Have you read a hospital chart carefully?

[Are_grits_groceries]

(Actual writings from hospital charts) 

1 . The patient refused autopsy. 
2. The patient has no previous history of suicides. 
3. Patient has left white blood cells at another hospital. 
4. She has no rigors or shaking chills, but her husband states she was very hot in bed last night. 
5. Patient has chest pain if she lies on her left side for over a year. 
6 On the second day the knee was better and on the third day it disappeared 
7. The patient is tearful and crying constantly. She also appears to be depressed. 
8 The patient has been depressed since she began seeing me in 1993. 
9. Discharge status: Alive but without permission. 
10. Healthy appearing decrepit 66-year old male, mentally alert but forgetful. 
11. Patient had waffles for breakfast and anorexia for lunch. 
12. She is numb from her toes down. 
13. While in ER, she was examined, x-rated and sent home. 
14. The skin was moist and dry. 
15. Occasional, constant infrequent headaches. 
16. Patient was alert and unresponsive. 
17. Rectal examination revealed a normal size thyroid. 
18. She stated that she had been constipated for most of her life, until she got a divorce. 
19. I saw your patient today, who is still under our car for physical therapy. 
20. Both breasts are equal and reactive to light and accommodation. 
21. Examination of genitalia reveals that he is circus sized.
22 The lab test indicated abnormal lover function. 
23. Skin: somewhat pale but present. 
24. The pelvic exam will be done later on the floor. 
25. Patient has two teenage children, but no other abnormalities.
(from an email)

Need a Stupidcheck.

[WingDinger]

1. Nurses, and some really sweet, good ones, all seem to be non-caucasian, engrish speaking these days.

[Egalitarian Thug]

4. Philippines largest export; People, particularly nurses.

The problem, after the fact that they are brought in specifically to suppress wages, is that frankly their education is sorely lacking. As anybody in health care can tell you, the language of health care is very specific and very difficult to master and misunderstandings can and do lead to bad things including death.

[cynatnite]

33. Um...no...

There is a nursing shortage in this country. That is why nurses are being imported. Not only that, wages for nurses are generally pretty decent. A nurse can make 50-60K a year right out of nursing school depending on where they live.

[riverwalker]

39. no shortage here

at least in Minnesota.

[cynatnite]

42. Well, this data says even in MN there is a shortage...

http://healthyamericans.org/states/?stateid=MN#section=1,year=2012,code=undefined

Of course, some specialties are in more dire need of nurses than others. The aging population is probably where nurses are needed the most at this point in time.

[Egalitarian Thug]

41. Sorry, I know that's the rap but it just ain't so, or at least it isn't

here in the west. Every hospital, clinic, and office says they're looking for nurses, but they are not hiring the dozens of applicants they get for each position. What they want is a warm body that'll fulfill the quarterly report for $9 an hour so a local manger can make her numbers. Nobody gives a crap about the patients, they're just the current crop of insurance claims to run through the chute.

Are you a nurse? If there's such a great shortage of your colleagues why aren't you making more money?

[cynatnite]

44. I do know they're not going to hire just anyone for those jobs...

A lot of them look for GPA's of at least 3.0 and a decent to above average NCLEX score. Not only that, clinics and offices are the most prized positions for nurses. They're less work, less stress and can be high paying. Also, some of the better paying nursing positions are usually the most competivie. Neonatal units, surgical, and ER's are where a lot of the students I know want to go.

The least liked areas are geriatrics and hospital wards.

Also, there are waiting lists for nursing schools these days because they don't have enough qualified instructors.

I don't know who you know or what your experiences are, but everyone I've ever worked with in the medical field care deeply about their patients. As much as people want to do it for the money, you're no good to anyone if you don't care about the patients your there to take care of. That's a necessary attribute.

I spent many years in the medical field as an aide, medic and ER tech. I start nursing school tomorrow actually.

[Egalitarian Thug]

46. I'm talking about nurses with years of experience that can get in the door for an interview,

not new grads. Women (mostly) with years of experience and sterling histories and references, and the best they can get is an occasional temp gig with a shitty per diem and no benefits.

Where are you (generally, nothing too specific)? Cause out here it's corporate hell, a terrifying vision of the future of health care run by spreadsheet for LLC's under insurance company rule. I'm going to tell my friends to get to where you are, cause there's no point in staying here.

[cynatnite]

47. I don't know where you are at so I can't comment on that specific area...

I know in my area that there is nowhere near enough nurses. My aunt is an experienced RN and she makes well over 50k in Oklahoma. The friends I know that have graduated nursing school have had no problem with getting a decent paying job.

I can look online and nursing jobs are everywhere. There are sign on bonuses everywhere. The highest I saw was $12,500 which was in Texas. One girl claimed 50k sign on bonus, but we figure it was in a real crap hole or she was lying.

I think the jobs depend on specialty, regional need and cost of living.

The latest stats I've read says that upwards of 50% of all nurses will be retiring in the near future. The need for nurses is not going anywhere anytime soon.

At the site below, you'll find the states that need nurses the most. I'm in TN and we need over 18,000 nurses to fill the void.

http://healthyamericans.org/states/

http://www.nursingworld.org/nursingshortage

[Egalitarian Thug]

51. We're here in Vegas Baby!

I came out of a computer background, so I'm rather skeptical about stats and online adverts. According to them there are not enough qualified people to fill the millions of mythical jobs in the field and Monster/Dice/etc. have tens of thousands of ads up. The problem is that there are many reasons to post a position other than to fill it. There are lots of ads here too, but the jobs never seem to get filled.

But you have first hand experience with this, so I'll forward it to them and hope something comes from it.

[A-Long-Little-Doggie]

5. So many slurs in so few words.

"Engrish"?

[kentauros]

10. Try this reference:

http://engrish.com/

[patrice]

24. Does referring to "non-standard English" make it less slurish? It's the SAME truth. nt

[Mairead]

60. That's not really a slur, it's a phonetic representation of pronunciation

Japanese speakers don't distinguish between R and L, just as Chinese doesn't have separate pronouns for "he" and "she". And we don't encode word-meaning in our tone use. So hilarity --we can hope it's good-natured hilarity-- is bound to ensue.

I smile at the "Engrish" mistakes, but in sympathy. I can just imagine a native speaker's reaction to the mistakes I make when I translate into some language in which I'm not completely at home and don't have a proper dictionary at hand. (I did that the other day here, in fact. I used a word that translates correctly, but is nevertheless the wrong word. Any native speaker doubtless had a good chuckle at my expense)

[Art_from_Ark]

63. Actually, we do, in a way, encode word meaning in our tone use,

that is, in our intonation. Speaking with an intonation that is different from normal is one way of expressing sarcasm. That's why sarcasm expressed with just the written word is often so hard to recognize on this board without the accompanying smilie

[Mairead]

64. I agree that we encode emotion in tone, but

I can't think of an example where, e.g., sarcastic intonation changes the meaning of any individual word rather than changing the meaning of the whole phrase. Can you?

[Art_from_Ark]

65. Great!!

Great...

[Mairead]

66. *snork*

Okay, one- or two-word phrases can have their connotation (but not denotation) modified by emotion.

[rustydog]

27. A good 90% of the calls we receive regarding Code Gray (out of control patient)

involve asian nurses. Even though they speak English, the accent is hard for patients to follow and the nurses seem reluctant to try something other than: "Take this or you die", Or grabbing the angry person's arm and trying to administer medication without identifying the drug or asking the patient's permission!

[patrice]

29. I know an over 40 yr old Nurse Practioner who is saying that what's coming out of the nursing

schools is significantly declining in professional rigor. She refers to diploma mills.

[patrice]

31. I know it's anecdotal, but I have also talked to nursing students who said that they were

concerned about people in their license programs who seemed clearly more interested in finding marriageable opportunities than they were in their jobs. My guess is that there's too much "collaborative" learning going on, so people can get through programs without knowing everything they need themselves.

In a down economy, it's a secure job immediately anywhere in the country; we have to think about the effect of that fact upon how people decide that it's their profession.

[dflprincess]

40. Some hospitals also try to mislead patients and families by leaving titles off name taqs.

So that person your elderly mother called "nurse" may actually be an aide. I believe the Minnesota Nurses' union was fighting that but I don't know how it came out (I did notice at the hospital my mom was recently in the badge did say "R.N.&quot .

[Egalitarian Thug]

2. Still trying to figure out what was meant in #17. K&R LOL! n/t

[pennylane100]

7. They were just trying to be thorough.

[treestar]

9. Patient's thyroid is in an unusual place!

[Egalitarian Thug]

15. Or maybe the proctologist grabbed the extra, extra long colonoscope? n/t

[NYC_SKP]

16. Subsequent exams revealed normal elbow, ears, shoulder blades, and uvulae.

But the taint was found to be a bit traumatized.

[Sherman A1]

3. Priceless!

[randome]

6. I'd like to see those x-rated x-rays!

[treestar]

8. hahaha

like that list of stupid lawyer questions!

has been depressed since she began seeing me in 1993

[Odin2005]

11. #17 = WTF???

[Are_grits_groceries]

12. Looooooooooooog skinny arms. nt

[Rhiannon12866]

13. K&R! Funniest thing I've read all day!

But also scary as hell!

[shcrane71]

14. Another example why US healthcare is simply scary. nt

[Arkansas Granny]

17. Circus sized? Can you convert that to inches?

[Riftaxe]

35. That must of been one heck of

a Bris

[HillWilliam]

43. Do you want that in English measure

or AOL inches?

[Arkansas Granny]

49. Either one will do, since we've always been told that

this



is six inches.

[HillWilliam]

50. Oh, AOL inches then

[Baitball Blogger]

18. This happens because nobody respects English Majors.

[patrice]

26. That's more true than many people assume. Imagine the confusion for ESL cohort anywhere and

everywhere and then turn that confusion into what it costs $$$$$$$$$$$$$$$$$.

I kind of blame the "learning style" craze. Not that learning style is irrelevant, just that students need a balance between, e.g., "I'm an aural learner" and learning by reading and writing.

Grammar also needs to be taught as it's own subject in order to get people to think about the logic of English. But no one will do this, because it's just too politically incorrect and "there's no market", i.e. markets DRIVE what is taught, rather than the worth of a particular content area in and of itself.

[Ruby the Liberal]

19. Those are great!

#17 was quite the invasive exam.

[progressoid]

25. Talk about the 'fickle finger of fate'!

[GreenPartyVoter]

20. Ay-yi-yi-yi!

[LiberalFighter]

21. Funny! Where was this originally found?

[rocktivity]

22. #19: "(P)atient...is still under our car for physical therapy"

Maybe the physical therapy would be MORE effective if they got the patient OUT from under the car FIRST.


rocktivity

[rocktivity]

23. And now for something completely different: Reading car accident reports

"The other car collided with mine without giving warning of its intention."

"I collided with a stationary truck coming the other way."

"My wench slipped, losing my balance, and I hurt my back."

"An invisible car came out of nowhere, struck my vehicle, and vanished."

More


rocktivty

[justgamma]

28. True story. It happened to me.

I have a plate and screws in my ankle. One of the screws came loose. My bone doctor told the local surgeon to just take the screw out. He acted like he had never seen anything like that. He told the nurse to call maintenance for a screw driver. LOL

Anyway he ended up taking a tweezers and taking it out.

On my chart he wrote." Screw loose, removal of hardware."

[LiberalAndProud]

58. It's good to have surgeon with a sense of humor.

That really is funny.

[silverweb]

30. Possible reasons:

[font color="navy" face="Verdana"]
(1) Medical staff using voice recognition software, with resulting transcripts not being reviewed/edited by themselves (dangerous & foolish!) or a medical transcriptionist/editor who can refer questions back to them.

(2) Foreign and/or ESL medical transcriptionists/editors without adequate supervision/quality assurance to make sure such errors do not get into the final medical record.

(3) These are examples of errors caught and corrected by dictators/transcriptionists/editors/quality assurance staff before finalization. My former supervisor would collect these kinds of things and send them out to all his transcriptionists for (a) chuckles and (b) warning of what can happen without proper attention.

[patrice]

32. Looks like something that the nurses unions should step up to the plate on. Who best to

address professional standards than the workers themselves, that is, if they weren't so busy defending themselves from termination by some "health" "care" corporate-citizen number grinder.

[silverweb]

34. Nurses can complain, certainly.

[font color="navy" face="Verdana"]Unfortunately, I don't know that they can actually do much otherwise.

Ultimately, the accuracy of a medical record is the responsiblity of the person who wrote or dictated it. Practitioners who dictate medical records are legally liable for reviewing the resulting transcripts for accuracy before signing off on them. Anyone who skips that step is a complete fool.

Those of us who transcribe/edit medical dictations are all too well aware of our responsibility to get them right. Medical transcription has been transformed over the past decade or so from small local companies, independents, and professional in-house staff to corporate drones employed by monstrous entities competing with each other for proprietary software market share. Even so, we are acutely aware of our responsibility for accuracy and have some pretty rigid standards in place.

In the end, however, it comes down to the practitioners who dictated the reports being responsible for their final content. If they're not happy with the work they should let us know, but they should never ever sign off on something inaccurate or substandard.

[patrice]

37. I guess what I'm thinking here is something more formal process-wise, something with actual power,

something more than complaining, between layers of what looks like a seriously stratified environment. Edward Demming-esque regular quality assurence and assessment systems with profession-specific liasons that are responsible for feedback and processing specific self-knowledge performance data within the organizational construct. Just brainstorming here about problems my family has encountered with care, especially elder care, over the years. I know that there are aspects already in the systems that does stuff like what I'm thinking of, reporting systems of various kinds, but I wonder if it isn't at too high a level, not granular enough, and not nearly directly enough amongst ALL of those responsible for the actual work, whatever that work is, itself . . . there appears to be hard systemic lines preventing effective organized communication between areas, to mentor and deal effectively with problems.

[silverweb]

52. Possible, I'm sure.

[font color="navy" face="Verdana"]I work at home, like so many transcriptionists today, and have no direct contact with anyone in the institutions I transcribe for.

It would take someone familiar with the strata and structure of a hospital/clinic setting to figure that process out. Committees and such, I'm sure.

[cynatnite]

45. The hospital I used to work at used VR for a good portion of their doctors...

The transcriptionists usually worked out of home and didn't have access to patient records. I did transcription work in an OBGYN clinic and it made for an easier job with access to the patient charts. We were still paper and the records room was just down the hall. We also had access to patient information on the computer.

With as difficult as it was to understand some physicians at times, I can only imagine how difficult it was for those transcriptionists who did not have access to this information in order to prevent critical errors.

With all the transcription work that was outsourced oversease, I wondered how those ESL did a decent job. I wonder if some of these silly errors were the result of an ESL transcriptionist.

[silverweb]

53. Probably a combination of factors.

[font color="navy" face="Verdana"]VR comes up with some hilarious/ridiculous misinterpretations of things. Doctors with heavy accents, who can't enunciate, or who just talk too damn fast don't do well with VR, and ESL transcriptionists, no matter how hard they may try, are similarly limited.

Access to prior reports on a patient is a great help, but HIPAA restrictions curtail that. Sometimes we just have to send reports with blanks to our QA people, who can then contact the dictator for clarification, who then might try a little harder to be clear and/or give us the opportunity to create a template for that dictator.

Do you still do transcription?

I have to get back to it... 2 more hours in my shift tonight.

[cynatnite]

54. No...

There was me and another transcriptionist at the OBGYN office. She has been at it for 25 years and she was very protective of her position. I was new out of a technical school and their program was not that great. It just made for an uncomfortable situation. I was supposed to fill in 1 day a week at an internist office, too, but it was no different there.

It seemed like they were very protective of their positions and it was very competitive with the rest of the transcriptionists. I loved doing the work, but the competitive nature took out the enjoyment I got from it. When I first started I was at 65 LPH and when I left I was at over 100 LPH. That took about 10 months of work to reach 100.

I was told by my supervisor I would likely never get to work out of my home. That was when I saw I would never get anywhere at that position and under those conditions I wouldn't get far.

I said screw it and went back to school. Just got accepted to nursing school and I start this week. I'd rather do clinical work anyway.

[silverweb]

62. Congratulations on starting nursing school!

[font color="navy" face="Verdana"]I hope you love it and find it immensely rewarding.

Because I've worked at home for years now, I haven't personally experienced the competitiveness among in-house transcriptionists, though I don't doubt for a minute that it exists. The rapid computerization (including voice recogniton) and corporatization of our work has left a lot of transcriptionists feeling very threatened, which is apparent from MT discussion boards.

Basically, many MTs now work harder for less in return. Computerization and being removed from the in-house clinical setting means a certain amount of isolation and depersonalization, as well as having "more, better, faster" demanded of us.

In any case, I'm still doing transcription and still enjoying it, but I also feel very lucky to be near retirement age, a natural night owl (working hours that few others want), and without a need to compete for work.

Best of luck to you in school and in your future clinical profession!

[TahitiNut]

36. "Rectal examination revealed a normal size thyroid." OUCH!!!

Man, talk about a THOROUGH rectal examination, with a VERY long endoscope or (even more worrisome) digital probe!!

I wonder if they checked the heart and lungs en route??

[malaise]

38. Hilarious

[Stinky The Clown]

48. Funniest thing I've read in a long time!

K&R

[HiPointDem]

55. charts more likely to read something like this: Pt w/ hx cvd, dvt, c/o chest pain.

[Are_grits_groceries]

57. Are you the Post Police?

You seem to take issue with quite a lot of things.

Charts have had and do have some odd remarks. You seem to be an expert on all of them though.

[HiPointDem]

59. looks like you are, actually. all i was saying was that medical personnel typically chart using

abbreviations, not full sentences. which is true.

don't know why you have a problem with it , or me, such that you felt called to make it personal, which i didn't.

[silverweb]

61. Translation.

[font color="navy" face="Verdana"]This: Pt w/ hx cvd, dvt, c/o chest pain.

Translates to: Patient with history of cardiovascular disease, deep vein thrombosis, complains of chest pain.

A dictated hospital or clinic chart would never be allowed these days to look the way HiPointDem's example does, but a hand-written chart in a private office might (where no one but the doctor and staff have to decipher it).

[fruitsmoothie45]

56. Ahahaha... this made my day!

"Circus sized". LMAO.