MTSecond Job, Better Job

1/99, from Jean, http://www.mtdaily.com/wwwboard/messages7/352.html, computer-aided notetaker, real-time captioner for deaf students.

11/98, from Mary, http://www.mtdaily.com/surveys/sr/messages/457.html, two companies where a total of 15 MTs are now Editors of automatic-voice-to-text-produced medical documents: AVRI, hiring nationally, and Linguistic Technology in Minnesota, hiring locally, http://www.linguistech.com.
2/97, from Mary:
For MTs wanting to diversify, here are some possibilities:
Teaching, supervising, writing, editing, recruiting, advertising, consulting, selling, ebmonitoring, online networking, nursing, med tech, coding.
2/97, from Darla Haberer,dhaberer@I1.NET:
That's my name on the inside covers of the Word Watcher (published 3 x a year), GI/GU and Dermatology/Allergy/Rheumatology and Infectious Disease all by Stedman's. I got started by attending a state meeting, talking briefly to the rep there and being interested in reading journals. I started out reading Cancer Journals and submitting words to them for the Radiology/Oncology book 1995 that Cathy Baxter edited. Since then I have been privileged to work with a number of great MTs from all over the U.S. Being "somewhat" computer savy (or is it savey? Netscape needs a speller!) definitely has helped. We no longer have to mail our disks back and forth (most of them anyway) and now we use file transfer protocol to "zap" our files back and forth. We still have some who have to have someone else put the info on disk but 9/10 are either on-line or have access to being on.

It is a great learning tool for me. I often use the sites on the net to research to make sure what we have is correct (and even then, we are human and sometimes the companies reps themselves give different spellings and answers.) It takes some time but is definitely worthwhile.

There are other publishing companies that also use MTs. There is a need for us for working on all sorts of textbooks and publications, as well as the word books we use. After all, we are the medical word experts.. It's another avenue for MTs who find the keyboards too taxing to be pounding day after day.

I would recommend that you at least know your way around the computer somewhat (and if you are reading this here.. you already probably do!) If you are interested, talk to the representatives at meetings, contact some of the publishing houses (there are many) that do textbooks, MT books, etc. I know one lady who said they usually need indexers too (people who are willing to read through them sometimes very boring othertimes very interesting). Their job is to put that this word is on that page... etc.. I always thought that was done automotically.. but at least for some.. there's a real person needed for that. You can even contact some of them via the net. I know Stedman's and HPI both have sites..

Almost all of the MTs I work with are CMTs but not all of them are. I think the important things are 1) You have a real love of words and a burning desire to learn more; 2) You can communicate well via the net and on that thing called a what's it.. oh yeah, a phone.. :) 3)You have the time to do it and can meet the deadlines; 4) You don't hope to get rich from it.. I have put in a lot of hours but I really believe it has benefits that far outweigh the few down sides to it.

7/96, from Mary:
I am still surprised at how few people seem to die in the hospital. Even when I typed a lot of discharge summaries, I only came across a death about once a week or less. Anyone else wonder about this? I wonder if rehabilitation facilities would be different. I wonder if some of the reason they shuffle people on their way if they are terminal is to protect other patients from the sadness of death near them. Perhaps they want to keep the hospital the curative place, keep comfort care separate from that. And what about the legal and morgue care, expenses hospitals might want to avoid. Hmmm....
From Liz:
Every now and then, "The Philadelphia Inquirer" will run an article about hospitals and their rankings based on several factors, the prime one being number of inhouse patient deaths.

When my mother was in one Philadelphia hospital thirteen years ago, in the final stages of heart disease with an aneurysm and emphysema, the hospital was very insistent that my brother and I make arrangements to have her placed in a nursing care facility, which we did post-haste. (BTW, no sooner was she in the nursing home than she made a remarkable recovery and went on to live another 3-1/2 years before dying at age 81!) Later I realized that they didn't want to soil their reputation.

From Kim: I'm rather inexperienced, and have only typed two death summaries to date. My first encounter with this type report was a 14-day-old infant going through heart surgery (which I cried all the way through, being the emotional creature I am!), and the only other one I've ever done was on an elderly patient with the final note being "was transferred to a nursing facility where he expired shortly thereafter". The dictating physician called this a death summary and gave a date, but I always wondered if it wasn't really a discharge summary, technically speaking, rather than a death summary...
6/97, name withheld:
I've been online for almost six months now and feel much more confident, informed, and less isolated as a hospital-based transcriptionist than I did before the Net. The atmosphere in our department is such that free speech is a fond memory. For now, I am locked into this job that I have loved for eight years (20 years transcription experience--words iz my liffe!) simply because I am very stubborn and interested in the process, and my husband had colon cancer resection last year and I am the insurance carrier for the family --the old pre-existing condition clause (though I will research this).

Change is an interesting topic. The biggest change in our department in the last two years is that we are about to be presented with our second pay cut. The first one cost me around $4000 per year. Adminstration one year before our present supervisor came decided that we were overpaid on our incentive system--$38,000 to 40,000 for those of use who worked very hard and were willing to work "premium shifts" evening weekends. The RRA department head who administered this blow, with hospital management cheering in the background, had the most contemptuous, adversarial attitude that I have ever encountered in the workplace. She told us that we were overpaid and pampered and had no business making the kind of money that we had earned in the past. So much for the first year. She hired our present supervisor one year ago last May. The RRA has since departed, our supervisor is now our boss and part of an expanded "management team" that directs the entire medical records department. More managers saves money, apparently.

Radiology and cardiology, as of this week, are going to be typed in a new system, the famous and semi-mystical paperless medical record system. Our general medical is typed in Soft Med's ChartScript, which we all like very much. Recent management edict is that we are expected to type radiology and general medical in the future--one of the changes. Okay, fine. I like to be well-rounded. There will now, we were informed, be another "change in method of compensation." The new system cannot count lines! Our incentive is based on 1000 lines, 70-character line. We are now told that our incentive pay will be changed and possibly tied into turnaround time and our QA results and other suspiciously subjective data. This very mysterious program has yet to be presented to us by Human Resources (don't you love that name). All of us are wondering just what our next paycheck is going to look like. The new system supposedly went up yesterday.

That is the thumbnail sketch of conditions in my workplace--forgot to mention that my supervisor is targeting certain of us as "troublemakers" and has written them up for bad attitudes. Did I mention free speech! I have become amazingly tactful and cosmically cooperative. In the background floats the just slightly pitying and condescending attitude towards those of us who have not sought CMT certification.

I believe that my hospital and others in my city have targeted our salaries as a place to cut costs and have conspired to bring salaries down all over the city. Just a wild guess. We now are expected to work harder for less money and accept the fact that change in our department now means more clerical duties. Another story.

That said, why would certain national transcription services pay a premium for CMT? Does the quality of our work not count anymore? I have been scrupulous bordering on fanatical about accuracy, education, and production. If I worked for one of these services, is my work assumed to be of lesser value because I am not a CMT, regardless of how good it might be IN REALITY?

I am very confused right now and if I were younger, I assure you that I would probably make a sharp U-turn at Careerville. Newbies are facing great surprises, particularly in hospital work. If my present situation--as one of those overpaid, pampered, glorified clerk malconents in transcription--is an indication of future changes, it is dark indeed.

Now the story is going to get worse regarding "compensation." Possible rumor is, no incentive at all. Base pay, period. In two weeks, we should know the answer. The new system went up on Monday. Yesterday was my first day back on my evening shift. I was "trained" in five minutes by our supervisor and our systems manager, neither of whom have system figured out yet. No phrases entered. No explanation of what reports ready to type, etc.

6/96, Judy in Portland wrote about a USA Today article:
I read the article in the library today. It's an interesting program. From what I read the hospital has purchased computers for their employees to work with at home. They did say they are careful to pick the most computer-knowledgeable employees. The hospital is happy with the increase in production this program brings them . They said they were thinking about letting go one of their outside vendors, but it wasn't clear to me if that was an outside transcription service or what. How are the employees paid - is it still per hour or line? From what I read they are still considered employees, not IC's.

I'll be interested to see if this is a trend for the future in transcription - some of the benefits of at home work for the employees, but lower rates and more control for the employer (as compared to a service).

From Stacy:
In order to work in our home program, we must have been employed by the hospital for at least six months and transcribe a minimum of 13 minutes/hour. Then we must take a "computer literacy" evaluation (no need to be an expert, but we need to know at least about directories, moving files, etc., so that we can do our own trouble-shooting, maintenance tasks, and occasional upgrades). The supervisor visits the home to be sure that the work site is acceptable (good lighting, privacy, good ergonomics, etc.). After we are accepted into the home MT program, the hospital sends us home with a computer and modem, digital transcription station, chair (we each had our own chairs in the office anyway, so we take them with us), reference materials, and extra phone lines. We work in shifts basically the same way we would if we were in-house, with specified start and finish times. (Our supervisor is wonderful about being flexible with this, though.)

With the shortage of transcriptionists here and several current openings in our department, the department is having to send some of the work to outside services. However, it is much more cost-effective to do the work in-house, and the home program seems to been a positive step in that direction as far as increasing production, reducing absenteeism, keeping employees happy, and attracting new employees who like the idea of working at home with the benefits of being an employee rather than an IC. We are paid per hour and have full benefits. For me personally, this has been wonderful!

From Stacy:
If the supervisor feels that the work site is unacceptable, you would either have to make changes so that the site would be acceptable (there's not a lot to that, really; the most important is that you have a desk in a quiet area of the apartment or house, good lighting, grounded outlets, and a keyboard that is at the proper height) or else you would have to continue working in-house at the hospital. To my knowledge, no one has ever had a problem in meeting the home site criteria.

There is a standard evaluation "checklist" for these site visits which deals mainly with workstation setup, safety, and security. There is also a "telecommuting contract" specifying the responsibilities of the employee and the hospital with regard to equipment, confidentiality, and safety of the work area, as well as procedures in the case of equipment failure, power outage, etc.

6/96, from Tracy Hughes, TCHughes@gnn.com:
There has been much discussion lately about comparisons between the national services. I'm relatively new to working at home (currently at 1-1/2 years at home after working several years in hospitals). I'm trying to get an overview of what's out there and some of the benefits and drawbacks of each MT company.

1. Does your company have an adequate supply of work, or are there sometimes "slow" days when you are asked to come off the account?

2. Does your employer provide the equipment you need to work, or do you?

3. Are you required to pay the phone bill or any other "extras"?

4. What is the pay range at your company, and are new hires (regardless of years of experience) started at the bottom of the pay scale?

5. Are there regular reviews and pay increases, or does your employer state that since you are paid by production and get regular software upgrades, that is sufficient for you to produce more, making line rate increases unnecessary?

6. Does your employer give bonuses to CMTs or actively encourage MTs to become CMTs and/or join the AAMT?

7. If your employer is not located near you, were you required to travel to them for any part of the hiring process?

8. Are there any benefits of your company that you feel significantly contribute to your success and make it superior to the many other services out there?

6/96, From Stephanie:
I took the CMT test in 1991 after two years of very thorough hospital experience (neonatology, neurology, oncology, psychiatry, orthopedics, GI, cardiology, pathology, radiology, and a few other specialties). I had 10 years of office experience prior to that (family practice, rheumatology, GI, and cardiology). I really don't think I would've passed the test without ANY hospital experience because that's what the test WAS: consults, op notes, maybe a discharge summary or two. I realize the test has changed since then. We had strictly 30 minutes of dictation to transcribe and that was the test. Now I understand the test is in two parts.

What makes the hospital experience so invaluable is the range of specialties, I believe. We really stay up to date on the medications doing all those ER notes and H&Ps. No matter what somebody is admitted for -- small problem or large -- they have an H&P and all their meds listed. I DO remember having to struggle with some meds on the CMT test. It's important to have up-to-date references if you take the exam.

As far as higher pay for CMTs, the hospital I work for doesn't directly pay more for that. You are, however, recognized and rewarded on your evaluation for seeking out continuing education by attending local AAMT chapter meetings, symposiums, conventions, etc. Also, another thing, our local chapter of AAMT will help pay for these exams if you are a member in good standing! I don't know if other chapters do this or not. A pretty good deal!

As far as the exam, I took it for my own satisfaction, and I'm glad I did. Some of this stuff you can't put dollar amounts on. The certification is also rather handy when looking for a job--I work for some doctors at home, and got the job simply on the recommendation of another CMT who I knew through networking with local AAMT chapter who knew the office manager. Never had to test or interview for these doctors....we have a great relationship so I assume they're happy with the work...been with them now for almost three years!!

From Betsy Gee:
It's also very possible to get work without certification. I am self-taught, having been "mentored" by a very kind podiatrist, who started me off with my first account. I have obtained every account since then, including one at the local hospital, strictly by word of mouth, recommendations, and my ability to market my services. No interviews or tests with any of them. There is no single "right way" to get into this field. Let your own abilities, instincts and temperament be your guide...good luck!
6/96, Christine Myers
The idea for this course to help MTs prepare for hospital transcription is a perfect example of what networking and brainstorming together will do for us. It's also the kind of thing the AAMT should be backing and helping to develop. Part of their job should be finding solutions to the difficult problems of getting the required experience to advance in the field.

An MT today that graduates from a course that follows all of the guidelines set forth by the AAMT on what to look for in a course will be very well trained BUT will not be considered for most jobs out there simply because of lack of actual experience. There's a big gap there between graduating and being ready to take that test for the hospital transcriptionist position and perhaps they should be helping us learn how to close it rather than lecturing on where to put the colon and we're careful enough with our pronouns.

I have no doubt that since the idea was formed it will happen now, simply because there are MTs out there who care enough and feel strongly enough about helping each other advance that they'll MAKE it happen. Amen to that and count me in!

6/96, Wendy Hunter
I've read so many posts about "hospital experience" that I must add my two cents. I was a transcriptionist for a cardiology practice for three years (radiology prior to that). When I was in radiology, we marveled at the abilities of the surgical transcriptionists - how did they learn all those terms and equipment and sutures.....? When I got my cardiology position, I was terrified - how would I learn all those tests and the medications....? I got burned out in cardiology and applied for a position at a local hospital advertising "three years hospital experience required". I knew that if I could conquer radiology, then cardiology, surely I could learn surgical. Lo and behold, I did - now I wonder what the big deal was. Now my coworkers and I marvel over those transcriptionists in BIG hospitals like Northwestern, Loyola, etc. - they really have to be on the ball and be on top of the newest procedures, instruments, meds, etc....I know where I'm heading next! Transcription is about learning. If you have the basic skills and the drive, you can go anywhere!
6/96, Peggy LaChance
Do you really need 3-5 or more years of experience transcribing hospital medical records dictation in order to survive with a large service? Maybe, maybe not. I tend to think that you might.

In order to work for a national service, you must be able to work in a completely independent manner. That means NOBODY to help you -- EVER. Granted, some services have editors, but you can't expect them to do your work for you. YOU have to be able to do EVERYTHING and ANYTHING which comes across your line, regardless of what it is, who is dictating, or how bad the recording might be -- and they're often pretty bad, especially if you have to download and re-record your dictation onto tapes to avoid paying excessive long-distance charges.

I do believe that the work done on a large teaching hospital account is more technically complex and demanding than work done at even large multispecialty clinics. While you may encounter a "recap" of an operation in your office dictation, you will actually get the "real" operation in the service dictation -- and it may be six pages long and will invariably be dictated in a recovery area, so you get to listen to an exhausted, mumbling surgeon who is NOT trying to be heard over several screaming patients, continuously clanging metal, beepers, audio systems, and LOUD commotion on the part of the OR staff.

I think one of the main differences between large teaching hospital and small hospital or clinic is in the sheer numbers of dictators you will encounter. I don't just do ONE hospital, I do SEVERAL hospitals, and each of them may have several hundred dictators! I may go days between hearing the same voice twice! They have no idea who I am, and they can't "dictate so I'll understand," because they assume I know everything I need to know. In clinics and offices, the doctors dictate to the level of the MTs -- this is something which happens automatically.

If you really want to start doing service work, I think you should start out working for a service close to home. Then, move up to something bigger when you're ready.

6/96, From: Russ Dunn, Regional Sales Manager, Medifax/SecrePhone, RUSSDORI@aol.com
Just a note to those who post on internet boards. Employment opportunities may vary in different parts of the country at different times. This is even true within companies with multiple offices across the country. If you are looking for work, try and give your geographical location, as many potential employers "surf" the net to keep abreast of industry issues. The most important asset for any transcription service is their transcriptionists and they know that.

Also remember that persistence pays off. Most transcription services give a test to prospective employees, regardless of experience. Your ability to perform may convince someone to give you a chance even if you do not possess the 2-3 years of experience they are looking for. Also large companies do enough variety of work where they are able to assign work to those with limited experience and gradually cross-train them into other specialties.

The bottom line is to not become discouraged too easily. There remains a real demand for medical transcriptionists and it is equally frustrating for employers to find and hire sufficient numbers of qualified people. If you are really dedicated to this field you will be persistant and find someone to give you a chance. Also remember that transcription services MUST meet the quality standards their clients demand. Work done by new employees, even with experience, must be proof read verbatim to insure these quality standards are met. This proofreading must be done by some of your most experienced people and is very expensive. This is why employers are hesitant to hire people with only the educational background and no real experience.

From Judy:
Wish I could figure out what's sacred about hospital experience. I've been doing this since 1989 for a multitude of specialties. When I was "in house" I saw plenty of awful transcription from the local hospitals in the charts so working at one is no guarantee of accuracy or ability. The same doctors that dictate at the hospital work at the clinics, and they don't necessarily use less terminology or detail in their dictations. They quote the same path reports, radiology reports, etc from the hospital. I worked for a local ER and didn't find a lot of unfamiliar words. The only real difference was that the hospital wanted 5 copies on a laser printer and only paid for the lines dictated so it was too much wear and tear on my printer. So why the insistence on hospital experience?
From Mary Morken: I think you make a good point about hospital experience not being that different from all the rest. For people with 5+ years of experience, I think you could argue the point and they would listen. They often have clinics as well as hospitals.
From Janie: I know there are below-average MTs in the hospital, too. However, when I went from clinic work to hospital medical records, I felt more than a little overwhelmed. They were willing to train me, so that helped a great deal. The operative reports were more technical, the specialties more diverse, the language more complex and less "layman's" terminology. I have done ER reports and found them much less complex than hospital medical records work. I also briefly did some radiology reports and found them less technical in some ways than the medical records reports. HOWEVER, I DO agree that if one has had a wide range of experience in clinic work (nowadays many clinics perform day surgeries and in-house procedures), then one SHOULD be considered a candidate for the job. After all, one thing with MT work, if you can't cut it, it is very obvious from the start. What would they have to lose? And they might have lots to gain in a new high-quality employee.
From Mary Morken:
You talked about Consultations and Ops and the vocabulary used. My experience has been different; while I had a lot of new terms to learn when I went from office MT to hospital MT, I had already been exposed to some consultations and ops while doing office typing, since some doctors have their own transcriptionists do those dictations. I think anyone with experience in a variety of specialities for years would not find hospital typing hard. When there are MTs with 10, 20 and 30 years still making $12 an hour, I sure hope they can give themselves a promotion to better pay wherever they can find it, and it's out there.
From Debbie Hahn, debbicmt@visuallink.com
The service I work for also requires 3-5 years experience at an acute care hospital. You simply cannot get experience transcribing OP notes by working anywhere except a hospital or other surgical facility, and the terminology used in OP notes is not to be found in a clinic setting. Most large transcription services have mostly hospitals for clients, and the volume of OP notes is generally heavier than any of the other types, at least at my service.

My advice to someone who has years of clinic experience but no hospital experience, and wants to go to work for a national service, is to try to find someplace 'on the side' where you can get some experience transcribing OP notes. The hospital in my town was willing to hire 'per diem' transcriptionists for fill-in and vacation and a few hours here and there, and that would be one way to get some hospital experience without possibly having to quit your 'other' job. Or perhaps you might find a small service or a hospital that would let you come in on your time (for free) and transcribe some 'old' OP notes. I think most national services that require hospital experience would still be willing to consider someone even with that sort of experience.

In response to Mary's note, that MTs with many years of office experience wouldn't have much trouble transcribing hospital dictation, I have to disagree somewhat. I started with this national service 5-1/2 years ago. When I started with them, I had just finished 10 years of working as sole transcriptionist for a group of 8 physicians. For the 10 years prior to that, I had worked in various clinics, and hospitals. My last 'hospital medical records department' transcription experience had been 10 years previous to starting with the service. When I started with the national service, even though I *had* worked in hospitals in years past, I floundered for the first few months - I had to look up almost everything related to OPs, and even though the Surgical_Word_Book was fairly new at that time and had a lot of terms I needed, there were many other terms, especially instruments and names of new techniques, and 'regional' terms that I had absolutely no place to look for. And working at home alone for a national service gave me no 'co-workers' I could ask or have listen on my earphones. It was a rough few months, but eventually started getting easier and at the end of a year I was up to speed on OPs.

A lot depends on the particular accounts any particular service has - of course some are easier than others. As an editor for this national service now, I can say without reservation that an MT with absolutely no hospital experience would never succeed with *our* service, with the client hospitals that we have. I have seen many try, and fail or give up in desperation. And we simply don't have enough 'clinic and ER' type accounts to put the less experienced MTs on.

From Catherine Baxter:
In the first place, you are absolutely correct about working in a hospital setting does not assure quality of work; however, if you have worked in a hospital setting with a good quality review program in place, an MT coming from that setting should be capable of transcribing most anything. The one single-most important difference is that a hospital-trained MT will "USUALLY" have experience in transcribing operative reports. You won't find a clinical MT with experience in transcribing organ transplants, open heart surgeries, hip replacements, and maxillofacial reconstructive procedures, just to mention a few.

In the past, when I was in a position of hiring MTs, I would take into account the particular hospital or clinical setting that the experience was gained in. If you transcribed at a major medical center facility, more than likely you would have a broader knowledge base than an MT who worked only in a clinical setting or who worked solely for a small community hospital in a rural setting. There are few, if any, hard and fast rules in this business...just guidelines taught by experience and the school of hard knocks. Oh, there is one rule that rarely, if ever, should be broken: If a physician spells a word for you, look it up!

From Alisha:
While I definitely agree that, in general, hospital experience is needed - I recently worked for a plastic/hand surgeon and occasionally typed consultations, procedures and op notes for his extremely specialized field. While I knew a lot about what he did, I had about a three-month learning time in which I was looking everywhere for some of his terminology, tests, procedures, etc. Yet, in hiring my replacement when I left the job to move elsewhere, I had to refuse numerous applicants because they were fresh out of school and there was no one in the office who could help them learn the language. Out of about 30 applicants - two were acceptable - the first hired stayed with her former physician's office which finally put her to work full-time with a raise to keep her - the second could not work both days preferred by the doc, but seems to be working out well and certainly knew the lingo.

So, there are special cases in reverse. I still have to use my references for EENT work, and different eye doctors around the country dictate their notes a little differently than others, so there is always a learning curve for something.

Ah, yes, it's funny that doctors can't spell the words they use every day, isn't it? However, can the average person spell some of the words in every day use - a woman hired for radiologic MT in my transcription room spelled 'pneumonia' differently every time she typed it - and she never even had to use a dictionary!

I believe the most important thing a transcriptionist needs is the ability to figure out where to look and what to look for - let's see, what else sounds like "sss" .... we have c, s and, oh yes, ps as in psitticosis. It's a tough one for sure.

From TJ Currey:
The one-year course that I took at Linn-Benton Community College (LBCC), in Albany, Oregon, had within their course only hospital transcription. The test tapes we had included autopsies, intense op reports, discharge summaries, etc., etc. I was one of the lucky few and got hired 3 months before the course was over, at The Corvallis Clinic, which happens to be a huge multi-speciality clinic (over 65 physicians at that time, all specialties). I had no clue what a CHART NOTE was until I started working for the clinic!

I was asked by the administrators of the LBCC course to come back the next year and speak to other hopeful transcriptionists and nurses regarding the program, because they were going to completely revamp it, and my imput was that basically they needed to start covering clinical stuff as well, because not all transcriptionists run to the hospitals to find a new job. At that time, I was lead medical transcriptionist at The Corvallis Clinic for swing shift, in charge of six other transcriptionists, one of which trained me (AAAAKKK!).

My own humble opinion is, is that any med. transcriptionist with drive, determination, and the "know how" to find things quickly in books should be given a chance nearly anywhere. I've never had a day where I didn't learn something new, whether it be doctor lingo, a new drug, a new procedure, and frankly, every day can be new to learning things. As long as you have the patience, a good ear, and an aptitude for the job, the door should be open no matter where you look.

I had a wonderful woman looking over my shoulder when I was in the learning phase, never telling me the answers when I had a question, but breaking apart the word or looking at the surrounding words to get the idea of she showed me HOW to look for the answer--frankly? I think that's the most important skill a transcriptionist could have, and yes the dictionaries are there, and yes, the word books are there, but if you don't know how to break apart the word or look at the surrounding words to get the idea of where you are at in the body and what disease process you are currently typing, it's hard to find a word you only heard part of, or not at all.

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