DO NO HARM by Allen Langley

I am a former Coast Guard Hospital Corpsman. We were taught quite solidly about risk taking and treatment under stressful situations. I recall vividly a certain phrase that really stuck with me—DO NO HARM—and what this meant to patient care/crises.

This is applied to a situation where a patient may have to be treated while unconscious and obviously unable to help the caregiver. It is a guiding feature when medics on the scene of an accident automatically place injured patients on spine boards, not allowing a victim to suddenly get up and start walking, etc.

Applied to medical transcription, it has everything again to do about risk taking. I abhor blanks. They are an ugly manifestation of failure in communication. But of greater abhorrence to this writer is the out-and-out sin of GUESSING and its cousin, ASSUMING. Guessing is a hell-bent attitude sometimes forced by a transcription service and sometimes forced by the "professional pride" of a transcriptionist, and it screams full face into the admonition: DO NO HARM. In some parts of a document, guessing (assuming) can be benign, but this benignity is short-lived when dealing with medications, dosages, allergies, injury history, etc.

I have never been called on a blank wherein I explained the reasons for leaving it dealt directly with doing no harm. I have never been called on the carpet by any physician for leaving a blank and have actually had a few "thank you's" passed along to me.

The other kind of blank that should not be left...

If anyone is doing this at home, you should be committed to the point of having the latest and best references and continue to read any medicine-oriented materials available to you. My personal favorite is the Merck Manual (published by Merck Pharmaceuticals). This is no work for the faint at heart. It covers hundreds of disease processes and treatment of same. It is rich in medical terminology, and it will sharpen your understanding of medicine. A new Merck comes out every two years or so and the fresher the better. Hooray for English and grammar skills, but understanding medicine to some degree is an inherent requirement for transcribing accurately the information generated in the field.

If you do not cover yourself with a depth of knowledge, there will be few takers in the medical field for your typing skills. Some of us may have had contact with persons who come selling themselves as fully capable of taking on this work, only to find that in the trenches they shoot blanks because they haven't the knowledge of medicine to do the best job. Truthfully, it is why it is so difficult for a newbie to break into transcription. It is also why a good transcription supervisor will take upwards of a year to train a new transcriptionist — even after graduating from a college or technical school course in medical terminology and transcription.

Blanks are a necessary evil when the corrupted communication lies at the feet of the dictator or an equipment failure at the dictation source.

I have had a share of muttering, fire walling, comma crazy, staccato delivering, soft speaking, lazy, tired, just-off-the-boat doctors. I do them all for the most part with gusto; however, I am unashamed that I have turned back work that was so fully lost that even the hospital of origin has had to ask the doctor to redo, or their own MTs have had to actually pull the medical record to complete the report themselves.

Rest assured, the good doctor no more wants bad information than anyone else. DO NO HARM. We gave out every year at our hospital THE SILVER TONGUE AWARD to two doctors (250 physicians). These folks actually competed for this honor and looked forward to receiving the plaque. They have to be reminded that someone human is on the other side of the handset listening to whatever they are saying, taking it seriously, and producing an intelligible typed record from it.

I love the physician who says at the end of a report, "If you had difficulty understanding any part of this report, please call me at ext 555 for help." (Usually, this is a concise, dot the "i's" type and almost never needs the call.) This kind of request is generated by competition and sometimes it is even generated by the physician really wanting his record to be the best it can be for the patient (and lawyer). How about a doctor who comes up and says "Allen, I sure am sorry about that sloppy dictation on Ms. Smith, but I had Mr. Jones waiting on the table and they were paging me." Frying Smith to save Jones, but the doctor knows you were at the receiving end of an ignoble effort.

There will always be blanks — the best are those generated by common sense and the worst are those generated by ignorance.

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