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.


  1. LMF (ad libitum) says:

    Gruntdoc, I’m glad to have stimulated a discussion on this topic. I don’t think my conclusions are different from yours (i.e. it’s not unethical to blog provided due precautions are taken). The two articles I referenced are quite thought-provoking, and the full text is available by clicking on the links. I’d encourage you to read them. LMF (ad libitum)

  2. This ownership of our lives is absurd. It’s an extension of the mindset that some celebrities that every word that comes out of their mouths is copyrighted and may not be used without their permission.

    Imagine all of us wearing a button that says “Do not quote me without permission.”

    I think we would have to generally look at blogging of the sensible kind as memoir or in some cases truth-based fiction. It might also be considered a public service to show how some people come across to their doctor, or what their doctor is thinking while they interact. The reality is, for every doctor blogging about something or other there are thousands who are thinking similar thoughts and perhaps acting on them.

    A very basic rule of blogging sense would be to first of all presume that anyone reading your blog can figure out who you are, and if you blog about an interaction with patients or other professionals, they may happen across your note. If you are comfortable with the possible consequences of that happening, blog on.

  3. A further note. If openness and honesty in blogging is so important, why the secrecy about who LMF is? “A neonatologist.” “Male” Location:”United States” — at least he was more specific than “Planet Earth” or “Milky Way”

  4. Ad Libitum says:

    Take a look at this post, titled ‘Steambath Boil’:

    It’s a very interesting post, and one that is very respectful of the patient. But I’m not sure how much of the patient’s medical information is ‘fictionalized’ and unrecognizable. Also, we cannot assume that the patient (especially if the one in the photograph) will be OK with his medical information being on the internet.

  5. The House Whisperer says:

    My ED has some informed consent in the “consent to treat” form that specifically states that EKGs, X-rays, and other data derived from their visit may be used for educational purposes, lectures, seminars, and research. I don’t think there’s anything in there about blogging, though I think it could reasonably fall under the category of education. We have a separate form for consent for video and photography. The wording is vague, but it does say that the video/photo could have multiple venues and uses.

  6. The House Whisperer says:

    By the way, I own the above comment–it is my experience only and not to be commented upon or shared.

  7. I have written, and now blogged, about doctors and patients for many years (see Nightshift at the above web site). I made the mistake of allowing a doctor’s identity to be recognizable once. Thankfully, he didn’t read the publication. But many of the nurses in the ED did. I learned an important lesson. Now my stories are “inspired by real events” i.e. fiction. But everyone knows that they reflect real people. Identities are protected and I still get the point across.


  1. […] to remind all of their duty of confidentiality to the patient. It may be that blogs are too public. Gruntdoc disagrees: his point about patients melding into each other and being anonymized is much more difficult when […]

  2. […] GruntDoc recently wrote 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. […]