[Editor's note: This article is a complement to our July cover story, "Take QA Into Your Own Hands."]

A run-on sentence. A misspelled drug. A superfluous comma. Heck, maybe even a split infinitive. Dictation errors can irk word-wary MTs, but should they be forced to overlook such grammatical offenses? Thus begins the debate over verbatim transcription, a contractual item that makes MTs withhold all judgment -- medical, grammatical or otherwise -- and simply type what the dictator says. The controversial practice pits risk management against quality assurance (QA), but MTs' reputations and patient care are what's on the line.

While traditional transcription lets MTs correct punctuation, misspellings and dictation errors at their discretion, verbatim transcription requires MTs to transcribe notes exactly as dictated. The practice is usually based on the client's preferences; if a doctor doesn't want his words altered, the MT is expected to transcribe word-for-word. There are arguments for and against the no-edits approach, but most MTs aren't thrilled about it.

The running joke is, "If you want verbatim transcription, I will put in every 'uh,' 'ah,' 'oh' and 'um' that you have dictated," said Barb Marques, CMT, AHDI-F, president-elect of the Association for Healthcare Documentation Integrity (AHDI).

In reality, it's no laughing matter.

Risky Business
Doctors can make mistakes, so risk managers champion verbatim transcription as a way to keep MTs from taking the fall, according to Donna Brosmer, CMT, AHDI-F, NREMT-B, quality officer, Spheris. If the document ends up in court, an MT can claim no culpability because the doctor requested the dictation be transcribed word for word. If the MT changed any words, he or she might be held accountable for the error - a mark hospitals and medical transcription service organizations (MTSOs) don't want on their hands.

But many say verbatim transcription neglects the value a skilled MT can bring to the table. With knowledge of diseases, diagnoses, treatments and medical terminology -- not to mention, a knack for grammar and punctuation -- MTs can serve as the first line of defense against errors, according to Brosmer. "You have a group of very intelligent people creating these reports, transcribing these reports," she said.

For example, a good MT would know the difference between Xanax and Zantac and could correct the mix-up if a doctor misspoke, Brosmer said. MTs are also trained to notice when a doctor switches between left and right.

"If he said 'right foot' five times in the report and he gets down to the bottom and says 'left,' 99.9 percent [of the time], he really does mean the right foot," Marques said.

Errors like that are becoming more common as good dictators become few and far between. With doctors able to dictate from their Blackberrys and iPhones, MTs are struggling to hear over the background sound of gyms, pools and oncoming traffic, Brosmer said.

Physicians are also getting more lax. Marques said today's rising doctors do not speak in complete sentences, making it harder to understand the report. While a skilled MT would have the confidence to edit and make corrections without delaying the report, with verbatim transcription, the MT would have to query the physician or flag errors in hopes he would re-examine his work.

Making matters worse, many doctors don't review their transcribed reports, according Lesli McGill, director of U.S. operations, SPi Healthcare. McGill hails from the "old school" of transcription, where she learned to edit as she transcribed. She recalled the "rubber stamp" method physicians used to approve reports -- simply passing it on without so much as a glance. In today's electronic environment, that stamp has been replaced with a click of approval, making it even easier to overlook flagged items.

Employee Pride
What the controversy boils down to is quality. MTs pride themselves on delivering a timely and accurate record, so they loathe initialing a document that isn't up to par -- especially if that document is hauled into court. "[MTs] want people to understand they did the best job they could with that document," McGill said. "It reflects badly on them if it's a verbatim account and you've got a bad dictator."

The squabble isn't likely to end soon, the experts said. The topic was among discussions at the Medical Transcription Industry Association (MTIA) Convention last April, and it's expected to be on MTs' minds at the AHDI conference later this month. In health care, quality isn't something to take lightly; a mistake that slips through the cracks could mean the difference between life and death. MTs are supposed to be the first defense against errors, but amid the skirmish of lawsuits and legal liability, some fear verbatim transcription will push patient care to the wayside.

Cheryl McEvoy is an editorial assistant with ADVANCE.