A medical transcriber prepares doctor's notes into formal, legal documents. Medical transcribers are also called transcriptionists. They may work in a doctor's office or hospital or in their own home. In order to work from home, a medical transcriptionist or transcriber usually has on-site experience first. Some online medical transcription companies hire transcribers to work from home with minimal, yet proven, experience and qualifications.
Reporting either to a transcription supervisor or directly to the doctor, a medical transcriber may transform hand-written notes as well as dictation into typed documents. Each time a doctor examines a patient or refers him or her to a specialist or testing lab, the session must be documented. The doctor typically makes notes during the patient's visit, then records that information into voice equipment. Traditionally, cassette tape recorders were used, but today telephone application technology can send the doctor's audio message directly to the transcriber's computer server. Once received, the medical transcriptionist then listens to the message and types the information into documents as the audio file plays.
Using quick, accurate typing skills, medical transcribers must not only rely on their training to include the correct terminology, but stop the dictation recording to consult reference materials when necessary. They may have both online medical journals as well as textbooks on subjects such as anatomy or pharmacology to consult. A medical transcriber must also pay attention to using proper spelling, grammar and punctuation. The completed reports, even if they are brief notes for a medical chart, must be of professional quality.
Returning the completed transcription on deadline is important for the transcriber. Patient information needs to be constantly updated, yet accessible by doctors, nurses and medical assistants. If a medical transcriber works under a supervisor, this person checks the finished documents for accuracy. If the transcriptionist works directly with the doctor, self-checking the assignments thoroughly several times before delivering the finished documents is required. Most medical transcribers keep a log of all the assignments they do with the start and completion dates noted.
Maintaining patient confidentiality at all times is absolutely mandatory behavior for a medical transcriber. Whether working from home for a transcription service or directly in a doctor's office or hospital setting, medical records are required by both law and ethics to be confidential. Trained, qualified medical personnel, including transcriptionists and assistants, may view and work with patient information, but must not discuss any of it with unauthorized persons.