Posted on August 23, 2004

Indian Transcription Service ‘Putting Lives At Risk’

Press Association, Guardian (UK), Aug. 18

Patients’ lives are being put at risk because letters from hospital doctors are being sent to secretaries in India to be typed and returned to GPs with mistakes, it was claimed today.

In one example, the drug Lansoprazole, used to treat stomach ulcers, was transcribed as the popular holiday resort Lanzarote, in another case, a “below knee amputation” became “baloney amputation”.

Eight hospitals in London are using the services of the medical transcribing company Omnimedical to clear a backlog of hospital doctors’ letters due to a UK shortage of medical secretaries and to free up admininstration staff to help with patient care.

But the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR) warns that the use of Indian secretaries increases the risk of mistakes in medical letters, which could have potentially fatal consequences.

Omnimedical contracts a pool of secretaries in India to transcribe the letters sent from hospitals to GPs about the treatment of their patients. The service is being used by St George’s hospital in Tooting, south-west London, and seven others around the capital to type around 7,000 letters a month.

Hospital consultants dictate their letters on to voice recorders as usual, and the sound files are then sent via email to Omnimedical, which removes all the information that could identify a patient and replaces it with a number.

After the letter is typed up by the staff in India it is returned to Omnimedical, which replaces the patient information before it is returned to secretaries at the hospital for checking.

St George’s said that there were rigorous safeguards in place to ensure that letters were accurate.

But Michael Fiennes, of AMSPAR, said he was aware of many examples of mistakes creeping into letters, some so serious that they could lead to patients being given the wrong dose of medication.

“Medical secretaries should be properly trained, but they are appallingly badly paid for the work they do and that is why the work is being sent abroad,” he said.

“This increases the chances of mistakes creeping in that could put patients’ lives at risk.”

In one example, “phlebitis (vein inflammation) left leg” was changed to “flea bite his left leg”, said Mr Fiennes.

He added that, while these might seem amusing, mistakes could also occur by changing the dosage of a drug given, for example from 5mg to 50mg.

Mr Fiennes said that GPs were generally picking up the errors, but because of their workload the potential for mistakes not being spotted was “very worrying”.

“We would always recommend that medical secretaries are properly trained and rewarded for the work they do, because it is not just typing letters,” he said.

A medical secretary is paid an average of £14,000 a year in the NHS after undergoing training lasting, in some cases, two years.

A spokesman for St George’s, which has been using the service for about two months, said: “The bottom line is that the transcription service is better for patients, better for GPs and better for medical secretaries.

“GPs now receive timely information about the care given to their patients, while medical secretaries have been freed up to provide better support to consultants and the patients they see.

“The transcription service is secure and confidential, and there are rigorous safeguards in place to ensure the accuracy of letters before they are sent.”

An Omnimedical spokesman disputed the claims made by AMSPAR. He said that overseas transcribers provided a much higher standard of service than the large number of temporary administration staff which the NHS relied on due to a shortage of medical secretaries.

He added that all letters were signed by the relevant consultant before they became legal medical documents, so the chance of any errors not being picked up was remote.

The spokesman said he could not comment on the contents of any particular letter, as he was not in a position to verify whether they were transcribed by secretaries contracted by Omnimedical.