Yesterday, I read two articles in JAMA on pimping. (Yes, I still get JAMA.) The article suggested that pimping medical students and residents may be “old school.” Used inappropriately, it may serve more as a tool off abuse and humiliation as opposed to a pedagogical art.
Duh.
Some say there are two types of online sites. Those that know they have been hacked. And those that have been hacked, but don’t know it.
Sobering.
Everyone is busy. The important question is what can be done to mitigate the downside of sites being hacked.
You want two outcomes: (a) minimize the likelihood malicious hackers will empty all the cash in your accounts; (b) prevent malicious hackers from using nuggets of information to steal your identity and open new accounts in your name.
What to do.
First, don’t reuse passwords. Access by a hacker to one site should not make it easy to access every account you have on many sites. A unique password for each site should confine the damage to one site. Some use a password manager, which does simplify the process. But, that’s not mandatory. Just don’t have all your eggs in one basket.
Next, place a security freeze with all three large credit bureaus. This will make it difficult for a third party to open an account (credit card, bank, etc.) in your name. If you need to unfreeze your account to allow a known party to do a credit check, you can authorize that action for the briefest of times to get the job done. Then put the lock goes back on. Security freezes make sense for people who are not opening accounts or having credit checks done on a regular basis. This means it is useful for most people.
https://www.experian.com/consumer/security_freeze.html
https://www.transunion.com/credit-freeze/place-credit-freeze
https://help.equifax.com/app/answers/detail/a_id/159/~/placing-a-security-freeze
That’s it.
You can always do more. But, if your New Year’s Resolutions include the above tips, then you’re absolved from losing the ten pounds you’ve been promising to do every year.
We often write about serious topics.
Not today.
I want to give a shout out to a site called Gomerblog.
GOMER is medical slang for a patient in the emergency room who is not in need of emergency services. For those of you not old enough to remember, it first appeared in widespread print in Samuel Shem’s book called House of God. GOMER is the acronym for Get Out of My Emergency Room. I learned this morning that gomere is a female gomer. Who knew?
Back to Gomerblog.
It bills itself as the Earth’s Finest Medical Satire and News. It’s certainly among the best. Here’s a sampling:
Uber Boston Announces New Services in Partnership with Ambulance Drivers.
Non-physician hospitals, The Web-MD and Wikipedia Clinic, to open in 5 major cities
Ophthalmologist Accidentally Agrees to See Inpatient Consult
Breaking News: Orthopedic Surgeon Completes 1000th Surgery with EBL of 50cc
Enjoy.
An old joke says that the best way to keep a secret is to tell it to only one person, and that person should be dead.
All kidding aside, the greater the number of people who handle information, the more likely that confidentiality will be breached. That’s why physicians take histories and examine patients behind closed doors, in addition to employing numerous measures to safeguard their medical records.
Here’s a common joke I heard during my residency.
“What’s the problem with every other night call?”
“You miss half the cases.”
The gist was that the more you saw, the more you did, and the more you learned.
Because it was believed that patient safety suffered in the wake of such extensive hours, the Accreditation Council for Graduate Medical Education (ACGME) restricted the amount of hours residents could work.
The rules:
In 2003, the ACGME limited the work weeks of all residents to 80 hours, averaged over 4 weeks, and on-site duty, including in-house call, to shifts of no more than 30 hours. These 30 hours consisted of a maximum 24 straight hours of duty and up to 6 additional hours, designed to give residents time for patient handoffs, outpatient clinics, and didactic activities, among other things.
In 2011, the ACGME restricted first-year residents to shifts of 16 hours, and other residents to 24 hours. For the latter group, “strategic napping…is strongly suggested,” especially after 16 hours of continuous duty and between 10 pm and 8 am. Residents beyond their first year also can be asked to stay after their shift if need be, but not beyond 4 hours.
In 2009, the Institute of Medicine suggested that studies should be performed to see if the change in hours impacted patient safety.
One study just wrapped up and the data is being analyzed. It was called FIRST. Flexibility in Duty Hour Requirements for Surgical Trainees. That study included ~160 hospitals across the country. General surgery residents were randomly assigned to one of two arms. The first was the status quo – embracing the long standing ACGME restrictions. The experimental arm was free to ignore all ACGME restrictions except three: Residents still could not work more than 80 hours a week on average nor take in-house calls more frequently than every third night, and they had to have at least 1 free day per week on average. So, it was possible to have a 30-36 hour shift.
The primary outcome measure is patient death within 30 days. Secondary outcome was serious morbidity.
The second trial is called iCOMPARE. Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education. This study will address internal medicine residents at 63 hospitals. The experimental group will mirror that of the surgeons in the FIRST study.
The chief investigator of the surgeon study, Dr. Bilimoria, stated “There’s a balance. Sleepy residents may commit errors, but breaks in continuity of care can make for worse patient care.”
Asked whether the experimental study embraced informed consent, Dr. Bilimoria replied that if residents strongly disagreed with the prospect of longer hours, “they could choose to work elsewhere.”
Dr Bilimoria said he has not heard of any complaints from residents in FIRST about extended shifts. Instead, “the enthusiasm among residents and faculty has been high,” because duty-hour flexibility improves patient care, particularly by reducing patient handoffs.
It is undisputed that the more hours you spend in a hospital during a residency the more you will see. And it is presumed you will learn more. The question is whether the benefits outweigh the risks. We’re about to find out.
Most parents have uttered the phrase “Because I Said So”. You know precisely what it means. You know why you said it. And, on occasion, your offspring will also know what it means.
In the medico-legal domain, experts are generally needed to make the case to the jury. They need to explain why the defendant doctor violated the standard of care; and how that violation caused damages. Many times, that opinion is supported by years of experience, the medical literature, and more. But, sometimes, the expert’s opinion propelling a meritless case boils down to ““Because I Said So”.
Medico-legal challenge?
We can help.
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