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Medical blogs: Potential minefield for writers
Careers can be enriched, derailed on-line
Blogger beware — some on-line medical diarists have found the benefits of sharing experiences and observations via their web logs ("blogs") can come at a cost.
Dr. Flea and Barbados Butterfly are two of the most-recognized recent examples of "don't-do-this" clinical blogging, and their travails led one group of doctor/bloggers to create a "Healthcare Blogger Code of Ethics" to help guide blog authors in making sure their on-line diaries don't hurt anyone, including themselves.
Two recent cases testify to the need for such guidelines, the author of the code of ethics points out.
Dr. Flea — Natick, MA, pediatrician Robert P. Lindeman, MD — had a popular blog in which he used humor and rapier-sharp observations to educate and editorialize. However, those qualities his readers appreciated turned into a huge liability in May when he blogged about a malpractice trial he faced that arose from the death of one of his patients (a trial Lindeman blogged that he expected to go in his favor). His mistake — blogging during the trial, posting entries that ridiculed the plaintiff's attorney, made fun of the jurors and judge, and revealed his defense strategy. When he took the stand, the plaintiff's lawyer asked, "Are you Flea?"1
The question told Lindeman's attorney that the opposing lawyer was prepared to reveal to the judge and jury the existence — and contents — of the blog. Lindeman's lawyer proposed a settlement, and Lindeman shut down his blog.
Just two months earlier, Melbourne, Australia, surgical resident Jillian Tomlinson found that her highly popular blog, Barbados Butterfly, was not anonymous enough, at least as far as her employer was concerned. Tomlinson was suspended by her hospital for one week, and her blog, while still in existence, is now accessible by invitation only.2
Australian Medical Association President Mukesh Haikerwal, MD, told the Melbourne The Age that there are risks involved in trying to "de-identify" patient information. "There's more to it than just rubbing out the name," he said.
Stories like those of Dr. Flea and Barbados Butterfly have sent a chill through the rapidly growing medical blogosphere. Estimates of the number of health care blogs on the Internet vary depending on who you ask; it is safe to say that the number of blogs written by doctors went from just a few less than 10 years ago to somewhere in the neighborhood of 1,000, according to several networking sites.
'De-identify' with care
Some precautions necessary to safely blog about medicine are obvious — for example, naming patients, or giving enough details to identify patients, is a clear privacy violation.
"De-identification" is a hot topic among medical bloggers. According to the U.S. Department of Health and Human Services' Summary of the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule, de-identified health information "neither identifies nor provides a reasonable basis to identify an individual." But de-identification can be more complicated than merely changing names and dates. (See box.)
Other problems arise when bloggers who post anonymously, so as to be free with opinions and information about colleagues and their employers, suddenly find their identities uncovered. Angry co-workers and disgruntled employers and medical societies are among the least of the problems that can arise from careless blog posts — litigation can be initiated or, as Dr. Flea discovered, impacted by a clinicians' blog activity.
On a more positive note, blogs are widely appreciated as a means of quickly sharing advice, gaining informal consults, and alerting peers to important literature. A form of web-based "grand rounds" is a popular format, with some bloggers forming networks and rotating the role of "host" of the grand rounds. Some blogs resemble miniature poster sessions, with scans, ECG tapes, and unusual presentations posted for comment and educational value.
One blogger, interested in preserving the integrity of medical blogs while offering guidance for bloggers to protect themselves, created medblogcode.blogspot.com, home of the Healthcare Blogger Code of Ethics. (See box.)
The code addresses confidentiality, privacy, and bias, and is mainly intended to protect medical bloggers who post anonymously, says Rob Lamberts, MD, an Augusta, GA-area pediatrician and internist who launched the blogger's ethics site. Lamberts is himself a blogger (distractiblemind.ambulatorycomputing.com), though not an anonymous one.
"I do not want the whole medical blogging community to post with their identities open," he stated in introducing the code of ethics. "There is a part of the life of someone that becomes closed to the public when they lose anonymity."
And in some cases, he says, blogging anonymously protects the people and institutions being written about. Having a code not only gives bloggers a checklist to go by, but can be useful in demonstrating to employers and colleagues that the blogger intends to adhere to a certain standard.
The ethics code — and whether it actually can have meaning — is still in development, Lamberts points out. One proposal would have those who opt to adhere to the code list it on their sites, and in turn they would be listed on the medblogcode site. Violators of the code would be subject to having their sites "de-listed" from the ethics code site.
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