This article, "Cicero Teaches Dictation: Lessons From Ancient Rome", is intended for physicians, residents, interns, medical students, nurses, and physician assistants.

The following week, I got six reports in a row by someone who talked at breakneck speed while barely opening his mouth, and great chunks of what should have been a usable report were never dictated at all. Example: Segueing from admission physical examination to laboratory values, what the man actually slurred was: "No clubbing, cyanosis, or edema. Elevated at 16,000," and then proceeded to give a garbled account of some of the patient's labs.

Oh, right! Since the patient was admitted with pneumonia, it's (almost) obvious that the 16,000 refers to an elevated white count, but I could not assume that. I'm not a physician, I wasn't there, and he never said the words. If the words were never spoken, they cannot be transcribed.

I fear for this doctor's patients. Never mind that I got sick of working after 1-1/2 hours of fighting terrible dictation and spent the rest of the day playing computer games; I was able to make up for the lost time. The fact is, dictation such as this is hazardous to patient care.

Perhaps Dr. Mark Greene of ER was speaking for the MTs as well when he said, "We're not saints. We just try to get it right as often as we can."

Work at home in your jammies!

Have you seen the ads on late-night TV for the schools that teach medical transcription, bartending, auto mechanics, and other careers one can study for in one's spare time? Some people take jobs in medical transcription because it's advertised as something a person can do at home, on one's own schedule, taking care of children at the same time.

While there is some truth to this -- I don't have children at home nowadays, but I still work at home in T-shirt and sweatpants -- some MTs are incredibly dedicated, highly knowledgeable, and wouldn't dream of doing anything else for a living. These people expend substantial amounts of their own money, and their unpaid time, on research and continuing education because they want to do the job as well as humanly possible.

For us, the internet has created new methods of researching terminology, new ways for colleagues to stay in the loop, new employment situations -- and new, sometimes cutthroat, competition.

Caveat emptor!

Especially during your residency, you will have little control over the means by which your dictated words are transformed into a finished document. Medical transcription is big business. Outsourcing of transcription is the norm. Hospital transcription departments and small local transcription agencies still exist, but in recent years the field has come to be dominated by a few very large corporations. The largest employs more than 9,000 transcriptionists and has annual revenues of well over $400 million.

The new global economy has spawned competition by some unlikely players.

"We are software/web development firm located in Islamabad. We are looking for getting some medical transcription projects and forming a long term business terms, we have got professionals and doctors to handle the job efficiently."
- Internet ad placed 03/29/2002 for a company in Pakistan.

"Diversified into Medical Transcription as the part of company's expansion program. We are in this field since November, 2000. Our parent company has proven their expertise in the field of industrial fans' manufacture for the past 30 years."
- Internet ad, 03/29/2002, for a company in India.

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