Transcription is such a pain! It's one of the most important aspects of my practice, but it's the bane of my existence. So one day, I tried something new, and boy, did I get a surprise!

I'd gotten an unsolicited fax, urging me to "send" my dictation via phone line, to a company in Florida. Their "experienced transcriptionists" would do the dictation overnight, and we would have it back by e-mail the next morning. And all for just 7 cents per line! Jill, my office manager, called to investigate. They offered two days for free. They were really good. We signed up.

Within a few days, though, odd things began to happen. The dictated word "tummy" became "tummee." The name Juanita became Rawneeda. The syntax and punctuation were incorrect. There were commas everywhere. Common over-the-counter products like Pepto-Bismol, Ex-Lax, and Advil were left as blanks.

The emphatic answer was "No."

"Do the typists speak English?"

"Of course."

It was so weird that I called the outfit myself.

"Is my dictation being done by people?" I asked.

"Yes."

"Where are they located?"

"The majority are here, right in South Florida, maybe not 100 percent."

"Where are the rest?"

The woman hesitated, and finally said, "India."

That explained a lot. They didn't know common English names. They didn't know common American products. They did, however, have every generic and brand name drug perfect. And their medical terms were also perfect. We figured that for the demo period, they used Florida staff, and once we had signed on, we were directed into the regular system. It also explained how they could do the job so cheaply.

Now I have absolutely nothing against people in India making a living. But I practice in an area that is heavily industrial, and around here, any outsourcing of jobs is a real blow to the local economy. My patients feel it. And here I was, in my own small way, adding to the problem. I felt awful!

Soon another unsolicited fax came, this time from Cadillac, MI, a small town not too far away. They offered the same service. They provide a little recorder that can be downloaded and e-mailed back and forth.

Our transcriptionist is named Barbara. She works out of her home in Cadillac, and she is a delight. She calls now and again to make sure everything is okay, and to tell us how much she enjoys doing our dictation.

Last week, I watched a program on outsourcing on PBS. It was a timely look at the difference the jobs make in the lives of people in India. The vast majority highlighted were workers in the telecommunication business. These workers are required to learn either American or British English. When a call comes in from Detroit, say, the current weather in Detroit pops up on the worker's screen, along with the names of local teams, and how they've been doing. "Warm lately, huh?" "Wasn't that a great Tigers game last night!" Had the transcription company I used trained their employees the way the featured one did, I wouldn't have realized that I had outsourced a job.

For some physicians, this may not matter. Perhaps some would like to support foreign workers, and improve their lot in life. If that is your decision, I say, "Go for it!"