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Understanding Dictation as a Medical Transcriptionist

What to Keep in Mind with ESL dictators:

English as a second language (ESL) physicians or dictators with their foreign accents can be a challenge to medical transcriptionist/healthcare documentation specialists (MTs/HDSs) as well as other medical language experts.

Keep in mind, however, that the ESL physician or dictator often speaks a variety of languages, and English is just one of many. ESL dictation can be difficult at first; but with practice, the complexity can be overcome, and speech patterns can be comprehended over time.

Most dictators, even ESL, keep to a similar pattern in their reports; once you’ve “cracked the code,” their transcription becomes easier.

A Note on Languages:

  • The Romance languages (those developed from Latin), are similar in structure and include Italian, French, Spanish, Portuguese, and Romanian.
  • The Celtic language is spoken in Ireland, Scotland, the Isle of Man, Wales, Cornwall, and Brittany.
  • Germanic languages (Western Germanic) include English, German, Dutch, Frisian, Pennsylvania Dutch, Luxembourgish, Yiddish, Afrikaans, and the Scandinavian languages.
  • The Arabic language is spoken in the countries of the Arab League and in some parts of Asia, Africa, and Europe.

The MT/HDS must also deal with regional American English accents and the occasional speech disorder, as in a lisp, stuttering, a cleft palate, or the dictation fluctuations that may be caused by vocal polyps or nodules (as seen in some long-time smokers).

Understanding Accented Dictation:

Each MT/HDS must embrace the challenge of learning difficult and accented dictation. A person’s accent is based on their pronunciation, which is learned at home, at school, and in social settings.

Phonetics is “the study of speech sounds, their production and combination, and their representation by certain symbols” (Webster’s 2002). In any language, the components that make up an accent include intonation, rhythm, stress, and, of course, vowels and consonants.

Intonation—this refers to the “pitch” pattern of speech, the rise and fall of the voice as one speaks. A voice can be pitched high, as in the soprano singing range, or low, as in the baritone or bass range.

In English, typically the voice is pitched down at the end of a declarative sentence. When we ask a question, the voice typically is pitched higher at the end.

Examples:   Put that sign down when you come in. (“in” pitched low)

Were you going to put that sign down? (down” pitched high)

Rhythm—this includes how slow or how fast a person speaks. Rhythm can change from person to person and from language to language. Think of poetry and how it has certain rhythms. Even in prose we speak in rhythmic patterns.

Example:    Father, Son, and Holy Ghost (spoken in a certain pattern)

Stress—this refers to sounds and syllables spoken harder or longer. Stress patterns differ in various languages; therefore, emphasis on different parts of a word might be heard from the ESL dictator. Think of the word tinnitus (ringing in the ear). It might be pronounced with the stress on the middle syllable, as in “tin-NI-tus” or on the first syllable, as in “TIN-ni-tus”. Both pronunciations are equally correct.

Examples:   Con’tro-ver-sy    (American English)

Con-tro’ver-sy    (British English)

Dictation as a Legal Requirement:

“No barriers to communication” might be dictated when it is the patient whose language is other than English—a legal requirement. Often dictated at the end of reports are phrases like, “dictated but not read”, “signed but not read”, “dictated but not read, subject to transcription variation.” And what does “transcription variation” mean? In this context, transcription variation may be any liberties an MT/HDS may have taken while editing a report that vary from what was dictated. However, no matter how many phrases a dictator might use at the end of a report, ESL or not, it is the physician who is ultimately in charge of the report and the patient’s care.

What Else to Be Aware Of:

The MT/HDS must remain aware of sounds spoken during dictation that are not words, as in random mumbling, saying “uh” or “um” as the dictator might be thinking, or an aside spoken to a colleague.

Keep in mind dictation habits, like “period paragraph” after each sentence, a heavily accented attempt at “thank you”, or even “please” that may sound like “peas” or “peace”. If nothing else, our ESL dictators are unfailingly polite and grateful for all the help they are given. Feel free to ask for help, if needed, from your ESL dictator.


Written by: Patricia A. Ireland, CMT, AHDI-F  Medical Transcription Instructor, Consultant


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