For years, physicians have been dictating their patient reports while medical transcriptionists have been trying to figure out what they’re saying. A recent article in For the Record discusses how technology such as electronic health records (EHRs) and speech recognition are turning these transcription challenges into serious downstream problems and what can be done to fix it.

Various habits and practices cause poor dictation, and even articulate dictators can sometimes fall victim to one or more of them. The propensity to multitask also can undermine the quality of the dictation. Physicians may eat or yawn while talking. They may be trying to speak on a speakerphone while driving in the car with the windows down. Oftentimes, dictation is done with others in the room so the medical transcriptionist must decipher one voice among four others in the background.

Unfortunately, the more physicians in a health system, the broader the range of poor dictation excuses. Melissa Campion, RHIA, CHDA, CHPS, CMT, an eHIM senior systems analyst for transcription at a big integrated health system in Melbourne, Florida, says that foreign accents, which many would assume to be an issue for transcriptionists, aren’t always a challenge. “The accents are actually easier to deal with because most of the doctors with a heavy accent are aware of it and try harder to make it clear,” Campion says, adding that her team has more difficult with dictation from physicians from the Deep South who may be oblivious of how their accents come through in the reports.

However, poor dictation isn’t really about accents, background noise, or speech patterns. Manager of transcription services at Lancaster General Health in Pennsylvania Kathy Lengel says communicating correct and complete data in an effective manner also can notably influence the quality and timeliness of the final report. “Poor dictators are very inconsistent in the format they use,” she states. “They don’t provide good patient information, and some of our poor dictators enter no patient demographic information. They jump all over the place. They have no rhyme or reason to how they’re dictating.”

The safety and quality of patient care are the main concerns when dictation challenges arise as they affect the timeliness and accuracy of the report. Treatment decisions are based on information in a patient’s chart so accuracy is of utmost importance as incorrect dosages could be disastrous or fatal. Many organizations refuse to fill something in if they aren’t 100 percent sure. The uncertainty impacts turnaround time and often requires reports being sent to the hospital to be manually fixed.

Being a good dictator takes several qualities, including being cognizant of the fact that someone on the other end has to be able to make sense of what you’re saying.

Medical transcription service organizations (MTSOs) may want to contemplate including contract language that tackles dictation problems. Medical transcriptionists are paid on a production basis, so having to struggle with poor dictation hampers their income potential. MTSOs may want to consider charging more if physicians are poor dictators and unwilling to improve the quality of communication.