Archives for July 16, 2007

Professional Scolds of Medicine

There are those in medicine who hold themselves out as so terrifically thoughtful and sensitive and a) since they’re so terrifically sensitive and thoughtful everyone should do what they believe, and b) if you don’t, you’re wrong, and unprofessional to boot. They’ll look down on you, and want you to look down on yourself, too. They’re fun to annoy by not playing their game.

I have thought about this before, but Ad Libitum’s latest made me remember why I avoided a few of my peers in med school, and why I like the refreshing groups of realists I work with in Emergency Medicine.

The point of the post is that, essentially, docs cannot ethically blog about their patients, and I take exception to that. Per Ad Libitum

The key underlying principle about physicians writing or blogging about their patients is that, as pointed about by Charon (2), patients own their stories. In fact, Charon recommends that physician-writers must have patients read and approve any narrative about them for publication.

I don’t know a thing about Dr. Charon, but I don’t buy this underlying assumption, so the rest is built on nothing. To accept this idea makes the Physician some sort of detached bystander, which isn’t how medicine works as I practice it: both I and the patient are part of their story; yes, it begins as the patient’s story, but once they communicate it to me, as their doctor, it’s OUR story. (Personal stories are like secrets: the only way to have one is to never tell it to anyone else).

IMHO there is nothing unethical in blogging about patient interactions provided they’re suitably anonymized, and not illegal (which is different) providing you follow the HIPAA guidelines. Although I won’t hold myself out to be a paragon of blogging perfection, when I blog about patients they’re so anonymized that frankly I’m more at risk of a non-patient of mine thinking I’m writing about them than my actual patient (or patients) that spurred the post. As a practical aside, it’s unlikely any of my patients will ever find this blog, let alone scour it to find a case that might be them (hint: it’s not you).

More Ad Libitum:

…It can alter the blogger-physician’s view of patients – each patient encountered can now be seen as a subject about which the physician can write or blog, and the physician may change his or her interaction with the patient in order to extract more writing/blogging material.

Anyone who does this is an idiot, and I wonder about people who worry about such things (more Scolds). Medicine is hard enough without trying to view every interaction through some ‘is this bloggable filter’, and I bring this up here to squash it like a bug. I and every other medical blogger don’t write about 99% of our interactions, and it’s because they’re either not noteworthy, or too noteworthy (not able to anonymize) or we just forget. Frankly, most of what we do isn’t that interesting, or notable, like our patients.

I don’t think Ad Libitum’ a scold, by the way, but I do think the premise of his post is off: it’s not unethical to blog about patients, providing common-sense precautions (and good judgment) are used.