact. Deep tendon reflexes were not tested, but the patient had no difficulty in ambulation and walking, or any other physical activities. The patient has a [3:51 sl terse?] sensorium.

ASSESSMENT: Healthy male. History of asthma, asymptomatic. History of back pain, asymptomatic. Cerumenosis in the

PLAN: Lavage of the right ear. Laboratory studies have been ordered. We will follow.

My 1st week of job...

I have spent a total of 1 week in this job from Friday of last week, and I'd say that our software is amazing and really meant to increase productivity.

Well, Friday was "getting-to-know" more about the software and my initial 4 dictators. My production that time was so sliw, but I was maximizing my autotext feature (embedded in the software) and that added to my slowness. Building up my autotext database may be slow, but it will be my tool to make my production explode later.

Monday morning, theres wa not much to do, and I was asking my employer about it. Well, since my dictators are in CA, and I am in ME, that means we have a 3-hour difference in time. What were available to me early in the morning were leftover from the weekend. Then I had to wait til 11 a.m. before the dictation files came pouring in.

However, on Tuesday, I stil found a lot of vacant times, and I had a dictator that talked rapidly, that I asked my employer whether she could try to match me to other dictators who were dictating more slowly. I specifically asked to be tried on their ESLs, since I am an ESL myself, that I thought I might find it eaay to listen to them, since I am so used to hearing foreign tongues, even had Chinese, Japanese, British, Pakistani, Indian and Bangladeshi patients/correspondents before, aside from exposure to American tongues, thanks to western movie and TV shows.

Hence it was because of such a correspondence with my employer that the next day, Wednesday, she did give me a trial flow on several dictators, both ESLs and Americans, which kept me glued to the computer the whole day. The good thing is I found these dictators to be rather easy, such that, instead of having only 6-8 dictators in my pool, I now have 11 (minus the difficult rapid talker) in my pool! Now I will never run out of dictation files to transcribe! The most recent addition was a podiatrist, and that is soooo easy! Imagine concentrating on the feet! Anatomy of the foot is easy for me to listen to (though I vaguely recall the exact anatomy of it, hearing the terms brings them back to memory). Anyway, I got a goooood flow of work that Tuesday, trying new dictators. I made about 400+ lines that day. That night I printed out several reports for each dictator and familiarized myself with their styles, and made some shortcuts (autotext) for phrases that they routinely use. I love the autotext feature. Imagine, I can type something like "rsmb" and the text will automatically be converted to "I reinforced self multi-breast examination, daily calcium needs and exercise," or "tcph" for "The patient is coming in with a history of." Isn't that cool? Now it is not too puzzling for me to read in forums and employer requirements of making 2000 lines per day. Imagine, if you are making a radiology transcription and they have a template for every report where you only have to enter values for measurements, that would be easy to reach! However, at the end of my 1st week, I only came to about 600 lines. I hope that with the autotext feature I will be able toa chieve my targeted goal of at least 1000 lines per day, or even 1200 per day, plus I also hope that my QAs will recommend my removal from QA stage, meaning they won't have to edit my work, only to fill in blanks, which will then also lead to increase in pay.

Thursday was slow, and apparently it had something to do with the spring break in CA, such that most of the drs might be out with their kids. I had some dictation that came pouring in more regularly later that afternoon, but I had to prepare supper.

With the schedule in mind, my thoughts went to planning ahead for the summer, particularly working on my garden. I thought that I could use the early hours in the morning to transcribe leftover of the previous day, then go out and attend to the garden, have lunch before 11, start working from 11 a.m. through 5 p.m., take a break for cooking and eating supper, then work some more for additional 2 hours to make it an 8-hr job. If I would be too tired to do that, I have the option to just be lazy at night.

Friday, since I had not much to do in the morning, I checked my production. The software also has an automatic counting-line feature based on a 65-cpl (characters per line), and I transcribed 2187 in my first week, and of these, the delivered transcriptions were 2032, which at $0.07/65-cpl would translate to $142.24 in my first week of work. Not bad for a ramp-up period, especially that I don't have to buy wardrobe and gasoline and, best of all, don't have to kiss somebody else's ass. Just plain work and that's it. My first paycheck would come, however, at the end of April, then it will be bimonthly. My employer is also working on a direct-deposit method of payment. I really like her, and I am very satisfied with the system; I only now need to see how good my boss is when it comes to giving the salary of her MTs (i.e., on time) .

The rest of the day went quite smoothly with all these dictators, but since I started at 11, I felt it was still early when my boys were back from school. You know how it feels to want to go on, but you have to stop because you have to attend to your family's needs first. AT least, it is a good thing that after supper, I can go back and work some more, pile the dishes in the sink filled with water to keep the debris soft, attend to it the next morning when there is less work (actually optional work on a weekend). Before I was to conclude my work that night, I noted I made about 513 in 8 hours, but I noticed the appearance of a new dictator, the podiatrist, and I got intrigued as to how I would do with him. So I extended some more, made extra 35 lines and achieved a total of 602 lines in 9 hours. Hmmm...podiatrist dictator may be easy, but his notes are so short that I spend more time verifying and entering the demographics than transcribing the actual case. So he is not much of an increase in my productivity. But then, more of my slowness also could be attributed to my researching effort to familiarize myself with his style, his terms, especially for procedures and what he uses, but once I learned, I made autotext of these again, also of phrases such as "ico" for "Informed consent was obtained for," "spd" for "sterilely prepped and draped," and "aisd" for "alcohol irrigation, sterile dressing." I'm sure he will be easier.

The next day, Saturday, my ever-loving sweet and thoughtful hubby went to Wal-Mart and surprised me with an ergonomic chair (he even bought me a gel pad to protect my wrist after I complained about it that night after my first day of working. What can I say? Life may not be so easy, but I sure don't feel empty.

My work is exciting enough that I am learning and reviewing medical cases, akin to being an apprentice of these doctors, only without having to be their assistant. My researching on the net about their cases is like reviewing the pathophysiology of these illnesses and seeing the logic in the management. Very good exposure to the system here. I also learn their brands of drugs which are the equivalent of what I used to prescribe in PI for such common symptoms as fever, headache, joint pains, etc.

But I am not considering this to be a long-term career unless it becomes my own business. I am just using this jobs as a means to an end: to get either in a medical practice or in a medical teaching (clinical instructor or public health) position. I am still considering the possibility of being a doctor and having the MT business on the side. Having this MT job as a bridge for me to reach the other side just made me realize I do have a lot of options there waiting for me...