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Author Topic: De-Composition
philocinemas
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"Composition" is the technical term for putting words and sentences together to form coherence - writing.

I work in the social/psychological sciences field, which usually requires a bachelor's degree except for very special circumstaces. We are required to write daily, quarterly, and yearly notes on the progress of the individuals with mental illnesses who we service. These notes are required to be written using "clinical language" - omitting unneccesary articles, avoiding most proper nouns, past tense, technical language, etc. My position with my company has recently changed from writing these notes to reviewing them.

I should also add that I started college as an English major and taught English in middle and high school for two years.

That stated, in reviewing the notes from my all-college-graduate staff, I have found that many of my clinicians struggle with writing complete sentences in simple past tense. Some of these are on par with some of my least proficient students from 8th grade. I do not understand how someone can graduate from a four year college and not be able to write legibly!

Now, college is NOT the litmus test for intelligence or writing ability, but I would expect someone with a bachelor's degree to be able to write coherent senteces and paragraphs (sporting scholarships aside). These notes do not even require more than two tenses. How can the professors at these colleges sleep at night, knowing that they are passing these people who cannot write complete sentences?

OK. Now that I have ranted about my frustrations and irritations regarding the lack of composition skills among my clinical staff, I will ask you, my fellow Hatrackers, have you witnessed any unimaginable skills deficiencies in writing either among coworkers or laymen?

[This message has been edited by philocinemas (edited February 01, 2010).]


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Brendan
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quote:
but I would expect someone with a bachelor's degree to be able to write coherent senteces

Oh, this was too delicious to not point out. Sorry philocinemas.

I have marked a few college level laboratory pracs in my time. After a while, I moved over to a fairly rigorous marking system, with communication skills comprising about 20% of the total. They were science students, so English wasn't always their forte, and you always had to have some understanding for ESL students, but even in science, communication is important.


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philocinemas
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Thanks, Brendan.

I knew I'd end up making some gross mistake somewhere. Too bad it had to be that sentence. I did review it, but inevitably, I knew I'd make some error. My point in writing this, was not mispellings per se, but a general inability to write something that is understandable.

I am certain none of the individuals in question would ever visit this site, but I don't won't to quote any of them out professional courtesy.

Here would be a generalized example of what I'm receiving:

Clinician provided accompany to client with training to visit doctor. Client feels doctor is listens to clients problem. Doctor wrote perscription for help to clients anger. Clinician provided training on important of dealing with pass abuse. Client thinks it was well that doctor gives her psychological information.

...you get the picture. Now, not every one of my clinicians writes this way, but I have about three of them that write this way fairly often. It is excrutiating!

[This message has been edited by philocinemas (edited February 01, 2010).]


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dee_boncci
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Well, I don't know what you are seeing or what the expectations are in your field, but the term "notes" in my field doesn't imply a report with careful grammatical structure. Ours tend to be terse and fragmentary and are primarily intended as a memory aid to the note taker, not a memorandom for someone else.

Apparently your colleagues don't take notes that utilize good grammer, but that's a much different thing than saying they can't write a correct sentence.

[This message has been edited by dee_boncci (edited February 01, 2010).]


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philocinemas
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"Notes" in my field refer specifically to "professional" Progress Notes that must be submitted to Medicaid for billing purposes. The quarterlies and annuals are actually reports. EVERYTHING has to be typed and written clinically and goes into a client chart. The clinicians are regularly informed of what is required and of the importance of the notes. Medicaid will fine us thousands of dollars for notes that do not meet certain specifications.
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andersonmcdonald
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Excrutiating? Grammer? LOL. I'm kidding I du thys all the thyme!
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philocinemas
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Wow, I'm just killing my argument, aren't I? Yes, excruciating. I'm trying to type between taking care of my son (answering his questions and comments about a video game) and reading notes. Maybe I'm becoming infected.

But my point is not the mispellings. I can live with an occasional mispelling. It's the lack of coherency that is driving me crazy.


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satate
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When I first married my husband he couldn't write. He knew grammer and could write a complete sentence but couldn't really write. I watched him try and write a one or two page paper. He would write one sentence then delete it then try again. Then he'd look up some words in a thesarus and throw in a few big words. Then, maybe he'd go on to the second sentence. It took him hours to write anything and at the end it was still almost unintelligible. I finally stopped him and asked what he was doing. He's a math guy and likes everything to be in a formula so the often vague instructions of his english teachers left him confused. He thought good writing should be as complicated as possible and filled with as many big words as he could fit. I told him writing was just communication and the clearer he made his ideas the better (the paper was for some accounting class). Then I told him to try and just write like he would say it. He did that and recieved his first A on a written assignment.
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andersonmcdonald
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A wise uneducated house painter once said, "When in the company of idiots, learn to think like an idiot."
Maybe if you tried "thinking" incoherently...

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philocinemas
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Well, I make corrections in the documents as best as I can, but it really slows the process.

I keep thinking to myself that maybe I should just let it go and hope for a government auditor that reads like these clinicians write.


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MAP
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Don't blame the college professors. Your co-workers probably did write coherently during college but since then got lazy.
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Teraen
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I think it is due to the fact that scientific writing is by nature intended to eradicate voice, make passive constructions as ubiquitous as possible, and generally avoid the possibility that someone untrained in scientific writing could understand the article:

http://www.null-hypothesis.co.uk/science/spoof/articles/writing_publication_cite_expert_advice


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philocinemas
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This should be something that is fairly simple - here is a sample note showing how it should be written (I will try very hard not to make any errors):

Clinician accompanied client to (such-n-such place) and/or provided training on (this-or-that). Client responded by doing (whatever). Clinician modeled or role-played (or fill in the blank) with client on how to (do a certain task). Client demonstrated (or did not) appropriate method of completing task. Clinician provided (encouragement or positive feedback) to client for his/her efforts.

Now, this will vary depending on what the client’s needs are and what is being addressed, but almost every note can follow this pattern. A typical note will have ¾ of a page filled with these types of blurbs and an objective number. It’s not rocket science! We have provided what I would consider a sufficient amount of training (one day in training, a guidebook, one-on-one training, and monthly refreshers) to clinicians on how to write these notes (not including what they got in college). They use a template formatted in MS Word, which should catch those nasty spelling errors I made earlier. Also, this is not an entry level position – most of these people are making between $ 40-60K a year.

I feel that everyone is trying to give these people the benefit of the doubt, but what it really comes down to is that they have very limited writing skills. I just don’t understand how one acquires a four-year degree without learning how to write simple past tense sentences.


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Robert Nowall
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I was inclined to say "poor state of our system of education," but it would seem there's more to it than that. From your comments it would seem the writing assignment comes down almost to finding paragraphs and sentences that fit and pasting them in. Even someone who finds that kinda boring to do could do it...
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philocinemas
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It's not really a formula, but what I wrote above would cover most situations. The sentences will vary, and some more client-specific information can be inserted in various places, but yes it is basically this simple. Instead, I have clinicians who write things like:

Clinician provided accompany and training to client to PCP (primary care physician). Client displayed well behavior. Clinician facilitated client with direction on verbalizing thoughts. Clinician praised client.

I mean, what the heck? This isn't exactly what some have written, but it is very similar. I'm sure some of it is people trying to use words larger than their vocabulary like satate suggested, but "provided accompany", "well behavior"...

I just don't get it.


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babooher
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My father has a similar kind of job where he has to review the notes of nurses and surveyors. He constantly gripes. I chuckle.

Are the problems in the writing consistent (and thus evidence of a true misunderstanding) or sporadic (and thus a sign of laziness and poor proofreading)?

I've been trained to read those wonderful essay portions on state standardized tests. One of the things I've learned is that you can't really say someone doesn't understand a grammatical point unless he or she consistently does it wrong.

As for the state of education, I'd like to point out that many secondary school teachers have over 150 students a day. Teaching real writing requires a lot of practice, but how is any sane person supposed to read 150+ writing assignments (which might be several pages each) on a regular basis? I've read some stuff by Stephen King (who used to teach English) where he describes having an extra prep period just to read student papers. I have never in my life seen that. I don't think schoolboards would allow it.


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philocinemas
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The problems I see involve using multiple verb tenses in one sentence, not matching number of items with correct verb forms, incorrect use of words, incorrect use of prepositions, verbs (that are not functional adverbs) immediately preceding other verbs, and the list goes on.

This doesn't even include the fact that even more of my clinicians (including the ones that can write intelligible sentences) seem to have difficulty matching their progress notes to the correct objectives.


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genevive42
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It almost seems like English isn't their first language. Is this the case?

I still can't believe that people that had to get a degree could communicate so poorly. However, just because they got a degree doesn't mean they did it with a good GPA or didn't just eke by in their English classes.

I was amazed when a past co-worker didn't know that light traveled faster than sound. Okay, he didn't have a degree, but still.


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BenM
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Working in the software industry, the number of times I have seen really abysmal descriptions, instructions and other blocks of text released as part of a product beggars belief. In many cases I'd cringe as I imagined a user seeing some obscure instruction and wondering if we ran an automatic translator from Japanese or something.

No, we didn't. Those programmers understood "English"; the problem is they understood C++ better and quality control was nonexistent, or clueless non-technical management were scared to upset the nerdy gurus in their dungeon. Thankfully my current employer gives a damn and so I see a lot less of this these days.


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philocinemas
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No, English is the first language for all three of these people. One of them, the worst writer, mysteriously writes legibly about once every three weeks. I have sent several of her progress notes back due to other problems - I'm guessing she's getting help. I'll try and find a few sentences for examples tomorrow that wouldn't compromise any confidential information.
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Pyre Dynasty
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Well I'm in college right now and I have people in my class (my English major class) turning in papers written in txtspk. (Text speak.)
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aspirit
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Philo, your examples look to me like the writing of someone who's exhausted. Is the speech of your coworkers jumbled at times?
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philocinemas
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The clinicians often work long hours with clients during the week (by choice - they make about $45/hour after around 30 hours) and they write their notes late on Sunday nights (time billed at regular hourly wage) in order to meet Monday deadlines. Although they are not supposed to, I suspect they do some copying and pasting, which could account for some of the mistakes. One of my responsibilities is to make sure they don't turn in identical notes. If they do, I have them rewrite them. I often correct the grammatical errors like what I've been describing by using approved editing techniques - single line strikes, inserted notations, etc.

It is when sentences read like they were typed by Koko that I become so frustrated.


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philocinemas
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Their speech is OK, except for some slang and lots of coloquialisms.
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Robert Nowall
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Asimov leaves an account in his memoirs and elsewhere of having to write "Navy style" when he worked in the Philadelphia Navy Yard during World War II. I suppose adhering to a rigid style will move things along but must be hard on those who know how to write better.
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JSchuler
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As someone who has graded papers written by college students (actual papers, not lab reports), I can only say: you have NO idea. The state of writing today is god-awful. It's not just in spelling, or grammar, but in structure, argumentation, and research. In a research paper, it's not surprising to see a works cited page that is almost completely Wikipedia and Ask.com. I must say, I've had fun reading about gorilla warfare and how World War I started sometime in the mid-twentieth century. The real howlers come from students that fall in love with a word and use it at the most inappropriate times. There are also students that like to cram every academic post-modern normative realist discernment neo-institutional game theory lacuna... I'm sorry, I forgot where I was. Anybody know what's for dinner?
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goldhawk
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"Clinician provided accompany to client with training to visit doctor. Client feels doctor is listens to clients problem. Doctor wrote perscription for help to clients anger. Clinician provided training on important of dealing with pass abuse. Client thinks it was well that doctor gives her psychological information."

This looks like some form of dyslexia to me. Perhaps they write this way because they can't distinguish good grammar from bad?


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