Facebook and unprofessional behavior among surgical residents

Have you ever wondered about the behavior of surgical residents on Facebook? I have. A study from the Journal of Surgical Education posted online in June 2014 looked at the issue.

The paper, "An Assessment of Unprofessional Behavior among Surgical Residents on Facebook: A Warning of the Dangers of Social Media," identified 996 surgical residents from 57 surgical residency programs in the Midwest and found that 319 (32%) had Facebook profiles.

Most (73.7%) displayed no unprofessional content, but 45 (14.1%) exhibited possibly unprofessional material. Clearly unprofessional behaviors were noted in 39 (12.2%) resident profiles. The paper said, "binge drinking, sexually suggestive photos, and Health Insurance Portability and Accountability Act (HIPAA) violations were the most commonly found variables."

There were no differences in the rates of unprofessional behavior between male and female residents or by postgraduate year.

I have blogged previously about the ill-defined nature of professionalism, and the papers authors acknowledged that it can be subjective. Some of the behaviors they felt were potentially unprofessional such as photos of residents holding an alcoholic drink, holding a gun while hunting, or making political or religious comments are debatable.

They referenced another paper that found similar rates of unprofessional behavior (16%) on Facebook among applicants to an orthopedic surgery residency program.

A 2005 New England Journal of Medicine case-control study found that practicing physicians disciplined by state medical boards were significantly more likely to have had documentation of unprofessional behavior in medical school as well as lower Medical College Admission Test scores and poorer grades in the first two years of medical school.

Unprofessional behaviors listed in the New England Journal paper were irresponsibility, diminished capacity for self-improvement, immaturity, poor initiative, impaired relationships with students, residents, nurses, or faculty, impaired relationships with patients and families, and unprofessional behavior associated with anxiety, insecurity, or nervousness.

Some of those seem a bit vague. Are diminished capacity for self-improvement and poor initiative really unprofessional behaviors?

Facebook unprofessional behavior and the unprofessional behavior documented in the NEJM paper which pre-dated the widespread use of Facebook may not be comparable.

But I suppose one could say that some of the Facebook behaviors could be categorized as immature or irresponsible.

Until stories about residents being rejected for jobs after training start emerging, there probably wont be a change in the way they use Facebook or other social media.

Or maybe society will change.

In 1987, politician Gary Hart had to withdraw as a candidate for the Democratic Partys presidential nomination because he had an extramarital affair, and just a few years later, the president himself had a dalliance with an intern in the White House and survived.

Who thought marijuana use would ever be legalized?

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Can cholecystectomies safely be done at night

A new study from surgeons at UCLA found that laparoscopic cholecystectomies done at night for acute cholecystitis have a significantly higher rate of conversion to open than those done during daylight hours.

Nighttime cholecystectomies were converted 11% of the time vs. only 6% for daytime operations, p = 0.008, but there was no difference in the rates of complications or hospital lengths of stay.

The study, published online in the American Journal of Surgery, was a retrospective review of 1140 acute cholecystitis patients, 223 of whom underwent surgery at night.

The authors advocate delaying surgery until it can be done in the daytime, but this conclusion needs to be examined.

Although the percentage of gangrenous gallbladders was similar in both groups, it wasnt clear from the data how many patients were semi-elective and how many were true emergencies.

Operative procedure durations were 110.5 minutes for nighttime and 92.4 minutes for daytime cases, and 1.5 and 2.0 days elapsed respectively before the patients were taken to the operating room, both p < 0.0001. The hospital lengths of stay were similar at 3.7 days for the night group and 3.8 days for the day patients. The causes for these lengthy operations, delays in operating, and long hospital stays were not explained in the manuscript.

The authors acknowledged that patient follow-up was no better than 50%.

Unreported confounders such as variations in the level of skill of the surgeons or whether or not a resident did the procedure could have influenced the results.

Another recently published study from the University of Texas Health Science Center in Houston found that although there was a slight but significant increase in complication rates [mostly retained stones and superficial wound infections] for patients having cholecystectomies at night, conversion rates of day and night surgery were similar.

Durations of operations averaged about 80 minutes [a more realistic figure than those in the UCLA study] in both groups. Hospital lengths of stay were significantly shorter [2 days vs. 3 days] for the nighttime patients. The authors acknowledged that a limitation of their study was that severity of gallbladder disease was difficult to accurately assess.

The decision about timing of cholecystectomy for acute cholecystitis depends on the availability of operating rooms, the severity of illness, the presence of comorbidities such as diabetes, and the surgeons schedule and other responsibilities.

Most surgeons agree that the sooner patients with acute cholecystitis undergo surgery, the more quickly they will recover and get back to normal activities.

In my own practice as a solo community hospital surgicalist taking care of emergency cases only, any patient with acute cholecystitis who I was consulted on before 6 or 7 pm had surgery that same night if an OR was available. If not, they always had the operation within 24 hours. The length of stay (LOS) averaged under 48 hours and the median LOS was 1 day.

Because one of the two hospitals involved in the UCLA study is a major trauma center in Los Angeles, the papers findings may not apply to other institutions where nighttime OR availability may be better.

Based on these papers, surgeons and patients should not be wary of undertaking cholecystectomies during evening hours.

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