Monday, August 4, 2008

To Write or Not To Write: a question for doctors who blog

Just as the medical blogosphere is burgeoning with opportunities for health care workers to draw back the curtain and demystify what goes on behind the scenes in medicine, and how people who work in medicine approach certain situations and decisions both intellectually and emotionally, the naysayers are criticizing this growing transparency and even implying that doctors shouldn't be free to express themselves, to have a voice, to tell their stories.

But as Dr. Mary Johnson, a pediatrician in Asheboro, NC, once wrote on her blog, "I live in America. I did not leave my right to have an opinion at the door when I got my medical degree."

Physician bloggers, including me, got shaken up when Robert Lindeman, a.k.a. Flea, had to quit blogging because of the way he was "outed" during a malpractice trial. Interviewed later about the ordeal, Dr. Lindeman reflected, "Writing as a physician is a dangerous activity, and that’s a shame. That’s a message I’d like the folks to know. For physicians, writing is dangerous and there is something really messed up about that."

For those of us who love writing and who love medicine, these are painful words.

Dr. Johnson aptly points out elsewhere in her blog that we shouldn't let our voices be silenced by others' fears:

I have noted in the past that most medical bloggers do so anonymously. Provided they change the names and blur the locations in order to protect both the innocent and the guilty (not to mention, dodge those snarled privacy laws) . . . and as long as they don’t tell too many people who they really are . . . they generally can get away with discussing their days . . . their patients . . . their opinions . . . with the wit and wisdom and insight that can only be borne of the experience of actually being a doctor.

The public really needs to hear this stuff. In this era of “Walmart medicine” and a "me-me-me-now-now-now" society that expects the state-of-the-art best (not to mention good outcomes no matter what) for next to nothing (and OBTW, society's members will sue the doctor's pants off if they don't get it), this kind of thing needs to be part of the discourse.

Amen to that.

I know this:
  • I know I am not truly an anonymous blogger - no one is.
  • I know I need to protect people's privacy and am committed to doing so.
  • But I also know that STORY MATTERS. Ultimately, for me, story is the whole POINT of writing, and, arguably, the very way in which we define ourselves and forge our connections with one another - even in medicine, where taking a good history, learning a patient's story, is one of the most important steps in the healing process.

The authors of the article "Online medical blogging: don't do it!" (published in the journal of the Canadian Medical Association) assert, "Telling personal stories about individual patients poses the risk of eroding the public's trust in the particular physician involved, as well as in the relevant department, hospital and university, and in physicians in general." What a limited and limiting understanding of the powerful positive role writing about one's experiences can play in medicine. So many visitors who have been kind enough to leave comments here on this blog have described just the opposite phenomenon: an increased trust in, and understanding of, physicians due in part to a particular story related here. Who better than the surgeon himself to describe what it's like to be feel almost inexpressible sorrow over an outcome, or to convey, as this surgeon did, the momentary intimacy of an office visit in which compassion for a patient's physical and emotional lesions, and the willingness to become part of another's story, transform a mere "encounter" into something much greater?

To the authors of that journal article, I must say that perhaps five or ten years ago a discussion of whether or not doctors should blog might have made sense, but considering the plethora of truly remarkable, valuable, fruitful, and praiseworthy blogs out there by now - open your eyes and take a look, please - I think the horse has left the barn.

I'd like to thank Melissa Healy of the L.A. times for featuring Notes of an Anesthesioboist on today's roundup of "Medical Blogs For Doctors and Patients Alike."

Other medical blogs included on her list were
From Medskool
Emergiblog - "The Life and & Times of an ER Nurse"
GruntDoc by former Marine infantryman and physician Allen Roberts, an ER doc in Fort Worth
Blogborygmi by Dr. Nicholas Genes, an ER doc from Mount Sinai Hospital in New York - "husband, father, physician, writer"
DB’s Medical Rants maintained by Dr. Robert M. Centor, an internist at the University of Alabama School of Medicine
Dr. Val and the Voice of Reason
Kevin, M.D. by Nashua, N.H., internist Kevin Pho
California Medicine Man, by Dr. John S. Ford, assistant UCLA professor and an internist at Harbor-UCLA Medical Center
Fingers and Tubes in Every Orifice.
Ob/Gyn Kenobi
Mothers in medicine
Musings of a Distractible Mind by Dr. Rob, a primary care physician in the Southeastern U.S.
Head nurse
Clinical Cases and Images
Medical Jokes, Cartoons, Videos
Placebo Journal Blog -"Medical Humor With a Purpose," by family practitioner Dr. Douglas Farrago of Auburn, Maine. (Thanks to you, Dr. Farrago, my husband will never look at a cast iron stove the same way again...)

Addendum August 25, 2008:
Here's an article on the website of the American Medical Association on physician blogs: . There seems to be an underlying assumption about what blogs should be - tools for dissemination of information by "professionals" with proper "citations" only, whereas blogs are clearly different things to different writers, including journals, art exhibits, family albums, etc. The genre is fluid and undefined; it can be personal, not professional. Not all physicians who write blogs are writing in their professional capacity as physicians. I think Dr. Rob stated it brilliantly: "Physician blogs should not be seen as an attempt to replace other sources of information, but instead as a new kind of medium -- a view into the minds of the rank-and-file members of medicine."

And via KevinMD on August 26, 2008:
Here's another site that expresses my view pretty well, which is that in this country that glorifies the First Amendmet, my right to write whatever I want should be respected, not abrogated:

More links on the subject here - specifically, on the story of a Scottish doctor suspended for something he wrote on a doctors-only blog forum - found on September 2, 2008:

Addendum 9/30/08:

Addendum 4/21/09:


Dr. Rob said...

Agree 100%. I am not anonymous but try to respect patients' privacy - which is hard as a PCP. Flea's problem was not that he wrote, it was what he wrote that got him into trouble.

I have never felt that anonymous blogging is wise for physicians. It is like sneaking around - it raises suspicion. So far, things have worked out for me and I have done it for over 2 years.

Here's hoping.


Marysienka said...

When I got my copy of the CMAJ, that article caught my eye and I decided to read it first (it's on the last page of the journal). What can I say? I was kind of shocked by the article, I just thought the author didn't understand the idea behind a "medical" blog (it's not as if we were telling the *real* stories, including personal details concerning patients).
I was glad to see your entry this morning though, and I couldn't agree more with you! I see the exchange between bloggers and commenters (other docs, patients, etc.) as a very positive experience, where I sure get to learn a whole lot!

Marysienka (Canadian medstudent and blogger!)

T. said...

Hi, Rob and Marysienka - thanks for visiting!

I definitely blog as if the whole world knew my name, and I know that it would be relatively easy for any reader to find it. I like the persona/pseudonym because to my mind it's removing yet another possible identifier for any individuals whose stories are alluded to here - and I try to be pretty conscientious about removing those / changing details to protect the innocent, etc. I even go back later sometimes to old posts just to be sure!

I could be wrong, but it did sound to me like the authors of the CMAJ article hadn't taken the time to really understand the positive exchanges and rich intellectual, and sometimes societal, rewards made possible by the interactive nature of blogs. Granted, there can certainly be trouble, too, but on the whole, having perused many, many medical blogs and their comment boards, I've seen a lot of good things and think these gentlemen have been short-sighted and small-minded to fail to appreciate the benefits of medical blogging done well, with the right safeguards, and in the right spirit.

Lisa Johnson said...

Congratulations on the mention T!

K. said...

God bless you for writing this blog! I really needed to read this. I don't write medical stories because I am DEATHLY AFRAID of pissing someone off. Fortunately, I am not into medical drama writing anyway so I have plenty of other stuff to write about.
I think it is so important to allow and encourage doctors to write. Don't we want our doctors to be emotionally sensitive and reflective and know that they take home our concerns and think aobut them afterwards? Isn't it nice to know our doctors are human beings and not just automatons that do their deeds and forget the next minute. Writing can be cathartic and can also teach us about ourselves and our patients and help us become even BETTER doctors.
Thanks for this post. You should write an article about this and get it priinted in mass media! Everyone needs to know...