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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Media blames Batman and cosplay for the behavior of a Mad Man

On Friday July, 20th the world woke up to the news that a crazed gun man walked into a midnight screening of the Warner Brothers film "Dark Knight Rises" and opened fire. Like many, I watched the report stunned at this horrific act of violence. I was angry that this had happened but my anger grew as the reporters claimed that it was a man in costume who committed this crime. One reporter suggested that he was dressed as Bane. The topic then shifted to the violence in the film and that it had somehow inspired James Eagan Holmes  to gun down movie goers even though no one in the theatre had seen the movie yet. Even after a survivor from the theatre called into the Today Show on NBC saying the man was not in costume but was wearing body armor and a gas mask to protect himself against the gas he ignited, the reporters remained ignorant and still pointed the finger at Batman and "passionate" people in costumes.

The media is no stranger to sensationalism (and reporting things that arent true yet failing to correct themselves) but in this case, many people in the comic and cosplay world were offended. Reports were essentially saying that it was one of us who went on a murderous rampage. A cosplayer took it too far. A comic fan wanted life to imitate art. It was Batmans fault. Its comic books fault. Its the cosplayers fault. Why was the blame shifted to us and not the lunatic who committed this crime? Why were they making excuses for him? Why were they bringing the art of comics, cosplay and movies into this? People have been committing violent acts since the dawn of time, before there were movies, comics or indoor plumbing. Jack the Ripper murdered prostitutes in London in 1888. Cain killed his brother Able in the Bible. In the Middle Ages acts of torture included limb and finger removal, bone breaking and boiling. There was no Batman to blame, only the perpetrator. Because of the Colorado shooting and the media spotlighting comics and cosplay, I wouldnt be surpried if Movie Theatres begin banning anyone in costume for Midnight Showings.





I have been a victim of the press and its sensationalism. A few years ago my grandfather was murdered in his own home. Because my Uncle is a Police Officer, the local news and media was all over the story, calling it "Father of a Police Officer Murdered In Home". Dealing with the death of a loved one is hard enough but its a million times worse when they are taken from you. The press kept hounding my mother who unwillingly became our family spokesperson to help get the word out to catch the murderer. The press was very insensitive. I broke down in hysterics when I saw my grandfathers body being carried out of his home in a body bag on television. When it was time for the funeral, the reporters and camera men had surrounded the church, snapping shots of anything they could get. They went into a frenzy when my Uncles Police District arrived to pay their respects along with the Special Crimes Unit. After the casket was loaded into the hearse, a camera man jumped in my face to snap a shot of me walking with my mother. She grabbed my hand. I turned my tear stained face away so he couldnt get the shot. They didnt care about me or my family and many of them reported things that werent true. But it didnt matter. They just wanted to get a story.

Safe to say, I dont like reporters very much and strive to be different from them when it comes to my own writing. I am going to be very clear in making my point: The shooting in Colorado was the fault of  James Eagan Holmes. Not Hollywood, not Batman and not the cosplay community. New reports from the police are saying that this was done with "calculation and deliberation". His apartment was rigged with explosives and he murdered 12 people and wounded 58 others. Unconfirmed reports stating that he was inspired by the Joker are irrelevant. He wanted to kill. Hes a murderer, just like Jack the Ripper and other madmen before him. I can tell you personally that you cannot reason with madness and chances are you will never get your answer as to why it happened. I still dont know why my 80 year old Grandfather was murdered; why he was chopped up in his own home. I can tell you that it wont change anything even if I knew the answer. In all honestly, I dont care. I dont want to hear the excuses of the man who took my Grandfather away.  NOTHING will justify that and NOTHING will justify the shooting in Colorado. Like Micheal Cane memorable said in "The Dark Knight:"

"Some men just want to watch the world burn."

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Cosplay 2012 A Year In Review

2012 turned out to be the busiest year in my cosplay career. I debuted nine costumes, a record breaking number for me. I also did my first ever body paint photo shoot. As a costumer, its always exciting to work on new projects and get creative. Below is a list of all of the characters I brought to life in 2012.

Lois Lane

When Superman asks you to be his Lois Lane, how can you say no? As a child, I loved the Christopher Reeves films and regularly dreamed of flying with the Man of Steel among the clouds. Getting a chance to live out that dream was beyond exciting for me. Dressing as the Pulitzer Prize winning reporter was not only easy but very comfortable. Lois was also one of those rare characters where I used my real hair. No wigs or extensions were required. I had the opportunity to pose with not one but two Superman cosplayers, Danny Kelley and Dustin Dorough. What more could a girl want?  Lois Lane gallery.

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Elektra

2012 also marked my first Marvel character, none other than the sexy assassin Elektra Natchios. The costume was debuted at this years Wizard World Philly show and was loaned to me by Allycat (who also made the costume).  I required the outfit as part of the Marvel photo shoot that took place at the event. When I had to choose a character, my mind went immediately to Elektra. Although I havent read much on her, I was always intrigued by this female assassin in red. For years my friends had told me I look like her and I was thrilled that I finally had the chance to portray her. Elektra gallery.

1950s Catwoman

Forget everything you know about Catwoman in the 1950s! This design was completely original and was the brain child of Han Pan and Lucid as part of their 1950s Sirens Group. Drawing inspiration from that era, Han (Harley Quinn) and Lucid (Poison Ivy) designed and created three beautiful dresses that we debuted at this years Wizard World Philly show. I drew inspiration for the hair, makeup and  jewelery not only from Miss Kyle, but Elizabeth Taylor as well. The response from fans was overwhelming and we took home the second place prize in the costume contest. Harley, Ivy and Selina never looked this classy!

Cheetah (Vintage)

The Superfriends was one of my favorite cartoon shows growing up. My siblings and I watched it every Saturday morning. I was approached by my friend who runs ZQ Costumes about modeling one of his creations; a vintage Cheetah costume complete with a tail!  Playing  Wonder Womans nemesis for a day was fun. The photo shoot took place at a local Arboretum and the attendees got quite a shock to see  Cheetah climbing trees and posing for photos. Cheetah gallery.

Snow White

Mirror mirror on the wall, who is the fairest of them all? The story of Snow White is my favorite Grimm Fairy Tale for numerous reasons (See my article The Psychology of Snow White to find out why). The costume, which is made of velvet and satin, is in the tradition of the Disney film with slight modifications. When approaching this iconic character, I really wanted to make it my own and not just mirror her appearance in the Disney film. I took the greatest liberty with the hair, choosing a long, curly wig. The photo set is my favorite  session I did in 2012. The shoot took place at a local art school which coincidentally, had an outdoor Snow White exhibit. The woods also made for the perfect backdrop and resulted in breath taking photography. Snow White gallery.

Sydney Savage

This year I discovered Danger Girl, the spy girl series brought to you by superstar artist J. Scott Campbell. I instantly fell in love with the catsuit wearing, whip wielding Aussie, Sydney Savage. She was funny, sexy, smart and an all around badass. This was one of those costumes where I used pieces from other cosplays. The catsuit, belt and boots are from my Catwoman costume. The whip was an Indiana Jones accessory and the wig is a lacefront that I purchased for the Dragoncon Celebrity Cosplay group (where I was Angelina Jolie). At this years New York Comic Con show, Allycat and I had the opportunity to take photos with J. Scott Campbell while we were dressed as Sydney and Abbey Chase. The ultimate compliment is when the creator of the character you are portraying says that you look great!

Huntress

"Cry of the Huntress", released in the early 1990s, was my first comic book featuring Helena Bertinelli. Unfortunately I had issue 4 of 6 of the mini series and was completely lost with the story line.  Huntress however made an impression on me and I wanted to learn more about the character. I did so by reading more books that featured her and later watched her appearances on Justice League Unlimited. I was intrigued by Helenas family connections (and tragedy) with the mob and her no nonsense approach. She was willing to cross a line most heroes werent and for that, she was an outcast. Love her or hate her there is no denying that Huntress is not one to be messed with. I debuted my Huntress costume made by Rage Costum Designs at this years New York Comic Con. While walking around in Artist Alley, I was stopped by artist Joe Staton, who helped designed Huntress original outfit. He requested to take a photo with me and said I portrayed the character wonderfully. Getting praise from creators is the highest honor you can receive.

Steampunk Alice

Steampunk was something I always enjoyed and wanted to try. I finally dove in head first with a steampunk version of Alice in Wonderland. The idea was inspired by Candy Keane, who wore her version of Steampunk Alice at this years DragonCon show. The dress, socks and waist cincher are from her online store Three Muses Clothing. I choose to remain traditional and selected a blonde wig from my collection. I added a top hat (from my Zatanna costume) and a pair of steampunk goggles. Gloves from my Tomb Raider cosplay and boots completed the look. I was thrilled with the results and the pictures that were taken of this costume. I really enjoyed doing a steampunk look and plan to do more variants in the future. Steampunk Alice gallery.

The Wicked Witch of the West (Elphaba)

While putting some things away into storage, I spotted my witchs broom and hat that I had purchased years ago. I suddenly had an epiphany. If I combined those items with a vintage black dress I had in my closet with a waist cincher and put on some green makeup that was sitting in my closet, it was an instant Wicked Witch of the West! The creative juices were flowing  and I was filled with euphoria as I grabbed the items (including a wig) and put it all together. I was quite startled once I saw the results of the makeup I applied. I loved it and felt quite proud. This wasnt about being pretty or glamorous nor was I trying to sex it up. It was about something much more in depth. I am very pleased with the test shots. The only correction that has to be made is a better choice in makeup. I would not recommend the "Body Paint" tube from a local party store. After applying three coats to my face and neck, the makeup still did not look smooth and resulted in looking  "spotty". Not bad for a thrown together costume on a boring Sunday afternoon.

Cheetah (body paint)

Body paint is something that I always wanted to do. The process and the results are nothing short of stunning and is a whole new level of creativity. A big issue I had was finding someone that I trust. Im not just going to strip down naked for anyone and allow them to paint my body. As fate would have it, I met a very talented costumer at a show this year who also specializes in face painting. He spoke to me about his interest in wanting to paint someone and asked if I would be interested in doing a project. His talent, combined with his positive energy made me very comfortable and we selected the DC character Cheetah. Because this was a first for both of us, the process took roughly about eight hours. I was entertained by watching episodes of Dr. Who (which I am now addicted to) and slices of pineapple pizza. The results were amazing and I was stunned by the first official photo from our session. Safe to say, Roy and I will be collaborating on future body painting projects.

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Dont jump to conclusions about that JAMA surgical readmissions paper

On February 3, JAMA published a paper online about readmission rates after surgery. The focus of most tweets was on the most common cause for readmission—surgical site infections (SSIs)—in 19.5% of readmitted patients.

At first glance, this suggests that infection rates after surgery were 19.5%, but that is not so. The paper said that 19.5% of the readmissions were caused by infections.

Of 498,875 total operations reviewed, only 30,270 (6.1%) were readmitted for any reason, and only 5576 (1%) of all patients were readmitted for SSIs.

According to the full text of the paper, the authors had two main points:

One, "because most readmissions were attributable to well-described postoperative complications, readmissions after surgery are mostly a proxy measure for postdischarge complications and in effect penalize hospitals twice [my emphasis] for postoperative complications (ie, other pay-for-performance programs include postoperative complications such as SSI)."

Two, "the majority of hospital readmissions were related to SSI and ileus [non-mechanical failure of bowel peristalsis]. Identifying clinical interventions to reduce the occurrence of these complications to below current levels has been challenging."

An article about the paper in US News quoted an editorial by Lucian Leape who said "system-wide changes need to be made." One such system change, the Surgical Care Improvement Project (SCIP), has been ongoing for more than 10 years.

The paper confirms what I wrote in 2010 about SCIP and other process measures and points out that "Most hospitals in the United States have high adherence rates for the SCIP SSI-prevention process measures; however, compliance with these process measures has not been shown to be strongly associated with reduced SSI rates."

And I am unaware of a conclusive study showing that the incidence of postoperative ileus can be lowered by any intervention.

I agree with the comments of the papers authors who say, "It is important to note that many readmissions may be unavoidable and are actually the correct course of action for surgical patients. [My emphasis] Many complications should be treated in the inpatient setting, and surgeons should not be deterred from readmitting patients because of concerns about quality measure performance and resulting penalties."

Every effort should be made to lower the infection rates of all procedures. But this papers results should be viewed not with alarm, but rather as reassurance that the problem is not out of control.

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