There are misspellings and punctuation errors.

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 I told him to clean the area with hydrogen peroxide, and, after that, he can apply the Neosporin ointment. 

How would the punctuation be on this sentence?  Did I do it right? 

Thanks in advance for the help..

HI,

  I am taking my medical transcription course through Allied Schools. I am having a problem trying to punctuate the dictations properly. I would like to know if anyone can help me with this problem. What I thought was proper punctuation seems to be different with medical transcription. Are we supposed to transcribe the punctuation as the doctor dictates or correct it to what we believe is correct?

   Also, I have an assignment that I just transcribed that is impossible for me to punctuate. If anyone can help me, I would truely appreciate it.

I was very careful about punctuation until I had to research things and found that the MTs at my hospital NEVER use commas. I could barely understand some of the long, strung out sentences. I always researched obscure medical terms to make sure my work was accurate, yet I make $10 less an hour than others there because the pools are set up so some MTs get the profitable work before the rest of us. The point of this is, I don't feel that my excellent work is appreciated, and I don't believe the pool situation is fair, so I just do minimum to get by.  I also work IC to supplement my income,  and my IC work is much better because I feel appreciated.

Regarding the posts down the list about the docs who dictate run-on sentences or add bunches of periods, etc.  I am wondering why they are not instructed to not include punctuation at all.  Our company has us disregard what they say anyway (since it is usually way off), and it seems they are making it extra rough on themselves.

I have one who says comma practically every other word.  It really threw me off at first, but now I hardly even hear it (so used to ignoring it).  But think how much easier it would be for them to not even think about it.  What works the best is when they just use their voice inflection to signal the end of one thought/subject and the beginning of another.  Being someone without a whole lot of medical background, it gets confusing when they don't.

Why is it no one seems to communicate with the dictators about such things? 

I have MS Word 2003. This program has always capitalized the first letter after a colon (:) and for some reason today it stopped. I cannot figure this out for the life of me. I have been in Tools, etc, and see nothing that addresses this problem. If anyone has had this problem and knows how to correct it, please enlighten me. LOL

TYIA

Should I leave it up to the doctors to add their punctation for this verbatim account?  Not putting commas around the word "however" is driving me crazy!

then something was wrong from the get go.

>>>It sounded good because I thought it would be less wear and tear on my hands. I type already all day on a FT regular job. I never had a report that didn't need massive changing and it just didn't take long to see that I was getting the proverbial screw.

Like I many times before:  [1] have the correct sound card; [2] have the correct microphone (the one that comes with the product is probably not good enough); [3] have VR analyze as many documents as you have available (I have more than 500 MB); [4] add words and phrases to the Word List (decreases errors in the long run); [5] do not dictate like you talk to someone ... you need to ar-ti-cu-late correctly; [6] take the time to correct errors when they occur or at the end of the day. But, if you see an error and change it manually, the program is not going to learn; [7] You cannot use VR for all dictators, but you can for all good dictators. I would not use it for the nightmares from hell, unless they are so repetitive you know what they are going to say as soon as they start to say it.

These are the most critical factors involved with using SR (speech recognition) software. If you eliminate or skip over any ONE of these items, you're going to reduce accuracy.

I've been averaging 99.5% (one to two errors per page) for a long time. It think it's obvious I'm doing something right.

There's nothing more I can say. 

Is it typical for a co. to deduct for errors?  I have had some, but nothing that is overly noticable.

Do you find that it irritates you probably more than it should to see errors in the newspaper, etc.?  I mean, something that will be read by so many people should be proofread to perfection, don't you think?  They seem to just jump out at me and I know I'm more critical since I am an MT.  How about you?

You did not specify how many examples you wanted, so I included quite a few, hope it helps.  All of these are from one group of radiologists, all american.  In answer to your question, unfortunately most of these I believe to be the result of laziness.

THREE-VIEW RIGHT HAND

There is decreased relative small of the distal aspect of the 4th metacarpal. (There is diminished size of the distal aspect of the 4th metacarpal.) Otherwise, the hand is unremarkable in appearance for a patient of this young age. 

MRI LUMBAR SPINE

This is best visualized from L3-4 through L5-S1 where there are actual images in addition to the sagittal imaging through the entire lumbar spine.( This is best visualized from L3-4 through L5-S1 where there are axial images in addition to the sagittal imaging through the entire lumbar spine.)

ABDOMEN, THREE VIEWS

The colon has lost his Hounsfield markings in the transverse portion and splenic flexure. (The colon has lost its haustral markings in the transverse portion and splenic flexure. )

CT ABDOMEN W/WO CONTRAST

There is a small left inguinal hernia with fat within the hernia sac but no bile (no bowel).  No inguinal lymphadenopathy.

NAME OF EXAMINATION:  Sinuses.

FINDINGS:  Paranasal sinuses demonstrate generally some metric pneumatization.( Paranasal sinuses demonstrate generally symmetric pneumatization)  No bony abnormality is seen.

MRI OF THE LUMBAR SPINE

Compared to December 23, 2003, there has been no objective change in the L5-S1 left posterolateral disk herniation. It causes narrowing at the left lateral recess. It doe snot produce central stenosis. ( It does not produce central stenosis.)

OB ULTRASOUND COMPLETE

There is no polyhydramnios. However, the fetal kidneys are abnormally hyperechoic. This has been associated with polycystic kidney disease and so I recommend a postnasal follow-up study.( This has been associated with polycystic kidney disease and so I recommend a postnatal follow-up study.)

MRI OF THE HIPS WITHOUT IV CONTRAST

The muscles about the shoulder show normal signal on all sequences.( The muscles about the hips show normal signal on all sequences. ) There are no soft tissue masses.

RIGHT HIP TWO VIEWS

DISCUSSION: There has been destruction of the right femoral headache and femoral neck.( There has been destruction of the right femoral head and femoral neck. )

AP PORTABLE CHEST

EXAM DATE: January 22, 2005 at January 12, 2005 hours(January 22, 2005 )

MRI ANGIO ABDOMEN BEFORE AND AFTER IV CONTRAST

TECHNIQUE: 3-D time of flight MRA of the abdominal aorta and renal arteries was obtained following contrast administration. In addition, evidence of the kidneys was also obtained before and after IV contrast.( In addition, imaging of the kidneys was also obtained before and after IV contrast.)

TWO-VIEW CHEST

FINDINGS: Left apical pneumothorax measuring 1-2% is stable. Left lower lobe maxillary sinus is again demonstrated.( Left lower lobe mass is again demonstrated. )There are no other findings.

GALLBLADDER ULTRASOUND

 In the porta hepatis, there is a consistent with echogenic lesion measuring 1.1 cm.( In the porta hepatis, there is an echogenic lesion measuring 1.1 cm) This could represent a lymph node in the porta but also could represent an exophytic hepatic meningioma. (This could represent a lymph node in the porta but also could represent an exophytic hepatic hemangioma. )

OB ULTRASOUND COMPLETE

DISCUSSION: There is moderate dilatation of the left renal pelvis. There is mild dilatation on the right. However, neither uterus is abnormally dilated. (However, neither ureter is abnormally dilated. )

 ULTRASOUND OF RIGHT BREAST

There is heterogeneous echo texture in that region compatible with typical combination of breast parenchyma and fatty/femoral tissue, but a discrete mass lesion is not identified. (There is heterogeneous echo texture in that region compatible with typical combination of breast parenchyma and fatty/normal tissue, but a discrete mass lesion is not identified.)

AP PORTABLE CHEST

Underlying fusion is suggested, again worse on the left than the right.  (Underlying effusion is suggested, again worse on the left than the right.)

LEFT SECOND TOE

There is an old, healed fracture of the proximal phalanx of th cleft third toe.( There is an old, healed fracture of the proximal phalanx of the left third toe.)

TWO-VIEW CHEST

There are remote compression fractures involving the right 5th and 6th ribs.( There are remote fractures involving the right 5th and 6th ribs. ) The lungs are otherwise clear.

THYROID ULTRASOUND

DISCUSSION: In the left lobe of the thyroid, there is a moderately large maxillary sinus that measures 2.2 cm in greatest diameter and is mostly sold and have a cystic center. (In the left lobe of the thyroid, there is a moderately large complex mass that measures 2.2 cm in greatest diameter and is mostly solid and has a cystic center.) The remainder of the left lobe is normal.

There is a small 6 mm nodule in the inferior aspect of the right lobe. The gland itself is not overall enlargement. (The gland itself is not overall enlarged.) The gland is heterogeneous overall in echogenicity.

TWO-VIEW ABDOMEN

No convincing evidence of small bowel obstruction, although developing shortness of breath could theoretically give this appearance and follow-up is recommended. (No convincing evidence of small bowel obstruction, although developing small bowel obstruction could theoretically give this appearance and follow-up is recommended.)

OB ULTRASOUND

DISCUSSION: There is an intrauterine gestation with a large yolk sac. However, the crown-rump length measures 7 mm and this corresponds to an estimated gestational age of about 6 weeks 4 days. However, there is no detectable cardiac activity. The amniotic fluid volume is probably normal of ra fetus of this age.( The amniotic fluid volume is probably normal for a fetus of this age. )    The placenta is closed. (The cervix is closed.)

EXAM OF LEFT FOREARM

FINDINGS: No fracture. There is prominence of the anterior fat patient which suggests effusion. (There is prominence of the anterior fat pad which suggests effusion) No other findings.

MRI LUMBAR SPINE WITHOUT CONTRAST

Tip desiccation of L4-5. (Disk desiccation of L4-5.)

TWO-VIEW ABDOMEN

FINDINGS: Findings of right chest, cardiac size is normal, no infiltrates or effusion. (FINDINGS: Upright chest, cardiac size is normal, no infiltrates or effusion.

TWO-VIEW CHEST

Stable right breast opacity, likely represents

fibrosis.( Stable right basilar opacity, likely represents

fibrosis.)

AP CHEST

Picture of congestive heart failure/volume

overload not significantly changed from

exam 4-hours earlier.( Features of congestive heart failure/volume

overload not significantly changed from

exam 4-hours earlier.)

RIGHT SHOULDER

FINDINGS: The patient has history of a right humeral fracture, plus surgical fixation noted.( The patient has history of a right humeral fracture, postsurgical fixation noted. ) Alignment is intact.

IMPRESSION

1. Postsurgical change involving the right

proximal femur.( Postsurgical change involving the right

proximal humeral.)  Alignment is anatomic.

OB SONOGRAM

FINDINGS: Transabdominal and transvaginal evaluation of the pelvis was performed. An intrauterine collection and yoke sac is identified. (An intrauterine collection and yolk sac is identified. )

 LEFT HIP

FINDINGS/IMPRESSION: Two-view left hip demonstrate a fracture of the neck of the left humerus in varus angulation.(  Two-view left hip demonstrate a fracture of the neck of the left femur with varus angulation.) No additional fractures identified.

THREE-VIEW ABDOMEN

In this since, bowel gas pattern slightly improved since the 14th, but otherwise there has been no significant change. (In this sense, bowel gas pattern slightly improved since the 14th, but otherwise there has been no significant change. )

NUCLEAR MEDICINE CHOLESCINTIGRAM WITH GALLBLADDER EJECTION FRACTION

.After initial accumulation of tracer within the gallbladder, the patient was given solid bolus intravenous injection of CCK and additional anterior sequential imaging was obtained.( After initial accumulation of tracer within the gallbladder, the patient was given slow bolus intravenous injection of CCK and additional anterior sequential imaging was obtained. )

MRI BRAIN BEFORE AND AFTER IV CONTRAST -

There is confluent periventricular signal abnormality in the lungs bilaterally consistent with chronic small-vessel ischemic change.( There is confluent periventricular signal abnormality in the pons bilaterally consistent with chronic small-vessel ischemic change.) Probable remote lacunar infarcts noted in the left posterior frontal subcortical white matter.

THREE-VIEW ABDOMEN -

There is gas within the large and small-bowel. No distension. There is a round calcification in the pelvis which probably represents calcification in the wall of a cyst. There are no suspicious calcifications. No pathologic skin or nipple alterations(this sentence does not belong in this report). Mild hypertrophic change in the lumbar spine.

TWO-VIEW CHEST

REPORT: Bones free of consolidative infiltrate.( Lungs free of consolidative infiltrate.) No pneumothorax or pleural effusion identified.

LUMBAR SPINE SERIES

REPORT: There is very mild levocurvature of the cervicalium spine. (There is very mild levocurvature of the thoracolumbar spine.)

THREE-VIEW ABDOMEN

No evidence of bowel destruction. (No evidence of bowel obstruction.)

CERVICAL SPINE SERIES

FINDINGS: There is a fracture of the CT vertebral body inferior to the junction of the dens with the body.( There is a fracture of the C2 vertebral body inferior to the junction of the dens with the body.)There is retrolisthesis of the dens in relation to the CT vertebral body. (There is retrolisthesis of the dens in relation to the C2 vertebral body. )

I read below about the mistakes and I have to admit, I make mistakes, I am human.  My accounts know I am human.  I just re-read one of my physicals and I had somehow put "See expensive data base in chart" and it should have been "See extensive ..." it is not often but it does happen.  If we were perfect we surely would not be here on earth right now.  It is hard for us to see and find our own mistakes.   But for those who say that they have 98 or 99% error free, what does that actually mean -- for every 100 words you can have two errors, or what.  Never have been able to figure that out.   If I do 3000 lines per day, can I have 30 to 60  lines with errors?   All I know is that the majority of us do a darn good job and the best we can and those that make continuous errors, just like in any line of work, won't  be in it for long but mistakes and errors do happen to all of us.   For those that have no compassion for anyone that does make errors, be careful as it is a long way to fall off of the pedestal.    My two cents worth go ahead and flame me, I have broad shoulders. 

PS --my accounts have been with me for 5 to 15 years and I make over $50K a year but I do make mistakes.