Do you know I've had people email me to ask how to get into medical transcription? It's true. As if this were something I'd be doing intentionally.

There's some P.J. O'Rourke bit, I believe in Eat the Rich (but I'm too pressed for time to look it up), in which he explains the whole guns-and-butter economic, uh, thingie, using John Grisham and Courtney Love. The idea is, you start by assuming that Courtney Love can write trite, hacky legal fiction too, only, not as quickly as Grisham can; likewise, Grisham can write trite, hacky pop songs too, only not as quickly as Love can. And you end by concluding (after you actually, gasp, do some math--but it's very basic), that even though Love can do Grisham's thang and Grisham can do Love's thang, it's actually best, if you wish to maximize the quantity of both bad fiction and bad music, to let them each do their own hacky things, the ones they're, ah, best at.

Don't ask me why you'd want to maximize output by either of these people. Just keep the general principle in mind for a minute here.

I used to work a few places where this principle was understood and practiced. Sometimes this worked to my disadvantage--like when I worked at McDonald's and wanted to learn to work the kitchen. Management's reasoning was, "Why should we take a perfectly competent drive-thru worker, put her back in the kitchen where we can expect her to be perfectly incompetent for at least the first few shifts, and put Jorge, a perfectly competent grill cook, in the drive-thru, where he'll be perfectly incompetent for at least the first few shifts--and likely more, because Jorge no habla ingles?"

My argument was simple. Basically it amounted to: "Because if you DON'T get me out of this #$@* drive-thru VERY, VERY SOON I am going to come to work WITH A GUN. I might aim OUT the window at the customers, or I might not. It depends."

You have to loathe people a lot to beg to be closer to the grease and the grime, but believe me, after a year and a half of order taking--that's a year and a half of bitches begging me to change out their Happy Meal toys to appease Bratty and Snotty; a year and a half of assholes trying to cadge extra Monopoly pieces; a year and a half of halfwits wanting to know why we didn't serve onion rings--I really, really loathed people. Going home smelling of hamburger grease seemed a small price to pay.

But okay, management had a point: In terms of benefit to the employer, taking me out of the drive-thru was stupid.

This concept of keeping people in the jobs they're best at, so easily grasped by--for crying out loud!--people whose idea of higher education was Hamburger University, is still viewed with mistrust by my present employer.

My present employer is all, "Wait--so, you say you hate typing acute care?*"

"Yes."

"Why come?"

"Because I'm not very good at it most of the time, and even when I am, it literally bores me to sleep to transcribe."

"Well, but we're really backed up on acute care right now, so . . . ."

So you know what happens? They start routing me discharge summaries (a horror I've already complained about here before) and preoperative history & physicals and consultation notes. And I type them, poorly at worst, disinterestedly at best, half-asleep the whole time. And I don't really make much dent in the backlog. I know, go figure.

Meanwhile the ER starts backing up, as ERs are wont to do--particularly at night, which is when I work.

So the next morning, while I'm asleep, a panicked email goes out to the team from the supervisor begging for help and overtime on the backlogged ER reports. In that email, the supervisor will claim complete ignorance of any possible cause of said backlog. It is for all practical purposes a magic backlog, able to appear out of thin air.

Later, when I sign in that night, I will have a dozen emails waiting for me from transcriptionists who have no idea what Dr. So-and-So-of-the-ER is saying, and could someone please send them a sample? And they're so sorry, only, they normally work acute care and are only transcribing ER reports to "help with the backlog."

That would be, yes, the backlog that could have been relieved, possibly even avoided altogether, by letting the ER people transcribe ER and letting the acute care people transcribe acute care, the way God intended.

Really, it sounds so simple put like that.

I don't know. I shouldn't complain--I'm lucky there even IS emergency transcription anymore, since I gather a lot of places are going to this point-and-click sort of system where the doctor just fills in the damn report himself.

But do you have any idea how boring it is to transcribe a list of every conceivable risk associated with carpal tunnel surgery? I suppose I should make note of them, seeing as how it's what I'm destined for if I don't get the hell out of this line of work shortly. But every risk. Can't just say the patient gave informed, written consent, no. And maybe there's even some legal reason--hello there, HIPAA! And fuck you very much, William Jefferson Clinton--why every single risk has to be dictated, but there just is not enough coffee in the world to keep me awake through them.

It all brings up a very valid question:

If I'm going to be stuck doing work I'm not qualified to do, why am I not trying my hand at hacky legal thrillers?

UPDATE ONE: And must all specialists be imported from India?--Oh, oh, I know, I know, how insensitive of me. And I must be the only person in America with this rancid cultural insensitivity, because heaven knows I hear nothing but love coming from people who call technical support for help with their PCs only to speak with the staff in Calcutta, am I right? If you think being instructed to "rrrrreee-boot jur Vwin-doze" is fun times, you should see what that accent does to phrases like "Charcot-Marie-Tooth disorder."

UPDATE TWO: I should be fair and point out that it is actually not my immediate supervisor who sticks me with this crap--it's the supervisors covering for her. I know this because when my immediate supervisor's on duty, this doesn't happen. I love my immediate supervisor, honest. But some of the rest of the bunch haven't the brains God gave a paramecium.

UPDATE THREE: Did I have an email just now (the following day) requesting a sample transcription for an ER physician? Did that email come from a transcriptionist who normally works acute care but was "only helping out with the [ER] backlog?" Have I made a horrible vocational error? Would pounding railroad spikes into my eyeballs be a more productive use of my time? Is it poor professional form to "Dean scream" at a computer monitor if I do so in the privacy of my own home?

*This is like, the regular hospital stuff--people who get admitted overnight for observation, people who get admitted to the hospital period--versus emergency medical, your basic emergency room visits, which is the stuff I actually don't suck at.

Posted by Ilyka at July 28, 2005 03:36 AM in in praise of idleness | TrackBack