Facing an acute shortage of medical transcribers, eight hospitals in London decided to outsource transcription services. Instructions and letters were dictated into digital voice recorders and the files forwarded to a company called Omnimedical, which would then send the recordings to a team of transcribers in India.
In theory, it's a straightforward process but reality proved otherwise. The mistakes in the transcriptions were so serious, they prompted the Association of Medical Secretaries to go public, with spokesman Michael Fiennes citing several horrific examples in the Daily Mail : below knee amputation became "baloney amputation" and phlebitis (vein inflammation) left leg was changed to "flea bite his left leg".
Hilarious? Not if such blunders cost lives.
This episode evoked memories of the venerable Ian Rush, one of Liverpool's greatest strikers. Rush's post-match TV interviews always proved tricky... due to his Welsh accent, "goal" was the only word I could usually decipher.
Football, or soccer as some call it, transcends linguistic and cultural barriers simply because all over the world, players apply the same set of rules. The motley mix of accents and colloquialism, however, means that the English language is open to local interpretation and can sometimes be incomprehensible.
On the surface, it may seem like the onus for patient safety lies in Omnimedical's hands but it is the hospitals that should be held accountable.
They say the prime motivation behind outsourcing the workload is to provide better service to patients but they fail to address the ramifications of such a move.
The root cause behind the dearth of medical secretaries -- a combination of low wages and dim career growth -- has been skirted in favour of offshoring, the magic short-term solution.
The monthly wage of medical secretaries in India is reportedly one-third that of their British counterparts. The hospitals will argue that cost wasn't the only factor in deciding to outsource. In fact, any suggestion that hospitals wilfully put patients' lives at risk would surely be met with furious rebuttals.
This is the peril of outsourcing to India, some camps might say. What if the destination was Australia, Scotland or the United States? Would that have made any difference?
The outsourcing of transcription services can be juxtaposed against the offshoring of call centres -- the perennial favourite among many large enterprises. Some companies implement a "follow-the-sun" approach which seeks to ensure that customers from all continents are serviced 24 hours, seven days a week. Noble idea but frustrating when the operator can't tell the difference between "today" and "to die" or when Toorak becomes "Two Rack". Organisations that compromise on language and local knowledge will eventually pay the price. The question is, at whose expense?
Talkback
On Flea bites and Baloney.....
Good medical secretaries are becoming a rarity as a result of the poor pay and general lack of self-esteem in the NHS inspite of heavy workload.
'Fleabites' (Phlebitis) and 'Baloney' (Below-kenee) are not exclusive to off-shore productions. The home made varieties are not infrequent and are often grosser. As the number of experienced and trained medical secretaries in the UK dwindle, we are faced with a phenomenal inability to cope with medical terminology in dictation.
In any case, all transcriptions should be checked for mistakes by the medical staff who have dictated them and then be authorised. If unchecked letters were sent out from a hospital or placed in patient records, it is the responsibility of the system and the medical authorities have to shoulder it.
It is not uncommon in the NHS to have clinic letters typed 4-6 months after being dictated in clinics and on the medical wards. There are wider issues which need to be approached and addressed before knee-jerking at secreterial errors.
Offshore-bashing will continue to escalate as the domestic workforce is threatened with losing jobs at home to millions of unemployed and skilled workers overseas. There are worries that this will result in a backlash in public attitude fuelled by resentment.
A casual backward glance at History should make one realise that lesser issues have ignited and fuelled conflict. The current global political milieu provides fertile ground for repeating mistakes. Of this, we must be wary.
Rather than righteously adopting the role of the invaded and seeking short-term solutions, introspection into the root causes of these phenomena is needed.
I work as a medical secretary, my job is going because of the outsorcing. No one not even the people at the top are sure that it is going to work, but, they need to save money NOW. We have had several trials, some work well, english speaking consultants who dictate very well. When it comes to the majority who dont always speak clearly, not english, change their minds.....things went dreadfully wrong, and in fact it made more work. The consultants will now get all their letters back to check, because there will be no qualified people to do so, we now send out letters dictated but not signed. Now the consultant will have to check and amend as necessary....is this what they should be doing when there are such long waiting lists!! I think something should be done, this should be stopped before it is all far too late.