01 June 2007

Another one bites the dust (sigh)

TrenchDoc is gone. GruntDoc, as usual, has the lowdown. This brings the body count of prominent medbloggers in the last couple of months to, what, five? TrenchDoc, Flea, Barbados Butterfly, CharityDoc and Fat Doctor (thankfully resurrected). I might be missing one.

I started thinking about this issue a little while ago when I agreed to allow my real name to be used in a certain prominent publication. I knew beforehand that, as Flea recently learned, anonymity is a thin veneer in the blogosphere. Anyone with a bit of diligence and a good understanding of Google can figure out your real identity. So I was not too apprehensive about letting the cat out of the bag, since it was never really in the bag, was it? So I keep up the pretense of anonymity primarily to remain HIPAA compliant. As Scalpel noted, as long as you have no identifying patient info on the blog, you are probably OK. Well, that includes geographic area (smaller than a state), and putting my name on the blog would, I think, narrow the geography enough that individual patients (if not fictionalized) probably could be recognized.

But beyond that, there are far more powerful forces at play. All politics are local, no? Trenchy and Barb appear to have been canned due to local reactions to their blogs. It's not exactly a secret in my circle of professional friends that I am blogging, and I suspect that there are people at my institution reading this, who I never would expect to do so. So I try to write as if my identity were open, and so I would not be embarrassed if my mother and hospital CEO were to read the blog. In fact, my mother does read the blog. (Hi, mom!) While it's nice to feel like you can say anything you want under cover of anonymity, it's important to recognize that anonymity is an illusion, and you can and will be held accountable for anything you write, especially if you piss off the wrong person.

So, mindful of the example of our fallen blogger brethren, I decided it was time to come clean. After a brief discussion with counsel, I called up my hospital CEO and told him about the blog. (Hi, Larry!) I should note that I interact with him on a regular basis and have a good working relationship, so while I felt like I was taking a calculated risk, I had good reason to feel like I would get an open-minded reception. I followed up with this email:

I am writing you to let you know about something I have been doing as a hobby, not because I think you need to know, but because I feel that trust begets trust and I would like you to be aware, though you may have little to no interest in the matter. I have been maintaining a weblog, or “blog,” for a little over a year; this is a personal web site, which is sort of an online journal.

On my blog, which is irreverently titled “Movin’ Meat,” I reflect on life as an ER doctor, politics, national health policy, my personal life, current events and pop culture. I publish anonymously, and neither I nor the hospital nor any other identifying details are evident. Additionally, I am scrupulously compliant with HIPAA, and any clinical cases I describe are generally fictionalized either in whole or in part, and no protected patient information has or will ever appear on my site.

I started the blog on a bit of a lark, but have come to enjoy it. It is a pleasant creative outlet, and a useful forum for me to advocate on political topics which I have a passion for – universal healthcare being a major item. As it is a “journal” of sorts, I publish on good days and bad, and there are items which are irreverent or off-color or reflect frustration and cynicism. I do not really self-edit in this regard. Nevertheless, I am proud of the overall body of work thus far, and I feel that it reflects well on me, and, were the relationship known, would reflect well on the hospital.

At this time, I have no intention of removing the veil of anonymity. It would not, however, take too much detective work or inductive reasoning to make an educated guess to my identity or my practice site. I wanted to voluntarily disclose this activity to you so you were aware. There have been cases of bloggers who have run afoul of their employers, and I feel that prevention is the best medicine. I have attached the URL of the home page below, as well as links to a number of representative posts for your perusal.

I believe that this activity in no way conflicts with my role within the medical staff or the physician leadership for the hospital, or with the mission of the organization. If you have concerns in this regard, I would be happy to meet with you privately to discuss them in detail.
To my delight, the response was "I love it! Don't stop!" He did refer it to the hospital compliance office for review, but as I have been careful about HIPAA, I think I should be OK on that point. This is actually a great relief for me. I would hate to do anything which would unwittingly get me in trouble, or more importantly, jeopardize the relationship our group has with our most important customer -- the hospital. It is, of course, no protection against bad behavior. If I should pull an Imus, that support would evaporate right quick. But to a certain degree I feel like it provides me with a degree of inoculation against the sort of local blowback that bit Trenchy et al.

I particularly like the notion that 'trust begets trust,' that by voluntarily disclosing this activity to administration absent any negative feedback, I create the trust within the relationship such that, should there ever arise a question regarding the existence or content of this blog, the administration is already aware of it and has no objections in principle. And also, I defuse the "surprise" bomb; I have never met an executive who likes surprises, especially those that accompany complaints.

Medblogging is an interesting and unusual beast, and I think it's going to take a while before well-accepted standards of acceptable and ethical behavior develop. I suspect, sadly, that we will see a number of other blogs go down in similar fashion as things shake out. Conversely, the growth rate seems to far exceed the attrition rate, so I do not share GruntDoc's concern about being the last man standing. The way I see it develop is twofold. The "named docs" on their blogs will probably be more or less prohibited from ever discussing a real case, unless highly fictionalized or temporally distant from the incident case. The "nameless ones," on the other hand, will enjoy a bit more freedom but perhaps a higher risk profile, since I predict that the illusion of anonymity will continue to induce them to speak more frankly than may be healthy.

And Flea, Trenchy: you will be missed. Hope you can find a way to come back, but if you can't, well, thanks for sharing. I enjoyed reading your stuff.


  1. Nice of you to fictionalize further by obfuscating CEO and Larry's actual title.
    I'd be very interested in hearing your take on Flea's case. To my mind the issues it raises of transparency in processes that are supposed to be about patient safety are the most salient.

  2. Some of us coworkers have been with you from the beginning. Keep it up!

  3. My wife and I had a conversation earlier about the opposite - about people knowing too much about our lives. It is a thin line when you are writing in public with your ultimate goal of becoming famous. Flea found out the price of fame (he is more famous than ever). Since I blog with my name out there (not blatantly, but easy to figure out), there are other risks. Your path may be the best, but there are always risks.


  4. Good post! Glad that worked out for you. :)

  5. I am not anonymous but also notified my employer and agree with the "trust begets trust" concept.

    Great post.

  6. I should probably add some more security features to my blog, like a cheesy nickname or something You people are scaring me.

    BTW, when I first saw the blog title "Movin' Meat", I knew it would be an ER blog. We say "Move Product" however to denote getting people out of the department/patient flow.

  7. Great post - and (like the aforementioned article in Annals) it has certainly got me to thinking about the best way to keep blogging without putting myself or my group at risk.


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