We need actual examples of patients harmed by outsourcing

• Outsourcing - LilB
  • Outsourcing - Jad
  • If U can't beat 'em join 'em - none
  • ONLY WAY TO FIGHT THIS IS...SM - Bayou MT
    • We need actual examples of patients harmed by outsourcing - FBL
    • Public - weekene worker
  • Time to change doctors! - :(
  • HUMPFF - Small MTSO
    • I love it! - LilB
      • PLEASE.... - BabyFirefly
        • physicians pinching pennies - kyrie
        • Another good idea is to write a letter to the editor...sm - oldtimer
          • Ohhhhh, that's a GREAT idea too!!! (nm) - BabyFirefly
    • Same here. I tell them specifically and have them write it in my chart that I do not wany any of my - MSMT

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Could you give me any examples of questions asked?  I am just curious.

Thanks!

I am looking for examples of flyers to in the physican's boxes at the hospital for medical transcriptionist services.  Does anyone know where I could find some good examples....or does anyone have something they would like to share with me (from someone that is not very creative making flyers/resumes).  If you have something you wouldn't mind sharing you can email me at norma_OK@yahoo.com.  Thanks for the help.

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 would put 32-year-old male, but no hyphen if it's something like *Patient is 32 years old.*  (Same with 11-pound weight loss vs pt has lost 11 pounds.)  I can't quote the rule on this offhand, but whatever the rule is, I personally I think the hyphens make it easier to read/understand. 

drink, don't have alcohol in the house except for cooking wine/sherry, don't smoke, don't do drugs, are honest, hard working people.  My oldest son has "friends" who smoke, who put vodka in their Coke cans, cuss, steal, etc.  My son is a good kid and no I'm not naive and he isn't doing this stuff behind my back because we spend lots of time together.   My son is a health freak and won't allow anyone to smoke around him.  We've also tried to explain to him that even if he isn't drinking if someone he is with is caught drinking then he is guilty by association and he knows he needs to avoid these kids.  He has come home before upset that kids were using seriously foul language.  The "F" word at our house is spelled f-a-r-t. 

We live in a country club community.  The kids around here get new cars when they turn 16.  The parents don't keep up with their kids, just give them money.   My son has to earn his car with saving $$, keeping out of trouble, and good grades.  I don't keep tabs on him 24/7, but I know where he is at ALL times so that if I need to find him I can.  He even asks me if he can get on-line so I know he isn't using the computer for porn.  He is concerned that he doesn't have enough testosterone because he isn't wanting to sleep with anything that stays still long enough.  Don't know that his friends are, but they talk a good talk anyway.  

I think you are wise to be concerned and just need to keep open communication with your kids and hope that he makes good choices.  My son was a follower when he was younger and I had serious concerns about how he would be growing up, but now he has become a leader and I'm very proud of him because so far he is making good choices. 

to see so they don't want to spell things out.  Do they cut corners on patient care, as well, when they have 30 patients to see - or is that reserved for us peon MTs?  So they're "frustrated" with 30 patients - well, cut your patient load!  We're not paid to "guess" or have to look up everything they don't feel like spelling, especially other doc's names.  Just won't do it. 

By the way, I wonder if they know how many documents we have to type a day (30 maybe?) to even eke out simple minimal wage - but that's OK, I suppose, compared to their 5 or 6-figure salaries.

Just give everybody the bum's rush because you have 30 patients.  Suppose we did the same? 

Apparently mine have more than one because I have one dictator who likes to use the following phrase:  Patient was told that he might have death and loss of current life. 

An invoice by the patient?  Some clients need to do their own book keeping.  It is bad enough you have to worry about the content of the reports.  To have to retype a patient name into an invoice with the line count is utterly ridiculous especially as an IC.  IC's get taken advantage of.  As an IC, yes you should be charging for "everything".  If you're an employee, they can put it under "other duties as needed".  Business is business.  If it takes more time, that takes more money.  End of story.  Don't do nothing for nothing.  Your clients sure do not.  They go all this time with this Transcriptionist with her invoicing and then all of a sudden decide they want each patient name and line count?  Cut me a break.  You don't think there should be a charge for that?  You can work for free, but I certainly WILL NOT!  To make statements like be paid to walk to the computer is really being a bit of a smarty pants in my opinion.  Keep it to yourself if you want to work for free, most people don't!  Have a great day making nothing to do A LOT! 

For, say, an orthopedic surgeon, or  a family practice doctor.  Or, maybe, how many minutes of transcription on average per day. 

THANKS.

even cancer and continue to smoke.  In our local paper they are following a woman in her battle with cancer.  She continues to smoke, as does her husband.  They were broke before the cancer diagnosis, having to borrow daughter's babysitting money to pay bills.  Just think how much money they've blown on cigarettes.

I've even known one man with a trach who smoked through his trach.  

and you know how famous they are for dictating "Krenazcyssky, Jane, that's J-A-N-E.

Doctors today are totally incompetent for the most part.  YOU cannot worry about it when it comes to transcribing their gawd awful reports.  THAT is between the patient and the doc.  Just knock the report out as fast as you can and make sure it's accurate and then after that, forget about it. 

The docs make the big bucks - you don't!  Let THEM worry about things that will eventually catch up with them, one of which is called the Karma bug, and that little bug ALWAYS bites those who don't deal fairly right in the butt!  And big time, too!  

real estate agent.  You are thinking of the money you think you could save, but what it will end up turning into is a bigger mess.  If you sign a 60 or 90 day contract with a for sale by owner agent (i.e. Help-U-Sell, Assist2Sell, BuyOwner) and all they do is plunk a sign in your yard and give you a lock box then you're not getting much.  They don't do a lot of advertising other than on their own website and they might print a few flyers for you. 

With the market soft right now, unless you price the house really low just to get rid of it, expect it to sit for 90 to 120 days.