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Reprinted by permission.
Murder, He Transcribed
by Bill Bentsen
The body is that of a well-developed, well-nourished white man who appears the stated age of 22 years. According to reports filed by the police, this man had been at a party where reportedly marijuana and "acid" had been used. He disappeared from the party and was reported missing two days later. Three weeks later, his body was recovered from a lake under approximately eight feet of water. The body was transported to the morgue. There is no evidence for intention of self-injury or suicide. Preliminary cause of death appears to be drowning.
My name is Bill Bentsen. I am a medical transcriptionist living in the wilds of Tennessee. Quincy and I do autopsies. Actually he does them, and I transcribe them!
The body is admitted to the morgue dressed in wet clothing consisting of the following items: long-sleeved gray shirt, blue jeans with no belt, black high-leathery boots (laced up and tied, splitting at the right lateral side and bottoms worn), two white socks with bluish green dye runoff, brief white undershorts and white short-sleeved tee shirt. Artifacts of decomposition are present, and there is significant putrefaction.
Medical examiners are charged by statutes to determine the actual cause of death when normal medical supervision is absent. Sudden and violent deaths are their domain. The gory, macabre and bizarre are normal in the Medical Examiner's office. All of the suicides, homicides and accidents, plus the unattended natural deaths, go through their doors.
The head is normally shaped. Scalp hair is long, thick, straight and brown. The head, face, neck and upper shoulders show no suffusion. The facial hair consists of a mustache.
Each case is assigned a case number. In a report that will run eight or more pages, the pathologist will document three areas: the external appearance of the body, the internal appearance of all major organ systems and, later, results of toxicology and other laboratory tests.
There are no acute or recent medical artifacts present. Rigidity is generalized with the arms at about 35 degrees abduction, the forearms at 90 degrees flexion, the right wrist at 90 degrees flexion, the left wrist at about 35 degrees flexion, the thighs flexed at about 4 degrees, and the legs are flexed at about 60 degrees. The skin shows significant water-wrinkling effect, and there are numerous insect and marine animal bites. The body has no embalming or other mortician's artifacts.
As in histories and physicals, discharge summaries and operative reports, the organs of each system are palpated and described. At autopsy, each is removed, weighed, sectioned and visualized. This is dictated and transcribed for the permanent written record.
The body cavities are opened in the standard autopsy fashion. The organs are present in their usual anatomic locations and relationships. There are no abnormal collections of fluid or blood in the pleural, pericardial or peritoneal cavities.
This written record is my area. I transcribe faithfully the dictated word, creating the medicolegal autopsy report which describes the body, its anatomy, its normal and abnormal physiology, its height and weight, its hair color, its identifying marks, tattoos, lesions, abrasions, injuries and the condition of its organs.
The right lung weighs 1190 gm, the left 1220 gm. The lungs are markedly edematous and only mildly congested. The other internal organs show congestion but are not otherwise remarkable. There is no evidence of catastrophic or chronic illness. The stomach contains 50 ml of thin, clear liquid with slight mucus.
Each person has his own story to tell, and, even after the end of life, there's always someone to listen.
Sections of heart and lungs show a mild increase in the number of pigmented macrophages along with the grossly-noted edema.
And when his story is told, I make it a permanent part of his history. I transcribe the final minutes and seconds of his life and the vivid details of the body after life. And I love the suspense and excitement.
The skull is opened in the normal manner. There is a laceration of the left parietal scalp, 9.0 cm below the top of the head and 2.5 cm posterior to the top of the head. The central area of the wound has charring and slight soot deposition, and the wound itself is a four-point stellate laceration, overall 4.5 x 5.5 cm. The entrance wound is not visible due to severe decomposition. Circumstances are extremely suspicious for homicide; there is no clear-cut evidence that this is a suicide. The body cavities are opened in the standard autopsy fashion. The organs are present in their usual anatomic locations and relationships. There are no abnormal collections of fluid or blood in the pleural, pericardial or peritoneal cavities.
The story of death is like the story of life. Each of us walks a thin line with death waiting. And when death occurs, there are still transcriptionists working, typing, researching and correcting the record.
Three (3) small pieces of deformed lead bullet fragment are recovered, totaling 1 gm, the largest piece present beneath the scalp at the entrance wound, and the other two (2) pieces recovered from within the brain itself. X-rays show no other projectiles or fragments.
And I'm one of those transcriptionists, keeping up the patient's record, even after the patient dies. The dictation I type may wind up solving a murder.
Postmortem toxicology reveals the presence of lysergic acid diethylamine (LSD), marijuana metabolite present at 296 ng/ml, chlorpheniramine detected, but no acidic drugs detected; also positive for ephedrine/pseudoephedrine.
MANNER OF DEATH: HOMICIDE.
CAUSE OF DEATH: EXSANGUINATION DUE TO GUNSHOT WOUND OF THE HEAD.
And so it goes.
Released in late 1994, this book replaces The Style Guide for Medical Transcription (AAMT, 1985), otherwise known as the "Gold Book." It is written by Claudia Tessier, CAE, CMT, RRA, executive director of American Association for Medical Transcription. The Book of Style is a soft cover book arranged in an A-Z format and numbers over 500 pages. Included in the new book is information about punctuation, grammar, editing, format, and other style issues. It also features several appendices, including sample reports, confidentiality issues, and AAMT position papers. It is usually those "little things" that slow us down in our work. Some of the helpful items you will find in this new book are:
"Do not use a comma or other punctuation between units of the
"The infant weighed 5 pounds 3 ounces."
A thorough guide to cardiac terminology, including electrocardiographic terms, e.g., to use Roman numerals when typing standard bipolar leads.
An extensive guide to typing numbers, e.g., 5-cm incision, two-week history, 4 x 4's.
GPA terminology, e.g., gravida 1, G1.
The Book of Style is available for $79 (AAMT member discounted price is $49). To order, contact AAMT at 800-982-2182.
Yeah, well, it's a gift: COPD flair. (flare)
It's rampant in Aspen: Diagnosis: Attitude sickness (altitude)
Pangs of conscience, perhaps: Diagnosis: Acute cheat pain. (chest)
Condition on admission: Improved: The patient is a 93-year-old man with a history of hypertension who was sent to the emergency room due to general decrease in deterioration.
The Ultimate Peer Review: I feel the patient needs to be in a chronic pain clinic as does Dr. Smith.
Hello, Prudential? The patient displayed emotional liability and tearfulness. (lability)
Would you just leave the man alone? Recommendation: One may wish to evaluate elvis with ultrasound. (pelvis)
You'll never find it at Mrs. See's: The cyst was punctured, and 3 cc of chocolate-covered fluid was aspirated. (colored)
One strep throat and there goes the farm: The patient defervesced, with the white count falling to the $8000 range.
Would this be considered a preexisting condition? Status post left toe and right foot fracture in the distant future.
Haven't we all? The patient suffers from romantic heart disease.
Looking for love in all the wrong places: Diagnosis: Suprapubic punctate keratitis. (superficial)
The Original Kissing Disease: Lungs are clear to osculation. (auscultation)
Editor's note: Linda owns D&T Medical Transcription in Aurora, Colorado.
A: MTs who are in business for themselves are responsible for providing a service regardless of their personal illness, vacation, etc. This is the nature of being a businessperson. Clients who use transcription services do not agree to be responsible for employment issues whether these employment issues are vacation backup, sick pay, payroll taxes, etc. So, the independent MT, i.e., one who is performing work other than as an employee, is responsible for the continuity of service during a vacation or illness UNLESS there is a written or verbal agreement to the contrary. Thus, it is important to state in a written contract exactly what services will be provided, particularly if the MT does not agree to provide continuity of service since the presumption is that it will be provided. One of the significant issues in the business of working independent ly, and as a medical transcriptionist working from home in particular, is that the worker must adopt an entirely different mental set of being a businessperson and not being an employee. An employee has a contract with an employer, sometimes in writing, that is regulated by Federal and state labor laws. The employer is legally required to provide certain benefits payroll taxes, unemployment insurance, etc. Many employers go beyond the requirements of the law and provide additional benefits such as vacation, holiday and sick pay. A businessperson, however, is solely responsible for his/her own welfare and is not regulated by the labor laws with respect to him/herself. As an employee, any and all benefits of employment are provided by the employer of the MT!
Many of the issues being discussed in the industry today can be attributed in part to the lack of change in mental set from employee to businessperson. This is a difficult transition to make, and it is a transition that is oftentimes not consciously acknowledged at the time of making the change to working independently at home. It is reflected in pricing issues: A price is arrived at without taking into account compensation for vacations and holidays, payroll taxes, office expense, equipment purchase, etc. Your client's charge for services reflects these expenses; do yours? It is also reflected in the independent contractor issue service owners dictating work hours and volume of work and acceptance of these dictates by independent MTs.
As the IRS would say, you are either an employee or you are not. If you are an employee, there are specific benefits provided under the law that accrue to you. If you are not an employee, then you are a businessperson and there is an entirely different set of specific benefits provided under the law, such as tax write-offs. It is important to understand the differences and not expect the benefits of either work status without also accepting the obligations. For example, you can not take advantage of business expense write-offs and expect your client to pay you when you don't work. Likewise, you cannot allow your client to dictate your work hours unless the client pays your employment taxes. The most rewarding consequence of understanding and accepting the differences of employment versus businessperson is self-respect.
The way you lay out your computer, furniture and office can have enormous impact on your work. The single most important interface in the Windows Land of Interfaces is the one between you and your computer where your hands and eyes meet the machine, where rubber meets the road. That small step between your computer and your senses can be a giant leap for your physical, if not psychological, well being. Products that can be crucial in your effective use of a computer are the keyboard and the mouse. It doesn't pay to get a cheap keyboard or mouse. Your hands deserve the best. Repetitive-motion disorders sound like some sort of ruse an ambulance-chasing shyster invented to milk big companies out of insurance dollars. But I can testify, first hand, that carpal tunneling and tendinitis can be excruciating, debilitating problems. Numbness in the fingers. Shooting pains in the wrist and forearm, like somebody jabbed you with a knife, then dunked the knife in salt and jabbed and twisted again. It gets so bad you slam your hand on a table, just to see if you can feel something, anything. Oh yeah, I've been there. Folks who think you're faking it are lucky; they've never been through that sort of hell. If you've experienced problems like that, if you're prone to tendinitis, repetitive motion syndrome, or any of those excruciatingly painful side effects of touch typing, try a wrist rest. A rest hasn't cured my problem, but it does help.
Most of all, if you have shooting pain in your forearms or wrists, or if your fingers get numb from time to time, find a doctor who understands, a doctor who knows the disease, who knows what he/she is talking about. No matter what the company nurse or doctor says, it is not your imagination, it is not stress-induced, and it will not get better if you take a day or two off. You need a good chair. A desk that can hold that 100-pound monitor. Lighting from almost any direction except the glare position just above or behind your head. A phone you can reach without pulling a Rosemary Wood. And on and on.
Adjusting all that stuff can be problematic. The top of your monitor should be even with your forehead. When you plant your feet firmly on the floor, your thighs should just clear the chair. When you type at the keyboard, your elbows should bend down just slightly, so your wrists come out straight a position that's virtually impossible to attain with the keyboard sitting on a desk.
This article is excerpted from CD-MOM: THE MOTHER OF ALL WINDOWS BOOKS CD VERSION, copyright (c) 1993 by Pinecliffe International and Barry Simon, and is reprinted by special arrangement with Addison-Wesley Publishing Company. CD-MOM can be found wherever trade computer books are sold, or can be ordered by calling 1-800-358-4566.
Why do doctors use the telephone to dictate rather than the dictation system? Is it because they have to walk two or three feet to the telephone? Is it because they don't like the color of the dictation phone? At any rate, when they dictate over the telephones in the hospital they sound like they're calling from the other side of the world using a cellular phone in a speed boat while chasing James Bond at a high rate of speed across a large body of water.
Why do doctors take it personally when you leave directions by the dictation phones? Why do they dictate hateful little messages to you concerning the directions? Perhaps as a child they had a bad experience with a dictation phone. Perhaps when the obstetrician was dictating the delivery note he accidentally dropped the dictation phone into the incubator because he didn't understand the directions.
Why is it that when doctors insist that they dictated a report and you take them to the main computer terminal and show them every one of their reports in the history of the world which have all been transcribed along with the ones yet to be transcribed and the ones yet to be dictated in the future, they STILL dictate, "This is a RE-dictation of an H&P which I have already dictated. Please don't lose this one and make sure it gets put on the chart!"? Why do doctors still think we are typists who type reports on typewriters? Why do nurses always throw wild parties behind the doctors while they are dictating? Why do radiologists dictate as if they're World War II pilots? "Check, check, test, test, Roger, over and out."
Why do doctors hold the phone receiver up to the ceiling intercom every time someone is paged overhead? Why does someone from Housekeeping cruise by with a vacuum cleaner or floor buffer when a doctor is dictating a term never before used in the history of Medical Transcription? Why does the transcription get eaten after it is charted? Why do some doctors dictate everything there is to know about the patient in the first sentence? "This patient is a 34-year-old, tea-drinking, cigarette-smoking, truck driving, white married female who lives with her husband and two children in a two-story brick home overlooking the river where she spends her free time in river boat races and in wild, carefree romps on the beach with her cocker spaniel Ted."
Why do cardiologists burp, snort, and chew gum while they dictate?
Why do doctors and nurses think that x-rays and cardiology reports are dictated and transcribed as the patient is being wheeled from Radiology back to their room?
Why do orthopedic doctors like to play with the record/rewind button on the dictation phone receivers so that every other word is cut out? The patient is . . . left femur and . . . totaling 32 cc . . . Trendelenburg position . . . follow-up next week." Why do doctors keep holding down the record button on the dictation phone receivers while talking to a nurse or talking to their wife on a phone? "Ha-ha-ha, yes, the patient is suffering from delusions of grandeur, he thinks he's the administrator!" and "Yes darling, I'll pick up a jar of pickles on the way home. I love you, too, you beautiful thing, you!"
Why do doctors entertain their children while they're dictating by dragging the TV set over by the dictation phone and turning up the Power Rangers or Mutant Turtles as far as the knob will rotate? Why do doctors dictate as a jazz ensemble stands beside them performing "The Girl From Ipanema" and you can't help but try to listen to the music instead of the doctor? The music occasionally drowns out important phrases, such as, "The patient survived surgery and returned to his room." Why do doctors deliberately mispronounce words in an attempt to be funny? You spend hours searching medical books for the word "table."
Editor's note: Keneta is a medical transcriptionist at Tri-County Baptist Hospital in LaGrange, Kentucky.
Remember those multiplication tables you memorized in grammar school, practicing them over and over until you finally had them? If you use Flash Forward or another word-expanding utility and you forget the short forms you have set up, here are five quick tips to help your memory and your productivity. NOTE: I used WordPerfect 5.1 for these documents, but you can easily adapt the methods for other word processors.
TIP NUMBER 1: As you begin a transcription session, open a document on your "switch screen" then return to your normal editing screen to begin work. Whenever you miss a short form, set up a new term on the fly, or encounter a short form you had to really struggle to remember, use a macro to select that word, copy it into the document on your switch-screen, add a hard return to position for the next entry, and return to the line you were editing. (My macro uses an Alt key, takes two keystrokes and about one nanosecond!) When you have finished your transcription, switch to the document containing the words you need to memorize and print or save to file. (This document is a perfect source for the Tip #2.)
TIP NUMBER 2: Because you USE your short forms
while you are typing, TYPING is
the most effective way to memorize them.
Here is a document that
prompts you for the words you need to learn, then
let you type them with built-in correction. Load your word utility and
print your current word list or, if you already know your bugaboos, use
that list instead. Hint: You could also record on tape your problem
and practice typing short forms that way.
--A. Begin a new document, and create a table with six columns and as many rows as you have words to learn. (I typed in ALL my Flash words to use as a frequent drill.) Adjust your line margins and font size to accommodate your longest word.
--B. WITH YOUR WORD UTILITY LOADED, start at the first cell (top left side) and type the short form of the word you need to learn. Your utility will fill it in. Advance the cell below the one you just used (set up a quickie macro for this.) Type the next short form and so on, until you have entered all the words you need to learn. Your document should have ALL the words ONLY in the leftmost column. SAVE THIS DOCUMENT FOR USE AGAIN AND AGAIN, then save again to a "working" filename for this session.
--C. TO DRILL: WITH YOUR WORD UTILITY STILL LOADED, position the cursor at the top of the document, in the second cell. Typing the short form, match the word in the left column. For example, if the word on the left is "abdomen," type its short form. If your utility doesn't complete it for you, move to the next cell to the right and try it again. Then practice a little in the next three or four columns. When you are ready for a new word, move downward to the blank cell adjoining the next problem word. Keep going until you have really learned all the short forms that will keep you more productive and less fatigued.
TIP NUMBER 3: For those particularly pesky short forms that are close relatives of other short forms, or ones you can NEVER remember, make a cheat-sheet. I have cheat-sheets for each specialty I transcribe and hang them from a copy holder attached to my monitor. I created the sheets using a 6-column table, alternating full word, short form, full word, etc. (Type DOWN the word column with your utility loaded; turn it off when you are done.
TIP NUMBER 4: Like any other program worth its salt, your word-expanding utility requires a little housekeeping now and then. Take a few minutes on a regular basis to skim through your word list to eliminate unnecessary words and make related short forms more consistent for quicker recall. This is particularly important if you allow your utility to add short forms for you. Use this maintenance time to update your cheat-sheets, too.
TIP NUMBER 5: With all the speed and ease your word utility adds to your transcription, wouldn't you hate to lose its word file? ADD IT TO YOUR DAILY BACKUP. You've invested time and money into its creation; don't take a chance on losing it when your disk drive fails!
Hand out fortune cookies. Kim Seitzinger of Illinois told me, "One year we typed up sayings to put in fortune cookies... such things as 'Confucius say, He who spells the patient name is a good dictator.' We typed them up, cut them out and found an oriental kitchen in Chicago that made up the cookies for us." Have an open house. Invite doctors and other departments in for lunch. Let them see what you do. Hold a symposium. Whether it is an educational meeting or an introduction of medical transcription as a career option to interested individuals, hold a seminar in conjunction with your other activities. Play Medical Trivial Pursuit. Dig out your old Trivial Pursuit game. Choose six medical specialties and put together questions for each category. Play singles MTP or get teams together. Play medical word Scrabble. Play singles Scrabble or get teams together. Play transcription bingo. Make up cards with squares of medical terms, and read the question out loud. Have the MTs figure out the answer and look for it on their card. Example: Inflammation of the middle ear. Answer: Otitis media. See if you can get your local book reps to donate prizes. Post the best bloopers... from the transcriptionists and physicians. Raffle off last year's drug books and PDR. Send a press release to local newspapers. Give the date of MT Week, describe what a medical transcriptionist does, tell about celebrations you plan, and name those MTs given special awards.
Editor's note: Thanks to Rose Combs and Kim Seitzinger for the majority of these ideas.
Adato Sil 5000 (a.k.a. Adatomed Silicone
Oil): Silicone oil injected into the eye to treat complicated retinal
detachments, including those related to cytomegalovirus retinitis.
Bair Hugger: A patient warming system.
Biotel kidney: A test kit for detection of diseases of the kidneys, bladder and urinary tract.
Biotel u.t.i.: A home test kit for detection of UTIs.
Blockaid surgical glove liner: A combination of stainless steel and synthetic fibers result in a cut-resistant glove liner, reducing risk of exposure to blood-borne pathogens during surgical procedures.
Chick orthopaedic table: Patient access is improved for orthopaedic procedures because Midmark Corporation's table does not have a big table base but instead uses a suspended overhead rail system.
Chiroflex, Model 32-C11XX, single-piece, silicone, posterior chamber intraocular lens.
Ciba Corning ACS CEA Assay: For quantitative measurement of CEA in serum in cancer patients.
CLOtest: A test that determines urease activity in gastric biopsy samples.
Cosmeti-Suture: A new suture.
Dornier Lithotripter Compact (DLC) dyslipidemia: Isolated elevated triglycerides, low HDL cholesterol or elevated LDL cholesterol, or a combination of the above.
ĆEvans Blue Dye:A diagnostic aid to measure plasma volume.
Gen-Probe: DNA probe test.
Grieshaber scleral buckling balloon catheter: Temporary implant used during scleral buckling procedure.
Immunex CRP: A test for detection of C-reactive protein; used to diagnose inflammatory conditions.
Neurolite: A radioactive diagnostic.
PRIME-MD: A patient questionnaire provided to PCPs to assist in diagnosing mental health conditions; from Pfizer, the makers of Zoloft.
Rheumatex: A test for detection of rheumatoid factor.
Rheumaton: A test for determination of rheumatoid factor.
Sonic Accelerated Fracture Healing System (SAFHS): The first ultrasound device to speed healing of new bone fractures in the lower leg and lower forearm of adults; consists of two main components, a signal generator and a transducer which is applied 20 minutes a day.
Stereotactic radiosurgery: outpatient radiosurgery that uses CAT scans of the brain to assist in precise delivery of high-dose radiation to tumors, minimizing damage to normal brain tissue.
SureCell Strep A Test: Detects Group A streptococci.
Toftness spinal correction: A chiropractic experimental treatment for migraine headaches currently under investigation; an instrument called the Toftness system is used to detect microwave level radiation in the spine followed by a Toftness adjustment (slight sustained pressure is applied over the spinous processes).
Sources: New terminology for this column has been gathered from a variety of sources, including medical transcriptionists, on-line information systems, clinical specialty journals and manufacturers' product information.
Aredia: pamidronate disodium, for Paget's disease.
Axocet, butalbital and acetaminophen, for tension or muscle contraction headaches
estradiol: transdermal estrogen patch.
Crolom ophthalmic solution; vernal keratoconjunctivitis.
Cystagon: cysteamine bitartrate, orphan drug used to treat nephropathic cystinosis.
Cytovene: ganciclovir, antiviral; for treatment of CMV retinitis.
EC-Naprosyn: naproxen, enteric-coated naproxen, 375 and 500 m.g
Ergomar: ergotamine tartrate, sublingual tablets; treatment for vascular headaches.
Flonase: fluticasone propionate, corticosteroid nasal spray; for allergic rhinitis.
Fragmin: dalteparin sodium, anticoagulant; to prevent DVT in abdominal surgery.
Gemcor: gemfibrozil, antilipemic agent.
Glucophage: metformin HCl, oral hypoglycemic agent.
Havrix: hepatitis A vaccine.
Lamictal: lamotrigine, therapy for epilepsy patients with partial seizures.
Luvox: fluvoxamine maleate, for obsessive-compulsive disorder.
Navelbine: vinorelbine tartrate: treatment for non-small cell lung cancer.
nisoldipine: extended-release calcium channel blocker.
Premphase: medroxyprogesterone acetate hormonal replacement therapy; used with Prempro.
Prempro: estrogen hormonal replacement therapy; used with Premphase.
ProHance: contrast media for MRI.
Renormax: spirapril, antihypertensive.
ReoPro: abciximab. monoclonal antibody used in angioplasty patients.
ReVia: naltrexone, for treatment of narcotic and alcohol dependence.
Serzone: nefazodone, antidepressant.
Syn-Rx: pseudoephedrine HCl/guaifenesin, 14-day treatment regimen for sinusitis.
Thioplex: thiotepa, antineoplastic agent; alkylating agent.
Trusopt: dorzolamide, drops for treatment of elevated intraocular pressure.
Vexol: rimexolone, ophthalmic corticosteroid solution.
Vivelle: 17-beta estradiol, transdermal estrogen patch; 0.0375 to 0.1 mg t.i.w.
CSM's Computer Guide $15.00*
MEDTERMS computer-based medical terminology training, $49.95
MT Monthly Drugs on Disk, Vol. II, $15.00*
MT Monthly, one-year subscription, $48.00
MT Monthly, two-year subscription, $90.00
Stedman's Abbreviations & Acronyms Book , $24.00
Stedman's Electronic Medical Dictionary, $129.00
__ DOS/Windows, __ Mac
Stedman's Medical Dictionary, 26th Edition, $44.95
Stedman's Medical Equipment Words Book, $34.00
Stedman's Pathology & Lab Medicine Words Book, $28.00
Stedman's Plus 3.0 Medical Spell Checker, $99.00
__ WordPerfect DOS/Windows, __ MS Word & AmiPro
SUM Beginning Medical Transcription, $840.00
SUM Cardiology Advanced Program, $280.00
SUM Gastroenterology Advanced Program, $280.00
SUM Orthopedics Advanced Program, $280.00
SUM Pathology Advanced Program, $280.00
SUM Radiology Advanced Program, $210.00
Working as a Medical Transcriptionist at Home, $15.00*
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