Accountability and Transparency

 

Have you ever noticed that in sports and athletic medicine, a catastrophic event is frequently required to prompt change?  How paradoxical that we heavily emphasize prevention yet often fail to implement appropriate measures for minimizing risk. For example, how can we truly state that our interventions prevent injury if we aren’t even counting exposures and tracking injury rates over time?  Instead, we are frequently forced to respond reactively which in turn, often creates more of a mess.  The case I am trying to build extends beyond routine injury prevention initiatives and into the administrative aspects of athletic training.  The national attention attributed to the University of Maryland, not just the devastating news of the heat-related death of a student-athlete, but also for the aftermath circus of firing, re-hiring and firing again should make every one of us cringe.  This situation could easily happen to any athletic medicine program (regardless of setting) who fails to follow professional practice standards. As the independent review of the death of Jordan McNair illustrate, failure to comply with professional standards, resulting in a tragic outcome, may result in litigation as a response to falling short in ethical standards of making the patient the primacy of their care. Principle I of the NATA Code of Ethics is dedicated to making the individual patient the focus of the athletic trainer’s ethical obligation.

Several years ago, in the Journal of Athletic Training, colleagues and I published an editorial titled, “The Need for Accountability and Transparency in Intercollegiate Athletic Medicine.”  We promoted the idea of the development of an athletic medicine review board (AMRB) to assist in the oversight of all health-related programs and services for student-athletes. After much consideration of an AMRB, and after serving on one at the University of Georgia for the past 4 years, I am even more convinced of the critical and beneficial role that such a board plays in promoting transparency of operational procedures and best practices. I have even changed my position since co-writing the editorial in that I advocate for such oversight for athletic medicine programs in all settings, not just intercollegiate.  

 One would be hard pressed to come up with a more effective way for a well-intended, but overwhelmingly busy athletic training staff to ensure that the existing policies, procedures and protocols are up-to-date, than to put them before an AMRB for their expert and analytical review. The Board serves as another safeguard to ensure that the AT staff adhere to professional practice as required by the NATA Code of Ethics.  Such a practice can transform weak programs into strong, and help strong programs become even stronger as I have witnessed firsthand at U. Georgia. Not all programs can afford the travel expenses of bringing in the Board every year, however experts for your Board may already exist in your own back yard.  Consider who works in your community.  Certainly there are individuals with the necessary expertise (legal, ethical, medical, administrative, etc.) who would be willing to volunteer their time to review materials and meet as a group at least once a year. The athletic medical review board should be empowered to raise concerns and recommendations on care and services based on professional standards and mitigation of risk. These recommendations are communicated to the top executive of the school and the athletic director, as well as the sports medicine staff. The message this sends to the administration, athletes, parents, and to the community is that you are dedicated to providing the best level of care to such a high level that you are willing to open up all aspects of your athletic medicine program to an outside review process.

Finally, let’s consider the alternative, which is to maintain the status quo and take the chance of being the next national news story. Any cultural shift must obtain a critical mass for change to take place. If we sincerely embrace patient-centered care, we cannot continue to function within the same culture that has failed to adequately protect student-athlete health and welfare in far too many cases.

 

A special acknowledgment of appreciation to Gretchen Schlabach and Tim Neal for their review and feedback of this blog.

 

Sound Practices for Protecting your Online Reputation

 

The latest data from GlobalWebIndex1 shows that the average internet user in the U.S. spends approximately 6 hours each day using internet-powered devices and services – that’s roughly 1/3 of our waking lives. Two of the 6 hours is allocated to social media (SM). The adoption and diffusion of SM has increased at a rate unparalleled by any prior form of media. This is the new wired world:  always connected, always communicating, always multitasking. The benefits from SM far exceed the disadvantages. While the NATA Code of Ethics establishes important external guides, ethical decisions about social media use stem from informed individuals with developed ethical thinking. Notwithstanding, younger individuals typically possess strong technology skills, however, older individuals possess experience, and are perceptive at understanding important questions, such as: When do you need to avoid responding? What impact do SM decisions have on people? What are the effects of common practices?

We can conclude this much about the ethics of SM: When we stray from truth that is based upon verifiable evidence, it is impossible to defend actions through moral reasoning. In that respect, SM are not different from other media contexts. Simply tell the truth, which is the first and foremost sound practice that should be employed. Aurelius Augustinus of Hippo (aka, Saint Augustine) stated:  “The truth is like a lion. You don’t have to defend it. Let it loose and it will defend itself.”   

Other sound practices2,3 for protecting your online reputation are shown in the figure below.  Being transparent about your identity and relationship to your employer makes your honesty - or dishonesty – readily apparent.  Be judicious about protecting patient privacy, confidentiality and legal guidelines. As tempting as it can be, avoid venting about workplace frustrations or conflicts, whether they involve managers, colleagues or patients. Even harmless posts like: “TGIF: this was a horrible week at work!” can open the door for negative chatter around your workplace. Write what know on your areas of expertise and do so in first person. Do not forget to provide a disclaimer that your postings are your own and do not represent your company. The lines between public and private are frequently blurred which may lead to false perceptions. Make every effort to keep the two separate.

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Do your postings add value? If your post is not helpful, thought-provoking, or builds a sense of community, then don’t post it. Remember it is your responsibility to follow terms and conditions of SM platforms, as well as HIPAA Privacy and Security Rules. Be an online leader, avoiding inflammatory and sensitive topics, and if you make a mistake, admit it and be quick about it. Finally, trust your gut. Sit on it for a day or so before you post and never post when highly emotional.  There is an inverse relationship between intellect and emotions. If in doubt, try to remember the last intelligent thing you said when we you very angry.  To wrap up this blog, like any good relationship, a positive online reputation is determined more by how you listen than what you say. 

 

1.     https://wearesocial.com/blog/2018/01/global-digital-report-2018; accessed 5/1/18

2.     Farfan JM, et al. Online medical professionalism: patient and public relationships: policy statement from the american college of physicians and the federation of state medical boards. Ann Intern Med. 2013; 158: 620-627.

3.      Symplur LLC. Healthcare social media policy for physicians and staff.  Symplur LLC. 2018; https://www.symplur.com/public/healthcare_ social_media_policy_for_physicians_and_staff.pdf.

 
 

Protect Your Patients & Yourself

It's a mean world out there, and as much as we want to always believe that our athletes and patients are so happy WE are caring for them, if their return to play or life doesn't go as they expected it to, we can easily become a victim of legal problems.

Kornblau and Starling, in "Ethics in Rehabilitation", remind us to protect yourselfand list some steps we all should review:

  • Put your licensure law on your desk and read it frequently: It’s easy to think we're always doing the right thing.
  • Report ethical and legal violations to the licensure board: It's not "tattling" - It's protecting the integrity of our profession.
  • Open your eyes: If it doesn't seem right it usually isn't.
  • Follow the 4 "C's": Cover yourself with Contemporaneous, Complete and Comprehensive documentation. If it's not on paper it didn't happen.
  • Keep your athletes interest above all else: Do the right thing.
  • Understand the laws and rules that govern our world: JAHCO, Medicare and HIPPA give us important boundaries. Know them.

And finally, my personal advice: retain professional liability insurance. Your employer will protect you, but only if you do what you are legally allowed by your licensure and state laws. Nobody protects you like you.