I think it is unfortunate that medical record typing has now been reduced to a factory style time and motion production task. Medical letters/annotations are important (and legally standing) documents that have to be accurate first and foremost for patient safety. Over the last 10 years or so the role of the medical secretary and especially the typing aspect, has been sabotaged by management consultancies and opportunistic transcription companies who have turned it into a production/target based activity, many without understanding the knowledge required (most of the new support secretaries taken on at my Trust had no medical experience or training at all and were expected to perform well in a short period of time) and the importance of the clarity of the dictation and just how time consuming it is to produce an accurate document, at the expense of the medical secretary, as we now have 'middle men' involved. There is of course, the problem of ESL and unclear speakers and equipment failure, but there never seems to be any progress here in resolving/educating to improve this and hence much of the pressure falls on the transcribers, and without pay rises, if working for one of these transcription companies, the pressure increases over time. Ok, things have moved on and we live in a digital age, but patients still get sick, records still need to be accurate and the cost of living continues to rise, so just how long can this carry on?