On blogging


Category : Medical Rants


A PGY-2 has asked me to help publicize this project.  He asks interesting and important questions.  I would love to see a large number of comments to this post.

As blogging and online physician disclosures become more common, many raise concerns about the tone and content of posts by physicians. While posting HIPAA violations and directly identifiable patient information is clearly forbidden, how do we address the "gray areas" of blogging, such as derogatory portrayals of physicians, nurses, or patients, or use of crude language? Could privacy be violated indirectly through posts detailing patient encounters? Some institutions are beginning to create formal blogging rules and regulations to restrict this behavior for their own protection.

Given these developments, should formal professionalism guidelines be developed for physician blogging? If so, what should they include?

How do you make decisions about what to put online? What recommendations do you have for other bloggers to "stay out of trouble?"

My responses

  1. Since I do not blog anonymously, I am relatively careful about my posts.  I go by the same rule I use in medical charts – what if someone reads this in court?  What if someone reads this to me while being interviewed on national TV?
  2. Privacy could be indirectly violated through posts about patients.  Privacy can be violated when publishing case reports in journals.  I personally work hard to de-identify my presentations.
  3. Once again I am against formal professionalism guidelines for physician blogging.  As a libertarian, I consider my blog an extension of the First Amendment.  I take responsibility for my words, and do not want thought police, blogging police or physician specialty police telling me about what I can blog.  I should use common sense, but if I do not, that is my problem.
  4. I blog about issues that tickle my fancy.  I have no big plan, but take ideas from other bloggers, newspaper articles, rounds, discussions with non-physicians, and discussions with colleagues, residents and students.  This blog is my personal journal of ideas.  I write about things about which I feel passionate.
  5. How does one stay out of trouble when blogging – again use commonsense!  I have stirred passions often – malpractice lawyers often attack me, I have angered ER physicians several times – but generally I hope readers find this blog thought provoking and sometimes educational.

I will be glad to expand on any points that I did not address sufficiently.

What do you think?


Comments (9)

I enjoy reading about doctors’ experiences with patients and their thoughts on our healthcare system. It broadens my perspective, and I hope makes me a better patient. There is already a code of ethics for healthcare blogging. I always check to see whether nor not a blogger subscribes to this code of ethics. I agree with you on the free speech issue. http://medbloggercode.com/

IMO, derogatory portrayals aren’t a problem. They aren’t accompanied by names, so most people don’t know who is being railed against. Sometimes it’s amusing. Sometimes it’s sad. Most of the time it’s just someone letting off steam. It helps me to see doctors and nurses admit that they’re not all perfect.

Maybe I’d feel differently if it was ME that someone was blogging about, but I don’t think so. With names changed, only people already familiar with the issue will recognize what/who is being portrayed. As a professional, if a co-worker ranted about me online instead of approaching me to work out conflict in an adult manner, I would arrange a meeting with the person and ask how we could address the issue. It says volumes about a person’s character when they will malign another person behind their back instead of directly working out the problem.

As a patient, I would not have any problem with my doctor describing my case online – as long as my name is not attached. If I saw it (unlikely), it would give me insight into what my doctor is thinking. I’d either discover how to be a better patient (which I hope I learn from reading posts about other cases), or I’d realize that maybe I need to find a different doctor. Either way, it’s not a problem.

I think that doctors have a right to blog. Without violating HIPAA regs or my privacy as a patient of course.

That said, if a doctor I’m seeing blogs, and writes about “that patient I saw today” and I know I was there that day, and recognize myself, well, that’s going to have implications. But as another poster said, it’s either going to help me understand my doctor better and perhaps appreciate her/him more, or it’s going to be helpful information that encourages me to find another doctor.

Frankly, though, with some doctors, if they have the time to blog, they might better spend that time catching up on research and reading in their field, and reading patient blogs. There is so little time for many doctors to learn and listen — and especially to listen to what their patients are saying.

Frankly, for some doctors I’ve run into, the last thing in the world they need is MORE opportunities and venues to pontificate about their opinions, or more reason to think that what they say is eminently more valuable than everyone else…

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“Frankly, though, with some doctors, if they have the time to blog, they might better spend that time catching up on research and reading in their field, and reading patient blogs.”

Frankly, though, what a doctor does with their time off is their business. Is it okay if I go for a jog or do you want to tell me I need to read more? We all could read more. One time someone told a colleague of mine that he would be 100% of the doctor he could be instead of the 80% he is now if he would stay later and read each day. To that he replied, “Maybe, but then I wouldn’t be 100% of the father I could be.”

Not sure that derogatory depictions are as benign as you suggest–do you feel that constant ranting against patients further erodes patient’s confidence in their providers or may make them less likely to reveal information to their doctors that they may consider “silly”
or “naive” but may ultimately be very clinically relevant?

I guess blogging takes a certain amount of bravery. While these concerns are quite legitimate for blogging doctors, I think blogging and twittering and face-booking has implications for all those who are employed by others or provide a service to others. You gave some good tips. Thank you.

Blogging aside, if you believe your health information is protected by HIPAA, I speak from personal experience as a physician who deals with patients everyday and hear story after story not only in hospitals but out of hospital settings. So take it to heart when I say you have no idea how unprotected your information is.

People talk, no matter how many laws are written.

I agree with most of these comments: that common sense should guide doctor-blogging, that it’s imprudent to publish items that you wouldn’t want to say in front of a court room or on the 6 o’clock news, that doctors should probably just study more and spend less time pontificating, that we publish people’s stories in professional magazines, etc, and that anonymous stories don’t seem to fall within the realm of HIPAA.

That being said, as an intern blogging has been my main coping mechanism. My blog has allowed me to reflect and process in a way that a Word Document journal on my computer would not. One of the fabulous aspects of blogging is that anyone, at any time, may respond to a thought you have. I have had family members that I haven’t seen in years unexpectedly turn up in the comments section of my blog. My parents have been able to appreciate more deeply what being an intern has been like. During a time of intense isolation (INTERNSHIP), the blog has facilitated connections with distant family, faraway friends and, perhaps most importantly, my co-interns.

It is interesting that all of the commenters remain anonymous. Perhaps the first rule in any blogging ethical guideline should be that the blogger should identify herself. 🙂

However, I am against any blogging guideline for the following reasons:

1) There already exist various guidelines that should guide physicians’ blogs. There is HIPAA to protect patient’s privacy. Most institutions already have professional codes of ethics. A physician should behave on his or her blog as he does on the wards: with the utmost professionalism.

2) Any guideline specifically adopted for blogging, besides common sense and already existing codes of ethics, will only serve to limit free speech. How far are we going to limit free speech? Should we regulate Twitter too? How about Facebook? How about conversations between two physicians in the parking garage? How about email? How about team sign-outs? And should we extend such guidelines to NPs, nurses, lawyers, police officers, and countless other professions?

Common sense only goes a long way. I would rather have a few bad apples acting unprofessionally on the blogosphere than having all physicians too timid to write insightful reflections on their experiences.

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