This is an oldie but a goodie and it never fails to make me laugh. Dictating is actually much harder than you'd think.  Here are some important rules for dictating for clinicians.

Adherence to these guidelines will ensure the highest quality transcribed reports in the shortest amount of time.

• At the beginning of the dictation, take as deep a breath as you possibly can.  Now, try to dictate the entire letter before you have to inhale again.
• When dictating a particularly difficult word or phrase, please turn your head and speak directly into your armpit and speak as fast as you can.
• Since time is money, an effective way to cut your costs is to dictate your entire report as one sentence.
• It is not necessary to repeat the same sentence multiple times in the same dictation.
• If you have to sneeze or cough suddenly, please remove your head from your armpit and sneeze or cough directly into the recorder or microphone.
• If you must eat while you dictate, please stay away from foods such as marshmallows, bananas, and jelly.  Apples, pretzels, chips, and popcorn are much better choices.  And don't stop dictating just because you are eating.  Press on!
  
• Please don’t stop dictating when you yawn.  It throws off our rhythm.
• If the patient’s name is Alan Ratzlaffenhasenphephercewicz, please have the courtesy to spell "Alan" – there are several possible spellings, you know.  For the last name, simply say 'the usual spelling'.
• It is not necessary to repeat the same sentence multiple times in the same dictation.
• Please note – the phrase "I saw this 43-year-old mother-of-two in the clinic today" is only three syllables.
• Cardiologists, it is not necessary to dictate at the rate of your patient’s atrial fibrillation.
• Do not stop dictating in the event of minor background noise such as an office party, the cleaner’s vacuum cleaner, a screaming infant, etc. Again, it throws off our rhythm.
• Be sure to place the emPHAsis on the CORrect syLLABLE, especially if enGLISH is your SECond lanGUAGE.
• It is not necessary to repeat the same sentence multiple times in the same dictation.
• Talk as fast you possibly can.  Fair’s fair; after all, we type as fast as we possibly can.
• Please speak as quietly as you can.  We want to be able to hear what’s going on around you.
• If you need to pause for 5 or 10 minutes between words or phrases, pounding the receiver on the desk or repeatedly saying, "still dictating.... still dictating..... still dictating.... still dictating..... still dictating......" reminds us that indeed, you are still dictating.
• Just because you need to use the toilet is no reason to stop dictating.  Time is money! Besides, it's not as if we can see what you're doing so it's quite okay.
  
• Don’t dictate so loudly that you disrupt your fellow physicians’ football game in the doctors’ lounge.  In fact, you really should whisper all of your dictation, since the information is confidential.
• Similarly, if you are going to watch TV while dictating at home, please watch a war movie with lots of bombing, and be sure to have the volume high enough so everybody in your loungeroom can hear above your talking.  Likewise, if your family are having a noisy party or your kids have friends over, this is an excellent time to do some dictating.  Makes us feel a part of it all.
• If you need to correct yourself -- sorry, correct an error, please do not rewind the audio -- sorry, do not back up and record over the error -- sorry, wait, the mistake -- just continue with the sentence -- wait -- no, go back -- with the paragraph and fix the error -- um, the mistake.   
• Please go back and just delete that last guideline.
• When dictating on your mobile phone from your car, be sure to go through as many tunnels as possible.  This will ensure confidentiality of the information.  We also love it when you dictate at airports or while you are waiting for a train. On a train is even better.
  
• If you've dictated a letter on a patient previously and need to include something from a previous letter, just say 'insert that bit I said last time'.  Remote/off-site transcriptionists particularly love this and it keeps our memories in tip-top shape.
  
• You (y-o-u) do not need (n-e-e-d) to spell (s-p-e-l-l) obvious words (w-o-r-d-s) for us (u-s).  It is our job (j-o-b) to know (k-n-o-w) how to (t-o) spell words that (t-h-a-t) we learned (l-e-a-r-n-e-d) in grade (g-r-a-d-e) three (t-h-r-e-e).
• One last thing, it is not necessary to repeat the same sentence multiple times in the same dictation.

It's funny because it's largely true! Many physicians forget that we can hear everything they can, all the background noise and it can be very offputting and hard to transcribe when you're battling to hear the dictation over trains pulling in and out of stations, or the next-door neighbour whipper-snipping his garden!

Basically it's just a courtesy reminder that transcriptionists work much more effectively if the audios are clear enough and loud enough, without extraneous background noise.

Learning how to dictate well is a learned skill and a clear and effective dictator is as highly prized by a transcriptionist as a good MT is by her clients.

 Most clients have preferences for their work.  Fair enough, it’s their practice and they can set the rules.

But what do you do when you get a preference directive from a client that is clearly wrong, or in some cases downright laughable? Do you go along with it? After all, they are the ones paying your invoice.  Or do you stand on your principles and politely but firmly explain why you cannot or will not accede to their directive?

It can be tricky.  I know someone who worked for many years as a nurse/practice manager for a surgeon.  She did all of his typing.  One of his more, shall we say, unusual directives was that he did not ‘like’ apostrophes (not for plurals, not for possessives either) and that they were not to be used in his letters.  When told of this extraordinary rule, I remarked to my friend that I would simply refuse to type in such a way, as it was not up to this surgeon to dictate the terms of the English language to suit himself.  She simply shrugged and said it was easier just to do as he asked. *

I also once transcribed for a client who would not allow commas in his typing.  None at all.  The result was very odd, almost stream-of-consciousness letters.  Horrible to look at and I presume quite hard for the recipient to read.  As this client was undertaken through a large transcription company, I had little choice but to go along with it, but I have to say that it almost physically hurt to do that doctor’s typing!

Other smaller examples include doctors who favour words that are not really words.  For example, there is no such word as ‘unkeen’, yet a surprising amount of doctors dictate this non-word! I can't bring myself to type it and therefore I always change it to something like “not very keen on [the …]”.

Then of course there are those clients who want every drug capitalised, whether it is a generic brand or not.  For those who may not know, generic drugs/ingredients are typed in lowercase, such as prednisolone, methotrexate, doxycycline, whereas brand names are given a capital letter, such as Entocort (budesonide), Imuran (azathioprine), Plendil (felodipine).  This sort of client directive I can live with.  It’s a technicality and whilst I much prefer to follow the internationally-accepted formatting rules for such things, it doesn’t take anything away from the look of a report to have all drugs capitalised or in lowercase.  Likewise, a client whose preference is always for American English (color, center, orthopedic) over British/Australian English.  I can live with that, too.

In a way, this comes back to my earlier blog post on verbatim typing.  I believe that a good transcriptionist should alter any dictated errors and inconsistencies, without changing the context.  However, going along with rules such as ‘no commas’ or ‘no apostrophes’ is something I simply cannot bring myself to do.  If that means forfeiting a client, then I have to live with that.  In the end, my goal is to produce quality work for a client, which reflects well on the physician and the practice, and of course, is a correct record for the patient, who is the primary focus.  In turn, this reflects back on me as a professional transcriptionist who knows what she’s doing.

To produce a document which contains no commas or apostrophes when they are clearly required is something I don't really want my name associated with.

* Interestingly, when I did some typing for this surgeon whilst my friend was away on leave, I included all apostrophes in their required places and he never said a word.