MT Bio - Part 2

After my first at-home job with the medical transcription service that had NO experience in this specific business (se MT Bio - Part 1), I began to look elsewhere for employment when we first signed on to the Internet from home with our first dial-up service in 1996. I became aware that — lo and behold — there were MT companies in other parts of the country that would hire you (generally as an independent contractor with no benefits), and I found my first position with a company in Los Angeles. I would record from the hospital Dictaphone system onto microcassettes and transcribe from those, then send the reports back via a file transfer program. The reports were all done in WP5.1 (an application I continued to use until, believe it or not, 2006). I even did one account for them where they would play THEIR tapes over the phone line and I would re-record onto my Dictaphone transcriber. The pay was fairly decent — they paid by the gross line. Everyone in their office seemed pleasant — it was almost a family atmosphere. Over the years, technology improved to the point of .wav files and an Internet-based platform for receiving dictation and sending reports. But coincident to that, our pay rate changed (paying on a character-based line rather than gross line, which resulted in essentially a pay DEcrease). And then later, our paychecks started arriving more and more erratically. Some of their MTs were literally going months without pay. I was able to gain experience by doing QA/editing for this service, and I did thoroughly enjoy transcribing their accounts, but it was time to move on. They did eventually pay all that they owed me, but I did discover some weren’t so lucky.

From there, I answered an ad posted on MTJobs.com that sounded too good to be true: 14 cents per line. Fortunately, I landed that one (again as an independent contractor, but who cared at that pay?). It was back to accessing the hospital Dictaphone system to transcribe and using a file transfer program to return the work, but the dictators were clear, the work interesting and the boss a dream to work for. This job lasted for about 5 years. At one point, I also worked for another company doing part-time QA/editing to maintain that skill and, in the meantime, earned my CMT.

I knew it would happen someday — that it was all too good to be true — but the inevitable did occur at the end of last year (2006) when the service owner of my “dream company” notified us that their contract with the teaching hospital had been lost to one of the giant MT services. I did end up with a decent-paying (compared to others) job as an employee with a service that offered benefits, but nothing could match the pay I’d grown accustomed to.

I try not to think about my pay today compared to what it was 5 years go. Very depressing. A college degree, years and years of experience, certification in hand and I’ve seen my salary shrink over the years. Yes — I know I’m fortunate to have worked from home during much of my sons’ childhood years and even now — not having to drive the icy roads in winter or spend the $$ on gas or an office wardrobe. But the face of this career/job has changed dramatically.

Ten years ago, I would field numerous emails and phone calls from those interested in entering this field. Most wanted the luxury of working at home and felt if they knew “how to type” then that would be their ticket into a job as an MT. Their interest would wane a bit when I’d explain they’d require some type of formal training (the days of “learning on the job” are pretty much a thing of the past for MT), with some correspondence courses averaging a cost of $1500 to $2000. Now, if anyone expresses an interest in MT, I strongly recommend seeking some other career path. I feel I might be able to continue this until I’m ready to retire — even with “back end speech recognition” on the table at most MT services, they will still require editors verifying accuracy — but to start from day one in this job at this point in the game, I believe would be an error in judgment and a lack of foresight.

MT Bio–Part 1

I’ve been a medical transcriptionist since 1980…working from home since 1996. While I’m grateful for the fact that I have a way of earning a (modest) living from my home, over the years, I’ve begun to question the “career” I fell into. I’m a college graduate — but in “liberal arts” — OK so you can cast your stones now. While my husband was in graduate school, I had the opportunity to continue my education, with the plan to earn another bachelor’s in computer science. But I couldn’t qualify for aid, and I didn’t want to seek help from my in-laws or parents, so I went to work in my first allied-health minimum-wage job post-college as a receptionist in a physicians’ clinic. From there, I was able to work in another clinic, this time being taught medical transcription by the in-house transcriptionist. From there to a hospital (in those days, they were desperate and willing to train)…to another hospital, then to home.

In the “early days,” this actually wasn’t a bad job. At one hospital, though they actually required full-time, I was able to finagle part-time hours if I worked one weekend day since they had been unable to fill the position for ages (in fact, I had applied for an entirely different job, and Human Resources had noted my transcription experience and passed my application along to them). I was able to keep my kids out of daycare this way, since my husband watched the kids while I was at work–I was able to gain more experience and earn some extra cash.

My next job would end up being my first “real” at-home job (the previous hospital had allowed me to work from home one summer) but began in their office. This was the first “service” I had worked for and was my first taste of what strange and mysterious things can happen to your income when you’re an MT. Here, I was paid by the line for the first time. I should have known, too, there might be trouble down the road when I went in for my interview/testing, and it essentially was to transcribe one of their clients — an East Indian cardiologist. It turned out that this service was started by an older couple who were sold the idea of starting their own medical transcription service by a Dictaphone salesperson. The owner eventually admitted that the salesperson had stated that MT was something anyone could do if they could type!!! She sold them a Straight Talk system (double ugh) and off they went. Well, I guess they didn’t count on the need for knowledge of medical terminology, medical records, ability to understand ESL physicians (which — in southeastern Washington there were quite a few) and …. I felt like I was the one who earned that first dollar bill they eventually framed and put up on the wall. The owner’s co-owner wife had tried to transcribe this physician and was having difficulty (imagine that!) After the initial test, I worked for them off and on, then eventually on a more regular basis from my home office. I stuck with them for awhile but found bumps in the road with these employers unfamiliar with the business (but maybe there were a lot in those days: 1993). Quoted a decent per-line pay at the beginning, they later cut it with the explanation that: “Well, we overestimated costs, and you’ll be saving money by working from home.” Months later, there was yet another pay cut. Believe it or not, the explanation was: “Our office manager requested a pay increase. Don’t you think Susie deserves it? Plus…look at this pie chart that indicates how much of our expense goes into MT salaries.” (WHAT?!?! How much income would you receive WITHOUT the MTs?!) Well, I eventually did leave this local service. OH…one thing I nearly forgot was that while I was working on the premises, I discovered that my paycheck was DOCKED if I asked a question of one of their in-house transcriptionists. It seems she was complaining about her loss of productivity when answering questions, so this was their solution! I also remember a fellow transcriptionist–an experienced MT who had worked a number of years in the local hospital–complaining that the owner’s wife was actually the editor. Yes–there was a lot of respect for MTs there! Believe it or not, this service remained in business!

The Bridge

Ever since I first saw a piece on ABC’s 20/20 about the documentary, The Bridge, I’ve wanted to see the film. From a relatively young age, I’ve been fascinated with mental illness and suicide. I can recall one of my favorite books as a teenager was The Savage God by Al Alvarez. By chance, I noticed that IFC was airing it, so I tivo’d it awhile ago, then finally was able to find a good time to watch it. I knew it had to be in one sitting, without any interruptions, without anyone else to happen by and comment on the morbidity, etc.

The Bridge, by documentary filmmaker Eric Steele, chronicles the Golden Gate Bridge and those who attempt to end their lives there. He and a 10- to 12-person crew spent an entire year in 2004 filming the bridge, their cameras trained on specific sections, using close-up and wide-angle lenses to cover the entire expanse both day and night. There have been more than 1200 suicides from the bridge since it opened in 1937, yet there is still a mere 4-foot safety barrier as a hindrance. Apparently, a jump from Golden Gate Bridge is the equivalent of a 4-second, 25-story fall. Some have survived, but a body is usually shattered when it strikes the water at roughly 75 miles per hour.

By the end of the year, Steel and his crew had captured 23 of the 24 suicides from the bridge that year. Every member of the crew would immediately contact the bridge authority on speed dial whenever they felt someone was about to jump (one tell-tale sign being taking off a backpack or purse before moving toward the edge). Their team ended up saving 6 people, 1 person more than once.

Some criticisms leveled at the filmmaker were that it was morbid, that it was cruel, that it may cause copycat jumpers. As he has pointed out, though, those that choose such a final desperate act are often at the wrong end of a struggle with mental illness. It takes much more than viewing a film about suicide or hearing about suicide to lead someone to such a solution.

I’ve always felt that suicide was the topic no one likes to discuss. It’s an ugly secret for some families when a loved one takes their own life. But it’s something that should be discussed. I remember an acquaintance being brave enough to relate in her son’s obituary that he had taken his own life — it was something that needed to be told so that others might be on guard or at least more sensitive to warning signs — and ultimately to relate the unimaginable and unending pain suffered by those who are left behind.

This is yet another one of those films you’ll be thinking about and talking about long after it’s over. The interviews with families and friends of those who committed suicide on the bridge are poignant and telling. Some resigned to the fate they knew the loved one would meet someday after years of struggling with mental illness. Some still unable to understand what would compel anyone to such an act. All sharing a common bond of suffering and pain. Some interviewees were mere witnesses to the act. The young family snapping photos on the bridge when they encounter and speak to the young man just before he jumps. One person actually survives the leap — and relates that the moment he releases his grip and begin to fall, realizes it’s a mistake. How many others had the same thoughts as they fell to their deaths?

It’s a troubling and uncomfortable 90 minutes, but thought-provoking. All family members involved in the process have seen the film and were glad they had participated in it. There are no simple answers or pat resolutions to ponder. But, as Eric Steel stated:

“The answer is not to not show the film. I think the film gives you an insight into mental illness and suicide that no one’s ever offered before.”

“The answer is to have a discussion about suicide and mental illness in a way that produces different results,” he said. “And I hope that I have, in some way, contributed to changing the dialogue.”

I encourage you to visit the film’s official website, which offers more background information, press notes, reviews and a message board.

Capturing The Friedmans

I finally got the chance (thanks to my Netflix) to view this 2003 documentary. While not for everyone, if you are interested in the finer points of documentary filmmaking, I urge you to see this. The film follows the travails of an upper-middle-class family in the affluent suburban community of Great Neck, NY as the father and son are accused and later convicted of numerous charges of child molestation. 

The director, Andrew Jarecki, used much of the family’s home movies for this, creating a disturbing portrait of a dysfunctional family. You’ll find yourself haunted by the images and the thought-provoking content for days afterward. And you’ll be left with no simple, straightforward answer to the question: Did it really happen? or….Did SOMEthing terrible happen? I was blown away by this film. Though Michael Moore is our current documentarian de jour, I find his “in your face” style distracting and annoying to say the least. He places himself too much in the center of his films (”Look at me!!” “I have an important point to make.”) In my mind, the director should step aside and leave the audience to draw their own conclusions — conclusions which are sometimes undefinable or … uncomfortable. If you do see this film, I strongly urge you to follow that up with a careful study of the companion website: Capturing The Friedmans, where you can view additional legal documents and affidavits that help to further elucidate the veracity or lack thereof of the charges against them. It’s a frightening look at a period of time when peoples’ lives were ruined by false, or inaccurate, charges on a grand scale. I live in southeastern Washington state, and several years following this and the McMartin incident, the notorious Wenatchee sex ring was often in our headlines. I recall the mixed feelings of horror that something like this could happen to children and the undercurrent of disbelief — that this might be a fantastic concoction of lies. If you’re looking for challenging material that will make you THINK (and maybe squirm a bit), then I urge you to check this out!

More Kafka News!!!

A new graphic biography (it’s actually a reprint newly released) of Franz Kafka, titled Kafka, features illustrations by Crumb (or R. Crumb, as he is usually styled) and text by Jewish author David Zane Mairowitz. Wow! Check it out at Amazon and do a “search inside”!

“What do I have in common with the Jews? I don’t even have anything in common with myself.” Nothing could better express the essence of Franz Kafka, a man described by his friends as living behind a “glass wall.”

Kafka wrote in the tradition of the great Yiddish storytellers, whose stock-in-trade was bizarre fantasy tainted with hilarity and self-abasement. What he added to this tradition was an almost unbearably expanded consciousness. Alienated from his roots, his family, his surroundings, and primarily from his own body, Kafka created a unique literary language in which to hide away, transforming himself into a cockroach, an ape, a dog, a mole or a circus artiste who starves himself to death in front of admiring crowds.

David Zane Mairowitz’s brilliant text and the illustrations and comic panels of the world’s greatest cartoonist, Robert Crumb (himself no stranger to self-loathing and alienation), help us to understand the essence of Kafka and provide insight beyond the cliché “Kafkaesque,” peering through Kafka’s glass wall like no other book before it. The book is a wonderful educational tool for those unfamiliar with Kafka, including a brief but inclusive biography as well as the plots of many of his works, all illustrated by Crumb, making this newly designed edition a must-have for admirers of both Kafka and Crumb.

I also had no idea that Robert Crumb several years ago had penned R. Crumb’s Kafka, and this must be the earlier version: “A graphic novel approach relating the life story of the troubled but brilliant Franz Kafka. Crumb illustrates the main biographical events and portions from some of Kafka’s most celebrated works. Mairowitz, who wrote the text, does not try to embellish his work, instead his comments are sparse and to the point , thus better allowing Kafka the classic writer, and Crumb a world class gifted illustrator, to shine.

Yes, you still need books….

Many believe that the “old-fashioned” word books or other reference books for medical transcription have become dinosaurs in the age of the Internet, but I disagree. Yes — you can google phrases and the like that stump you, but I STILL find myself pulling one of my many specialty word books off the shelf and thumbing through it. If you can’t make out one piece of the phrase, you may well be stuck for many, many minutes furtively trying to find an answer on Google or other search sites–perhaps coming up totally empty-handed … and still frustrated. But, with a word book, say, for example, it’s a type of cell in the specialty of urology, you can pull out your Stedman’s GI/GU Word Book, look under cell and voila — what sounded like Cupper cells or Kupper cells or whatever….is actually Kupffer cells. Try googling that one when you have such a vague idea (and a marble-mouthed dictating doctor) to go on. I have to admit that if I were starting out this very minute in this career, I’m not sure I’d have the extensive library of word books I own now, but there’s rarely a working day that passes that I haven’t used at least 1 or 2 of them to help me out of a pinch and a blank. The drug books are sometimes still the quickest way to verify a dosage or use of a medication — and a lab reference book if you want to quickly and accurately learn the reference range or uses for a specific lab test. If you’re interested (even if you’re not, I’m doing it anyway) — here’s my list of current reference books:

Laboratory Test Handbook and Word Index

Dorland’s Pocket Medical Dictionary

Vera Pyle’s Current Medical Terminology

Medical Abbreviations and Eponyms — Sloane (abbreviations are VERY hard to reference on the Web!)

Saunders’ PharmaceuticalWord Book 2005

Dermatology & Immunology

Cardiology & Pulmonary

Psychiatry, Neurology, Neurosurgery

Ophthalmology

Orthopedic & Rehab

Tessier’s Surgical Word Book (the latest edition of this has more spelling errors than I’d prefer)

Organisms & Infectious Disease

GI & GU

Oncology

Plastic Surgery/ENT/Dentistry

AAMT Book of Style

Dorland’s Pocket Medical Dictionary

Stedman’s Medical Dictionary

Angels in the Architecture

Angels in the Architecture This is an amazing book by photographer Heidi Johnson chronicling the life and death of the Traverse City State Hospital (asylum) in Michigan. Told with the historical background and personal accounts of those who both lived and worked there layered over a backdrop of haunting photographs. Very moving and thought-provoking: the photographs alone will fill your imagination. The system of care proposed by Dr. Thomas Kirkbride is a fascinating study in and of itself. An entire architectural plan for care of the mentally ill that included exposure to the outdoors in a peaceful, calm environment and such tasks as gardening and tending to farm animals. It makes one wonder what would happen today if all of corporate America would combine their resources to renew and fund such a plan to house and care for those in today’s society who are the throwaways — the mentally ill with no support system. You likely won’t find this book in any bookstore, but as a fascinating read and just plain eye candy if you’re even vaguely interested in historical photography, I’d say it’s well worth the purchase. I came across all of this through the horror movie, Session 9, which was filmed and set in the Danvers asylum, another Kirkbride-planned institution. At the time I saw the movie, I was haunted by the notion of the people who lived and were treated there. A beautiful photographic essay of that institution is Abandoned Asylums of New England by John Gray, unfortunately no longer in print — also filled with eerie and moving photographs that seem to be filled with the spirits that inhabited the place.

CMT

This is something only medical transcriptionists would be even vaguely interested in, so here’s your fair warning. CMT is Certified Medical Transcriptionist — a certification visited on those who successfully pass the knowledge and performance examination adminstered by the American Association for Medical Transcription. You must have 2 years’ experience in acute care before attempting the exam, and to maintain the certification, you must complete continuing education requirements. Well, there are arguments pro and con as to why in the world an MT would even WANT to pursue the certification, and I’ll tread there in a future posting. I just know that, for personal reasons, I wanted to put a professional stamp somehow on this “career path” I had chosen (or fallen into, depending on how one looks at it). It was at a time in my life where I felt totally superfluous and unimportant. The whole exercise: studying on a regular basis (I bought The Language of Medicine and worked through the entire book — I made flash cards for Latin roots and anatomy terms), traveling alone to the nearby city where the test was administered and staying overnight all by myself at a nice hotel, then actually taking the exam — dealing with the nervous anxiety, the doubt — and finally seeing that final screen on the monitor that stated I had actually passed — it was all well worth the effort and expense. Now, I’m approaching my first cycle of recertification and am putting off getting those final continuing education credits. So I need to spend THIS summer, as I did that summer 3 years ago, organizing, studying, setting goals, so that I can complete that (there is NO WAY I want to take that frickin’ exam again!!).

Kafka News!

He’s been dead for over 70 years, yet you can still find Kafka-related news items in a Google News search! Just thought I’d try it and see what came up. This one made my day:

Remember View-Masters? Those 3-D viewers with 14-scene “reels” that we loved as kids (I can still hear that comforting clicking sound when it advanced to the next picture) and our kids loved — and now they’ve unfortunately modernized them to the point they’re no longer recognizable? Anyway — I digress: A Portland, Oregon artist has created a variety of the disks that she apparently uses as performance art. In 2003, she began making her own reels for second-hand View-Masters starting by interpreting four of Franz Kafka’s “parables.” She read up on how to make 3-D photographs, built her own scenes on a card table, and glued the images into custom-printed reels. She packaged these and sold them at local craft fairs. Since then, she’s created others. Check them out at her website, Etsy.com. Though it was several years ago that she created these, the reason it’s popped up in recent news is that there’s an exhibition called “The Magic of View-Master” at the 3D Center of Art and Photography in Portland, Oregon through May 27. Awesome! I need to dig through my closets to see if I can find a new-old View-Master (the model my kids used 20 years ago; unfortunately, my sister’s old View-Master is somewhere in toy heaven, I think). I am so going to purchase those Kafka reels! I used to be a Kafka fanatic in my younger days when I first read “Metamorphosis” (if he were alive, I would seriously have been his stalker — I used to pore over photographs about him — my dream trip was to visit his gravesite). And this blog is stirring up those feelings again! When I do get them, I’ll report back here with a review.

Medical Transcription / Kafka

You may ask: How is “medical transcription” Kafkaesque? The way I like to look at it (to help keep me from going insane), is that….in the same way a literary genius like Kafka held a mundane job, I am a medical transcriptionist. Although, in my case, you’d have to leave out the “literary” and “genius” part. I just like to think that someday I’ll get my act together and spend my time away from work creating amazing works of art. Unfortunately, that’s what I’ve been hoping for the past 25 years and it has yet to become a reality. Oh…and anyone out there reading this who IS a medical transcriptionist would likely agree that the job itself can be Kafkaesque.

I am grateful for being able to work from home, and reports can be interesting or challenging at times. Over the years, I’ve had to keep up with varying technologies. But the face of this “career” has changed much over the past decade. More later…

In the meantime, in a nutshell — to describe what I do: I first learned medical transcription on-site ages ago at an OB-GYN clinic. From there, worked at a hospital, then at another hospital when we relocated to another state (in those days, hospitals were desperate to find qualified people who could do this, so it was pretty easy to finagle your own schedule — as long as you agreed to work some weekends). Then when Internet usage became more commonplace, I began to work for distant medical transcription services from home: transcribing hospital reports primarily. And here I am to this day doing the SAME THING! Yes — it’s sitting in front of a computer, listening to physicians drone on. And, yes, speech recognition is changing the face of this job, but I hope that I am retired by the time it completely takes over. Based on how many (make that most) physicians speak, I’m not sure if it ever will 100% replace us.

Yes…more later…