On medical blogging codes

While I certainly agree that professional societies should not be policing blogs or writing rules for them… I think it’s reasonable for bloggers to voluntarily opt-in to a code of ethics if they want to. That way readers know what your principles are – and that (for example) you take steps to protect patient information and anonymity and offer transparency about any potential conflicts of interest (like getting paid to blog about a product). As a blog reader, I would find it valuable to know that sort of thing about a blogger.

Full disclosure: I helped to draft the healthcare blogger code of ethics with Dr. Rob Lamberts.

Just what we need, more rules, more codes, more drivel.
I graduated from medical school out of sync with my class, so I never went to a formal graduation ceremony – I was already at my internship by then – so I never “took” the Hippocratic Oath. I guess that means I’m not bound by its principles then, huh?

The issue of patient privacy and medico-legal risk has definitely crossed my mind as I blog. Of course none of us would use real names, but what about a nickname that is well known in the hospital and b family members. Of course the nickname can be central to the story since they are often so perfect. I don’t know the answer, and I won’t tell how I ultimately decided to deal with it so anyone who decides to read my nickname infused blog will just have to guess whether they are real or made-up.

HIPAA regulations pertain to all covered entities and individuals at all times. This provides at least a minimal set of standards to which all physicians, nurses, therapists and other individuals who have patient access to records must adhere in all aspects of daily life. This also applies to non medical organizations who may have access to patient information while consulting or providing a contracted service such as medical billing. Employees and affiliates of contracted firms are subject to the same standards as covered entities under HIPAA standards. Those who violate HIPAA standards are subject to severe penalties. Sometimes the wheel turns slowly but it does eventually turn. It is therefore unwise to risk your freedom, your business, your personal finances, your reputation and your personal relationships by violating these standards which are requirement of law.

As far as product recommendations are concerned physicians do that on a daily basis every time they recommend one form of therapy or medication over another. When patients require referal to another physician or clinic the referring physician may very well make a recommendation where a choice is available. These actions are inherent to the practice of medicine. The only ethical issue of concern would be whether or not the physician is reimbursed in some manner for making the referal. Referals made for the purpose of personal gain or “kickback” are highly unethical.

On the other hand many blogs feature advertising ‘bots’ that produce ads on the site that are intended to target individual visitors by geographical location and key words associated with the blog (thus each visitor sees a different ad selection). This type of advertising is of benefit to the advertisers, manufacturers and the company hosting the blog. They do not necessarily provide income for the individual bloggers.

It would seem unreasonable to prevent health care professionals from providing links to other sites where those sites feature information about how to obtain the therapy, medical devices or medications that are being discussed in the blog or where a bibliography is being provided to support information included in the blog. The only question that would be relevant to this circumstance is whether or not it would be appropriate for the blogger to accept reimbursement on each of the “click throughs” that occur when a blog visitor uses a link on the blog. It should be noted that this kind of compensation is routine throughout the World Wide Web. In many cases compensation may be sufficient to cover the cost of maintaining the website, domain or blog. This does not bear any similarity to “kickbacks” being paid to a physician for ensuring that their patients are always referred to a specific clinic for testing for example. Kickbacks are unethical and violate existing laws regarding a patients right to make their own choices in care.

It would also seem unethical for a physician or other licensed professional to accept any form of compensation from any pharmaceutical firm, medical device manufacturer or service provider without making that disclosure on the blog. There should be no bar to health care professionals working in related industries so long as there are no conflicts of interest that would disadvantage their private practice patients by unfairly restricting patient choice, failing to protect patient information, decreasing the quality of care, or increasing the cost of care as a direct or indirect result of that conflict of interest.

The necessity of observing standards already prescribed by law is self evident. The necessity of observing basic standards of integrity that are inherent to the standards of the health care professions should also be self evident. Unwillingness to conduct oneself in a manner consistent with these standards should be grounds to terminate that persons participation in any health care profession. However, it is also essential to utilize common sense when addressing issues of law, ethics and common practice whether it be in regards to a physicians blog or the everyday practices of a private citizen.

I drink milk to stay healthy.