More Beaumont drama

[Southpaw]

It may seem “dumb” when managing just a handful of providers but it is something that is required when managing hundreds of cases per day in a large practice.

sorry, no. My group covers many locations and certainly hundreds of cases a day. No one looks in charts, beyond listed surgery, to determine acuity/complexity prior to assignment.

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[GassYous]

Then u turf it to the young guy

Heh one of my classmates ended up in a malignant group with a 5 year track. I spoke to them and they were almost as slimey as Allied. Wouldn't tell me about the track length except "we have one" or the buyin amount. "Just come in for an interview and we can discuss this in person". Nahh. These ****ers gave him all the ****ty cases like "oh you just finished residency so you're comfortable with this kind of case right?"

 

[nimbus]

Heh one of my classmates ended up in a malignant group with a 5 year track. I spoke to them and they were almost as slimey as Allied. Wouldn't tell me about the track length except "we have one" or the buyin amount. "Just come in for an interview and we can discuss this in person". Nahh. These ****ers gave him all the ****ty cases like "oh you just finished residency so you're comfortable with this kind of case right?"

FWIW, that’s not possible where I work. We pick our own cases the night before based on call number. So if I end up with a crappy case, it’s my own fault. Which is why I’ll often review the chart before picking a case.

 

[PainDrain]

sorry, no. My group covers many locations and certainly hundreds of cases a day. No one looks in charts, beyond listed surgery, to determine acuity/complexity prior to assignment.

So you just throw a warm body into whatever situation arises regardless patient hx or complexity? Wow. Guess you don’t get those lap choles with severe MS (cause that typically isn’t in the surgeons booking).

 

[Southpaw]

So you just throw a warm body into whatever situation arises regardless patient hx or complexity? Wow. Guess you don’t get those lap choles with severe MS (cause that typically isn’t in the surgeons booking).

a lap chole with severe MS wouldn’t normally reveal itself the day before when the schedules are being made. It’d be referred weeks in advance to ensure adequate workup. And if it were felt TEE was needed then sure it’d go to a heart person. And even if not that’d still likely go to a heart guy/gal if possible.

if a case gets assigned and it turns out to be far more serious than posted, then arrangements are made but that’s rare.

We have a pretty large and extensive pre op eval system because of our size and how many places we cover. It just wouldn’t be realistic for an anesthesiologist, or a small team of them, to chart biopsy everyone and divvy cases as appropriate.

if it works for you that’s great. I guess my overall point is that I just don’t see it as wise for anyone to go looking in charts of patients that have essentially zero chance of personally caring for. But if it works for you, and you have the support of your hospital, then that’s cool.

 

[coffeebythelake]

So you just throw a warm body into whatever situation arises regardless patient hx or complexity? Wow. Guess you don’t get those lap choles with severe MS (cause that typically isn’t in the surgeons booking).

Your surgeons don't tell anyone if thry have patients with complex cardiac conditions?

 

[Blockit]

I have been watching this thread for a little while, reading the responses. I want to offer a little advice, take it for what I charged you for it, which is nothing.
Do not look at other patient records. Period.
There are some of you who have said “we do it all the time at my hospital, the hospital doesn’t seem to care.“ Wrong. They don’t care until they decide to care. Let’s say that you become a thorn in the side of a difficult surgeon. Because the guy treats everyone else like ****. And maybe he’s a bad surgeon on top of it.
At some point said surgeon decides that he is tired of you refusing to kiss his ring. He will go to administration and claim that you are a disruptive influence. Maybe he’ll make some threats to take his case elsewhere unless he can get a better anesthesiologist.
If the administration at your hospital is the type that values money over everything else (many of them), and if you also happen to be working in an “at will“ work state, this is what will happen. The administration will start looking at you. They will start looking at everything. They will start looking at everything possible that they could hang on you. And they will come across your alleged HIPPA violations. They will use that as ammunition to drag you before the MEC, possibly take action against your privileges, and possibly see to it that you are terminated. And because you live in an at will work state, you will have a little if any recourse. Don’t think that you can get yourself a lawyer, because that’s not going to work. The lawyer will be richer, you will be poor, and your hospital/employer will sail off into the night unscathed, ready to screw over the next quality physician that attempts to stand against the monsters.

meanwhile, you will then forever have to explain on every application for privileges or licensure why you have a ding on your record. And a significant number of those people that you were trying to explain this to either won’t care or won’t believe you.
I have seen this happen to several physicians throughout my career. Good physicians.
The moral of the story?
Do not delude yourself about what your administration, your colleagues, and even your friends will do. Watch your own ass, recognize what culture exists at your facility, and don’t break the rules.

 

[dhb]

Mine too. Along with work less. Make more. More rights. Less responsibilities. A unicorn would be nice too.

Not if you're playing leap frog

 

[coffeebythelake]

I guess this thread wouldn’t fly at some places.

Let's do some echo:

Let's do some basic Echo: This comes from my personal data base, so I hope you guys dig it. Med studs and residents first. Name 1-7

forums.studentdoctor.net

It is anonymized and there is nothing there that can be used to identify the patient. It js fine.

 

[coffeebythelake]

FWIW, that’s not possible where I work. We pick our own cases the night before based on call number. So if I end up with a crappy case, it’s my own fault. Which is why I’ll often review the chart before picking a case.

You mean you don't want the extra points for taking care of that ASA 4 and having to place those advanced monitors??

 

[nimbus]

It is anonymized and there is nothing there that can be used to identify the patient. It js fine.

I was replying to @agolden1’s post which said...

“Take picture of anything related to patient care on your phone and were seen? One warning, then fired for repeat offense. Happened to a surgeon.”

 

[agolden1]

It is anonymized and there is nothing there that can be used to identify the patient. It js fine.

Previous hospital’s opinion take on this, not mine:

Even without any identifiers, the patient did not provide permission for you to take this picture and post it and discuss their health on an online forum. If somehow you were doxed or a colleague reported it, you would be terminated without a second thought.

Easiest course of action when in doubt? Every hospital has a HIPAA person or office. If you have questions, quietly reach out and clarify. They’re happy to chat security often follow case outcomes across the country and can do tell you legal outcomes far better than our anecdotal stories.

Having very nearly been burned by this myself at one point in my career, it’s something I take as seriously as possible.

 

[coffeebythelake]

Previous hospital’s opinion take on this, not mine:

Even without any identifiers, the patient did not provide permission for you to take this picture and post it and discuss their health on an online forum. If somehow you were doxed or a colleague reported it, you would be terminated without a second thought.

Easiest course of action when in doubt? Every hospital has a HIPAA person or office. If you have questions, quietly reach out and clarify. They’re happy to chat security often follow case outcomes across the country and can do tell you legal outcomes far better than our anecdotal stories.

Having very nearly been burned by this myself at one point in my career, it’s something I take as seriously as possible.

I would refer to your hospital's policies on this, but this would be a misinterpretation of HIPAA laws. If they fired someone on this basis of HIPAA violation jt could be cause for wrongful termination lawsuit. However hospitals are allowed to have their own policies regarding privacy and social media use which are more strict. And that depends on how the employment contract is written (at will?)

 

[GassYous]

Thanks for the opinions I will stop chart checking but I don't regret doing it at the beginning of my career. Really learned a lot that way.

 

[Drangue]

I look at charts to see how other people run their anesthetics all the time. It really helps me develop my practice without actually doing 10,000 cases a year.

100%

We're encouraged and, as a resident, I find it helpful to learn about how other residents are running their anesthetic. We get jealous of each other when we get to be with certain attendings that allow us more autonomy so it's a thrill to see our friends do stuff that we don't normally do.

We look at our ICU patients, OB patients and OR patients allllllllllllll the time when we're not on those rotations. It also gives us an indicator if we need to help them with transport, ask them if they need drugs or even if we need to alert our ICU attendings (who happens to not be anesthesiologists) how bad the cases are, etc.

I don't think an anesthesiologist would ever be faulted for looking into a patients chart if it's for educational or preoperative purposes. I could be wrong.

 

[chocomorsel]

100%

We're encouraged and, as a resident, I find it helpful to learn about how other residents are running their anesthetic. We get jealous of each other when we get to be with certain attendings that allow us more autonomy so it's a thrill to see our friends do stuff that we don't normally do.

We look at our ICU patients, OB patients and OR patients allllllllllllll the time when we're not on those rotations. It also gives us an indicator if we need to help them with transport, ask them if they need drugs or even if we need to alert our ICU attendings (who happens to not be anesthesiologists) how bad the cases are, etc.

I don't think an anesthesiologist would ever be faulted for looking into a patients chart if it's for educational or preoperative purposes. I could be wrong.

Scroll up a few and read what @Blockit wrote. Very informative.

 

[IlDestriero]

Previous hospital’s opinion take on this, not mine:

Even without any identifiers, the patient did not provide permission for you to take this picture and post it and discuss their health on an online forum. If somehow you were doxed or a colleague reported it, you would be terminated without a second thought.

Easiest course of action when in doubt? Every hospital has a HIPAA person or office. If you have questions, quietly reach out and clarify. They’re happy to chat security often follow case outcomes across the country and can do tell you legal outcomes far better than our anecdotal stories.

Having very nearly been burned by this myself at one point in my career, it’s something I take as seriously as possible.

That’s actually part of our academic hospital consent. Deidentified photos/video may be taken and used for educational/research/publication/etc.
That doesn’t mean you should have that on your unsecured cell phone though.

 

[pgg]

Scroll up a few and read what @Blockit wrote. Very informative.

I just did some online training (ugh ) for a place I'm going to do some locums work. There was a whole module on some new automated system they have that proactively trolls, I mean audits, every person's EMR history looking for things to flag.
- chart access to patients you didn't write notes on or bill procedures for
- chart access to VIPs' records
- chart access to other employees' records
- chart access to family members' records
- chart access to your own record
- chart access patterns that are statistical outliers to other people in your specialty
- and a bunch of other things

Flagged events generate an automatic memo that goes to your supervisor, who can then OK things (if, for example, you were doing peer review, or M&M, or had some other legit reason to access a record).

This is the future. Anyone who pokes around the EMR is, or is gonna be, asking for it.

 

[Tony C anesthesia]

100%

We're encouraged and, as a resident, I find it helpful to learn about how other residents are running their anesthetic. We get jealous of each other when we get to be with certain attendings that allow us more autonomy so it's a thrill to see our friends do stuff that we don't normally do.

We look at our ICU patients, OB patients and OR patients allllllllllllll the time when we're not on those rotations. It also gives us an indicator if we need to help them with transport, ask them if they need drugs or even if we need to alert our ICU attendings (who happens to not be anesthesiologists) how bad the cases are, etc.

I don't think an anesthesiologist would ever be faulted for looking into a patients chart if it's for educational or preoperative purposes. I could be wrong.

Try to convince hospital admin or an attorney with this logic. Looking up patient's chart if you're not directly involved in his/her care is HIPAA violation, period.

 

[dannyboy1]

I just did some online training (ugh ) for a place I'm going to do some locums work. There was a whole module on some new automated system they have that proactively trolls, I mean audits, every person's EMR history looking for things to flag.
- chart access to patients you didn't write notes on or bill procedures for
- chart access to VIPs' records
- chart access to other employees' records
- chart access to family members' records
- chart access to your own record
- chart access patterns that are statistical outliers to other people in your specialty
- and a bunch of other things

Flagged events generate an automatic memo that goes to your supervisor, who can then OK things (if, for example, you were doing peer review, or M&M, or had some other legit reason to access a record).

This is the future. Anyone who pokes around the EMR is, or is gonna be, asking for it.

This will be hard to enforce in anesthesia. I am constantly looking up patients who I don’t end up working on for various legitimate reasons. Usually the patient was on the schedule and got cancelled, or someone else relieved me when I was getting ready to do the case ect..

 

[MirrorTodd]

This will be hard to enforce in anesthesia. I am constantly looking up patients who I don’t end up working on for various legitimate reasons. Usually the patient was on the schedule and got cancelled, or someone else relieved me when I was getting ready to do the case ect..

Those supervisors gonna have a grand ole time okaying hundreds of charts reviews a day. lol

 

[Arch Guillotti]

This will be hard to enforce in anesthesia. I am constantly looking up patients who I don’t end up working on for various legitimate reasons. Usually the patient was on the schedule and got cancelled, or someone else relieved me when I was getting ready to do the case ect..

or it gets moved to another room, etc.

 

[chessknt]

Equifax can lose my ssn, address, loan and bank numbers online and I get a coupon for 25 cents off lifelock meanwhile we look at someone’s chart to become better doctors and we get fired and fined a million dollars. Sounds like a good system.

 

[nimbus]

This will be hard to enforce in anesthesia. I am constantly looking up patients who I don’t end up working on for various legitimate reasons. Usually the patient was on the schedule and got cancelled, or someone else relieved me when I was getting ready to do the case ect..

Same

 

[coffeebythelake]

Equifax can lose my ssn, address, loan and bank numbers online and I get a coupon for 25 cents off lifelock meanwhile we look at someone’s chart to become better doctors and we get fired and fined a million dollars. Sounds like a good system.

When u want money from the government u gotta bet they will act like little bitches doing everything to deny it to you

 

[D P356]

When u want money from the government u gotta bet they will act like little bitches doing everything to deny it to you

Same can be said of some insurance companies