After almost 11 years as an MT it is not words like mesencephalohypophyseal or lactoylglutathione that make me stop and do the Macarena! Without even thinking about it I know exactly which hip to swivel on and which hand to throw up behind my head in order to grab the book needed to verify a medical spelling, my eyes never have to leave the computer screen and my ears never miss a single word of dictation as it plays in my ears.……. mesencephalohypophyseal…. Dorland's page 1089! Hey! Macarena!

It is those other words that trip me up. Good old English language words, obscure perhaps, indigenous to a specific country, state, town, not really slang, but certainly colloquialisms that are fully understood by the dictator, the nurses, the patient...and, 9 times out of 10, whose meaning is a puzzlement to the MT, who might be a country away or just one mile down the road, trying to make sense of the voice coming through the headphone! These words slyly hide in the middle of a sentence, tippy-toeing around to smack me right between the eyes and bring my production to a screeching halt while I attempt to locate a proper spelling; make the all important decision... edit or not edit; flag it or not to flag! These are words that make QA supervisors gnash their teeth in frustration while they watch MTs using up precious minutes trying to document them; words they don't teach you about in MT school; words that the dictator took the time to speak and darn well wants in the medical record..."that is what I said and that is what I meant, put it back in there right now!" ...says the dictator... Hey! Macarena!

Some days I feel like one of those people in Russia who make a practice of jumping into a hole chopped out of river ice in the middle of winter, my body in total shock as I root around on an old bookshelf trying to locate a Spanish-to-English dictionary used years ago in high school because the ESL (English as second language) dictator forgot what country he was seeing this patient in... "patient states he has dolor de echo con nausea, vomito o sudor and he just does not feel well... " Macarena! Macarena! Macarena!

Medical words are by and large self-explanatory. If you can break the word down into its syllables you can pretty much figure out what it means and whether or not it is appropriate given the context of the dictation. Laryngectomy means just what is says, larynx-larynx, ectomy-excision, laryngectomy, excision or resection of the larynx. English words get a lot trickier!  When the dictator says the "patient was scorched" the MT is expected to know from the context of the report whether the patient has a bad burn; had too much alcohol to drink; took an overdose of drugs; is having a very bad temper tantrum or whether that portion of the dictation needs to be flagged because the word makes no sense at all... Hey! Macarena!

"EMS report from the scene says patient was the belted driver in a T-bone." Certainly no one smacked (belted) the patient in the face, in this instance the word is a shortened form of seatbelt, a mandatory safety requirement for drivers in many states. Not wearing the belt at the time of an accident often results in the car insurance company refusing to pay medical costs. Webster's shows that a T-bone is a cut of meat and I don't think that dictator was taking a stroll through the butcher's section of the grocery store while doing medical records! T-bone is the shape made when one car hits another smack in the middle and forms the shape of the letter T when the two vehicles come to rest, a common accident that happens frequently at intersections when one driver is not paying attention. Even though it will not be found in a dictionary it is a commonly accepted term used by ER physicians, patients, the insurance company and should be used in the medical record exactly as dictated. A couple of weeks doing emergency room reports is enough to douse any MT with a lot of very cold ice water and make clear that physicians have a language all their own; a language that has nothing to do with dictionaries, medical or English.... Ohhhh Marcarena!

Sometimes it is perfectly valid words that cause the hips to swivel and rotate in the chair while the MT does the "double-reference grab" (subconsciously ticking off the mental minutes used to search through the references) and to make decisions about what words do and do not get included in the medical record.  If "patient presented as a crispy critter..." floats through the headset it is probably a good idea to edit the dictator's slang. Crispy critter is a descriptive phrase for breakfast cereal with a crunchy, toasty texture. It is a phrase often used by emergency personnel to describe badly burned patients. It sort of goes hand in hand with another commonly heard phrase "patient is a train wreck..." meaning a trauma victim coming in with multiple serious injuries. Unless I am on a strictly verbatim account (what the dictator says is exactly what gets transcribed, no exceptions) that is edited to "patient presented as a burn victim...or patient has multiple injuries" and the report will be flagged with a "dictated/transcribed" note. A little hip swivel and twist in the chair and on we go to the next dictation ...Ehhhh Macarena!

One thing MTs learn the hard way is to avoid second-guessing what the dictator really meant to say! Just because a word looks or sounds weird or is not one we would have chosen to use does not change the fact that it is a perfectly valid word that needs to be transcribed exactly as spoken. One cardiologist I have transcribed for years uses the phrase "eyeball ejection fraction is..." when recording echocardiogram results. Thinking he could not possibly mean "eyeball"... perhaps he really meant "estimated” that phrase was flagged and referred for verification ... he really did mean eyeball, as in that is the way the test results "looked" to him and back that word went into the patient record...MACARENA!!
 
I live in Florida, the Deep South, a place where story telling is not just a tradition, it is a way of life. Medical dictation is no exception to that tradition. Hospital administrators may admonish the dictators about brevity and cost effectiveness all they wish, but southerners just do not know how to make it "short and sweet"... I suspect it is some sort of genetic deficiency... they "use as few words as possible" gene got left out of the pool somewhere along the line. It is not at all uncommon for me to transcribe the exact recipe for the collard greens and grits, cooked by the patient's third cousin once removed, that was detailed by the patient during his gastroenterology consultation. Southern dictating habits present some unique challenges when it comes to documenting words used in a medical record. Where else would one go but to the Burpee Seed Catalog to verify whether or not zipper cream peas get capitalized or if cow peas really exist? The Farmer's Almanac is the definitive source for learning that swamp cabbage (a generic term) really is a tasty dish enjoyed by many Florida crackers (derived from the sound made by the whips used to drive cattle to market when Florida was first settled by pioneers); the inner heart of a palm tree's trunk, cooked slowly with pieces of fatback (Webster's page 516)...feet dancing on the foot pedal and a shimmy-shake of the torso as I perform the over-the-shoulder, eyes-closed, toss of the reference book  back onto the bookshelf....Macarena!

My teachers never told me in MT school all those years ago that I would one day be citing Jeff Foxworthy, standup comedian, as a reference source... does the dictator mean the patient's neck is really red or does the dictator simply mean "redneck" as a generic description for someone who lives in the rural south and works on a farm? Redneck used to be considered derogatory slang, judiciously edited, but over the last few years it has morphed into an odd badge of honor that many southerners use to describe themselves with pride, moving out of the slang category and onto the list of acceptable terms for the transcribed medical record.

Macarena! Macarena! Macarena!

© February 2002 Renee M. Priest, CMT
Renee ("Nae") Priest, CMT, has worked as an off-site, acute care, MT for Gilbert Medical Transcription for 11 years. Her unique perspective on the working world of MT can also be found in humor columns in "The Latest Word" and "Perspectives."