When the patient visits a doctor, the doctor spends time with the patient discussing his medical problems, including past history and/or problems. The doctor performs a physical examination and may request various laboratory or diagnostic studies; will make a diagnosis or differential diagnoses, then decides on a plan of treatment for the patient, which is discussed and explained to the patient, with instructions provided. After the patient leaves the office, the doctor uses a voice-recording device to record the information about the patient encounter. This information may be recorded into a hand-held cassette recorder or into a regular telephone, dialed into a central server located in the hospital or transcription service office, which will 'hold' the report for the transcriptionist. This report is then accessed by a medical transcriptionist,it clearly received as a voice file or cassette recording, who then listens to the dictation and transcribes it into the required format for the medical record, and of which this medical record is considered a legal document. The next time the patient visits the doctor, the doctor will call for the medical record or the patient's entire chart, which will contain all reports from previous encounters. The doctor can on occasion refill the patient's medications after seeing only the medical record, although doctors prefer to not refill prescriptions without seeing the patient to establish if anything has changed.

It is very important to have a properly formatted, edited, and reviewed medical transcription document. If a medical transcriptionist accidentally typed a wrong medication or the wrong diagnosis, the patient could be at risk if the doctor (or his designee) did not review the document for accuracy. Both the Doctor and the medical transcriptionist play an important role to make sure the transcribed dictation is correct and accurate. The Doctor should speak slowly and concisely, especially when dictating medications or details of diseases and conditions, and the medical transcriptionist must possess hearing acuity, medical knowledge, and good reading comprehension in addition to checking references when in doubt.

However, some doctors do not review their transcribed reports for accuracy, and the computer attaches an electronic signature with the disclaimer that a report is "dictated but not read". This electronic signature is readily acceptable in a legal sense. The Transcriptionist is bound to transcribe verbatim (exactly what is said) and make no changes, but has the option to flag any report inconsistencies. On some occasions, the doctors do not speak clearly, or voice files are garbled. Some doctors are, unfortunately, time-challenged and need to dictate their reports quickly (as in ER Reports). In addition, there are many regional or national accents and mispronunciations of words the MT must contend with. It is imperative and a large part of the job of the Transcriptionist to look up the correct spelling of complex medical terms, medications, obvious dosage or dictation errors, and when in doubt should "flag" a report. A "flag" on a report requires the dictator (or his designee) to fill in a blank on a finished report, which has been returned to him, before it is considered complete. Transcriptionist are never, ever permitted to guess, or 'just put in anything' in a report transcription. Furthermore, medicine is constantly changing. New equipment, new medical devices, and new medications come on the market on a daily basis, and the Medical Transcriptionist needs to be creative and to tenaciously research (quickly) to find these new words. An MT needs to have access to, or keep on hand, an up-to-date library to quickly facilitate the insertion of a correctly spelled device, procedure, or medication dictated.

What basic knowledge is required for providing medical transcription services?

Knowledge of basic to advanced medical terminology is essential.
Average to above-average verbal communication and memory skills.
Ability to sort, check, count, and verify numbers with accuracy.
Demonstrated skill in the use and operation of basic office equipment/computer.
Ability to follow verbal and written instructions.
Records maintenance skills or ability.
Average to above-average typing skills.
Knowledge and experience transcribing (from training or real report work) in the Basic Four work types.
Knowledge of and proper application of grammar.
Knowledge of and use of correct punctuation and capitalization rules.
Demonstrated MT proficiencies in multiple report types and multiple
specialties.


What is outsourcing medical transcription?

Due to the increasing demand to document medical records, other countries started to outsource the services of the medical transcriptionist. In the United States, the medical transcription business is estimated to be worth US $10 to $25 billion annually and growing 15 percent each year citation needed. The main reason for outsourcing is stated to be the cost advantage due to cheap labor in developing countries, and their currency rates as compared to the U.S. dollar.
It is a volatile controversy on whether work should be outsourced, mainly due to three reasons:

 1. The greater majority of MT's presently work from home offices rather than actually in Hospitals, working off-site for "National" Transcription services. It is predominantly those Nationals located in the United States who are striving to outsource work to other-than-US-based transcriptionists. In outsourcing work to sometimes lesser-qualified and lower-paid non-US MT's, the Nationals unfortunately can force US transcriptionists to accept lower rates, at risk of losing business altogether to the cheaper outsourcing providers. In addition to the low line rates forced on US transcriptionists, US MT's are often paid as ICs (Independent Contractors); thus, the Nationals save on employee insurance and benefits offered, etc. Unfortunately for the state of healthcare administrative costs in the United States, in outsourcing, the Nationals still charge the hospitals the same rate as they did in the past for highly qualified US transcriptionists, but subcontract the work to non-US MT's, keeping the difference as profit.

2. There are concerns about patient privacy, with confidential reports going from the country where the patient is located (the US) to a country where the laws about privacy and patient confidentiality may not even exist. Some of the countries that now outsource transcription work are the United States, Britain, and Australia, with work outsourced to Pakistan, Philippines, India and Canada.

3. The lack of quality in the finished document is concerning. Many outsourced Transcriptions simply do not have the requisite basic education to do the job with reasonable accuracy, much less additional, occupation-specific training in Medical Transcription. Many foreign MT's who can speak English are unfamiliar with American expressions and/or the slang doctors often use, are apparently unfamiliar with medical reference books, and are unfamiliar with American names and places. An MT Editor, certainly, is then responsible for all work transcribed from these countries and under these conditions. These outsourced transcriptions often work for a fraction of what transcriptions are paid in the United States, even with the US MT's daily accepting lower and lower rates.