Joseph S. Eastern

My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.

But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.

RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.

Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.

To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.

Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators

It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.

Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)

In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.

And you can expect to see many more new uses of RSS feeds in the near future.

It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.

Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)

Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!

My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.

But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.

RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.

Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.

To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.

Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators

It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.

Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)

In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.

And you can expect to see many more new uses of RSS feeds in the near future.

It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.

Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)

Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!

My recent column on Web searching techniques has generated more questions, comments, and discussion than any other. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site, www.skinandallergynews.com

Obviously this is a popular topic. As well it should be, because as I mentioned in that column, the sheer volume of information on the Web makes quick and efficient searching an indispensable skill.

But once you have become quick and efficient at finding the information you need, a new problem arises: The information changes! All the good medical, news, and other information-based Web sites change and update their content on a regular but unpredictable basis. And checking each one for new information can be very tedious, if you can remember to do it at all.

Many sites offer an e-mail service to notify you of new content, but multiple e-mail subscriptions clutter your inbox and often can't select out the information you're really interested in. RSS feeds are a more efficient and increasingly popular method of staying current on all the subjects, medical and otherwise, which interest you.

RSS (which stands for “Rich Site Summary” or “Really Simple Syndication,” depending on whom you ask) is a file format, and Web sites use that format (or a similar one called “Atom”) to produce a summary file, or “feed,” of new content, along with links to full versions of that content. When you subscribe to a given Web site's feed, you'll receive a summary of new content each time the Web site is updated.

Thousands of Web sites now offer RSS feeds, including most of the large medical information services, all the major news organizations, and many Web logs.

To subscribe to feeds you must download a program called a “feed reader,” which is basically just a browser specializing in RSS and Atom files. Dozens of readers (also known as “aggregators”) are available, and more are coming as RSS grows in popularity. Some can be accessed through browsers, others are integrated into e-mail programs, and still others run as standalone applications.

Many readers are free, but you'll pay a nominal fee for those with the most advanced features. (As always, I have no financial interest in any of the enterprises discussed in this column.) A comprehensive list of available readers, free and otherwise, can be found at http://en.wikipedia.org/wiki/List_of_news_aggregators

It's not always easy to find out whether a particular Web site offers a feed, because there is no universally recognized method of indicating its existence. Look for a link to “RSS” or “Syndicate This,” or an orange rectangle with the letters “XML” (don't ask) or “RSS”. These links aren't always on the home page. Sometimes, on the site map, you'll find a link to a Web page explaining available feeds and how to find them.

Some of the major sites have multiple feeds to choose from. For example, you can generate a feed of current stories related to the page that you're looking at on Google News by clicking the RSS ∣ Atom links on any Google News page.

Once you know the Web address (URL) of the RSS feed you want, you provide it to your reader program, which will monitor the feed for you. (Many RSS aggregators come preconfigured with a list of feed URLs for popular news Web sites.)

In addition to notifying you of important news headlines, changes to your favorite Web sites, and new developments in any medical (or other) field of interest to you, RSS feeds have many other uses. Some of the more popular ones are notification of arrival of new products in a store or catalog, announcing new newsletter issues (including e-mail newsletters), weather and other changing-condition alerts, and notification of additions of new items to a database, or new members to a group.

And you can expect to see many more new uses of RSS feeds in the near future.

It can work the other way, too: If you want readers of your Web site to receive the latest news about your practice, such as new treatments and procedures you're offering, you can create your own RSS feed. Any competent Web administrator will know how to do it, or you can do it yourself if you're so inclined.

Some will insist on doing it from scratch, but for the rest of us, a multitude of tools is available to simplify the process. (If your site includes a blog, for example, many blogging tools automatically create RSS files.)

Detailed instructions abound. You can find them easily with—what else?—your favorite search engine!

Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?

Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.

Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.

Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.

Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.

Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.

Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.

Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.

Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.

Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”

Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?

Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.

Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.

Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.

Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.

Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.

Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.

Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.

Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.

Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”

Last month I listed the various options for storing your old medical records, and made the case for keeping them indefinitely. (If you missed that column, you can find it on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

Once you've found a permanent home for your medical records, what about all those other records, business documents of all kinds, that are probably gathering dust in boxes, taking up expensive space?

Before you can decide what to keep, of course, you have to determine what you have. So get out all those boxes and have an employee sort everything into identifiable categories, by date.

Now comes the hard part. As a recovering “pack rat” myself, my instinct is to keep everything, but that's impractical and usually unnecessary. While your corporate minutes book must be maintained and updated perpetually, and a few important documents—which I will point out as we get to them—should be preserved for the duration, most records have no value after varying periods of time or the information they contain is readily available elsewhere, so they can be safely destroyed.

Of course, these are only suggestions. You should check your state and local laws for any statutorily mandated time limits, and your individual circumstances may dictate longer—or shorter—retention times for some documents than those suggested here. When in doubt, consult your practice lawyer.

Among standard business records, experts say day sheets, patient billing slips, and other original entry items can be discarded after 7 years. Ditto for year-end financial and management reports; third-party insurance explanation of benefits forms, correspondence, and other records; and paid invoices and other bills. (The Internal Revenue Service cannot normally go back further than 7 years, but audited files can be reopened at any time, so keep any receipts and papers related to an audit forever.) Internal monthly summaries and financial data need only be kept for 3 years.

Routine business correspondence should also be preserved for 3 years, but keep anything really important (particularly if related to litigation or major purchases) indefinitely. Expired insurance policies can be discarded after 3 years, but hang on to your malpractice policies, as well as insurance payout records, claims reports, and related documentation.

Keep bank deposit slips and monthly bank statements for 1 year. Canceled checks can be tossed after 7 years, except those for taxes, major asset purchases, and similar important transactions. Those should be filed permanently with the papers related to the corresponding transactions.

Personnel records, including original employment applications, should be kept for 3 years after the employee has left. Employee time clock records as well as payroll records and summaries, including payroll tax forms, should be kept a minimum of 7 years.

Tax returns should be kept at least 7 years, along with worksheets, lists, schedules, and other supporting items, though some tax lawyers recommend keeping the returns themselves indefinitely. Important legal documents such as deeds, mortgages, and bills of sale of major items should be kept permanently. Keep partnership agreements, corporate shareholder agreements, corporate minute books, and charter bylaws for 7 years after you cease being a shareholder or partner.

Finally, there are a few documents which should never be kept, even for a day. Unsolicited resumes, for example, pose legal risks that you have no need to take. Unsolicited resumes should be returned to senders immediately, accompanied by a note to the effect that you have “a strict policy on such submissions: Without exception, they are returned without review. But thanks for your interest.”

If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.

Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html

▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.

▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.

▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.

▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.

▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.

▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com

So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:

▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.

▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.

▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.

▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com

Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.

If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.

Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html

▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.

▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.

▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.

▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.

▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.

▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com

So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:

▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.

▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.

▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.

▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com

Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.

If your office is anything like mine, you have too many medical records and too little storage space. And since the laws in your state require that old records be kept for only a finite amount of time, you may be tempted to get rid of your oldest charts.

Unfortunately, regardless of your state's retention laws (a list of which can be found at http://pcarchiver.com/statelaws.html

▸ According to one malpractice insurance carrier, GE Medical Protective, 10% of medical claims are filed at least 5 years after the incident, and 5% are brought at least 10 years after—regardless of state laws and statutes of limitation. Without a record, there is only the doctor's word against the patient's word: a treacherous situation.

▸ Statutes of limitation are often indefinite, or greatly extended, when the patient is a child, especially when birth defects, mental retardation, or parental disputes are involved.

▸ There is no time limitation on state medical board actions. Patients have been known to file complaints with state boards decades after alleged improprieties. Without the medical record, your ability to defend yourself against such a complaint is severely limited.

▸ In most states, if a patient alleges that a doctor said an outcome was not the one expected—even if this is only the patient's recollection, true or not—the destruction of the record can be considered hiding evidence, a criminal offense.

▸ Medicare and the IRS have a 7-year limit on pursuing billing errors, but there is no time limit if fraud is alleged.

▸ Regardless of any statutes, the Medical Liability Monitor (http://www.medicalliabilitymonitor.com

So as much as you would like to dispose of old charts, in general it's not a good idea. But office space is limited and expensive. Where should old charts be stored? You have several options:

▸ Self Storage. The most obvious option is to physically move old records to another location. While your attic might be an obvious and cheap option, those records are a fire hazard, and chances are your spouse will not be happy. For a monthly fee you can stash old charts in a commercial self-storage facility. This is the least expensive method, but finding a specific record when you need it can be a chore. In addition, make sure the storage company is reputable—and the roof doesn't leak.

▸ Archiving. You can hire an archival firm to keep your old records. They will pick them up periodically, store them, and when you need to see an archived file, they'll deliver it back to you within a day or two.

▸ Microfilm. This method allows you to keep the records on site, but in a much smaller space. A microfiche company performs the transfer, and you buy the equipment necessary to read the films. When you need a hard copy of an old file, you simply print it out.

▸ Computerization. Clearly, the wave of the future is digital archiving. The simplest method of doing this is scanning the old records onto a hard drive with backups on disk. Many large clinics already are using such systems, and turnkey programs are now available for smaller offices. One popular system is called PCArchiver (http://pcarchiver.com

Once you've found a home for your old medical records, what about all those other records—business documents of all kinds—you've been meaning to do something with? Which of those need to be kept, and for how long? I'll talk about that next month.

A lot of things have changed in my office in the 24 years I've been practicing medicine, but nothing quite so much as the way I look for information.

Finding the latest articles on a rarely encountered disease used to entail a search through multiple textbooks, shelf after shelf of old journals, perhaps the hospital library, or even the med school library across town. It was tedious and time consuming, and all too often a hit-or-miss affair.

No longer. Nowadays I can find all the medical data I need—or indeed, any category of information at all—in a few minutes on the Internet.

The problem, of course, is that there is so much information located online, finding exactly what you need takes experience, practice, and often a bit of luck—unless you have mastered some shortcuts. I do a lot of searches, both medical and nonmedical, and here are some of the tricks I've picked up for finding all sorts of information both quickly and efficiently:

Don't limit yourself to one search engine. While Google is obviously the engine du jour (and has been for quite a few jours now), there are lots of other options, each with its own variations and advantages. If you're not finding it on Google, AltaVista, AlltheWeb, Teoma, Yahoo, Lycos, or HotBot, or one of dozens of others, might have what you want—and might even be better suited to your style. I'll be referring mostly to Google because it's so popular, but most of the techniques that follow will work on most search engines. (As always, I have no financial interest in any of the companies or Web sites I discuss in this column.)

Put quotes around words you want searched as a phrase. This is an old trick, but an important one. If you want to know if melasma has been linked to isotretinoin therapy, search “isotretinoin and melasma” so that Google won't waste your time finding a million Web pages containing the word “isotretinoin” and another million containing the word “melasma.”

You can also exclude words, by putting a hyphen (think of it as a minus sign) before any word you want screened out. For example, if you're researching tigers, you'll have to wade through scores of baseball sites unless you design the search as tigers-Detroit. Conversely, if you are looking for information about the baseball team and want to exclude anything relating to big cats, the search should be tigers + Detroit, meaning the word “Detroit” must be present.

You can widen your search by putting the tilde symbol before a word to get pages containing that word and anything similar. For example, ~tigers will pull up tigers, lions, leopards, and many other kinds of cats.

Another way to widen a search is with an asterisk at the beginning or end of a word. Searching acro* yields any word beginning with those four letters—“acrochordon,” “acronym,” “acrocyanosis,” and so on. Searching *genic yields “cryogenic,” “photogenic,” “dysgenic,” etc. (AltaVista seems to do this best.) You can also use an asterisk as a wildcard when you can't remember every single word in a phrase or name that you're seeking. For example *lupus erythematosus will yield “systemic,” “discoid,” “drug-induced,” etc.

Phrase your question in the form of an answer. Many people have been taught the opposite—to ask questions as questions—but you're not looking for Web sites that ask your question, you're looking for the answer! So “capital of California is” works much better than “What is the capital of California?”

For medical searches, consider limiting domains. If you're researching metastatic disease, you probably don't want thousands of extracts from cancer patient chat rooms, or commercial sites aimed at the general public, lawyers, etc. To pull only those pages posted on academic sites, use the “site:” syntax tool to limit your search to the .edu domain—in this case, metastasis site:edu. Avoid a space after the colon, or the engine will consider “site:” as a separate search word.

You can search news articles using the same techniques. Say you need to know what your patients are reading about a particular drug—isotretinoin, for example. Click “news” on the Google home page and search the same way you would search Web sites. If you want to see all new articles on a particular subject as they appear, go to Google Alerts and type “isotretinoin” and all its brand names into the search box; Google will e-mail you each time a story on that subject shows up online.

Search for clinical photographs in the same way. Say you're tapped to give a talk on short notice. On the Google site, go to “Images” and search the subject of your presentation. Narrow your search to PowerPoint files by using the “filetype” syntax tool (for example, psoriasis filetype:ppt), and you'll often find entire presentations, ready to download!

If you click a link and get the dreaded “Error 404, Document Not Found” message, do not despair. The message confirms that the site exists, and the Web page you want may still be there. Delete the last part of the address until you come to the next “/”. Hit enter and see what you get. If it's another error message, repeat the process. Eventually you'll end up on the home or index page, which may very well have a search box, or a link to the page you're looking for.

Finally, keep in mind that in many cases, the Web sites at the top of your search result are there because the owners of those sites have paid for prominent placement. Some search services are clearer than others about what has been paid for and what has not. Take the time to read the “help” section, which usually spells out the service's policies, and frequently offers valuable tips for making the most efficient use of that particular engine. And check back regularly; the best services frequently add new features to keep up with cutthroat competition.

A lot of things have changed in my office in the 24 years I've been practicing medicine, but nothing quite so much as the way I look for information.

Finding the latest articles on a rarely encountered disease used to entail a search through multiple textbooks, shelf after shelf of old journals, perhaps the hospital library, or even the med school library across town. It was tedious and time consuming, and all too often a hit-or-miss affair.

No longer. Nowadays I can find all the medical data I need—or indeed, any category of information at all—in a few minutes on the Internet.

The problem, of course, is that there is so much information located online, finding exactly what you need takes experience, practice, and often a bit of luck—unless you have mastered some shortcuts. I do a lot of searches, both medical and nonmedical, and here are some of the tricks I've picked up for finding all sorts of information both quickly and efficiently:

Don't limit yourself to one search engine. While Google is obviously the engine du jour (and has been for quite a few jours now), there are lots of other options, each with its own variations and advantages. If you're not finding it on Google, AltaVista, AlltheWeb, Teoma, Yahoo, Lycos, or HotBot, or one of dozens of others, might have what you want—and might even be better suited to your style. I'll be referring mostly to Google because it's so popular, but most of the techniques that follow will work on most search engines. (As always, I have no financial interest in any of the companies or Web sites I discuss in this column.)

Put quotes around words you want searched as a phrase. This is an old trick, but an important one. If you want to know if melasma has been linked to isotretinoin therapy, search “isotretinoin and melasma” so that Google won't waste your time finding a million Web pages containing the word “isotretinoin” and another million containing the word “melasma.”

You can also exclude words, by putting a hyphen (think of it as a minus sign) before any word you want screened out. For example, if you're researching tigers, you'll have to wade through scores of baseball sites unless you design the search as tigers-Detroit. Conversely, if you are looking for information about the baseball team and want to exclude anything relating to big cats, the search should be tigers + Detroit, meaning the word “Detroit” must be present.

You can widen your search by putting the tilde symbol before a word to get pages containing that word and anything similar. For example, ~tigers will pull up tigers, lions, leopards, and many other kinds of cats.

Another way to widen a search is with an asterisk at the beginning or end of a word. Searching acro* yields any word beginning with those four letters—“acrochordon,” “acronym,” “acrocyanosis,” and so on. Searching *genic yields “cryogenic,” “photogenic,” “dysgenic,” etc. (AltaVista seems to do this best.) You can also use an asterisk as a wildcard when you can't remember every single word in a phrase or name that you're seeking. For example *lupus erythematosus will yield “systemic,” “discoid,” “drug-induced,” etc.

Phrase your question in the form of an answer. Many people have been taught the opposite—to ask questions as questions—but you're not looking for Web sites that ask your question, you're looking for the answer! So “capital of California is” works much better than “What is the capital of California?”

For medical searches, consider limiting domains. If you're researching metastatic disease, you probably don't want thousands of extracts from cancer patient chat rooms, or commercial sites aimed at the general public, lawyers, etc. To pull only those pages posted on academic sites, use the “site:” syntax tool to limit your search to the .edu domain—in this case, metastasis site:edu. Avoid a space after the colon, or the engine will consider “site:” as a separate search word.

You can search news articles using the same techniques. Say you need to know what your patients are reading about a particular drug—isotretinoin, for example. Click “news” on the Google home page and search the same way you would search Web sites. If you want to see all new articles on a particular subject as they appear, go to Google Alerts and type “isotretinoin” and all its brand names into the search box; Google will e-mail you each time a story on that subject shows up online.

Search for clinical photographs in the same way. Say you're tapped to give a talk on short notice. On the Google site, go to “Images” and search the subject of your presentation. Narrow your search to PowerPoint files by using the “filetype” syntax tool (for example, psoriasis filetype:ppt), and you'll often find entire presentations, ready to download!

If you click a link and get the dreaded “Error 404, Document Not Found” message, do not despair. The message confirms that the site exists, and the Web page you want may still be there. Delete the last part of the address until you come to the next “/”. Hit enter and see what you get. If it's another error message, repeat the process. Eventually you'll end up on the home or index page, which may very well have a search box, or a link to the page you're looking for.

Finally, keep in mind that in many cases, the Web sites at the top of your search result are there because the owners of those sites have paid for prominent placement. Some search services are clearer than others about what has been paid for and what has not. Take the time to read the “help” section, which usually spells out the service's policies, and frequently offers valuable tips for making the most efficient use of that particular engine. And check back regularly; the best services frequently add new features to keep up with cutthroat competition.

A lot of things have changed in my office in the 24 years I've been practicing medicine, but nothing quite so much as the way I look for information.

Finding the latest articles on a rarely encountered disease used to entail a search through multiple textbooks, shelf after shelf of old journals, perhaps the hospital library, or even the med school library across town. It was tedious and time consuming, and all too often a hit-or-miss affair.

No longer. Nowadays I can find all the medical data I need—or indeed, any category of information at all—in a few minutes on the Internet.

The problem, of course, is that there is so much information located online, finding exactly what you need takes experience, practice, and often a bit of luck—unless you have mastered some shortcuts. I do a lot of searches, both medical and nonmedical, and here are some of the tricks I've picked up for finding all sorts of information both quickly and efficiently:

Don't limit yourself to one search engine. While Google is obviously the engine du jour (and has been for quite a few jours now), there are lots of other options, each with its own variations and advantages. If you're not finding it on Google, AltaVista, AlltheWeb, Teoma, Yahoo, Lycos, or HotBot, or one of dozens of others, might have what you want—and might even be better suited to your style. I'll be referring mostly to Google because it's so popular, but most of the techniques that follow will work on most search engines. (As always, I have no financial interest in any of the companies or Web sites I discuss in this column.)

Put quotes around words you want searched as a phrase. This is an old trick, but an important one. If you want to know if melasma has been linked to isotretinoin therapy, search “isotretinoin and melasma” so that Google won't waste your time finding a million Web pages containing the word “isotretinoin” and another million containing the word “melasma.”

You can also exclude words, by putting a hyphen (think of it as a minus sign) before any word you want screened out. For example, if you're researching tigers, you'll have to wade through scores of baseball sites unless you design the search as tigers-Detroit. Conversely, if you are looking for information about the baseball team and want to exclude anything relating to big cats, the search should be tigers + Detroit, meaning the word “Detroit” must be present.

You can widen your search by putting the tilde symbol before a word to get pages containing that word and anything similar. For example, ~tigers will pull up tigers, lions, leopards, and many other kinds of cats.

Another way to widen a search is with an asterisk at the beginning or end of a word. Searching acro* yields any word beginning with those four letters—“acrochordon,” “acronym,” “acrocyanosis,” and so on. Searching *genic yields “cryogenic,” “photogenic,” “dysgenic,” etc. (AltaVista seems to do this best.) You can also use an asterisk as a wildcard when you can't remember every single word in a phrase or name that you're seeking. For example *lupus erythematosus will yield “systemic,” “discoid,” “drug-induced,” etc.

Phrase your question in the form of an answer. Many people have been taught the opposite—to ask questions as questions—but you're not looking for Web sites that ask your question, you're looking for the answer! So “capital of California is” works much better than “What is the capital of California?”

For medical searches, consider limiting domains. If you're researching metastatic disease, you probably don't want thousands of extracts from cancer patient chat rooms, or commercial sites aimed at the general public, lawyers, etc. To pull only those pages posted on academic sites, use the “site:” syntax tool to limit your search to the .edu domain—in this case, metastasis site:edu. Avoid a space after the colon, or the engine will consider “site:” as a separate search word.

You can search news articles using the same techniques. Say you need to know what your patients are reading about a particular drug—isotretinoin, for example. Click “news” on the Google home page and search the same way you would search Web sites. If you want to see all new articles on a particular subject as they appear, go to Google Alerts and type “isotretinoin” and all its brand names into the search box; Google will e-mail you each time a story on that subject shows up online.

Search for clinical photographs in the same way. Say you're tapped to give a talk on short notice. On the Google site, go to “Images” and search the subject of your presentation. Narrow your search to PowerPoint files by using the “filetype” syntax tool (for example, psoriasis filetype:ppt), and you'll often find entire presentations, ready to download!

If you click a link and get the dreaded “Error 404, Document Not Found” message, do not despair. The message confirms that the site exists, and the Web page you want may still be there. Delete the last part of the address until you come to the next “/”. Hit enter and see what you get. If it's another error message, repeat the process. Eventually you'll end up on the home or index page, which may very well have a search box, or a link to the page you're looking for.

Finally, keep in mind that in many cases, the Web sites at the top of your search result are there because the owners of those sites have paid for prominent placement. Some search services are clearer than others about what has been paid for and what has not. Take the time to read the “help” section, which usually spells out the service's policies, and frequently offers valuable tips for making the most efficient use of that particular engine. And check back regularly; the best services frequently add new features to keep up with cutthroat competition.

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

“What do you discuss at office meetings?” a colleague wrote me recently. “We used to hold them monthly, and I never thought we accomplished anything. So now we don't bother anymore.”

It's a comment I hear fairly often. Doctors and employees alike frequently dread staff meetings. Four common complaints about them are: Too much time is spent dwelling on trivia with no time left to address important problems; any important issues that do get covered are seldom if ever resolved; no one acts on any constructive suggestions made; and all too often they degenerate into petty gripe sessions. The problem, though, is not with meetings themselves, but with improper (or complete lack of) planning. Avoiding meetings is not the answer; structuring them effectively is.

First, call meetings only when necessary. No rule says you must have one every month if there are no issues worth meeting about, or that you must wait until the next month if an urgent problem arises. My office manager keeps a list of “meeting topics” contributed by everyone in the office. When she accumulates enough to warrant a meeting (from three to six, depending on their complexity), she calls one.

She then prepares an agenda, ranking the topics of discussion in order of importance, and determines whether the meeting will require attendance by the entire staff or certain subgroups only. I am a firm believer in including at least one “positive” item in every agenda. Most meetings are grim affairs that deal exclusively with problems needing fixing, and that contributes significantly to the hatred most people have for them. Positive items may include recognition of specific professional or personal achievements, displays of photos of new babies or pets, examples of positive patient feedback, etc.

The agenda should be typed and distributed in advance of the meeting to all staff members who will be expected to attend it, to allow them time to prepare questions, comments, and suggestions.

Put the phones on service. Order in lunch if the meeting is at lunchtime, refreshments if not. Start on time. Waiting for latecomers penalizes those who have been courteous enough to be prompt. Stay on time and end on time.

The primary objective of the meeting itself should be to follow a well-planned agenda. Assign someone to keep everyone on track and make sure all agenda items are addressed.

Someone else should take notes summarizing each agenda item, any and all suggestions for resolving the issues raised, and proposed strategies for implementing those suggestions.

Allocate a specific amount of time for each item. A common problem is failure to get through the entire agenda. Stay on track, and don't get stuck on any one problem. If you can't resolve an issue in the allotted time, make a note to continue discussion at the next meeting, or appoint a “task force” to study the problem and report back at the next meeting.

All of the above is for naught, however, without follow-up. Within a day or 2 of the meeting, your manager should distribute a written follow-up document outlining the agenda items covered, proposed solutions, tasks assigned toward accomplishing those solutions, and deadlines for each task.

This last is most important. Someone once wrote, “a task without a deadline is only a discussion.” Without a completion date in mind, the assignment may never even begin. A deadline emphasizes not only the importance, but also the urgency of the action that needs to be taken.

Running well-structured, effective meetings is a bit difficult at first, but the more you do it the easier it gets. And it provides a good foundation for a policy of open and honest communication that is a vital part of any efficient practice.

As I discussed last month, the rapid evolution of electronic medical records and electronic claims filing has greatly increased the role of computers in our offices, and this trend will continue for the foreseeable future, largely because the federal government has decreed that it will happen whether we like it or not.

But, of course, with progress comes new problems. As computers become more ubiquitous, computer abuse will become a larger and larger threat.

It is already a major issue in the general business world. Here are some statistics from a recent industry survey:

▸ Two-thirds of employees with Internet access admit to using it for personal diversion during working hours.

▸ At work, 30%-40% of Internet time is spent on non-work-related browsing, and 60% of all online purchases are made during working hours.

▸ Seventy percent of all Internet porn traffic occurs during the 9-5 workday.

In short, up to 40% of lost productivity can now be blamed on computer abuse.

But lost productivity isn't the only problem. Unauthorized Internet access increases vulnerability to viruses, worms, and trojans, which can shut down your network.

On top of that, an estimated 80% of computer crime, such as embezzlement and theft of intellectual property, is done by "insiders"—employees working within the victimized companies, on company time.

"Outsiders" can be a problem too. If your office runs an unsecured wireless network, anyone with even a marginal command of network mechanics can easily gain access to your practice finances, your patients' medical records—anything running on your computers.

If you have an application service provider (ASP) system, where your medical records are stored electronically on an offsite server, such potential security breaches are an even bigger issue, for both patient confidentiality and general efficiency. So it behooves you to pay close attention to how your computer network is set up and how your computers are used on your time.

Start with computer monitoring software. Several reasonably-priced programs are available. They automatically and discreetly record everything done on a computer, including Internet activity, chat rooms, instant messages, and Web sites.

Examples include Snapshot Spy (www.snapshotspy.comwww.spectorsoft.comwww.softprobe.com

Monitoring software runs quietly in the background and cannot be detected by users, but I strongly advise informing your employees that their computer use is being monitored for their safety as well as yours.

Protecting your network from unauthorized access and signal diversion is a more complicated issue. For starters, don't use the default system ID, since any hacker can find that in the user's manual. Change it to something unique—not your birthday or your pet's name. Disable "identifier broadcasting," which announces to the world that you have a wireless connection. Enable any encryption supplied with your network, and get more if you need it. (See below.) Configure your router to allow only incoming or outgoing traffic that you have approved. Depending on the complexity of your network, you may need more sophisticated protection, such as AirDefense (www.airdefense.netwww.cryptocard.comwww.lucidlink.com

It goes without saying that all of your computers, including private ones, need personal firewall software such as Zone Alarm Pro (www.zonelabs.com

As I discussed last month, the rapid evolution of electronic medical records and electronic claims filing has greatly increased the role of computers in our offices, and this trend will continue for the foreseeable future, largely because the federal government has decreed that it will happen whether we like it or not.

But, of course, with progress comes new problems. As computers become more ubiquitous, computer abuse will become a larger and larger threat.

It is already a major issue in the general business world. Here are some statistics from a recent industry survey:

▸ Two-thirds of employees with Internet access admit to using it for personal diversion during working hours.

▸ At work, 30%-40% of Internet time is spent on non-work-related browsing, and 60% of all online purchases are made during working hours.

▸ Seventy percent of all Internet porn traffic occurs during the 9-5 workday.

In short, up to 40% of lost productivity can now be blamed on computer abuse.

But lost productivity isn't the only problem. Unauthorized Internet access increases vulnerability to viruses, worms, and trojans, which can shut down your network.

On top of that, an estimated 80% of computer crime, such as embezzlement and theft of intellectual property, is done by "insiders"—employees working within the victimized companies, on company time.

"Outsiders" can be a problem too. If your office runs an unsecured wireless network, anyone with even a marginal command of network mechanics can easily gain access to your practice finances, your patients' medical records—anything running on your computers.

If you have an application service provider (ASP) system, where your medical records are stored electronically on an offsite server, such potential security breaches are an even bigger issue, for both patient confidentiality and general efficiency. So it behooves you to pay close attention to how your computer network is set up and how your computers are used on your time.

Start with computer monitoring software. Several reasonably-priced programs are available. They automatically and discreetly record everything done on a computer, including Internet activity, chat rooms, instant messages, and Web sites.

Examples include Snapshot Spy (www.snapshotspy.comwww.spectorsoft.comwww.softprobe.com

Monitoring software runs quietly in the background and cannot be detected by users, but I strongly advise informing your employees that their computer use is being monitored for their safety as well as yours.

Protecting your network from unauthorized access and signal diversion is a more complicated issue. For starters, don't use the default system ID, since any hacker can find that in the user's manual. Change it to something unique—not your birthday or your pet's name. Disable "identifier broadcasting," which announces to the world that you have a wireless connection. Enable any encryption supplied with your network, and get more if you need it. (See below.) Configure your router to allow only incoming or outgoing traffic that you have approved. Depending on the complexity of your network, you may need more sophisticated protection, such as AirDefense (www.airdefense.netwww.cryptocard.comwww.lucidlink.com

It goes without saying that all of your computers, including private ones, need personal firewall software such as Zone Alarm Pro (www.zonelabs.com

As I discussed last month, the rapid evolution of electronic medical records and electronic claims filing has greatly increased the role of computers in our offices, and this trend will continue for the foreseeable future, largely because the federal government has decreed that it will happen whether we like it or not.

But, of course, with progress comes new problems. As computers become more ubiquitous, computer abuse will become a larger and larger threat.

It is already a major issue in the general business world. Here are some statistics from a recent industry survey:

▸ Two-thirds of employees with Internet access admit to using it for personal diversion during working hours.

▸ At work, 30%-40% of Internet time is spent on non-work-related browsing, and 60% of all online purchases are made during working hours.

▸ Seventy percent of all Internet porn traffic occurs during the 9-5 workday.

In short, up to 40% of lost productivity can now be blamed on computer abuse.

But lost productivity isn't the only problem. Unauthorized Internet access increases vulnerability to viruses, worms, and trojans, which can shut down your network.

On top of that, an estimated 80% of computer crime, such as embezzlement and theft of intellectual property, is done by "insiders"—employees working within the victimized companies, on company time.

"Outsiders" can be a problem too. If your office runs an unsecured wireless network, anyone with even a marginal command of network mechanics can easily gain access to your practice finances, your patients' medical records—anything running on your computers.

If you have an application service provider (ASP) system, where your medical records are stored electronically on an offsite server, such potential security breaches are an even bigger issue, for both patient confidentiality and general efficiency. So it behooves you to pay close attention to how your computer network is set up and how your computers are used on your time.

Start with computer monitoring software. Several reasonably-priced programs are available. They automatically and discreetly record everything done on a computer, including Internet activity, chat rooms, instant messages, and Web sites.

Examples include Snapshot Spy (www.snapshotspy.comwww.spectorsoft.comwww.softprobe.com

Monitoring software runs quietly in the background and cannot be detected by users, but I strongly advise informing your employees that their computer use is being monitored for their safety as well as yours.

Protecting your network from unauthorized access and signal diversion is a more complicated issue. For starters, don't use the default system ID, since any hacker can find that in the user's manual. Change it to something unique—not your birthday or your pet's name. Disable "identifier broadcasting," which announces to the world that you have a wireless connection. Enable any encryption supplied with your network, and get more if you need it. (See below.) Configure your router to allow only incoming or outgoing traffic that you have approved. Depending on the complexity of your network, you may need more sophisticated protection, such as AirDefense (www.airdefense.netwww.cryptocard.comwww.lucidlink.com

It goes without saying that all of your computers, including private ones, need personal firewall software such as Zone Alarm Pro (www.zonelabs.com

The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.

Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.

There are two good reasons for this.

First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.

Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.

But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.

The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.

This, of course, is easier said than done.

For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.

The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.

The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.

Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.

The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.

Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.

Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.

With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.

The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.

Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.

There are two good reasons for this.

First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.

Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.

But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.

The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.

This, of course, is easier said than done.

For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.

The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.

The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.

Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.

The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.

Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.

Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.

With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.

The day will come—and probably soon—when you will have to seriously consider switching from paper to electronic medical records.

Most physicians dread that day, and with good reason: Choosing the right EMR system for your practice is difficult at best, and once you make the choice, conversion is often a nightmare. But unless you'll be retiring soon, it will become virtually inevitable.

There are two good reasons for this.

First, EMR is long overdue. If you compare how medicine was practiced in 1905 with how it is practiced today, virtually nothing is the same—except the way we keep records.

Several studies suggest that EMR does make a difference in health care outcomes, by shortening inpatient stays, decreasing risk of adverse drug interactions, improving the consistency and content of records, and improving continuity of care and follow-up, among other things.

But there is a second reason why EMR's time has come: Our government has decreed that it has, whether we are ready or not.

The Bush administration has outlined a plan to ensure that most Americans have electronic health records within the next 10 years. “By computerizing health records,” the president said in his 2004 State of the Union address, “we can avoid dangerous medical mistakes, reduce costs, and improve care.” And in January, in one of his first speeches following his second inauguration, President Bush reaffirmed his commitment to that goal.

This, of course, is easier said than done.

For one thing, EMR is still by and large slower than pen and paper because direct data entry is still primarily done by keyboard. Voice recognition, handheld devices, and wireless devices have been tried and have largely failed except for specialized tasks. For another thing, physicians have been slow to warm to a system that slows them down and forces them to change the way they think and work. In addition, many fear that EMR will interfere with clinical decision making and intrude on physician-patient communication. The prospect of a malfunction bringing an entire clinic to a grinding halt is not particularly inviting either.

The special needs of dermatology—high patient volumes, multiple diagnoses and prescriptions per patient, the wide variety of procedures we perform, and especially digital image storage—present further hurdles. Nevertheless, many of us will be looking to install EMR systems in the not-too-distant future. And when you start looking, be careful.

The key phrase to keep in mind is caveat emptor. There is as yet no regulatory body to test vendor claims or certify system behaviors. And vaporware is still as common as real software; beware the “feature in the next release” if it is a feature you need right now. Avoid the temptation to buy a flashy new system and then try to adapt it to your needs; figure out your needs first, then find a system that meets them.

Unfortunately, there is no easy way around doing the work of comparing one system with another—or 20 systems against each other.

The most important information a vendor can give you is the names and addresses of two or more sites where you can go watch their system in action. Site visits are tedious and time consuming, but they are the only way to pick the best system for your practice the first time around.

Never be the first dermatology office with that particular system. Let the vendor work the bugs out with somebody else.

Above all, if you have disorganized paper records, don't count on EMR to automatically solve your problems. If your paper system is in disarray, solve that problem before considering EMR.

With all of its problems and hurdles, EMR soon will be a part of most of our lives. And for those who take the time to do it right, it will be an improvement.

Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.

That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.

So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.

First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.

And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).

You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.

Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.

Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.

After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.

Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.

My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”

Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)

Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.

If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.

Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.

That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.

So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.

First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.

And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).

You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.

Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.

Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.

After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.

Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.

My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”

Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)

Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.

If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.

Firing an employee may be the most difficult task most employers face, and it is particularly tough on physicians. We hate doing it so much that many of us prefer to tolerate poor and marginal employees rather than replace them with good ones.

That exacts a heavy toll on the efficiency of many practices. And the longer you procrastinate, the tougher it becomes as the mediocre employee forms relationships with other employees, and with you.

So it is important to recognize poor performance early on, and, if it cannot be improved, to replace that employee with one who can perform up to your expectations.

First, make sure your reasons for termination are legal. Federal law prohibits most employers from firing an employee because of race, gender, national origin, disability, religion, or age (if the person is over age 40). It also prohibits firing someone because that person is pregnant or has recently given birth, or because of any related medical conditions. It is also illegal to fire employees for asserting their rights under state and federal antidiscrimination laws, for refusing to take a lie detector test, or for complaining about possible OSHA violations or other illegal conduct.

And you can't terminate someone for refusing to commit an illegal act (such as falsifying insurance claims), or for exercising a legal right (such as voting, public demonstration, or other political activity).

You cannot fire someone for alcohol abuse unless he or she is caught drinking on the job, but many forms of illegal drug use are legitimate cause for termination.

Other laws may apply, depending on your state. To find out more about your applicable state laws, contact your state labor department or fair employment office.

Next, make sure you have all the documentation you need. When you give verbal warnings, be sure to document them. In today's litigious society, without proper documentation you may very well find yourself in a wrongful termination lawsuit, with the former employee claiming he or she was fired for one of the illegal reasons listed above.

After you have all your legal ducks in a row, don't put it off. Monday morning is better than the traditional Friday end-of-the-day termination. This will spare you from worrying about the dreaded task all week long, and keep the fired employee from stewing about it all weekend.

Explain to the employee the performance you have expected, the steps you have taken to help him or her meet that level of performance, and the fact that it has not been met. I try to limit the conversation to less than 5 minutes, and I make it very clear that the decision has already been made, so begging, pleading, or crying will not change anything. Avoid a shouting match at all costs.

My “speech” goes something like this: “I have called you in to discuss a difficult matter. You know that we have not been happy with your performance. (This is where specific examples are inserted). We are still not happy with it, despite all the discussions we have had, and we feel you can do better elsewhere. So today we will part company, and I wish you the best of luck in your future endeavors. Here is your severance check, along with any other monies owed you. I hope there are no hard feelings.”

Be sure to get all your keys back (or change the locks if you can't), back up any important computer files, and change all of your passwords. (Most employees know more of them than you think.)

Afterward, call the staff together and explain what happened. They should hear it from you, not through the rumor mill. You don't have to give all the specifics, but you should explain how it will affect them, the responsibilities that will be shifted, and when you plan to hire a replacement.

If you are asked in the future to give a phone reference or letter of recommendation, make sure everything you say is truthful and well documented. Anything else could trigger a libel suit.

Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.

This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?

Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.

Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!

Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)

Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:

▸ Is it trash?

▸ Is it delegatable?

▸ Is it a task you must do personally?

The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!

Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)

That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.

Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.

Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.

Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.

Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.

This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?

Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.

Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!

Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)

Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:

▸ Is it trash?

▸ Is it delegatable?

▸ Is it a task you must do personally?

The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!

Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)

That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.

Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.

Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.

Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.

Do you have stacks and stacks of “important” tasks piled on your desk? If so, you're far from alone. A majority of the physicians' desktops I've seen are littered with letters, folders, journals, charts, mail, books, and other paraphernalia, often several inches deep.

This is all important stuff, those doctors insist. And all of it has to be on top of the desk, in plain sight, so they won't forget to attend to it. I call such arrangements “horizontal file cabinets,” and here's my question: If all that stuff is so important, why has it been sitting there, untouched, for months?

Chances are, when you finally go through it, you'll find that most of it isn't that important at all. Or it may have been important at one time, but the deadline for completing it has long since passed. Or it may still be important, but it should be done as soon as possible. Like 3 weeks ago.

Horizontal filing cabinets are an esthetic and organizational nightmare. (“Don't worry,” I can hear you saying, “I know where everything is on my desk.” No, you don't.) And all those piles make completion of current projects that much more difficult by taking up all the usable desk space!

Transforming your horizontal filing cabinet into an efficient and useful desktop isn't that difficult, or even that time consuming. But you have to make yourself an appointment several hours long, and you have to make sure you keep the appointment. Make sure you will not be disturbed. Put the phones on service. You'll need a large wastebasket and a box of manila folders, and you'll need to free up space in a real file cabinet nearby. (I prefer lateral files because they are easier to build into office cabinetry and all of the contents are immediately visible when you open the drawer, but a vertical file will do.)

Now go through each and every piece of paper, book, magazine, pamphlet, and reminder note on your desk. As you look at each one, ask yourself which of the following three categories it belongs in:

▸ Is it trash?

▸ Is it delegatable?

▸ Is it a task you must do personally?

The first category will probably be the largest, and you know what to do with it. Notice that there is no category for “file and forget.” A full 80% of the “important” papers you file away for some vague future use will never be looked at again. Don't save anything just for the sake of saving it. Be merciless with each and every document. If it does not require action on someone's part, and if it contains information that is readily available elsewhere, throw it away!

Everything that can be delegated should be, immediately. Physicians often have a problem delegating—they're convinced no one can do any job as well as they can—but the fact is that any task that does not require a medical license is probably delegatable. Get it to the proper desk and leave it there, with any necessary instructions and a deadline. (Deadlines are excellent tools for focusing attention and encouraging prompt action.)

That leaves only the tasks you must do yourself. Resist the temptation to do them immediately. Instead, prepare a folder, properly labeled and with a deadline, for each one. File the folders, in order of deadlines, with the most urgent first, in your file cabinet.

Now you have a clean work surface. From now on, only one project—the most urgent one in the file drawer—should be on your desk at any given time. Everything else will be waiting its turn, out of sight, in your file cabinet.

Every new item that arrives on your desk should be placed in one of the same three categories: to do, to delegate, or to throw away.

Avoid the temptation to procrastinate by putting it over in the corner, “to do later.” Without an established priority or a deadline, it's not going to get done. And that, after all, is how you ended up with a horizontal filing cabinet in the first place.