This article, "MT.Con: The Cockroach Problem In Medical Transcription", is intended for medical transcriptionists, MTSOs, physicians, medical records administrators, and student MTs.

American medical records belong in America. Hospitals are beginning to stipulate in contracts with transcription services that the work must remain at all times within the United States. Even the low-paying agencies are now stating that they will not respond to inquiries from overseas. This is a step in the right direction.

Indispensable resources
Stedman's Medical Dictionary and word book series
Quick Look Drug Book
Gray's Anatomy

Any good English language dictionary
- exhaustive online medical equipment catalog

- links to a mind-boggling array of info on absolutely everything
online English dictionary
- all the junk that's fit to debunk
- official website

4. Information overload

The internet is a networking tool and research assistant of unprecedented speed and awesome power; I would be crippled without it. Transcriptionists, device manufacturers, hospitals, medical publishers, and drug companies maintain websites that can help us find information quickly. Medical school, EMT, and nursing websites are also good sources.

With so much information out there for the asking, we need research techniques to zero in on what we're looking for. We need highly refined detective skills to allow us to determine whether information is trustworthy; this applies to all kinds of information, not just the medical lingo that is part of our job. Who hasn't been taken in by an urban or internet legend at least once?

5. Poor dictation

My article Cicero Teaches Dictation: Lessons From Ancient Rome gives one person's perspective on training the new dictator. Slurred speech, mispronunciation, garbled sentences, background noise, cell phones, and malfunctioning microcassettes also contribute to poor dictation quality.

"Man, it's particularly nasty weather," spoken on a muffled cell phone, sounds very much like "Can I tickle your ass with a feather?"

6. No QA, or overly picky/arbitrary QA

Especially for the new transcriptionist, QA that is both respectful and instructive is an absolute necessity. It is not an excuse to be rude or to dispense punishment. We are all striving to increase our knowledge, and the only "stupid" questions are the ones that do not get asked. MTs' pay should never be docked for leaving blanks or for questioning the dictator's use of a word or phrase.

In matters of style and usage, to slavishly follow AHDI's expensive Book of Style, which is also available by subscription at, may not be what the client prefers. Every hospital and/or its transcription agency should distribute a comprehensive style guideline to all of its transcriptionists.

7. sporadic availability of work, and its corollary:
8. benefits tied to production, which is not always attainable

It is just not possible to have exactly the right amount of work, at exactly the right time, all year round. However, it is definitely possible to tweak the distribution of work according to specific defined criteria; the large transcription agencies are in a position to do this quite efficiently. Why don't they? For many months now, a certain extremely large transcription agency has not had enough work for the MTs who work out of one of their California offices, yet they are constantly trying to recruit new transcriptionists for that office. Perhaps it is because their rate of attrition is so high.

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