Medical Transcription Proofreading Tips

Medical Transcriptionists often work independently, with no immediate on-site supervisor.  Mostly, supervisors are ‘remote’, and connected only through the Internet.  Correspondingly, Medical Transcriptionists need to be independent, self-motivated and be willing to take responsibility for his or her work.  Medical Transcriptionists take pride in the accuracy and completeness of their work.  As an important part of the healthcare team, they gain satisfaction from a job well done.

Excellent proofreading skills are critical for a Medical Transcriptionist.  Proofreading is looking for mistakes of all types in a transcribed document and correcting them.  The most common errors a Medical Transcriptionist will be looking for include:

  • Omission of important dictated words
  • Selecting the wrong English or medical word
  • Misspelled words
  • Typographical errors
  • Grammatical errors (tense agreement)
  • Punctuation errors (e.g. quotation marks)
  • Homonyms (sound-alike words)
  • Correct usage of words (e.g. affect and effect)
  • Consistency (e.g. using both disc and disk in a document)

As with all skills, proofreading skills will improve with practice.  Keep a log of mistakes that you find in your own work (or that your supervisor brings to your attention).  On a regular basis, categorize them into such areas as medical words and non-medical (English language usage) words.  Break them down further into medical words by specialty and types of English language mistakes.  Add these to your word lists, and review them regularly.

To help you achieve the best results from your proofreading, consider:

  1. Look up words in reference books as you encounter them.  Build a library of good reference books and book mark good Internet reference sites.  Don’t wait until the end of the report to look up a word.  You may forget to go back and check it, and you will have forgotten how some of the words sounded.  Leave a blank (*__) if you exhaust all resources and still cannot find your word.
  2. Briefly proofread what you transcribe as it appears on the screen of your word processor or the paper you are typing on.  This will help you catch missed words and typographical errors as they occur.  On a regular basis, especially with a new dictator, print out some of your reports.  It is easier to proofread a printed report than it is on the screen.
  3. If you cannot discern a word or phrase, leave a blank of an appropriate length, according to how long or short the word sounds.  Attach a flag (paper or electronic as appropriate) to the document.   Indicate by minutes (e.g. 2.31’), where the blank is in the dictation.
  4. Use both a medical and English spellchecker (with grammar turned on) as the final step in proofreading.  Always be aware that spellcheckers will not catch errors such as transcribing ‘no’ instead of ‘not’ or transcribing ‘ilium’ instead of ‘ileum’.

Excellent proofreading skills come only after continual practice to perfect.  Consider the following tips:

•   To avoid omitting important dictated words, adjust the speed control on the transcriber unit and transcribe slowly to assure no dictated words are overlooked.  Increase speed only as you learn to keep up with the dictator.  Don’t increase your speed until you’re typing nearly perfectly.  It takes time to realize you’ve made a mistake, backspace it out, and retype it.

•   Voice recordings, both tape and digital, do not perfectly reproduce the human voice.  Sometimes the words and phrases sound garbled or something quite different from what they really are.  Never transcribe what you “think” you hear.  Transcribe only what makes sense in the context of the report.  It is better to leave a blank than type something incorrectly.

•   Misspelling of medical and English words can be avoided by careful proofreading and using a spellchecker.

•   Grammatical errors are best identified through careful proofreading.  When you’re finished transcribing a document, read it through beginning to end to make sure that it’s complete and accurate.

•   Punctuation errors can actually change the medical meaning of a sentence.  Keep your punctuation references within easy reach.

Wherever possible, organize your work by physician and specialty.  Before starting a physician’s work for the day, review their style preferences and whether there are particular words or phrases that they use that are uncommon.   Pull your word list for their specialty, and quickly review it.  Watch for sound alike words or drugs (e.g. Tryptan for sleep and triptan for migraines), and be alert for any changes in consistency in formatting (line spacing, paragraphs, etc.).

Quality medical transcription plays an important part in patient’s quality medical care.

 

2Ascribe Inc. is a medical transcription agency located in Toronto, Ontario Canada, providing medical transcription services to physicians, clinics and other healthcare providers across Canada.  As a service to our clients and the healthcare industry, 2Ascribe offers articles of interest to medical professionals and office staff, as well as of general interest.  Established in 2002, 2Ascribe offers quality medical transcription, rapid turnaround (including STAT and same day) and excellent customer service.  For more information on our medical transcription services please contact us at info@2ascribe.com or 1-866-503-4003.

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