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
Edwinleap.com - "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
MedGadget
Medpolitics
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
Codeblog
Musings of a Distractible Mind by Dr. Rob, a primary care physician in the Southeastern U.S.
Head nurse
Urostream
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...)

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Addendum August 25, 2008:
Here's an article on the website of the American Medical Association on physician blogs: http://www.ama-assn.org/amednews/2008/09/01/prca0901.htm#1 . 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: http://www.medrants.com/index.php/archives/3718

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: http://thebrownstuff.blogspot.com/2008/08/story-here.html
http://thejobbingdoctor.blogspot.com/2008/08/suspension-and-resuspension.html
http://ward87.blogspot.com/2008/09/reinstate-dr-scot-jnr-support-free.html
http://doctorbloggs.blogspot.com/2008/08/harassment-and-bullying-in-nhs.html
http://witchdoctor.wordpress.com/2008/09/01/the-highlands-in-the-eye-of-a-storm/

Addendum 9/30/08:
http://www.scalpelsedge.net/2008/09/theres-something-about-med-blogging/

Addendum 4/21/09:
http://casesblog.blogspot.com/2005/08/simply-fired-how-not-to-blog-about.html