Social Media in the Workplace: the Good, the Bad, and the Very Ugly

By Daniel J. Burnick of Sirote & Permutt, PC

When I tell people that I am an attorney at Sirote, they usually ask what type of law I practice.  My response is Sex, Drugs and Rock and Roll.  After a little chuckle, I add that I do employment law, defending employers on claims of harassment, discrimination, retaliatory discharge and other employment related cases.  I also counsel clients on policies and procedures that I believe are necessary in today's workplace.  The use of Social Media (SM) is one of those areas that is often overlooked, and can lead to results that are good, bad or very ugly. 

Medical professionals may be asking what does SM have to do with me?  The following are two good examples of the bad and the very ugly. 

The Bad.  In Rhode Island, a Doctor was disciplined after she posted information about a patient on Facebook.  Although she did not identify the patient by name, she recounted enough of her ER experience that the patient could identify himself.  The Doctor had her privileges terminated at the hospital.  In England, EDP24, a regional newspaper, recently ran an article detailing numerous instances of hospital staff making inappropriate comments on SM sites, including congratulating a patient on her pregnancy after seeing her chart, and an employee "friending" a patient after obtaining information from the patient's records.   The Alabama State Nursing Association published an article in it's Fall, 2011 Newsletter about the problems nurses can face when using SM.   This is a must read for all medical professionals, in that it lists common problems that have occurred in real life.

The Very Ugly.  In California, a resident at a nursing home was attacked by a fellow resident.  His throat was slashed so severely that he was nearly decapitated.  When he arrived at the local hospital, staff took pictures of this mortally wounded man and posted them on Facebook.   4 staff members were fired and 3 others disciplined.  The LA Times story goes on to address numerous instances of hospital employees taking photographs of patients and/or medical records (such as x-rays) and posting them on SM sites or texting them to other employees. 

The GOOD.  SM has many positive benefits in the professional world.  These include the ability to market your practice, maintain or improve your reputation by publishing on blogs or professional sites such as BirminghamMedicalNews.com,   and the ability to keep up to date on recent news and innovations in the medical community.  There are also internet sites that rate businesses, including doctors.  These should be monitored on a regular basis to see what, if anything is being said about you or your practice.  Disgruntled/dissatisfied patients may post defamatory comments or false ratings.  Also, there have been some instances when lawyers have had made up positive postings made about them.  They did not do it, and did not know who was posting the comments.  The article also states that the same reviewers were also posting positive reviews about medical providers. 

The Dangers of Social Media in the Medical Profession.  There are numerous dangers that can be associated with SM in the medical profession, including:

                1.  The loss of one's license.   By improperly posting information on SM sites, Doctors and Nurses may be subject to disciplinary action by the licensing boards, including fines, suspensions or revocation.

                     2.  Claims by patients for invasion of privacy or HIPAA violations.

                     3.  Embarrassment.  No one wants to see their name on the front page of the newspaper as the result of a lawsuit or disciplinary action.

                  4.  Loss of reputation.  It takes a lifetime to build up one's reputation, and in the digital world, one click to ruin it.

How to Minimize the Dangers of Social Media.  There are many ways to attempt to minimize the dangers of SM.  These include:

                1.  Having a SM policy that outlines what is acceptable and what is not acceptable conduct when using SM.

              2.  Training, training and more training.  Training can include in person training, reminders during office meetings, via email, or in writing.

                3.  If an employee is posting on a SM site on behalf the employer via Twitter, Facebook, LinkedIn etc., the employer should be sure that they own the site.       

                4.  Monitoring of employees' SM sites.

                5.  Think before you post.

                6.  If it is something you cannot tell or show to your mother, it should not be posted on a SM site.

                7.  Google yourself on a regular basis to see what is out there.  Also, sign up for Google Alerts or other similar program.

The use of SM in the workplace presents very complex legal issues, and the issues change on a  regular basis due to developments in technology.  The law struggles to timely keep up with technology since it changes so quickly. You should consult your legal advisor to ensure compliance with the numerous laws and regulations that govern SM, as well as the medical profession. 

Healthy Weight Maintenance

By Keehn Hosier, MD

Somewhat lost in all of the furor over the recent Supreme Court ruling on health care legislation is one simple fact: we can dramatically reduce health care costs if more Americans attain a healthy weight.  But attaining such a goal has been more easily discussed than accomplished, often due to poor understanding of what actually constitutes a healthy diet and exercise regime.  Fortunately, with the proliferation of smart phones, we have educational tools at our disposal that make life much easier when we are trying to help patients (and ourselves!) reach our weight goals.

One of the critical components for anyone trying to reach a healthy weight is an understanding of how many calories are needed vs. how many are actually consumed.  Physicians have often advocated keeping food journals as a means of maintaining accountability, but there are several outstanding applications that make this chore easier.  Two that I have found work well are mynetdiary and myfitnesspal.  Both of these smart phone food journals will calculate the necessary daily caloric intake necessary to reach a desired weight.  Many foods are pre-loaded in the journals so that patients can simply type in something like “grilled chicken, 4 oz, hamburger bun, 14 oz sweet tea” and have an instant reading of how many calories may be consumed the rest of the day.  These applications will also calculate break down food into component parts: fat, protein, carbohydrate, cholesterol and sodium amounts.  These tools are very useful for helping patients maintain cardiac or diabetic diets.  As an added bonus, patients can also see how exercise affects net daily calories.  This often inspires people to exercise just a bit harder or longer to help accomplish their goals.  One trick that I have found useful is to slightly underestimate caloric expenditure, i.e. record 25 minutes of exercise rather than the actual 30 minutes that was performed, and slightly overestimate caloric intake, i.e when in doubt if that piece of chicken is 4 or 5 oz, record the higher value.  This gives the user a margin for error that helps reduce plateaus.  Both of these applications are available on both Apple and Droid platforms. 

Strength training is an often underappreciated component of healthy weight maintenance.  However many people approach strength training with trepidation, either out of fear of looking out of place in a gym or out of concerns about injury.  As a result, I frequently advocated short term personal training packages for those patients completely naïve to strength training.  A new application, Jefit, serves as a portable personal trainer.  Jefit is by far the best weight training tool I have encountered.  For each body part, there is a lengthy list of exercises that a person can try; some of the exercises require nothing more than body weight, a small hand weight, or a resistance band.  As a result, people can perform these exercises at home, eliminating the “I don’t have time to go to the gym” excuse.  Each exercise has a cartoon illustrating proper form with written instructions to prevent injury below each animation.  Users can construct their own workout routines or they can enroll, without cost or obligation, on the jefit.com website where there are user and trainer submitted routines that anyone can copy.  The days of pen and paper charting a workout routine are over, as the application keeps track of your workouts, your performance improvement, and your theoretical one rep maximum weight for each exercise. 

Anyone who has watched The Biggest Loser is familiar with the ubiquitous BodyBugg that the contestants wear.  The BodyBugg is a fairly complicated device worn on the upper arm that measures daily caloric expenditure.  There is an internal accelerometer, a skin conductivity sensor, as well as heat sensors, all of which combine to provide a fairly accurate measurement of a person’s basal metabolic rate and exercise expenditure.  I have found this device to be useful for people who grossly overestimate their daily activities then wonder why they can’t lose weight.  The BodyBugg is not for the timid or for those who are pinching pennies.  As a result, I more frequently recommend pedometers to keep track of daily walking.  These simple devices easily attach to any lace up shoe and generally come with rough formulas to help people estimate caloric expenditure. 

Perhaps the biggest benefit the new technological tools offer is the pure accountability that keeping track of the numbers provides.  When caloric intake visibly exceeds expenditure, it forces the honest user to make healthy lifestyle changes.  That, after all, is our ultimate goal.  

Technology Terror: It Never “Just Works”

By Byron Harrison of Jackson Thornton Technologies

I hate technology!   Why do we have to use this!?   I want to go back to the old way!

I have heard these comments time and time again in my position as an IT Consultant.  Individuals and businesses as a whole have historically seen technology as a necessary evil; something that cuts into their profits and does not help their business perform any better.  Further, and especially in the accounting, legal, and medical industries, the government is pushing technology down the throat of companies whether they want it or not.  Needless to say, perception of technology is oftentimes poor.

And who can really argue this point?  For such a long time information technology was limited to either that which was forced on you in your workplace or that expensive new home theater system with a 200 button remote that no one seemed to know how to use.  But the good news is that it was just that, perception, and not necessarily the technology itself.  In fact the technologies were and are quite remarkable but the negative connotations including cost, poor implementation, lack of training and complexity all led to negative perceptions.

All that said, over the past 2-3 years there has been an active shift in the perceptions of technology.  It is my opinion that this is a result of extreme popularization of consumer technologies that are actively making peoples’ lives better.  Technologies like Skype, iPads, Netflix, GPS, and SmartPhones, just to name a few, are changing perceptions.  It’s no secret that these technologies are older than 2-3 years, but what has changed during this recent period is the simplicity of these technologies and the fact that “they just work.”   As proof in point, my grandmother of 87 years asked me what my “Skype name” was last week.  That hit home.

As a result of consumer grade technology drastically improving in capability and simplicity, and people actively seeing it as a way to improve their lives, positive perceptions are spilling over into the workplace.  Instead of me, the IT consultant, showing a doctor how an EMR feature can improve their patient flow, I have doctors coming to me with ideas on how a tablet device they saw on the news last night might fit into their practice.  This is great news and has positively impacted countless businesses as they begin to embrace technology.

And while this effect has also improved my quality of life as an IT consultant, it does present an unwanted spillover.  The “it just works” factor does not simply apply to business class technologies like it does for consumer grade devices.  While consumer grade technologies are largely self-contained, the business class technologies have an incredible number if pieces that must perform flawlessly for the “it just works” factor.  For example, video chatting with Skype really just needs some battery life, a working iPad and a connection to the internet.  Not too much can go wrong.  However take that iPad to your medical practice for use with an EMR and it needs an application to connect to the EMR, a strong and secure wireless infrastructure, high performing EMR server(s) that are redundant and backed up regularly and the list goes on and on.  If any of these pieces are missing then failure results and perceptions are ruined once again.

So while there is a significant improvement in the perception of technology, there is a disconnect with respect to the perception of the management, planning, and implementation of that technology in the workplace.  Navigation of this terrain gets difficult.  The “Nerd Herd” can rarely solve business infrastructure needs or achieve the “it just works” factor as they can with consumer grade technologies.

In summary, as you continue to improve your business and make those critical decisions, ask yourself if you have used the following comments in the past 12 months:  I hate technology!   Why do we have to use this!?   I want to go back to the old way!   If you have, then an opportunity exists to leverage technology in a more cost effective, efficient, and “it just works” way.  Just remember, in order for technology to be an enabler in your business, managing that technology and the accompanying perception is key. 

New Options for Surgery in Women’s Health Available at Trinity Medical Center: da Vinci® Robotic Surgery Reduces Pain, Recovery Time

By Robert A. DeSantis, MD, FACOG

a da Vinci surgeon and Board Certified OB/GYN at Trinity Medical Center

Hysterectomy remains one of the most common surgeries performed in the United States today, second only to cesarean sections.  This procedure is performed for numerous conditions including endometriosis, uterine prolapsed, fibroids and cancer. 

While the majority of hysterectomies are still being performed by making a large incision in the abdomen - resulting in a large scar, increased pain, and extended time away from work while recovering - there is another option. 

New advancements with the da Vinci® surgical system provides patients and physicians with a minimally invasive approach that shortens hospital stays (less than 24 hours in most cases), recovery time, and time away from work.  Other potential benefits over traditional surgery include less pain, less blood loss, lower risk of wound infection, less scarring and fewer complications.

Compared to traditional laparoscopy, the da Vinci Robotic Surgical System provides us with enhanced capabilities and offers high definition 3D views with 12 times the magnification.  Any procedure that I would have normally performed through a traditional large incision on the belly can now be done with the da Vinci® using a one to two centimeter incision.

Don’t let the term “robot” scare you.  The system cannot act on its own; the surgeon is always in control of every move.  The robotic technology allows the surgeon to sit at a console viewing the procedure through a 3D image.  The surgeon’s fingers grasp the master controls below the display and the system translates the surgeon’s hand, wrist and finger movements into precise, real-time movements inside the patient.

Regarding gynecologic conditions, hysterectomy is the most common procedure I perform using the da Vinci® system. And I, along with other experienced surgeons, have taken the procedure beyond the basics.  I have also used the da Vinci® for endometriosis surgery, pelvic organ prolapse, ovarian cystectomy (cyst removal), tubal reversal in women who have undergone sterilization and desire reversal, myomectomy (removal of fibroid tumors from the uterus with preservation of the womb), and trachelectomy (removal of the cervix in women who have previously undergone a supracervical hysterectomy).

I trained on the da Vinci® system in 2007 and have now done over 300 cases.  Prior to becoming a da Vinci surgeon, I was performing approximately 50 percent of my hysterectomy cases open.  Over the past 36 months, my open rate is <1% for hysterectomy and <5% for all gynecologic surgery.  A recent study comparing da Vinci®, traditional laparoscopy and open abdominal hysterectomies was released and the operating time in the hands of an experienced da Vinci surgeon was shorter, blood loss was 50 percent less than traditional laparoscopy and 75 percent less than open, and the average hospital stay was 1.1 days compared to 1.6 for traditional laparoscopy and 5 days for open.

Although individual results may vary, I have had patients return to work within one week after hysterectomy, and I even had one patient return after one day.  Interestingly, 20 percent of patients who underwent an attempted hysterectomy with traditional 2D laparoscopy required open surgery to complete the case compared to 4 percent of those who underwent da Vinci surgery.  The system allows me to treat patients with more advanced benign disease including significantly enlarged uteri (due to fibroid tumors) and pelvic adhesive disease and scarring (due to severe endometriosis and/or prior pelvic surgery). 

I, along with my partners J.C. Brock, MD and Andrew Lemons, MD, now provide this state-of-the-art surgery at the Alabama Robotic Institute at Trinity Medical Center.  For more information about the da Vinci Surgical System® at Trinity Medical Center please call 592-5499 or visit www.trinitymedicalonline.com.

Chronic Sinusitis

By Sheldon Black, MD of ENT Associates of Alabama

What does it mean when someone says they have “sinus”? Most of the time, these patients have chronic sinusitis. This is often not a bacterial infection, but instead an inflammation or swelling of the lining of the sinus cavities. Treatment usually starts with steroid nasal sprays and nasal irrigations, but can include surgical intervention. Your doctor can diagnose this with good examination and CT scans of the sinuses. Do not just live with your “sinus”. It can be helped.

Judge Poole Rules Against Trinity Digital Hospital

By Steve Spencer

Montgomery County Judge Jimmy Pool has ruled against allowing Trinity Medical Center to move its operations to the Digital Hospital campus on Highway 280.

This decision is a big surprise, given that there have been five rulings by Alabama judges and the Alabama Certificate of Need Board that approved the move.

Trinity issued a statement saying they will appeal the decision to the Alabama Court of Civil Appeals and will seek their expedited review.

Practice-Based Research Affords Patients Additional Treatment

By Diane Paige, RN with Clinical Research Center of Alabama

Mr. Smith’s worsening COPD has left him unable to work or enjoy activities with his grandchildren. His doctor has prescribed multiple medicines, often expensive, rarely effective. Mrs. Jones has been to several doctors, and no one can find an effective treatment for her chronic hives. She’s tried this pill and that cream, enduring side effects with little or no relief. Little Johnny’s asthma keeps getting worse. His single mom struggles to afford the medicines he needs, and nothing currently available has worked. What do these tree patients have in common? They have all benefited from community practice-based clinical research.

The NIH Roadmap for Medical Research has prioritized the expansion of the community-based physicians’ role in facilitating the dissemination of evidence-based medicine. Practice-based research occurs in the office, where most patients receive the majority of their care and may be the essential link between bench discoveries, bedside efficacy, and everyday clinical effectiveness.

 A clinical trial may afford patients additional treatment options-beyond standard care-that are on the cutting edge, and at no cost. While delivering improved patient care, doctors, nurses, and research coordinators have the opportunity for professional development, acquiring expertise in therapeutic areas of interest as well as continuing medical education, training, and additional credentialing. Offices that incorporate research into their practice report higher levels of personal satisfaction amongst their staff. Conducting trials is also an excellent vehicle for practice growth while providing a new revenue stream.

Ultimately, office based clinical research is universally beneficial for patients and providers alike, and the future for translating research in to practice.