In This Issue I n Dr. Seuss’s classic story The 500 Hats of Bartholomew Cub- bins, an ordinary village boy is bul- lied by the king because he cannot doff his hat in homage. Every time Bartholomew takes off his ordinary hat with one plain feather, another appears on his head. The situation becomes more and more dire as Bar- tholomew is abducted to the palace and subjected to a royal hat maker, wise men, archers, magicians, and an executioner (who cannot execute anyone with a hat on—it’s against the rules). Finally, he is marched to the highest turret to be pushed off for insubordination. On this long march up a winding stone staircase, Bartholomew swiftly and methodi- cally takes off hat after hat after hat, dropping them on the steps as he climbs. Bartholomew is so intent on his task he doesn’t even notice that at the 451st hat, they begin to change. “Hat 451 had, not one, but two feathers! Hat 452 had three…and 453 also had three and a little red jew- el! Each new hat was fancier than the hat just before.” By the time Bartholomew reach- es the top of the tallest turret he is sporting the most beautiful hat ever seen; indeed, “Beside such a hat even Up the Turret (or The 451st Hat) training, skills, and knowledge will not only be best suited to navigate changes but will also be most like- ly to land on their feet. The need for accurate health records will al- ways exist; the best thing to do to ensure a place in the future of the healthcare documentation industry is to position ourselves favorably for what is to come. Volume 15 | Issue 4 | WINTER 2012 You Threw Off My Groove 2 Med Gab 4 In Your PajamasMaybe Not! 4 Mixed Media 5 A Grader’s Perspective 6 Student Spotlight 7 Finders Keepers 8 Dear Susan 9 Graduate Spotlight 9 Planning For The Final Exam 10 Speech Wreck 12 the King’s Crown seemed like nothing.” As soon as the king sees it, he offers to buy the 500th hat for 500 pieces of gold. The king places the magnificent hat over his crown, and Bartholomew returns home safe and sound with a big bag of gold slung over his shoulder. Historically, the job of an MT has been done by an army of ordinary people working in their homes throughout the country. For a long time, it was typewrit- ers, carbon paper, and cassette tapes; then it was mini cassettes, printers, and key- boards; next, came sound files, computers, and internet file transfer protocols; now, it’s voice recognition software, HIPAA guidelines, and the electronic health re- cord. Times and tools change; and, until recently, this has been the extent of it. At this point, however, more fundamental changes are afoot, and we must be adapt- able enough to keep up. If we insist on doing the same thing we’ve always done, we’ll only get into problem after problem—much like Bartholomew and his first 450 hats. It’s feasible to suggest the industry may be evolving from a model involv- ing a large population of people doing one thing—medical transcription—to a model involving fewer but more highly trained people with a wide range of skills and knowledge. Of course, it’s difficult to say exactly what the future will bring, but it’s safe to say that those with the most “If we insist on doing the same thing we’ve always done, we’ll only get into problem after problem...” Continued on pg. 7 Professionalism and Adaptability in the Industry’s Future
Transcript
In This Issue
In Dr. Seuss’s classic story The 500 Hats of Bartholomew Cub-
bins, an ordinary village boy is bul-lied by the king because he cannot doff his hat in homage. Every time Bartholomew takes off his ordinary hat with one plain feather, another appears on his head. The situation becomes more and more dire as Bar-tholomew is abducted to the palace and subjected to a royal hat maker, wise men, archers, magicians, and an executioner (who cannot execute anyone with a hat on—it’s against the rules). Finally, he is marched to the highest turret to be pushed off for insubordination. On this long march up a winding stone staircase, Bartholomew swiftly and methodi-cally takes off hat after hat after hat, dropping them on the steps as he climbs.
Bartholomew is so intent on his task he doesn’t even notice that at the 451st hat, they begin to change.
“Hat 451 had, not one, but two feathers! Hat 452 had three…and 453 also had three and a little red jew-el! Each new hat was fancier than the hat just before.”
By the time Bartholomew reach-es the top of the tallest turret he is sporting the most beautiful hat ever seen; indeed, “Beside such a hat even
Up the Turret (or The 451st Hat)
training, skills, and knowledge will not only be best suited to navigate changes but will also be most like-ly to land on their feet. The need for accurate health records will al-ways exist; the best thing to do to ensure a place in the future of the healthcare documentation industry is to position ourselves favorably for what is to come.
the King’s Crown seemed like nothing.” As soon as the king sees it, he offers to buy the 500th hat for 500 pieces of gold. The king places the magnificent hat over his crown, and Bartholomew returns home safe and sound with a big bag of gold slung over his shoulder.
Historically, the job of an MT has been done by an army of ordinary people working in their homes throughout the country. For a long time, it was typewrit-ers, carbon paper, and cassette tapes; then it was mini cassettes, printers, and key-boards; next, came sound files, computers, and internet file transfer protocols; now, it’s voice recognition software, HIPAA guidelines, and the electronic health re-cord. Times and tools change; and, until recently, this has been the extent of it. At this point, however, more fundamental changes are afoot, and we must be adapt-
able enough to keep up. If we insist on doing the same thing we’ve always done, we’ll only get into problem after problem—much like Bartholomew and his first 450 hats.
It’s feasible to suggest the industry may be evolving from a model involv-ing a large population of people doing one thing—medical transcription—to a model involving fewer but more highly trained people with a wide range of skills and knowledge. Of course, it’s difficult to say exactly what the future will bring, but it’s safe to say that those with the most
“If we insist on doing the same thing we’ve always done, we’ll only get into problem after problem...”
Continued on pg. 7
Professionalism and Adaptability in the Industry’s Future
2 WINTER 2012 STEPPING UP
Adaptability: Now, Soon, and ForeverWinter is here at last! As we
wind down the year, we also place the capstone on the professional-ism theme we’ve been exploring during 2012. In this issue, we focus on adaptability and professional-ism with articles from a grader’s perspective, and adaptability in the course, workplace, and in the in-dustry’s future. Dear Susan echoes the theme, a crucial reminder about the final exam timetable is a special treat from our Skills As-sessment department, and the re-maining short features, including Student and Graduate Spotlights,
Mixed Media, Speech Wreck, Find-ers Keepers, Working From Home, Employer Zone, and Med Gab com-plete this issue.
In 2013, look for Stepping Up reinvented on the Career Step Step-ping Up blog. Although we’re sen-timental about the traditional news-letter format and we’re sad to see it go, the blog will allow us to put out articles and information with a fresh look and feel while breaking free of the constraints of content length—now articles can be as long or as short as needed. We plan on provid-
ing the same amount of content, just spread out a little different-ly—a couple of articles every two weeks instead of everything at once every three months.
Please enjoy this final issue of Stepping Up in this format, and join us in January on the Career Step Stepping Up blog!
- Jill McNitt, Editor
Continued on pg. 3
You Threw Off My GrooveAdaptability in the Course and Workplace
I attended a fairly large univer-sity for my bachelor’s degree—
you know, the kind that has massive auditorium-sized general education classes. In one particular class there were over 300 students crammed into a theater-style lecture auditorium. I am a creature of habit, and I quickly found a seat on the left side of the au-ditorium in the corner. I sat there ev-ery class period for 6 weeks. One day, I came into the auditorium and there was a boy sitting in my spot! I was completely flab-bergasted. I had no idea what to do! I stood in the aisle by my row, glaring at the unsuspecting boy who continued to type away on his laptop, oblivious to my plight. I ended up sitting three rows behind him. I couldn’t focus on the lecture because I was so angry with him for the perceived wrong he had perpetrated against me. That boy continued to sit in “my seat” for the
remainder of the semester. When venting to my roommate a few nights after the initial incident, she quoted from that night’s episode of Grey’s Anatomy:
“Change. We don’t like it. We fear it, but we can’t stop it from coming. We either adapt to change or we get left behind.”
I was letting
myself get left behind because I wasn’t adapting to something as small as a guy sitting in my un-assigned seat!
Medical tran-scription and medical tran-
scription editing are professions that rely on your ability to adapt to chang-es in account instructions, doctors, and technology. If you are anything like me, adapting quickly can be diffi-cult. Luckily, I have been able to learn how to embrace the changes that come and use them to continue growing as
a person and an instructor. I hope I can provide some insight into how to adapt to changes while completing your program and how to adapt when in the workplace.
Gain Control The main reason why many of us
resist change so ferociously is because our first response is panic. Our minds start to race. Our bodies tense up. Our breathing rapidly increases. The first step to embracing change is to resist the urge to run in the opposite di-rection (our bodies have a similar re-sponse to danger), quit working on the program, and/or throw our computer out the window. Take a deep breath and try to clear your mind. Don’t try to figure everything out at once—just take it one step at a time. Once you give yourself time to gain control of your emotions and mind, you can face the change and come up with a way to adapt.
In the program, you are going to
encounter the following words almost daily: acceptable variation. For some
STEPPING UP WINTER 2012 3
of us, it is a new concept to see shades of gray instead of black and white rules. That’s okay! It’s good to learn new ways to look at things. One of the most common questions we get is along the lines of, “I transcribed one way, this key is telling me I’m wrong, but another report had it the way I transcribed it. Who is right?” The an-swer to this question is that either way is acceptable. Different medical tran-scriptionists with different account specifics transcribed the keys in the program. As long as you follow the account instructions you have been provided with for the block of reports you are in, you can feel confident that the format you transcribed in is cor-rect. Style differences do not mean that you have something wrong—they just mean that there are a couple of ways to do it right!
In the workplace, medical tran-scriptionists and medical transcription editors are frequently asked to adapt to new technologies, account specifics, and doctors. Instead of “rage quit-ting” your job or stubbornly ignoring the changes, use the tips above to gain control of your emotions. When you are in control of your emotions, you will be able to focus on accepting the changes and moving forward.
Stay Alert and Informed“I didn’t see that coming” is one
of the most common exclamations elicited from change. One of the best ways to combat those feelings of de-nial, despair, anger, etc. is to make sure you stay alert, ask questions, and stay informed.
Career Step strives to ensure that our students are well informed when it comes to completing our programs. We know that surprises occur from time to time, but we try to we give you all the information necessary to adapt to new skill sets and instruc-tions. Career Step’s Medical Tran-scription and Medical Transcription Editor programs are broken into two
main sections: objective knowledge (grammar, anatomy, pharmacology, etc.) and practical application (tran-scription and editing). The transition between the two areas can feel a bit like being dropped into the deep end of a pool and asked to tread water. It is important to recognize that the transition is coming and try to stay informed about what to expect. There are some great ways you can do this with the resources we provide. Our student forums are a great place for you to become informed on what to expect when you get into the practi-cal portion of the program. There are a couple of study groups that have formed over the years, and they are great for encouragement, tips, and in-formation. We also host chats Mon-day through Friday that allow you the opportunity to ask questions and stay informed. When it comes to adapting, knowledge is indeed power!
In the workforce, when you are called upon to adapt to new accounts, instructions, and technology, make sure you learn everything you can about the changes. Most companies want you to be successful, and they are willing to provide you with the information necessary to be success-ful. Don’t be afraid to ask questions and gather the information you need to feel comfortable. Employers would much rather you ask questions and stay informed than shy away and be-come overwhelmed. Staying informed on how you can make the transition smoother shows that you are willing to adapt and be flexible. That willing-ness to adapt and ability to be flexible can mean the difference between mov-ing forward with a company and being left behind.
ConfidenceWhen changes come—and they
always will—they can either be con-fidence boosters or confidence killers. In most cases, change is perceived as the latter. If you take just one thing away from reading this article, I hope it is that change is a time for you to dem-
onstrate your strengths and develop your weaknesses. It is not meant to kill your confidence.
A common statement I hear from students is, “I thought I had every-thing down pat; now the rules have changed, and I feel completely dis-couraged. I don’t know anything.” To overcome this feeling of discourage-ment, it is good to sit down and make a list of your strengths and how they can help you be successful in adapting to the new information, instructions, or processes. This should help keep your confidence strong in what you do best. Next, make a list of your weak-nesses that can be improved upon. When you think about adapting to changes in a constructive way, you can keep moving forward.
In the workforce, do the same thing! Take the opportunity to show your strengths, improve your weak-nesses, and be confident in your ability to grow with the company.
Change is the only constant in our lives, both academically and in the workforce. We can learn to be adapt-able and continue to grow, or we can choose to be left standing in the aisle, glaring at the person happily embrac-ing it. It’s up to you! n
- Alesa LittleCS Student Support Team
Continued from pg. 2 - Groove
4 WINTER 2012 STEPPING UP
In Your Pajamas… Or Maybe NotWorking from Home
When I tell people that I work from home, the first
question I’m often asked is, “Do you get to work in your pajamas?” Let’s face it, being warm and snuggly in an oversized pair of flannel pajamas in winter and staying cool and comfort-able in practically nothing in summer is appealing. It’s just one of the perks that come with having an office 10 feet from your bedroom, but have you ever considered the perks that come with wearing business attire even when working from home?
Consider the frame of mind you tend to be in for as long as you keep your pajamas on: I’m tired. I’m lazy. I want to go back to bed. I need a cup of coffee…yawn. Now consider the frame of mind you tend to be in once you get dressed into something snaz-zy: I’m ready to go! I’ve got a burst of energy! What should I do next?! I need a cup of half-caf, no-foam, non-fat, vanilla soy latte—make it a venti! Whoo!
With a perked up mind, you will find your desire shifts from wanting to
crawl back under the covers to want-ing to sit in front of your computer and get things done!
Don’t let your can-do attitude fade, though. Keep yourself going by mak-ing sure you have clear goals in front of you (literally—write them down on a piece of paper and set it down in front of you). Break larger goals into smaller portions so that you can reward yourself by checking items off your list as you continue to work throughout the day. A sense of ac-complishment will make you hungry for more.
Try to keep your desk organized and as neat as possible. A clutter-free workspace will contribute to a sense of professionalism, not to mention you will save time by being able to find everything you are looking for. You might want to add a few decora-tive touches to your office—perhaps a family photo, an inspirational post-er or calendar, a small stack of your business cards, or anything else that will remind you that you are perform-
ing or training for a job and that job is important.
This isn’t to suggest that you run out to Macy’s and buy a faux-leather-trim jacket and pants suit by Anne Klein for a small fortune, but instead that you consider leaving the paja-mas and bunny slippers behind in ex-change for an outfit you’d be happy to answer the door in. If you really want to dress the part, add some accesso-ries (omitting the clunky bracelet that drowns out the tappity-tap-tap of the keyboard, of course) and slip on a pair of shoes.
Changing your clothes changes your attitude. Once you dress in professional attire, you will feel more like a professional. You will notice your posture improve, your focus sharpen, your motivation increase, and, consequently, you will be more productive. Don’t believe me? Try it. I dare you. n
- Heather Garrett
CS Skills Assessment Team
Med Gab
1. A toe numb hick nerf is cyst him: ____________________
2. Center ulnar fuss is stem: ____________________
3. Sir eyebrows pine all flew it: ____________________
4. Mat gun attic reason hunts him aging: ____________________
5. Roulette: _____________________
6. Raid deed day shun there a pea: ____________________
7. Is him pat ethic inner fizzes them: ____________________
8. All um bear punks her: ____________________
Neurology can be a fascinating specialty! Try to solve the puzzles below that contain a set of unrelated words that make up some of the more common Neurology terminology and phrasing. Hint: It helps to read the phase out loud and sometimes quickly to understand the hidden phrase. Good luck!
ANSWERS: 1. autonomic nervous system 2. central nervous system 3. cerebrospinal fluid 4. magnetic resonance imaging 5. rule out 6. radiation therapy 7. sympathetic nervous system 8. lumbar puncture
Mixed Media
Staying motivated can be tricky when you are taking an online course. Below are some tips from students and graduates on staying motivated and succeeding in the course.
I want to finish the course, but it has been a year now since I originally started and I feel unmotivated to continue . I am nearing the middle of the course, and I just feel flat. Does anyone else feel this way? Most of the time I feel that I am progressing in learning all the MT words and such, and other times I feel like it’s my first day—unsure how to begin and continue. When I began this course, I had high hopes for my future as an MT, and I don’t want to quit and give up . How do I stay motivated and persevere??
Trust me, we have ALL felt that way one time or another. This course is HARD, and pretty much impossible to successfully get through alone. That is why joining up with a positive interactive group (for support, encouragement, etc.) is so important.
Hello . I think I understand how you feel. I love studying, but I feel lazy sometimes . What I do to make myself motivated is just remind myself that if I do not study, I will never finish this. Think of the bad outcomes that may happen if you keep being lazy. Your course that you want to complete will never be done . This is just how I re-mind myself, and I hope it will work for you too .
It’s all about goals and at-titude. Someone once said, “If you don’t have a goal, all you see are obstacles. If you do have a goal, all you see are challenges.” Nothing affects at-titude more than goals.
Think back to what made you want to do this in the first place. Has it changed? If not, good…If yes, that’s okay. You just need to recognize that and see whether it can still apply to your desire to become an MT/MTE.
The thing is to figure out what your goal is right now and make it real. Write a short statement defining your goal. Put it up where you can see it when you study. If it means staying home with your kids, put up pictures of you and your kids having a good time where you put your written statement. If it is to have extra money, put up pictures of what you will get with the money. (Groceries are acceptable!) Think of what it is that gets you fired up and stoke the flame.
You know the sayings. “You can if you think you can, or vice versa. Either way you’re right.” You know that you can. The trick is finding the reason that got you started up in the beginning, or recognizing what it is now.
I was the world’s worst procrastina-tor when it came to the course . I took over 2 years only because I piddled around and did everything but study .
My advice is to set aside some time each day whether it be an hour, 2 hours or whatever . Do nothing dur-ing that time but work on the course . Pretend it is a job, and you know you have to be there each day at that time . You will be chipping away like no-body’s business .
I have been trying to stay on track and make my daily goals. I think the best way for me to stay focused was to find
the time of day that works best for me. I find what works best for me is to split the amount of time I need to work on the course in to two sessions. Us-ing the study planner with the calender, and my target date. I took the calender and pro-grammed a date that i want to finish and then figured out how many reports on average I would need to do per day. It has really helped me stay on target.
You’ve gotten some great advice . I think the hard part about dealing with procrastination is that it becomes such a vicious cycle . You put something off, so then you have that nagging and guilty feeling in your head about it. That feels yucky, so you avoid the whole thing even more .
Try to think of a time when you procrastinated on something you dreaded doing, only to force yourself to finally tackle it and found it only took a couple minutes to resolve . Re-member that sense of relief at having it done and not having to worry about it anymore? It’s a great feeling! Remem-ber thinking to yourself, “Wow, I spent way more energy putting this off than it took to get it done in the first place!” This course is the same way .
I’d suggest setting small goals for the course and focusing on that sense of relief you feel when you meet them . Stop those negative thoughts in your head that say, “I’ve got to finish this course!” and focus on a different one instead, such as “I will spend Friday from 2-4 studying; then I’ll buy myself one new song from iTunes.”
Remember, it always seems impos-sible until it is done . n
Career Step has come a long way since the first text version of the MT course was mailed out from a residential basement. Currently, all our students have access to Student Support on the phone and email (both traditional and directly through the course), as well as the course forums, chats, and Facebook every day! This column is comprised of student comments from all of these media sources, so we call it Mixed Media. Enjoy!
STEPPING UP WINTER 2012 5
Keys to Successful Employment TestingA Grader’s Perspective
Coach John Wooden stated, “High performance and pro-
duction are achieved only through the identification and perfection of small but relevant details—little things done well.” Or as he more simply put it, “Little things make big things hap-pen.” You might be surprised at how many little things warrant your at-tention on employment tests in or-der to really make you stand out as a well-trained, up-to-date, and informed medical transcriptionist. Here’s my top 10 list in no particular order (be-cause they’re all important!).
1. Use the most up-to-date spell-ings. This includes both English and medical words, as well as any trends in grammar as accepted by the field of medical transcription. (It’s important to note that many trends in published writing, such as novels, remain un-acceptable in medical reports.) Let’s look at the example cannot/can not. It is far more preferred to transcribe this as one word. In fact, some people will even argue that it is simply erroneous to ever use it as two words. Whatever your stance on the matter, the fact re-mains that most people in the medi-cal transcription industry expect it to always be transcribed as one word—MT companies, dictators, QA staff, you name it. If you submit a transcription test with it spelled as two words, you may receive an unnecessary grammar error. Not only that, but you know the blue/red colors you’ve come to loathe when you submit a report? Those as-sessing employment tests don’t like them any more than you do. By using the most common forms and spellings, your test will look cleaner, which, in turn, makes your test appear more ac-curate. It also makes it easier to grade, so it’s a win-win situation for everyone. An example of a medical word that can sometimes trip transcriptionists up is urinalysis/urine analysis. There is no difference in what these two words mean, so even if the dictator fails to
combine these terms and states “urine analysis,” please join us in the 21st century and transcribe urinalysis. Us-ing older spellings can make your edu-cation and skills look outdated.
2. Do not use lackadaisical spell-ings. A medical report should never look like a long-winded text message. It is through, not thru. It is because, not cause. Actually, it’s not even cause. Cause means to make something happen, but people have gotten so lazy with their typing skills that they won’t even put forth the effort to include the apos-trophe that indicates it is the abbre-viated form of because (‘cause). These types of errors are likely to carry the full weight of a misspelled word or wrong word deduction. Remember that the reports transcriptionists type are not fleeting text messages to tell little Johnny that he’d better be home before dinner; these are legal medical records that are going to remain in people’s files for years to come.
3. Do not use British (Canadian/Australian) spellings unless you are testing for a company that requires you to do so. You have about a 1% chance of getting someone who is fa-miliar enough with British spellings to recognize them. The other 99% of people reviewing your employment tests are likely to apply misspelling deductions to at least some of the British spellings you use. For English words, British spellings include grey, colour, stabilise, practise, and so on. For medical words, British spellings include oedema, anaesthetise, haema-toma, and so on. I had to fight with my spell check just to be able to type those words.
4. Use consistent spellings and abbreviation expansions. If nothing else, it at least creates an odd feeling of confusion for the person grading the test when a word is spelled one
way in one sentence and then another way later in the report. However, it’s very rare that a word can be spelled two different ways without at least one of the words incurring a deduc-tion of some sort. If you double check for consistent spellings and abbrevia-tion expansions throughout each re-port, you might be able to save your-self from making an error or two. It’s surprising how many times I see H&H correctly transcribed one place but then erroneously transcribed as HNH in another. Try to use a bit of memory power from the old noggin while transcribing, remembering the terminology already used earlier in the report.
5. Be careful not to transcribe dictated punctuation as actual words. For example, it can be easy to mistake the period dictated at the end of a sentence for a period of time: The patient states she had an enjoyable va-cation period. Or sometimes a dictator will provide formatting instructions, such as “next paragraph” or “double space” or “all caps.” If you overthink it (or underthink it, for that matter), you might find yourself mistakenly transcribing, “Pair of extremities re-veal…,” when the dictator really said, “Paragraph. Extremities reveal…” No one wants to look that silly.
6. Do not use all capitals—not for an entire report, not for an en-tire section, not for an entire list. All capitals should be reserved for head-ings (and allergies if you so choose). While it is true that some radiology accounts require the entire report to be transcribed in all capitals, I can assure you that this is not the case with em-ployment testing. Employment tests are usually built with the average MT and the most common style in mind. This means that sentence case is used
6 WINTER 2012 STEPPING UP
Continued on pg. 11
STEPPING UP WINTER 2012 7
Continued from pg. 1 - Turret
It doesn’t sound very nice to say, but there is a lot of substandard MT work in medical files today—take a look at your own medical files if you need proof. The emerging model will likely demand a higher and more con-sistent standard of accuracy, technical expertise, and medical industry under-standing. The healthcare documenta-tion specialist of the future must ex-pect growth, change, and competition in the workplace and prepare for it. He or she must embody professional-ism—dependability, competency, loy-alty, etiquette, and the ability to adapt and grow. Those with the desire, abili-ties, and drive to be the best are most likely to be truly successful. A pleas-ant upside is that these people are also more likely to be well compensated for their time, knowledge, and training.
No matter where you are now, you can be one of those people. The medical transcription training you’re gaining is an excellent beginning.
You’re getting a solid foundation in medical terminology and a wide and varied understanding of surgery, pa-thology, pharmacology, anatomy, and medical specialties from orthopedics to psychiatry. You’re also gaining ex-perience handling medical records, privacy issues, doctors’ personalities, as well as constant exposure to the re-alities of the human aspect of disease, injury, and medicine. In the MTE pro-gram, you also benefit from working with computer-generated voice-rec-ognition files and medical editing soft-ware. After graduation, you will have a marketable skill to put to immediate use—but don’t stop there!
The next step up the turret steps is before you. Continue on by exploring another area, like the medical coding and billing aspect of healthcare docu-mentation or learning the tasks of a medical front and/or back office or taking a CNA class. Really, anything from a CPR certification to a stint as a home health provider to a degree in healthcare administration will expand
your knowledge and experience and improve your marketability.
Of course, this isn’t what everyone wants to consider. What I’m suggest-ing is an ambitious undertaking that may not apply to everyone’s circum-stances or needs; however, if you are looking to make a career in health-care documentation, please consider that we may be at the 450th hat right now. It’s time to look ahead and make a five-year plan that includes not only work, but education and experience in a variety of healthcare documenta-tion specialties. Instead of wistfully looking back at the piles and piles of plain one-feather hats and wishing for yesterday when such a hat was all you needed, start climbing those tur-ret steps so you’ll emerge qualified, strong, adaptable, and well positioned for new opportunities. n
- Jill McNittCS Student Support Team
Student SpotlightKelsey Reading
Hey everyone! My name is Kelsey Reading. I am
currently living in my hometown of Joplin, Missouri, with my husband, 4-month-old baby boy, and dog, Zeus. I was born and raised in Joplin and have lived here almost all of my life. After graduating high school, I moved up to Kansas City, Missouri, to go to college on a softball scholarship and to pursue a nursing degree. I stayed there for two years but decided to move back home when my boyfriend and I got serious. I ended up moving back in May of 2010, and he and I got engaged that Halloween. Then in July of 2011, we got married! Three months later, we found out we were going to have a baby! I spent a lot of time trying to figure out what I should do. Should I go ahead and continue my nursing degree or put it on hold for a
while? I decided to put it on hold and concentrate on working and being the best mom that I could be!
One day, when I was at work, I was talking to a coworker about really wanting to find a job that would al-low me to be home with my baby more often. She told me how her aunt was a medical transcriptionist and how she was able to work from home and be there with her kids. I was very in-trigued! I had heard of work-at-home jobs before, but I honestly always thought they were a scam. I was still a little skeptical, so I decided to do some research. I came across Career Step, and it seemed like the perfect fit for me! I would be able to do an on-line training program at home while I was pregnant, and after I graduated, I could work from home and be with my
baby! Plus, I would still have a career in the medical field like I had always wanted. So after talking with my hus-band, we decided that I should do it.
I began my MTE course with Ca-reer Step in January of 2012. During high school and my 3 years of college, I took classes in medical terminology, anatomy and physiology, and health sciences, so the medical field was not foreign to me at all! The knowledge I took away from those classes definite-ly helped me during my coursework. I went through the objective portion of the course relatively fast. It took me about 3 months to complete. The transcription portion, however, was a different story! I didn’t plan my time very well, and it took me a lot longer
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Continued from pg. 7 - Studentthan I expected. Transcription is defi-nitely not easy, especially when you get muffled voices, super fast talkers, or bad audio; however, when you work really hard and finally figure it out, it feels so good and it’s so rewarding! It took me another 5 months to complete the transcription and editing portions, and I’m now in the process of study-ing for my final exam.
A few things that really helped me get through the course were being in-volved in the forums, participating in the weekly chats, and connecting with other Career Step students on Face-book. This program has also taught me how to organize my time and how to set a goal and stick to it. Career Step’s program is great, and I would recommend it to everyone interested in doing medical transcription! The
instructors and advisors are awe-some and are always willing to help. It’s amazing how much I have learned since I have been taking this course! I am so excited to start my new career as a medical transcriptionist! n
- Kelsey Reading
Possibly one of the most difficult portions of just about
any medical report is the laboratory data section. No two reports are identical, dictators often fly through numbers and abbreviations, and until you become profoundly familiar with a wide variety of labs, you will likely find yourself double-checking normal ranges of lab values to ensure accuracy. Also, because the context surrounding any lab test and value can be very minimal and sometimes seemingly unrelated to the chief complaint of the patient, there usually isn’t a lot of information to assist you.
Take this little adventure for ex-ample: A colleague requested some extra listening ears for a report she was reviewing. The transcription key provided by the client showed the lab test and value “IB 4.4.” Stedman’s Pa-thology & Lab Medicine Words listed immune body and inclusion body as possible expansions; however, neither was compatible with the value 4.4. Al-though not everyone’s listening ears were in agreement, IP was the popular vote, and the wild goose chase began.
The dictator’s style was notable. He dictated every term in full in the laboratory section with the exception of BUN and the stumper term. There-fore, it could be reasonably concluded that this abbreviation represented a
very common laboratory term that didn’t require an MT with superpow-ers to decode.
Despite the context being pretty normal for the lab section—simply other labs and their values—it proved to be useful. The surrounding labs provided valuable clues as to the type of panel that had been performed and, ultimately, led to the missing term. The lab section containing the un-known abbreviation was dictated as follows:
It appeared the patient had a ba-sic metabolic panel, along with some other blood work. Calcium is part of the basic metabolic panel, but magne-sium is not.
Newer MTs may not be aware of some of the changes that have im-pacted the medical field and thus the medical report, and this is a great ex-ample of such a change. It used to be very common to hear lab results of a chemistry panel dictated as “chem” followed by a number. Chem-7 and chem-12 were at the top of the list for popularity. Over time, these tests changed a bit and are now more com-
monly referred to as the basic meta-bolic profile (BMP) and the compre-hensive metabolic profile (CMP). Further, the BMP generally includes 8 labs rather than just 7, with the ad-ditional lab being calcium. Chemistry panels weren’t limited to chem-7 or chem-12; one might have had a chem-10 or chem-14 or some other chem-number, depending on how many labs were included. The chem-10 consisted of blood urea nitrogen, creatinine, so-dium, potassium, chloride, carbon di-oxide (sometimes called bicarbonate), glucose, calcium, magnesium, and …ta-dah! phosphate! But wait—the ab-breviation for phosphate (phosphorus) is P, not IP…or is it?
It is actually the inorganic phos-phate that is measured when a phos-phorus lab is ordered, but the vast majority of dictators—and others involved in the medical field—refer to it simply as phosphorus or P; for the most part, the inorganic part of the term has been dropped. Ultimately, it comes down to dictator preference, and this dictator decided to be the odd duck who prefers IP. While he may be an odd duck, the wild goose chase was finally over. n
- Heather GarrettCS Skills Assessment Team
inders KeepersFLaboratory Data
8 WINTER 2012 STEPPING UP
STEPPING UP WINTER 2012 9
Continued on pg. 11
Dear Susan...Dear Susan—
I’m in the middle of Clinic Notes right now, and I’m upset with all the mistakes! Some of the keys aren’t right, with incomplete sentences left uncorrected and punctuation that doesn’t follow the rules I learned in school. I’m a perfectionist, and I cannot stand it! I’m also worried when doctors leave things out and make mistakes—in one report a doctor referred to a female patient as “he” a couple of times! I feel like I have to double-check every word to make sure the doctor’s right, and there’s so much research I don’t think I will ever finish the course at this rate, let alone be able to make money with it. Help!
Tearing At My Hair
Dear Hair Tearer—
A supervisor at a large MTSO once sent me this:
“I see this a lot from newly graduated MTs; they are obsessed with every little thing and waste far too much time trying to make sure the document is picture perfect. We
are all perfectionists by nature, which is why we gravitated to this field of work in the first place. However, it is important to realize what is worthy of your time.
With our company, error points are NEVER issued for punctuation unless the omission or insertion of the mark of punctuation changes the meaning of the sentence. Worrying over a period versus semicolon, for example, is a complete waste of time.
I recently had to terminate an MT because she was obsessing over every single little correction, wasting time poring over her corrected reports and sending editing challenges rather than transcribing. She had awesome accuracy, no doubt, but her production was the pits. She was unable/unwilling to let go of her obsession and focus on production. After months of counseling, I was forced to terminate her for lack of production.”
Learn to be adaptable enough to accept differing account preferences, and realize that spoken communication includes many features (like contractions, “umms,” backtracks, etc.) that should be left
out of a transcribed document; in addition, accept that grammar guidelines for MT are often different from the rules taught in English classes. Finally, trust the doctors to know what they’re doing. An MT can often make a left versus right or a gender correction, but you don’t need to research an open-heart surgery to make sure the doctor performed it correctly. The discrepancies you see in the keys are examples of acceptable variation, not errors. Keep this in mind: if you’re working within the instructions given, you’re okay. If there are a couple of ways to punctuate a sentence and your instructions don’t specify which way is preferred, then either way is acceptable.
Right now, as a student, it’s okay to go slow. Learn as much as you can from each report. One of the things to internalize is how to be flexible and adaptable. In the workplace, you must strike a balance with production and accuracy so you’ll be good at both.
Best of luck!
- Susan Tuckett, CMTCS Student Support Team
Graduate SpotlightRachel Pittner
the Air Force would be relocating us, thus requiring me to find a new job. When my hubby left for Air Force basic training, I was left in dire need of a distraction—what better time to start working towards a new, portable career? So began my search for a military-friendly online school. Because of Career Step’s partnership with MyCAA, I was able to begin the coursework shortly after my husband’s departure in September of 2011. Despite the ups and downs and trials
and tribulations of newlywed military life, I finally managed to complete Career Step’s Medical Transcription and Editing course the first week of October 2012. Many pep talks later (both from the Career Step Skills Assessment team and myself), I was ready to take a whack at the much reverenced (and dreaded) final exam. By the grace of God, I passed on my first attempt with honors and began
My name is Rachel. I enjoy spending time outdoors and
taking pictures with my DSLR camera (which I am still learning to master). I am a self-proclaimed crazy cat lady at the whopping age of 20, a Facebook addict, and a military spouse blogger. My husband and I were married in July of 2011, and shortly afterwards, my husband enlisted in the Air Force. I had worked in a law firm for 2 years prior to beginning the course and was quite discouraged when I was told
10 WINTER 2012 STEPPING UP
Planning For The Final ExamPreparing a Testing Timeline
Have you ever run a mara-thon? If you have, you know
that preparing for it is no light com-mitment! You have to start training months in advance. You create and undergo a rigorous training plan to safely work up to 26.2 miles of con-tinuous running. Wouldn’t it be fool-ish if you followed your training pro-gram diligently but forgot to sign up for the race or pick up your running packet in time or showed up two hours after the race start time? Just as you wouldn’t miss these crucial aspects of the race after training for so long, you wouldn’t want to miss out on taking the final because of some crucial as-pects of your program.
As a student, you have a lot to worry about—working through the course, retaining the information, as well as planning for employment after graduation. With all of these things on your mind, you may be tempted to put off the final exam until the last second, assuming you can begin it on your expiration date—but don’t, be-cause you can’t! It’s very disappoint-ing to learn you have to buy an exten-sion because you’ve run out of time. Make sure to plan for the time it takes to go through the testing process. Here’s what you should consider as the final exam draws closer so you can begin the race after all your months of rigorous training.
Current EnrollmentThe final exam needs to be taken
while your enrollment is current. Just like you have to run a marathon on the day it’s scheduled, you also have to take your final exam by a certain time. Your course expires at 5 pm (Moun-tain Time) on the last day of your enrollment; any exam attempts must be submitted by that time to avoid for-feiture on that attempt. Keep in mind, the exam is 48 hours long, so you need to have at least 48 hours remaining in your enrollment to begin the final.
you’d like (though we usually suggest taking at least a few days in between so you don’t just end up with the same results as your previous attempt). If you do not pass, you need to wait at least two weeks from the date you got your results in order to retake your exam. Generally, you want to improve your time between races, right? Because of this, you’d probably tweak your training program to im-prove your performance for the next race. This mandatory two-week wait-ing period is in place to allow you to work with Skills Assessment and take the time to practice so your scores will improve on your next attempt.
Plan Now!Once you factor in requesting the
exam (two business days for MT stu-dents), taking the exam (48 hours), waiting for your results (up to two weeks), and waiting out the two-week period (if needed) before you can take it again, you can see that taking the final exam up to three times before your course expires is not feasible if you wait until the last month of your enrollment to begin testing.
Plan ahead! Make use of your study planner tool; set an initial goal, and track your progress, as well. Please note that the timetable for the examination process is not included in the study planner tool, so make sure you plan to complete your course at least 6-8 weeks before it expires. Don’t be scared to read the Final Exam Preparation module before you finish the course work—read it now! Scheduling all three attempts inside your current enrollment is not an exact science; please feel free to call in to the Skills Assessment Department if you need assistance planning for your final. We want to see you cross that finish line instead of getting stuck at the start. n
- CS Skills Assessment Team
For example, if your course expires on a Friday, you need to start your final before 5:00 pm Mountain Time the Wednesday before your course expires. If you fail to remember this, you may find yourself paying for an extension in order to take the exam.
Request Final (MT only)As a marathon runner, you need
to make sure you sign up and pay for the race before the deadline. If you’re an MT student, you also need to “sign up” or request the final exam two business days in advance of when you want to begin it. For example, if you want to start your exam on a Monday, you will need to submit your request before 5 pm Mountain Time the previ-ous Thursday. If your request isn’t in on time, you will need to reschedule your exam date; if your course expires before you can finish and submit the exam, you will need to purchase an extension. Before you submit your exam request, make sure you’ve met all of the final exam requirements.
GradingAfter you submit your exam, it is
hand graded by our expert team. It can take up to two weeks to get your results. Usually people who run in a marathon need some time to rest and recuperate after the event but soon resume training to maintain their fitness level. Your end goal is not to just pass the exam and graduate but to find a well-paying job. Just like the marathon runner, it’s good to take this opportunity to continue practic-ing while waiting for your results in order to keep your skills sharp and get everything around you ready for the next step.
Pass or Fail? Finally your results arrive! Your
score determines your next step. If you pass, all is good and, if you want to retake for a higher score, you can begin the next attempt as soon as
STEPPING UP WINTER 2012 11
to transcribe most—if not all—re-ports and portions of reports used as comparison keys, with, as mentioned already, the exception of headings and perhaps of allergens. Remember the blue/red statement from earlier in this article? Imagine the reaction given to a test that has been transcribed in all capitals. Chances are pretty good that it will simply never be reviewed.
7. Do not use contractions un-less dictated as part of a quotation. People tend to use contractions fre-quently in speech; this includes dic-tators. Transcribing contractions as dictated indicates a lack of knowledge of industry standards, as does ex-panding a contraction dictated within a quotation. Because we use contrac-tions frequently, it’s very easy to let one slip past us. After you’ve finished transcribing the reports, give a quick search for apostrophes, which can of-ten lead you to contractions you didn’t intend to transcribe. You can even use the Find feature if you’re transcrib-ing the reports in MSWord—what a handy tool!
8. Do not use abbreviations for terms that have been dictated in full. Sometimes new MTs will try to compensate for their inexperienced lis-tening ear by showing how much they know in other areas. Never—I repeat, never—transcribe an abbreviation if the term has been dictated in its ex-panded form. Now that I have stressed never to do that, be aware of this one exception: metric units of measure. Metric units of measure are almost al-
ways dictated in their expanded form (dictated “milligrams,” not “mg”) but are almost always transcribed in their abbreviated form (transcribed “40 mg,” not “40 milligrams”). On the other hand, conventional units of measure (pounds, inches, feet, etc.) should be transcribed in their expanded form. Clear as mud?
9. Do not expand every abbrevi-ation. Much like #8, new MTs might try to compensate for other weakness-es by trying to prove their strengths. This fools no one. A better impression will be made if you expand disease-entity abbreviations in the diagnostic sections of the reports, as is consid-ered industry standard, and transcribe the rest as dictated. Now, there is a benefit to expanding every abbrevia-tion, so long as the expansion remains in your head while the abbreviation gets transcribed in the report; the ben-efit is that it gives you the opportunity to make sure the abbreviation fits the context. Using the example of H&H versus HNH mentioned earlier, simply expanding HNH in your head should provide your brain with enough infor-mation to determine whether it is the correct abbreviation, being that there is no widely accepted medical term expansion for it.
10. Transcribe essentially ver-batim. Many MTs find this tricky because verbatim is often open to in-terpretation. I will try to decode it for you in as few words as possible. Cor-rect dictated grammar, punctuation, and spelling errors. Correct and flag obvious terminology errors. Flag and question less-than-obvious terminol-
ogy errors. An obvious error would be MCP being dictated when review-ing foot films. If there is no question about what the term should be, use the correct term and leave a very brief comment, such as [dictated as MCP]. A less-than-obvious error might be a dose you cannot verify. In that case, transcribe as dictated and leave a very brief comment, such as [cannot verify dose]. If you are provided with in-structions to leave a blank if you are unsure of the dictation, follow those instructions and just leave a blank. Whatever you do, do not leave a com-ment for every change you make. No employment test grader wants to be told by every MT who takes the test why is has been changed to are or why q.d. has been changed to daily. Trust me on this.
Paying attention to these little things won’t get you inducted into the Basketball Hall of Fame, but it might help you score a job! n
- Heather GarrettCS Skills Assessment Team
Continued from pg. 9 - Spotlight
applying for jobs immediately. Not even a week after I had received my final exam results, I landed a job with Nuance Transcription Services. I began working just two weeks after graduating from the MTE program—unreal!
I am extremely satisfied with the education I received through Career
Step. Although the course was de-manding, it equipped me with not only the skills I needed to be a successful medical transcriptionist and editor but also the confidence to transition into this new career with ease. The Ca-reer Step staff is always eager to help and encourage students in whatever way they can. My new job is every-thing and more than I ever imagined it would be. I am able to work from
home and not worry about having to hunt down a new job every time my husband receives new duty assign-ment orders. Thank you, Career Step, for all that you do, especially for mili-tary families! n
- Rachel Pittner
Continued from pg. 6 - Employment Test
Stepping Up is published quarterly by Career Step for its students, graduates, and client partners.
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Career Step Quality Medical Transcription Training
