Online reviews can be found for just about everything – restaurants, hotels, health clubs – and even for healthcare services and the professional who provide the care.  And these reviews can carry an incredible amount of weight.  Studies have shown up to 70% of people who look at online review trust these recommendations – even though they come from complete strangers.  This, despite the fact that that we know people usually only take the time to post about something if they are either very happy or very upset. Everyday, quality care rarely gets a review.

Popular internet reviews sites, such as Yelp™ and Healthgrades^©, have a growing influence on the reputation of healthcare professionals.  Google™ reviews are everywhere and probably show up more than all other review sites.  In the past, the majority of healthcare-related reviews were directed at physicians.  However, increasingly patients are using these and other online sites to openly share their experiences with hospitals, pharmacies, out-patient clinics and home care companies. 

Online reviews of the services provided by healthcare professionals are in some ways more challenging to deal with than those offered by say a spa or a coffee shop. For one thing, confidentiality obligations can restrict a healthcare provider’s ability to respond to a negative review. Patients, on the other hand, are not prevented from singling out a specific practitioner or location.  In addition, healthcare is unique in that a practitioner can do everything right and the patient may still feel that the outcome was not what is should have been. Somethings are simply beyond our control. 

It can also be very difficult to get a negative review removed from an online review site, however there are things that you can do to lessen the impact and protect your reputation.  If a review violates the terms of service of an online provider like Google™ – such as if they are abusive or threatening – you can flag them as inappropriate and contact the provider to ask to have the review taken down.

Even though dealing with online reviews in a healthcare scenario can be difficult, it is important to be aware of what reviews are out there and whether they reveal anything that should be addressed. You should resist the temptation to respond publicly to a negative review – unless you truly think you will be able to improve the situation. Becoming defensive or engaging in an ongoing online discussion with a patient or their family will likely only make things worse.  Your focus should always be on providing the best possible care to your patients and learn what you can from feedback – regardless of the source.

Just this morning I read about a “wearable stethoscope” the size of a bandage that can listen to and record heart and lung sounds on a continuous basis. Yesterday I heard about some of the recent advances in home sleep apnea testing technology and how it is impacting polysomnography practice. There are pulse oximeters that now use Bluetooth® to integrate O₂ saturation with other measurements (such as temperature and blood pressure) into a smartphone or tablet app. Surgical robots have started to take over some of the more intricate procedures in the operating room, Automatic Dispensing Units (ADUs) have assumed some of the role previously filled by Pharmacists and researchers have already trialed robots that are capable of organizing staffing schedules and finding beds for patients.

It has been predicted that one–third of all existing jobs in the world will be replaced by software, robots, and smart machines by 2025. Automation has already had a tremendous impact on the labour market in general, and healthcare is no exception. I think we can all agree that technology is the driving force behind most of the recent improvements in healthcare, and that –for the most part-it’s a good thing because it has the potential to enable more efficient and accessible patient care. The science of medicine today requires the analysis of massive amounts of complex data, which can arguably be done much faster and more accurately by a computer chip than a human brain. But where does that leave a profession like ours that has its roots deeply imbedded in technology? Will RTs one day be replaced by robots?

As it stands right now, robots can’t make ethical decisions or establish trusting relationships with patients but that could very well change in the not so distant future.  Work is already being done to develop humanoid robots that can interpret human body language, read emotional responses and evolve as it learns more about the people they are interacting with. So, it’s hard to say precisely what healthcare tasks will be taken over completely by technology and what will continue to be more effectively performed by humans. The only thing we probably know for sure is that – to continue to survive as a profession – we constantly need to be acquiring new skills that extend beyond our existing technical ones.

It is entirely possible that technological advances will allow RTs to spend even less time gathering routine data and more time providing specialized and individualized care to a wider range of patients will a more diverse range of illnesses.  Roles played by other healthcare professionals may in the future be filled by RTs and others who could provide a more cost effective and timely service.  And as technology continues to take on more and more of what RTs do now, we will undoubtedly be required to rely a great deal more on other skills like leadership, communication, and innovation

We have had Personal Health Information Privacy legislation (PHIPA) in Ontario since 2004, and employers regularly emphasise to their staff the perils of indiscriminately viewing personal health records (and conduct random audits to determine compliance). Yet healthcare information privacy violations still occur – sometimes with very serious consequences for both the patient and the healthcare provider(s) involved. You may have heard about the two healthcare workers who looked into (it is actually officially referred to as “snooping”) the late mayor Rob Ford’s electronic health records – even though they were apparently not involved in his care.  Well, they have become the first in Ontario to be convicted under PHIPA. Under the Act, looking at even a single healthcare record of a patient if you are not within their “circle of care” is considered to be a crime.

Admittedly, PHIPA does not define what “circle of care” means. However, the Information and Privacy Commissioner of Ontario has created the concept of “circle of care” to guide a healthcare professional when deciding if they are permitted to rely on a patient’s implied consent to collect, use, disclose or handle their personal health information”.[i]  And when you think about it, it really is pretty easy to figure out if you are part of a patient’s “circle of care” or not.  Do you have a direct responsibility for providing care to that individual?  If no, then you are not part of their “circle of care” and have no authority to view their patient records in any way, shape or form.

It always surprises me when I hear that a healthcare professional, while understanding that they are prohibited from looking into a patient’s file if they are not involved in their care, do not appreciate that they cannot use their workplace access to view their own personal health records either.  Yet the same “circle of care” concept applies.  Do you have a direct responsibility for providing care (in a medical context) to yourself?  Not unless you are taking your own blood samples, doing your own x-rays, making your own diagnosis and developing you own treatment plan.  As a patient, you have a right to access your own health records but would need to do so via the same process as any other patient.

Being clear about whether you are in a patient’s “circle of care” or not is more important now than ever. Bill 119, an Act to amend PHIPA, was passed by the Ontario legislature earlier this year with the intent to, among other things, establish clear reporting requirements, increase fines and strengthen processes for prosecution in the event of a privacy breach.  In addition, the definition of what it means to “use” personal health information has now been expanded to mean “to view, handle or otherwise deal with the information”. The inclusion of the word “view” in the revised definition appears to be aimed at preventing “snooping” by those who are outside of the “circle of care”.

The CRTO has provided a summary of the changes to PHIPA, as they apply to RT practice and this can be found here.

[i] Information and Privacy Commissioner of Ontario. (2015, August). Circle of care: Sharing personal health information for health-care purposes. Retrieved from https://www.ipc.on.ca/wp-content/uploads/Resources/circle-of-care.pdf

How many of you spent time during your RT education considering the ethical issues you might face in your practice? Chances are your answer will depend on how long you’ve been in the game.  Currently, most RT educational programs provide their students with at least some opportunity to discuss ethical issues in healthcare and how those dilemmas might be managed. But if you’re like me and have been an RT for a very l-o-n-g time, you probably spent little or no time discussing ethics when you were in school. I personally don’t remember it being mentioned even once. I imagine it was simply assumed that RT’s don’t face ethical issues in the same way as say physicians or nurses do. Every day, in every health care organization, RTs face numerous ethical challenges – some that they (veterans and rookies alike) are ill prepared to deal with.

What I have observed both from clinical practice and from a regulatory perspective is that newer and more seasoned RTs tend to experience different ethical predicaments. Let’s say you are the new grad and you observe a patient being pressured into undergoing a treatment plan that they clearly don’t want.  Or perhaps you feel that, in order to keep your job, you need to do things that are not necessarily in the best interest of your patients.  You know in your gut that you should speak up, but that’s easier said than done when you are still trying to get your feet underneath you or don’t have any other immediate employment opportunities.  And so you stand by, say nothing and let it happen.

Most RTs who have been practising for a period of time usually have no problem speaking their mind; however, they can find themselves falling down very different ethical holes.  Too many patients, not enough time and too little organizational support and over time it can seem like ethics is something they only have time think about  when everything else gets done – or maybe they feel it’s someone else’s job.

RTs work at the leading edge of technology that can keep people alive – even beyond what they may feel is in the patient’s best interest. And yet these ethical considerations remain the elephant in the room.  Unfortunately, failing to recognize the role that ethics plays in RT practice can result in disengagement, demoralization in some cases suboptimal patient care – and ultimately – burn out.  We need to have an ongoing and open conversation about the ethical issues that all RTs face, the moral distress these issues can cause and the impact it can have on patient care.

From time to time, a staff RT will call to tell me that they have been asked to take on an additional role in their organization. Maybe it’s writing policies & procedures or perhaps it’s sitting on a special committee.  The question that generally follows is…”shouldn’t they pay me more money for doing that?”  And my response is always, “Yes they should…but they probably won’t.  Do it anyway.” 

I realize everyone is being pushed to do more with less and often it seems like there is simply not enough time.  I also know sometimes family and other commitments make it impossible to take on any additional workload.  But if the issue is not time so much as it is additional financial remuneration that you think should come your way, then I urge you not to let that hold you back.  Like time, there is never enough money, and it seems each year there is less money in the healthcare system.  So I am afraid that if you wait for the money to flow first – you may be waiting a very long time.

Someone in your organization obviously believes that you have something worthwhile to contribute to the project or they would have asked someone else (or maybe you were just the first person they saw).  Regardless…I am not really thinking about what you will give to the initiative as much as about what you will gain. Each policy, committee, in-service, etc. – painful as it may be at the time – is a step forward.  You meet new people within your organization and they meet you.  You learn just a bit more about how your organization works on a grand scale and you gain a slightly different perspective. Just as importantly, they learn more about you and likely more about the value of the RT profession to patients and the healthcare system.  It doesn’t matter if your career aspirations are staff RT or CEO.  Taking on something new almost always opens you up to possibilities you didn’t see before and sometimes to opportunities you didn’t expect. So if you can – do it anyway.