Beautifully written.

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back when I was in high school in the late 70s! The first high school I went to was just like that.... there was a large snob/bully society (the snobs were basically verbal bullies because they'd put down people that weren't in the "clique", and I had some idiot teachers. My algebra 2 teacher was so stupid that she would write a problem out on the board, stop, look at it and say "oh that's not right" and then erase it, doing this 2-3 times per problem,... then wondered why no one had a clue what to do on tests.

I was grateful when we moved to another town and the high school in the next town was much smaller. The teachers cared about the students and teaching, and the students generally cared about each other. There weren't snobs there because the area was economically depressed and no one had a lot of anything. I was able to participate in a program with a local college where during my senior year I went to high school 1/2 day and college 1/2 day, so the 10 of us that did this (out of a graduating class of 99) graduated from high school with 30 hours of college credits completed. We were also able to do this because the local college gave us discounts to participate in this program.

When I've asked on classmates.com about some of the snob/ bullies from the 1st high school not a single one of them has had a great life. One of the ones that was in the "it" girl group has been divorced 4 times now and is a heavy partier, and I've been told that she looks like crap from the years of partying. One of the guys who was the most "it" for the males died from AIDS which he ended up getting after he moved to New York to get into acting, turned to a life of male prostitution and picked it up there. The successful people are those who hung around with people like I did. Out of the group I hung around with 1 is a pediatrician, another a dentist, another is an architect, another is a software engineer and every one of us has stayed in contact throughout the years and get together occasionally.

First of all, let me explain that I work not from dictation but a handwritten template that I fill in--typewritten "transcription" in turn. The physician fills out the form while in the treatment room, circles correct choice from a list, etc.; sometimes the nurse does this. I've been instructed for the third time to "type as written" when I've questioned meds or inconsistencies. This goes against my training and principles (if that sounds sanctimonious, so be it)--when I can't reference things. I've had as much as half with questions and blanks where information was simply skipped. I don't have the patient charts to consult--just a stack of forms. I have respect for the doctor professionally; her patients, many of whom have been coming to her for years, seem to love her. Never had this experience before, either with transcription or as a secretary. Most of the time my supervisors have been happy that I caught errors. Please let me say these aren't nitpicky things--it is misspelled drugs like Demedex rather than Demadex!

The last time I said I wouldn't put my initials on the reports I questioned and was told I must put my initials "to tell who to return work to," even though I'm the only one doing transcription. Furthermore, the office manager told me the doctor takes ultimate responsibility because it's her signature on the notes. I'm going to comply while looking for other work, because this is one of many things we just don't see eye-to-eye on! What do you all think? How to deal with this? TIA!

formal demand for payment including any bank fee/charges. In the event you need to take it further you will need that evidence that you attempted to collect. I'd give her a specific time frame to submit the funds (i.e. 7 business days) via cash, money order or cashier's check.

I'd send the demand certified mail/return receipt for your proof. You can explore in the meantime the procedure for filing a complaint, etc., but that's not going to be a "quick" thing.

So, naturally, in whose favor would we expect it to be? Right!! 2 things I would get absolutely straight on a contract, though, is hours or schedule, if any is to be considered, and a definitive line rate, not in vague terms.

who says what he REALLY thinks about the JCAHO. Funny, I found it on Google when I typed in JCAHO and q.i.d. since I wasn't sure what to do about q.i.d. ........

The Death Star of American Medicine

I wish I had written this (JCAHO Unplugged; registration required), because it gives voice to the feelings that I (and probably 99% of the physicians in this country) have about the Death Star of American medicine -- JCAHO. A few excerpts (emphasis is mine):

That is why it really upsets me to watch the JCAHO people walk through my hospital like they were navigating a toxic waste dump. What upsets me even more is the utter paralysis of normal activity that occurs months before their visit and the huge sums of money spent on mock drills and consultants to prepare for the JCAHO invasion. JCAHO (the Joint Commission on Accreditation of Healthcare Organization) arouses more fear in hospitals than MRSA gone wild, and their "visit" has a greater institutional paralytic effect than circulating a neuromuscular depolarizing agent through the ventilation system.

A few unsigned verbal orders, or an anesthesiologist carrying a syringe of Anectine in his or her scrubs, or not locking up I.V. bottles of normal saline will result in conditional or provisional approval, and failure to take remedial action within 30 days may result in the death penalty, which for the hospital means bad PR, and more significantly, loss of all federal money. That's right, you can get the chair for parking tickets in the JCAHO world.

It doesn't matter that the hospital admits 50,000 patients a year, saves countless lives and performs daily miracles. Write q.i.d. twice and you can get your liver transplant someplace else.

A response by Russell Massaro, MD, FACP, Executive Vice President Accreditation and Certification Operations, JCAHO, follows Dr. Cossman's screed. The only thing I can say about it is that he makes clear that unannounced surveys will be forthcoming in 2006. Oh, joy!

A lot of the press in the past few days has been discussing issues such as oversight, accountability, and clearly expressed legal authority. JCAHO operates without any real semblence of these niceties, and does so with all the subtlety of a bureaucracy run by Darth Vader. Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader's underlings wilting in his presence --- and for good reason. Without the JCAHO seal of approval, they cannot operate an otherwise well-run, caring facility. The organization, as it was originally intended, was designed to ensure a basic level of safety for all hospitals. It has now become yet another "certifying" agency which must come up with new "critical" problems to fix in order to ensure its ongoing existence (those of you who have gone through the most recent mental masturbatory experience of banning QD and QID in orders know what I mean). What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.

Maybe I have my metaphors mixed up --- JCAHO comes in like the Death Star, but leaves no room for different institutions to solve problems in their own way. The JCAHO mantra can really be translated as "Resistance is futile. You will be assimilated!" As a result, I suppose JCAHO is really The Borg.