you *dictate for a pediatric neurologist*??
Posted By: pediatric offices are ALWAYS loud...sm on 2007-11-09
In Reply to: Patient doing/during dictation - speakeasy
I think you meant to say you *transcribe* for a pediatric neurologist?....meanwhile - in field 30 years - and if one chooses to work for a pediatric any-specialty MD - you're going to have MD dictating during working hours, in between patients (like most MDs do) or while consulting with the patients, and you are going to get LOTS OF BACKGROUND NOISE.
Know this now and it will not change and if you don't like it, don't do pediatrics.....but best of luck whichever way you choose and it's not just you - pediatrics tend to screaming/fussy/not-feeling-well children....or just for well visits.....but they are kids....they will act and behave like kids....
and MDs don't want to dictate at the close of their day nor at home nor on the weekends at home.....that's their time....
and so we suffer.......*lol* - and keep on keepin' on....
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Yep, they dictate in noisy nursing stations, dictate in the ER, dictate in the OR when they are
cleaning up banging around and we are supposed to hear them. So much for HIPPA.
Neurologist
doing a physical exam...
"NEUROLOGIC: The patient has no shlurred speeth."
The doctor started laughing so hard at himself, and I was laughing so hard I had tears coming down my face. I will never forget that one.
I have one neurologist that I can do 1:1...
x
Those are common. See your OB?GYN or neurologist
There are a lot of medications out that help that type of headache, and my neurologist's office (Dr. Scott Ferer and Dr. Philip O'Carroll in Newport Beach, CA) is doing a trial for those types of headaches too. I had those when I was younger. When I got pregnant with my son, they mostly disappeared. Have you seen a neurologist? They can do hormonal manipulation or other methods. Good luck!
Does anyone have a child with pediatric GERD? sm
My 4 y/o daughter has been vomiting, coughing, and gagging for 1 1/2 months straight now. Her pediatrician has finally diagnosed her with GERD and put her on Zantac. He has also referred us to a pediatric gastro doc. The Zantac seems to keep her from vomiting, but we are still putting up with the coughing, gagging and gulping for air throughout the night. I am scared to leave her alone at night because of the constant gagging so she has been sleeping in my bed for the last month and a half. Has anyone else gone through this and is there light at the end of the tunnel? We are exhausted being up and down all night, not mention that she it too! She is due to start preschool Wednesday and I feel so bad that she is up all night with this instead of getting a good nights sleep! Any help, suggestions, or comments would be greatly appreciated. Thank you.
Child with pediatric GERD.
My son is 5 and he was diagnosed at 6 months old with GERD. He is on Zantac also and he does the coughing and gagging. Our doctor sent him for asthma and allergy tests and he is now on medication for asthma also. His coughing and gagging has improved some with the medications but not totally yet.
I used to type for a pediatric psych facility.
At first I used to laugh, thinking maybe I'm not so dysfunctional after all. Some of the cases were just out of control kids and this was the only option, but there were 7-YO or younger who had attempted suicide. I don't do them now and don't know how someone can do them for very long.
My daughter will followup at MCV Pediatric Hem/Onc. for the rest of her life - sm
They said that is the norm there, granted this is cancer followup and not normal yearly physicals for an adult.....she is only 5 now so she still has a long way to go. But as for their normal pediatrician, I will take them their until they graduate high school (I did the same), then onto a regular family/adult doctor.
The hamster release I typed was on a pediatric neurology note. nm
:P
800 dictate can help you set it up.
Cannot dictate for MDs
You cannot dictate for a physician unless you have a PA or MD degree. We volunteered at the last in-house position I held to dictate the discharge summaries instead of paying quite a bit for interns/residents to do the dictating and were told it is not legal.
If they dictate
your hours, you are not an IC and the IRS will sooner or later jump on it. Do you file a schedule C with your income tax? Be careful, because if you're not a real IC your deductions may not be allowed.
I often dictate for a doc sm
that will send his patients to a therpaist named Candace Jones, but he always sends them to Candice Bergan.
If they dictate them, they want them on there.
x
1-800-dictate (342-8283) [mq]
nm
so, where do you get the information to dictate?
I mean, how much time do you spend on listening to a report and turning around and dictating into your machine.
Just curious...a male friend of mine suggested I do this years ago already.
He said, why not get a voice recog machine, and use it with your job.
Is this what you do, Snow Bunny? I am awful curious, because I was thinking of asking my employer, if they would pay for one of those machines so I can do my job better.
We could probably eliminate about half the MT work force...maybe that is what is happening already, why MQ is always out of work.
If that is the case, however, the only problem I have with that is that everyone should be able to have access to this technology, and it should be above-board from employer to employee...it should be like general knowledge that a company either uses this or allows this...
You have been doing this a long time and whether you know it or not are probably paving the way for the future.
I am the one who keeps trying to get everyone to check out what the MOHCA is doing...within a decade (my opinion) med records may not even need editors at all...
They are pushing for standardized text rather than free text, where a doctor does not even dictate anymore...will be a thing of the past.
My question is, then what?
Thanks.
they seem to be trained to dictate that way.
I worked at a hospital that had a podiatric residency program, and the residents were often required to do the dictation for operations performed by others. Obviously the long format wasn't something the resident made up on his own, it was something they had been trained to do. Other doctors tend to stumble into dictation without much in the way of instruction.
before they dictate....I presume...nm
x
Yeah, become a PA and dictate really WELL.
most surgeons dictate very well sm
That is one of the best things about ops. When I say "dictate well" I mean that they normally know exactly what they are going to say and use the same phrases over and over, which means a better line count for you. Plus, you are much more likely to get normals doing ops than you are consults and H&Ps (especially in acute care). Instead of doing one of these docs who repeat everything, or change everything, or a resident who is all over the report back and forth. That is what slows you down. I absolutely love op notes; they keep you up-to-date on equipment, etc., and the line count is great, but most of them get farmed out to Spheris (gee, I wonder why?) However, if you never type OP notes, they can be difficult at first.
Will it is true that not just anyone can dictate
notes, you have have other degrees and dictate. They have to be certified by the hospital to be able to dictate, at least at the hospital I work for. With psych dictation I often have RNs that dictate. I also have lots of NP that dictate.
LOL, did granny dictate????? NM
.
the doctor themselves dictate SS#
You are way off base here dear.
If this is your only job and the dictate when you work - sm
then by the IRS definition you are an employee, though it does not sound like you are having taxes taken out. I take care of this problem myself by having another IC job that all I have is a deadline and I must have my work in by then, they could care less when I do it, as long as it is done on time. I have another IC job, where they asked when I would be working, a schedule of sorts, sort of what you are doing, but I do not firmly stick to it. I think it is more to give them an idea of what days you plan to work and what time of day. They do not chew on me if I vary my schedule as long as I log in and do the work. They know as an IC they cannot dictate the hours I work. I don't/cannot write off my home office as it is in my bedroom, but I write off everything else I can. If you need clarification call the company you work for and tell them of your dilemma and how your tax person says the IRS considers you an employee and since they require "set" hours then they should start taking taxes out, etc. from your pay, and see how they backpedal on the set hours issue.
There are some accounts that do not dictate - sm
every day, very true, but some people also refuse to do anything but one thing. If they only want one doctor, then yes they can expect to run out of work. I work many different specialities and can type the majority of docs (and have). This LTS is in Richmond, VA; I have never heard of another but you never know.
I have several who regularly dictate sm
30 minute reports. Unfortunately, they only give me 100 lines. On the other hand, I have a female PA who dictates 4 minutes notes and that gives me 100 lines, too, because she dictates at the speed of sound. I have to slow her down to turtle speed to hear her correctly. I prefer to do the 30 minutes ones since they talk reaaaalllll slowwwww and I can run the voice file at chipmunk speed and zing through it.
Do counselors dictate? sm
I was going to send out another round of postcards to drum up business and was going to send to counselors but wasn't sure if they dictate like psychiatrists. Maybe any of you know this?
I don't believe it. I don't think even the doctors can DICTATE 700 LPH! sm
I think she's yankin' your chain.
She has to be using templates or something to get that.
As an IC the employer cannot dictate the
times you work. They can ask you when you will be working or you can tell them. If they have work available and you are not working, they can let you know so that if you want to work you can; but if there is no work available when you want to work, they do not have to supply any. You, as an IC, decide when you work.
Express Dictate
Hello
I currently use Express Scribe software for dictation. I was wondering if anyone has used the Express Dictate system. I am looking to expand and add more doctors and was wondering how this system worked.
Also, if you have any advice on a cheap start up not using tapes please let me know.
thanks!
Thank God for some nurses who DO dictate...
for the docs who are horrible dictators. I do progress notes for an ICN nursery almost nightly. Thank GOD for those nurses. There are 2 docs right from the old country who can't string a sentence together in English though good docs they may be. We're talking 7-8 page very detailed reports on some of these babies. The other night, one of these gals dictated the first part, God love her, and actually handed the phone to the doc to give his 2 cents worth, awful dictator. Hey, the best thing some of these docs can do is let their PAC's do the dictating!!!
I had one dictate from the jon and flush over and over again sm
Through, get this FOUR DICTATIONS!!! The pregnant pauses, the bobbing of the roll as he pulled out paper, the echo of the small room followed by FLUSH!!!
Express Dictate
My doctors are considering using Express Dictate. I did a search here to see if there were any comments one way or the other about this and if it was hard to set up and use, but I didn't really find anything recent or helpful. We went from a Lanier Voicewriter to EMR, and now there is 1 doctor who doesn't want to use the EMR and a couple others who just want to do a little bit of dictation, so they are putting me on contract to do this. I don't know much about how things like this work. I have used Express Scribe to test for on-line companies, but I don't know anything about Express Dictate. Any comments?
My take on how these physicians dictate
I question and I mean question about every day whether the person coming in as physician is really that. I have 1 that basically cannot string a sentence together, changes sentences 3, 4 or 5 times each sentence. I have physicians who pull the same stuff, going several paragraphs down and then asking you to add or delete something. I get really ticked when I hear all this and don’t hold my cool. The person in the room with me usually hears my ranting and raving. It is hard enough to get through the ESLs, mumbling, crunching, snorting, eating, sucking, sniffing, sorting papers and the list goes on without putting up with this. One change that was made at the hospital I work for was to tell dictators they could NOT use a cell phone to dictate. It worked. I only wish I were in charge so I could tell them more about how to dictate!
Actually, they can dictate a schedule and even pay.
It's not a black and white line on those issues. It is very gray and very subjective.
A client/company can state when they want the work done (time frames) or even how much they are willing to pay and even other issues.
Our working at home blurs the line and casts so much problem in defining this accurately.
But yes, they can definitely define those factors.
If only they would dictate/speak - sm
as clearly as they did when going for their interview for medical school or hospital position. If they spoke then they way they dictate now - they'd never have gotten into school or gotten their MD jobs -- so WE KNOW that THEY KNOW how to speak intelligibly when they want to; they just don't think we're worth the effort.
I appreciate and respect the ESL who puts forth an honest effort to be understood, over someone (usually English as FIRST language) slurring at 78 rpm, going through the HPI/PMH with ..ah, ... um ... (2 words) ... er ... (1 word) ....uh, ...(2 minutes pause) ... uh...uh... and then speed-racing through meds, labs, and whenever reading diagnostic reports verbatim .. so everyone knows that they know how to say those long words and which they wouldn't be able to come up with on their own. My pet peeve?? We're BORN knowing how to spell any doc's name, just because THEY know how: i.e, ."CC to Dr. Kryswkowskizhausen and then spells J-O-N-E-S.
Called that great 800 dictate and the
guy who answered did not even know what I was talking about !!!!!
So where do I go now????
I don't see how any company can dictate what you send to QA
That is preposterous to think that you can have say how many to send to QA!! At any given time, ANY doctor can dictate something that you would question or something you have no idea what it is. Noise, ESLs, mumbling.. just to name a few factors involved. All that does is tend to make the MT quess in order to keep down a QA count. The company I work for has NO limits on what goes to QA. They would rather it go to QA than guess. Under no circumstance, would they say to NOT send something to QA. You can't control the doctors, PA-C, NP, etc. to make them dictated where all could understand every word!
Do you think any of these dictators ever LISTEN to themselves dictate.
Sometimes they're downright HORRIBLE!!!!  
to dictate if you cannot speak English.
Sorry to gripe about this, as I know it comes with this industry, but I just transcribed (ha) a doctor, who sounded like this......
ditdada..ditditdadada..ummm, aaahh, shimaprazole, shinequapam, ditdootoday, patient no feel no good...ditditdazow. I quit.
doctors who dictate badly
I typed for a doctor who dictated once from the stands at a pro baseball game, once apparently at his kid's Sunday school 'cause they were all singing "Jesus Loves Me," and in the car on the way to Grandma's--both parents were dictating (both were doctors, my clients) with the kids carrying on about "When will we be there?" and one of the parent yelling at them without, of course, turning off their recorder. HIPAA would have had a ball with them!
I have one that can't even dictate by reading the H&P without errors!
He works for 6 doctors and always, always, mixes the doctor's names up on the reports, talks a mile a minute, and always screws up on the dosage amounts. He will dictate a discharge summary by reading the full H&P, with errors of course. He spends 2 weekends a month filling up the discharge summary line with hours of work, some reports 4 months behind! Yet, we can't let it go through like that, so we fix it, and the doctors think he is the greatest....love it.
Another one is a MA who can't even pronounce the word creatinine, let alone the drugs. Then there is the other one who always says "It was noted that..."
also depends on how fast they dictate
Depends on how fast the doc dictates -- if they compete with Superman's bullet for speed, they will knock out the lines. If they spend half of their time looking for the information they need to dictate (such as in discharge summaries or lab tests), then they will fall way short. The national average is 10 lines per minute of dictation. I have one doc that takes 25 minutes to dictate less than 100 lines (discharge summaries) and another who can belt out 16 lines per minute. You can speed them up or slow them down once you get used to them, but I don't recommend adjusting the speed much until you are used to them -- otherwise you will misunderstand words or skip words. Also depends on the software you are using. If you are using an internet based software, it will take you longer since you have to stop and upload the document and download the voice each job. If you download a bunch of files and work off your hard drive and then batch upload, then you will produce more. Lots of variables.
...sorry, with pictures. :( He didn't even dictate it. nm
s
What is it about radiologists who dictate mammograms?
We had one at a hospital where I worked who was constantly making jokes. If someone had an unusual name, he would find a humorous way to mispronounce it, and then say, "Boy, that's a mouthful! Oops - not supposed to say that when I'm dictating mammograms!" Or if the patient had the same name as someone famous, like Elizabeth Taylor, he would say, "Just call me 'radiologist to the stars'!"
Silly, but it certainly brightened up my day. 
Do PA's get paid to dictate by the line? SM
 I am doing a 25 minute preop of a patient admitted for removal of two lipomas.
I thought it was National Eat While You Dictate Day!
j
This doc takes 22 minutes to dictate...
um..she is presenting...uh..I mean....strike that..she presents..ur no, wait, yeah presents with.. or here, or I mean WITH symptoms of.........anxiety...................................................................................................................and depression. Period. Make that major depression....no, just depression.
I want to jab my temple with my pen...
thank you for the sarcasm, obviously I meant dictate
xx
(continuing from above) Don't dictate to the board
x
teaching dictators to dictate better
Exactly! But where is the motivation for them to do so? Yes, if you point out to them that they could be spending less time dictating and more efficiently whereby freeing them up to do patient care, maybe they'd listen. Certainly, if it hit them in the pocket there would be motivation to improve. For instance, if really, really, notoriously bad dictators were charged higher rates there would be big incentive to get/teach the providers how to use the equipment and how to dictate better. Money is a strong motivator!
I think about how there is going to be greater and greater emphasis on reducing costs of providing medical care. There's a huge opportunity for clinics/doctors/hospitals to improve and become much more efficient with transcribing. And who better to train them than us!!
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