I cannot believe this is happening. . . .

[Perrotfish]

Not to nitpick, but I am coming up with $40,000 ($400/head times 100 students). More relevant, I have poked around in UTD at our hospital and have not found it to be useful for my practice. I would guess that the folks that sell it are making a killing because it appears to be successfully marketed as the Holy Grail of medical knowledge, but from what I can see, there are plenty of other places to get that information. Then again, if the marketing is as successful as it appears to be, the Holy Grail might be self-fulfilling.

At least in my specialty, it's just consistently reliable and well cited in a way that nothing else on the market is.

There are a few free/cheap resources of similar quality, but they don't update very often. Cochrane, NEJM, and the AAP all do great updates for Pediatrics, but when I search for one more often than not the most recent update is 10 years old. If there's something in the last 2 years great, I don't need uptodate. If the most recent Cochrane review or AAP policy statement is 10 years ago, do I trust it?

Textbooks just don't seem to be written for anyone. They're generally too dull to use for board study, too unfocused to use as a fast reference, and too short to use for a more in depth understanding of a subject.

Cheaper, up-to-date-ish resources just aren't anywhere close in terms of the level of quality. I have a tried a handful, usually the articles contain less than half a dozen citations, the conclusions are often questionable, and the author is some EM doc doing part time work from home. Every uptodate article is cited like a major journal review article, and the author is usually a subject matter expect, frequently THE subject matter expert. For example with Kawasaki's disease the two authors that uptodate has used to write their Kawasaki articles have, between them, done 90% of the recent research on the disease process. No one else has that kind of expertise that consistently, including my specialty's main textbook.

Of course I can try digging into the primary research, but that's basically me trying to write my own metastudy. In between patients. Ok I've found one article with strong conclusions, but unless it has a great discussion section I really don't know how many others are out there arguing the opposite point.

Finally uptodate has a lot of features that other resources just don't. Their two tiers of patient handouts (8th and 12th grade levels) are awesome, I use them pretty much exclusively at this point. I really like their 'recent updates' page, I feel like if I just read that I probably won't fall too behind the time. Their articles that go over basic differentials (evaluation of the child with limp, evaluation of lymphadenopathy) are some of the best teaching resources being produced right now, I am constantly giving them to my corpsmen/medical students/residents, and I'll admit I still refer to them when I'm trying to make sure I didn't miss something.

I'm not saying its worth watching porn in public for, but its definitely worth $400/year.

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[Trauma Surgeon]

I have followed this thread with great interest, especially aPD's inputs.
Here are some questions of mine that maybe one of you that work overseas can answer, but before I ask them I have to admit I don't know exactly what the Google drive is and I work in Europe so not familiar with all the workplace rules of conduct in US.

Lets say that the material that OP had on his PRIVATE account in fact was porn which many of the post are alluding to, what is the crime in that (assuming it was not illegal stuff, which in that case he should be worried about prison time more than loosing his job!) as long as he did not watch it in hospital during his shift?

Lets say he had this material (porn movies, or pictures of himself dressed up at a party with Freddie Mercury) in his suitcase, stumbles and it ends up on the floor in front of the whole team including the PD. So what is the crime in that? Should he get fired over this incident?

I understand that some might have strong opinions about some stuff (i.e porn), but as long as the material is not illegal and it does not jeopardize patients care why even bother reporting it?

 

[IM2GI]

I have followed this thread with great interest, especially aPD's inputs.
Here are some questions of mine that maybe one of you that work overseas can answer, but before I ask them I have to admit I don't know exactly what the Google drive is and I work in Europe so not familiar with all the workplace rules of conduct in US.

Lets say that the material that OP had on his PRIVATE account in fact was porn which many of the post are alluding to, what is the crime in that (assuming it was not illegal stuff, which in that case he should be worried about prison time more than loosing his job!) as long as he did not watch it in hospital during his shift?

Lets say he had this material (porn movies, or pictures of himself dressed up at a party with Freddie Mercury) in his suitcase, stumbles and it ends up on the floor in front of the whole team including the PD. So what is the crime in that? Should he get fired over this incident?

I understand that some might have strong opinions about some stuff (i.e porn), but as long as the material is not illegal and it does not jeopardize patients care why even bother reporting it?

As terms of your employment, most hospitals have internet policies that ban things like running your own business while at work, gambling, looking at illicit material, etc.

I agree this is surely a gray zone as the OP only indirectly enabled someone else to view those images. I think a good lawyer probably could get you out of this if it comes to that.

 

[dpmd]

I have followed this thread with great interest, especially aPD's inputs.
Here are some questions of mine that maybe one of you that work overseas can answer, but before I ask them I have to admit I don't know exactly what the Google drive is and I work in Europe so not familiar with all the workplace rules of conduct in US.

Lets say that the material that OP had on his PRIVATE account in fact was porn which many of the post are alluding to, what is the crime in that (assuming it was not illegal stuff, which in that case he should be worried about prison time more than loosing his job!) as long as he did not watch it in hospital during his shift?

Lets say he had this material (porn movies, or pictures of himself dressed up at a party with Freddie Mercury) in his suitcase, stumbles and it ends up on the floor in front of the whole team including the PD. So what is the crime in that? Should he get fired over this incident?

I understand that some might have strong opinions about some stuff (i.e porn), but as long as the material is not illegal and it does not jeopardize patients care why even bother reporting it?

It isn't a crime but it is unprofessional and may violate hospital policy. Just like it isn't a crime to walk around in your underwear but you shouldn't show up to rounds like that, and it isn't a crime to shag in a call room but if someone walks in on you it may lead to disciplinary action (or more fun depending on who walks in)

 

[clausewitz2]

I have followed this thread with great interest, especially aPD's inputs.
Here are some questions of mine that maybe one of you that work overseas can answer, but before I ask them I have to admit I don't know exactly what the Google drive is and I work in Europe so not familiar with all the workplace rules of conduct in US.

Lets say that the material that OP had on his PRIVATE account in fact was porn which many of the post are alluding to, what is the crime in that (assuming it was not illegal stuff, which in that case he should be worried about prison time more than loosing his job!) as long as he did not watch it in hospital during his shift?

Lets say he had this material (porn movies, or pictures of himself dressed up at a party with Freddie Mercury) in his suitcase, stumbles and it ends up on the floor in front of the whole team including the PD. So what is the crime in that? Should he get fired over this incident?

I understand that some might have strong opinions about some stuff (i.e porn), but as long as the material is not illegal and it does not jeopardize patients care why even bother reporting it?

From the hospital's end, there is also a problem posed by this scenario in terms of how US employment law works. Specifically, another employee displaying porn everywhere and the administration doing nothing about it is a really excellent way to open up the institution to a discrimination complaint on the grounds of having created a hostile work environment. If you allow someone to display pornography at work, basically, it can be alleged that you are discriminating on the grounds of sex because you are cultivating a workplace atmosphere that is differentially uncomfortable for women (or men, depending on the circumstances). You need a pattern of such incidents to really establish a hostile work environment for the purposes of the EEOC, and probably for an EEOC complaint to be sustained you would need to be fairly egregious in terms of permitting this sort of thing to occur, but why risk it? The best way to prevent that from happening is to come down like a ton of bricks on anyone who does such a thing.

not saying this is morally right or my opinion on the subject, just trying to illuminate what is going through the heads of HR admin types.

 

[Trauma Surgeon]

From the hospital's end, there is also a problem posed by this scenario in terms of how US employment law works. Specifically, another employee displaying porn everywhere and the administration doing nothing about it is a really excellent way to open up the institution to a discrimination complaint on the grounds of having created a hostile work environment. If you allow someone to display pornography at work, basically, it can be alleged that you are discriminating on the grounds of sex because you are cultivating a workplace atmosphere that is differentially uncomfortable for women (or men, depending on the circumstances). You need a pattern of such incidents to really establish a hostile work environment for the purposes of the EEOC, and probably for an EEOC complaint to be sustained you would need to be fairly egregious in terms of permitting this sort of thing to occur, but why risk it? The best way to prevent that from happening is to come down like a ton of bricks on anyone who does such a thing.

not saying this is morally right or my opinion on the subject, just trying to illuminate what is going through the heads of HR admin types.

Not sure how it is "displaying" anything! If I understand OP, it was on his private drive and someone had to click his way through to see the content, or maybe I have misunderstood…

 

[clausewitz2]

Not sure how it is "displaying" anything! If I understand OP, it was on his private drive and someone had to click his way through to see the content, or maybe I have misunderstood…

I was responding to the scenario you outlined with dropping a briefcase full of porn. I agree OP's situation is a tad different as described, but at the same time it is perhaps due to our very different fields that you can't imagine this as being anything other than accidental and I have no trouble whatsoever picturing exactly what someone's face might look like when they "accidentally" drop some inappropriate images where their colleagues are bound to see it.

 

[Trauma Surgeon]

It isn't a crime but it is unprofessional and may violate hospital policy. Just like it isn't a crime to walk around in your underwear but you shouldn't show up to rounds like that, and it isn't a crime to shag in a call room but if someone walks in on you it may lead to disciplinary action (or more fun depending on who walks in)

If he was not watching it at work and only had some content on his memory/drive that was not illegal I can't see how it is unprofessional! I understand that there are social codes like not walking around in your underwear but it does not mean you should not have an underwear! From my understanding it was not that he was caught with his pants down watching porn, he had it on his drive and forgot to log-off and someone came and looked through the content and found it… Maybe I have misunderstood what went down!?

 

[dpmd]

If he was not watching it at work and only had some content on his memory/drive that was not illegal I can't see how it is unprofessional! I understand that there are social codes like not walking around in your underwear but it does not mean you should not have an underwear! From my understanding it was not that he was caught with his pants down watching porn, he had it on his drive and forgot to log-off and someone came and looked through the content and found it… Maybe I have misunderstood what went down!?

It may have popped up on the first page when you access Google drive so the whole having to look through the content may not apply. The most professional way to deal with things is to not access any personal sites where you have objectionable material (so no porn on your drive and don't go on Facebook at work if you follow pages that post racist rants or partially nude pics). Next most professional way would be to ensure any porn is hidden by layers of folders in case you forget to log out and of course try not to forget to log out. Next in ranking would be having porn not hidden under any layers of folders and forgetting to logout but you didn't even go in to your drive and you just forgot one login reaches it all. Next would be if you forgot to logout after logging in specifically to your drive that had porn not in folders. Next would be if you left it logged in on purpose knowing someone might see your porn. And finally would believing it logged in a playing your porn for someone else to find. Not saying what he does was bad enough for horrible consequences but it isn't good enough that there is no room for improvement.

 

[deleted109597]

Plus it isn't like you need to have access to it. I managed to go through med school and 5 yrs of residency (plus 5 yrs of attending life to date) never once having looked at up to date. And I had institutional access from residency onward (but by that point was used to finding info elsewhere)

I agree. Emedicine is pretty similar and free. I like the references better on UTDOL, but the problem is that it's basically wikipedia. They aren't using Cochrane reviewers or anything. I've seen them reference papers and give the opposite of the conclusion of the paper. That's understandable if you explain it, but they didn't (and they were wrong).

I will never understand how people do this. Uptodate is basically never closed on my computer.

There are other sources out there. They just require more work on your part to find out the real answers. The medical blogosphere (FOAMed) has exploded over the last 5 years. Try googlefoam.com next time you have a clinical question.

 

[deleted109597]

Perhaps it wasn't even medical content that they were accessing -- I honestly don't remember. Regardless, it was unacceptable. I was amazed that after being told once, it continued. For sure, all hospital computers have full access to everything, so they had other choices.

I'm going to go with this. Maybe it's just cookies from their dumb pron searches at home.

You can get per computer subscriptions, but they only are cost effective if you have at least three users per machine (1500/machine/year is the going rate) so many hospitals do it by user. UTD is crazy expensive, the hospital I'm at now literally can't afford it, as an example. I have it through my school, so I'm fine, but when they ran down why they don't use it I was shocked.

They did a survey for our residents. It was Dynamed vs UTDOL. The vote was 100% UTDOL. The hospital came back and said "nope, costs too much". Why bother with the survey? Also, Dynamed literally blows goats.

 

[Perrotfish]

Not sure how it is "displaying" anything! If I understand OP, it was on his private drive and someone had to click his way through to see the content, or maybe I have misunderstood…

Sorta. Unfortunately when you open G-drive it actually displays any images you have stored on it above the file name, rather than just the file name and the generic JPEG image. So it is probable that someone just typed the google drive web address into the search bar, and then got to see whatever images were on the OP's drive without taking any further steps/snooping.

 

[Perrotfish]

They did a survey for our residents. It was Dynamed vs UTDOL. The vote was 100% UTDOL. The hospital came back and said "nope, costs too much". Why bother with the survey? Also, Dynamed literally blows goats.

Yeah it sucks. Honestly, if you're going to buy Dynamed, why buy anything at all?

 

[clausewitz2]

Sorta. Unfortunately when you open G-drive it actually displays any images you have stored on it above the file name, rather than just the file name and the generic JPEG image. So it is probable that someone just typed the google drive web address into the search bar, and then got to see whatever images were on the OP's drive without taking any further steps/snooping.

I wonder also if what happened is what I have seen happen many times, namely, someone was meant to be giving a presentation to a group and went to get their slides from Drive and someone else was already logged in. In this case, the moment presenter hits enter, BAM a bunch of people get to see pr0n.

 

[Trauma Surgeon]

I wonder also if what happened is what I have seen happen many times, namely, someone was meant to be giving a presentation to a group and went to get their slides from Drive and someone else was already logged in. In this case, the moment presenter hits enter, BAM a bunch of people get to see pr0n.

Ok! this is exactly what I mean (and think that happened), so why in the hell do they go and report it! What they actually are reporting in my opinion is that the person has these files on his drive, not that he was watching it on the work and some female nurses were offended… so I still would say no harm no foul!

 

[dpmd]

Ok! this is exactly what I mean (and think that happened), so why in the hell do they go and report it! What they actually are reporting in my opinion is that the person has these files on his drive, not that he was watching it on the work and some female nurses were offended… so I still would say no harm no foul!

No harm, no foul if you are the reason a bunch of porn gets displayed at a conference? You don't see how that is inappropriate?

 

[Trauma Surgeon]

No harm, no foul if you are the reason a bunch of porn gets displayed at a conference? You don't see how that is inappropriate?

Dude, I was referring to OP's original post when I said no harm, no foul when someone accidentally sees that he has this on his private server! It is inappropriate, which probably all of us including me agree with, but cause of punishment? I think that is a bit harsh…
The bosses of OP could handle it just with telling him to be more careful in the future and don't log on his private server at work...

 

[Trismegistus4]

I understand that some might have strong opinions about some stuff (i.e porn), but as long as the material is not illegal and it does not jeopardize patients care why even bother reporting it?

My first thought about why the person might have reported it is to cover their own butt. As others have alluded to, Google Drive will show thumbnails of images on the front page. So this person sits down at the computer wanting to access their files on Google Drive, types in drive.google.com, and immediately sees a bunch of thumbnails of porn images. They panic and worry that they are going to get in trouble for viewing porn at work. So they report the OP in an effort to make it clear that this was not their fault.

But unfortunately, this was another drive-by OP. He hasn't even browsed SDN since he started the thread 8 days ago. So I am not optimistic we will get any clarification or an update.

As terms of your employment, most hospitals have internet policies that ban things like running your own business while at work, gambling, looking at illicit material, etc.

I agree this is surely a gray zone as the OP only indirectly enabled someone else to view those images. I think a good lawyer probably could get you out of this if it comes to that.

I'm no legal expert, but I don't think there's anything for a lawyer to get you out of if you are not being charged with a crime nor having a civil suit brought against you. Getting a lawyer involved would help only once they had actually done something--e.g., if they fire him, he could sue for wrongful termination. That opens up a whole new can of worms, though, because that will not return him to his status as a resident in good standing.