Optional Matters

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disc or disk
# or No.
percent or %
3-0 suture or 000 suture
PRN or p.r.n.
hyphenation at the end of a line
justification
Comma before "and" or "or" in a series of phrases: "No murmurs, rubs or gallops."
One space between sentences is becoming more acceptable.
What else?

From Bill Bentsen, 2/8/96: The question of whether to put periods in abbreviations appears to be very controversial.

Sheila B. Sloane in her book Medical Abbreviations and Eponyms (W.B. Saunders Company, 1985) states, "Nowhere was the question of proper usage more troublesome than in the use of upper and lower case letters and periods in listing the abbreviations." Sloane lists "M.D." for Doctor of Medicine and "MD" for words such as mitral disease and mentally deficient. She also lists all of the abbreviations in the first two lines of this paragraph exactly as shown, i.e. with the periods.

The Gregg Reference Manual (Glencoe McGraw-Hill, 1994) states in section 1804, "... (full name), M.D." is proper.

The Chicago Manual of Style (University of Chicago Press, 1993) states in section 7.26 that "Joseph Hershall, M.D." is proper.

Webster's 7th edition lists "M.D." as the proper abbreviation for medical doctor.

On the other hand, Stedman's Abbreviations, Acronyms & Symbols (Williams & Wilkins, 1992) chose not to use any periods in any abbreviation. They make an exception and include a period when the abbreviation might be confused with an actual word (e.g., all. or add.). They do say that they do not place periods in any abbreviation as that is the style they've chosen for Stedman's Medical Dictionary.

The American Medical Association Manual of Style, 8th ed., 1989, has chosen not to add periods to abbreviations; however, the AMA Manual of Style is a guide for authors who publish in AMA's various journals, and it does not attempt to influence style in other documents.

Interestingly, the AMA Manual of Style does not sanction placing periods anywhere. No academic degree nor honor includes periods; no days of the week nor month abbreviations have periods (Tues Wed Thurs Oct Nov Dec are fine with no periods); abbreviations for street, road, avenue, boulevard do not have periods; abbreviations for states do not have periods (Calif Ark Fla Ga Tex Tenn are just fine with no periods); familial and fraternal titles have no periods (WC Smith Sr, JC Jones Jr, Rep James Dunn, Sr Mary Frances, Sen Paul Simon); and business names are denied periods even if they use periods themselves (WB Saunders Co, JB Lippincott Co). Take a look at Dorland's Illustrated Medical Dictionary as W.B. Saunders Company actually does have periods placed.

My doctors and I like "M.D." with the periods. It seems to me that there are enough sources in agreement to continue its use without our being old fashioned. If any of you and your doctors like "MD" better, that's fine. I don't care. Just make sure they understand you do not mean "mentally deficient!"

Information system people don't care anything about document style! The general rule is: If you are using a monospaced font such as Courier (like an old typewriter), it is correct to put two spaces after a period or colon the way our typing teachers taught us to do. If you are using a proportional font, one that uses only the width that each letter needs, then you are trying to be more typographically "correct," and in typography they do not manually put two spaces after periods or colons. You can see this if you notice the type in books and magazines.

Normally the institution or organization settles on specific rules of style, and everyone who types for them should use that standard. I learned under the "old school" (manual typewriters) and we were taught to use two spaces after periods and colons and question marks at the ends of sentences. So it has taken me a long time to unlearn that when I am typing for anyone who is going to be using a proportional font. When I was typing for a newsletter, I had so much trouble unlearning this that I created a macro in WordPerfect to go in and clean out all the extra spaces. The man who published the newsletter also got upset about blank lines between paragraphs. "PageMaker takes care of that," he said, so I had my macro clean out extra blank lines, too!

Most of us in medical transcription aren't making a deal to set the spacing between paragraphs, so we just make a blank line. But eventually, if the software gets fancy enough, don't be surprised if they tell us, "Don't put in extra lines between paragraphs! RecordMaker takes care of that!"

I haven't been given specific instructions one way or the other; however, I do everything possible to avoid dividing words at the end of lines, including stepping down a point or two on the font size to keep a long word from wrapping around and leaving a large blank space on the preceeding line and using hard hyphens to avoid legitimately hyphenated terms from being split at the end of a line. Makes the report easier to read (hyphens interrupt reader's train of thought) and saves transcribing time since I don't have to double check to make sure words are divided properly and helps to avoid breaking some of the other "rules," e.g., last line of page ending with hyphen, two lines in a row ending with hyphen.

Since you predated AAMT and some of the standards set since then, I suspect that you started out in a time when MTs did as the clients asked, period. I haven't been at it that long. When word processors came out, it seem to be a fad or "stylish" to use the full justification feature and lots of hyphenation. But apparently (I haven't seen the citations) it has been found that ragged right text is easier to read, and reading hyphenated words slows down comprehension. So in the past few years it has been recommended that we go back to left justification (ragged right) with hyphenation turned off.

I first learned to use ragged right at my first hospital job. That hospital (or the people in charge of medical records, at least) thought that ragged right and no hyphenation was easier to read. We also used what we used to call "pica" size type (10 characters per inch) because our supervisor said that smaller print was also harder to read. I also suspect that this type reproduced more clearly when copied and faxed.

Here is what some of my sources recommend about justification and dividing words at the ends of lines:

Medical Transcription Guide: Do's and Don'ts by Marilyn Takahashi Fordney and Marcy Otis Diehl. W.B. Saunders, 1990, p. 163: "Use a hyphen to divide words at the end of a line. Avoid dividing words at the end of the line whenever you can. It takes time and breaks your rhythm and often confuses the reader. It is also easier to read and understand unhyphenated words. However..." Then they go on to give the rules for hyphenating if you need to. I did not find where they even addressed the question about justification. Apparently many MTs were still using typewriters when they wrote this part of the book. Were they behind the times in 1990? Or was our hospital a leader? I started in 1982, and they already had the word processors for a while when I got there. We had Wang word processors then.

A Syllabus for the Surgeon's Secretary by Jeannette A. Szulec and Z. Szulec. Medical Arts Pub., 1980: These authors don't mention it in so many words, but samples pictured early in the book show both division of words at the ends of lines and full justification in many of the documents. Some of these documents, though, were forms with blanks to be filled in by clerks. The sample operative reports were quoted, not pictured as they would actually appear on paper.

Saunders Manual of Medical Transcription by Sheila B. Sloane and Marilyn Takahashi Fordney, 1994. p. 99: They seem to stay pretty much out of the argument but apparently want to put it in the hands of the computer: "Hyphens are used mainly to aid the reader in clarity and pronunciation. Word Processors and computers feature automatically justified margins thus taking word division at the end of a line out of a transcriptionist's hands. However, hyphenation is used when keyboarding some compound words and phrases." Now the user can choose at least between full justification and left justification. Also, any word processor would allow the user to turn off automatic hyphenation.

They do point out, however: "Remember, a word divided in error is just as incorrect as a word misspelled."

AAMT Book of Style by Claudia Tessier. AAMT, 1995: "Avoiding end-of-line word division facilitates both communication and transcription: the reader of the document does not lose the flow of reading and meaning, and the medical transcriptionist does not have to hesitate or stop to determine correct word division."

She goes on to say, though, that if you do decide to divide words, you should follow the rules that she tells about, common rules I have seen in other places, but these are spelled out very clearly here.

Our daily newspapers are full of examples of how NOT to divide words. I have even seen some of these bloopers in magazines. A recent example was "of-fline." Since some software does a poor job of dividing words automatically, if an MT is unfortunate enough to have to work with such a product, it would be better to just avoid dividing words if at all possible.

An issue most of these authors do not discuss differentiating styles based on the specific types of reports being typed. I think that for short office notes, progress notes, etc., we need not take the time to hyphenate the words. But when we are working on a formal report or letter, then we may want to be more careful about the appearance, by using a nice proportional font, perhaps full justification, and hyphenation of words as needed at the ends of lines.

I think it would really help to see the styles of various types of reports discussed instead of lumping all transcription into one big category.

If you are sending the clients fully printed copies of the reports, this may be OK up to a point. But you may want to be aware of some of the newer word processors and some of the options they have.

I really know only WordPerfect. Even in version 5.1, you can change the distance between letters or lines. This is pretty technical, so I won't go into the nitty-gritty details here. The information is in the user's reference. In version 6.1 for Windows (I don't know yet about 6.1 for DOS) there is a feature called "Make it Fit" that lets the user simply tell WP where the text has to fit, and the program will do the work for you. Manipulating spaces, etc., does eat into your time. If you can find a program to do it for you, you are better off.

Again, a proportional font instead of a monospaced font like Courier will make the spacing better on the line. The skinny letters like "i" and "l" take up less space than fat letters like "M" and "W" do. Your print will come out looking more professional.

One thing to consider is that we are moving to the electronic medical record. What we type may not end up being printed in the same font as it was in on our screen. We will need to use a minimum of formatting codes in what we send in because wherever the report ends up will be the place that prints out out. Extra spaces inserted could create problems in that setting.

Again, I think we will need to deal with what is going to happen to our work when it leaves our machines. If it is simply uploaded for remote printing or incorporation into an electronic medical record, we would handle it one way. If we are sending what amounts to a finished printed document, then we would control all aspects of that, including making sure it looks right on paper.

About hyphenations, it is important NOT to use normal hyphens for dividing words at the ends of lines. Word processors normally use a special kind of hyphen for dividing words at the ends of lines. These show only when the word is "in the hyphenation zone" where the program will insert it to divide the word. If you later insert other words into the sentence or on the line preceeding that dividing hyphen, the word processor will go ahead and wrap that divided word on to the next line and hide the hyphen. If a person has simply manually inserted a hyphen, that hyphen will still show later if the word appears within a line somewhere. A word hyphenated where it shouldn't be looks very strange.