Black Wednesday: A dark day for the medical blogosphere

Grim news pervades the medical blogosphere today.

Fat Doctor has announced she is shutting down her blog:

Someone in my department printed out my blog and showed it to my boss. He tells me he didn’t read it and won’t interfere in what I do with my own time as long as I do a good job at work.

Flea’s blog mysteriously vanished. Perhaps not coincidentally, he is in the midst of a malpractice trial.

Last year, Barbados Butterfly was forced to shut her blog after her hospital found out:

Australian Medical Association president Dr Mukesh Haikerwal was surprised by the story and warned of the dangers of attempting to “de-identify” information. “There’s more to it than just rubbing out the name,” he said.

These episodes, however sad, should come as little surprise. Traditionally, medicine is one of the last adopters of technology. Witness the slow, painful introduction of EHRs. With blogs being at the forefront of the Web 2.0 advance, traditional medical institutions are again slow to adapt to the openness that defines the heart of the blogosphere.

Major media has recently viewed health care blogging with a somewhat critical eye. Earlier this year, the Detroit Free Press wrote a significant article on physician blogs. However, the focus of the piece was the concern about patient privacy. Yesterday, the USA Today also offered a look at health blogs, saying that it also “raises questions” about patient privacy.

Traditional medical institutions are either ignorant of, or not ready for, the blogging physician or the blogging health professional. Paul Levy, CEO of BI-Deaconness in Boston, admits that some of the competing hospitals view his blog with hostility. And what they don’t know, they’ll try to eliminate. The forced closure of the aforementioned anonymous physician blogs certainly will not encourage more physicians to join the blogosphere.

Until the medical establishment can join the 21st century and accept that blogs are here to stay, growth of the medical blogosphere will be limited. It may take awhile.

Update –
A roundup of reaction: Demise of the medical blogosphere?

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  • Tiny Surgeon

    It is indeed a sad day today. Here’s hoping that over time more people in medicine will realize that allowing doctors to network anonymously and vent actually helps us all.

  • Dr. A

    Very sad.

  • N=1

    As for Levy’s blog – he censors everything that is revealing about his hospital. It’s a marketing gimmick for him. And a lesson for us readers – corporate types blog for market share – not for personal reasons. He’s blogging with his CEO moniker, not as a private citizen. Important distinction.

    As for FD, Flea and BB (Hmmm, two insect names – I hadn’t noticed that before), they are all real losses, and I hope they’ll return under another iteration.

  • DR. MARY JOHNSON

    I expect Flea finally confessed to his lawyer that he authored a blog.

    Then his lawyer had a stroke.

    When he got back from the hospital, the blog came down. It is indeed a HUGE loss.

    Not blogging anonymously (and being in the blogosphere for a unique reason), I have gotten mixed responses. A lot of the colleagues that I’ve told about my blog are intrigued/amused/entertained and often offer suggestions. I’ve heard from former patients and old friends just as disgusted with the medical “status quo” as I am.

    On the other hand, I know it makes “the suits” nervous. Oftentimes, one cannot post comments on a blog from a corporate/hospital computer – indeed some systems will not even let you pull up blogs.

    There there’s the whole “local” scene (in Greensboro, NC) where bloggers have fractionated along political and ideological lines . . . and things (especially lately) have gotten quite nasty.

    I’ve sensed that being so in-your-face about what my hometown hospital (not to mention the NC legal system) did to me has hurt my ability to find work locally (I currently make my living as an independent contractor/Locum Tenens). But I did not leave my right to have an opinion at the door when I got my medical degree.

    It is my opinion that doctors must start speaking out MORE and signing their names . . . if we expect any of the garbage that is going on in our profession right now to change.

  • Orac

    Actually, even though I blog under a pseudonym, lots of people know who I “really am,” thanks to cranks who were willing to put a lot of effort into to plowing through Usenet postings from the late 1990′s to find some posts where I had (in retrospect) foolishly linked my name with my ‘nym.

    However, fear of legal threats or HIPAA violations is exactly why I only rarely ever blog about patient encounters anymore. I used to do it a lot, but decided that it was too big a risk. Now I just confine myself to commenting on science, alternative medicine, and various non-medical topics that interest me. Even though some of my older posts about patient encounters were heavily fictionalized in order to make it virtually impossible to connect the story with the patient that inspired it, it’s too big a chance to take. If I were to be sued now, an opposing lawyer might be able to try to impeach my personality and embarrass me using some of the sillier things on my blog (the EneMan posts, for example), but he wouldn’t be able to try to dredge up information about how I took care of patients or try to paint me as someone who doesn’t care or violates HIPAA.

  • Bertalan Meskó

    Great commentary, Kevin! You’re absolutely right!

  • geena

    When my blog was written about in Nurseweek, my coworkers and boss found out about it… someone who knew that I wrote it posted the story on the bulletin board at work and “outed” me.

    I wasn’t sure that I even wanted my boss and coworkers to know about it. I liked the feedback they gave me, but it put me under pressure.

    No one has ever said a bad thing about my blog at work, but I still felt weird. I’ve never been a frequent poster, but I posted even more infrequently after that.

    However… even my boss likes it and has never given me any reason to believe that I would face repercussions for having it and writing about work. I obscure details about patients and situations like everyone else.

    It’s very sad that Flea and FD felt the need to take down their blogs. I was a regular reader of both.

    But I understand. I hope they return.

  • timelessboulevard

    This whole thing is sad. :-(

  • coffee addict

    Greetings. I am a medical/surgical intern from Australia. I have debated with the issue on starting a personal blog to record the medical details of my internship as well as to meet likeminded doctor bloggers whom I greatly admire (I realise I am only starting on my career).

    The recent event with Barbados Butterfly has scared me a little. I truly respect the woman for what she has contributed to the medical blogosphere.

    Anyway earlier this week I thought, to hell with it all. I have officially started my blog. Being the coward that I am, it is not as academic as I like… Do we have to start asking for patient consent now when we want to post photos / radiology images on the web?

  • Mother Jones RN

    If you haven’t noticed this before, there is a war going on between mainstream media and bloggers. Bloggers have been known to beat reporters to the punch on news big stories, and frankly, mainstream news people don’t like the competition. I know that patient confidentiality is a big thing, but I don’t see much difference in what’s being revealed about patients in news stories, and what I read on blogs. I think the media is generating these stories in an attempt to shutdown blogs. I also think that this paranoia is also a reflection of our Big Brother culture. Health care corporations are making billions of dollars world wide, and the last thing they want is a whistle blower outing their unethical practices.

    I’ve always been very upfront with people at work about my blog, and I’ve invited my boss to read it anytime she wants. I think it’s wise to out yourself before one of your jealous coworkers does it for you. I don’t think that medical bloggers are going to fade away. I think this will make us stronger in the end.

    MJ

  • Dr. Deb

    It is a trend that I hope does not continue. So sad, indeed.

  • Roy

    Good suggestion, MJ, outing yourself rather than letting others do it. I mentioned I had a podcast and a blog to my CEO a few months ago. It was like I had told him I prefer oatmeal for breakfast.

    I see a lot of docs are getting on Sermo, a physician-only-after-verified social networking/polling site … a few have confessed to dropping their blogs and mostly using Sermo. But it’s a different motivation (only docs see it). Also, the pt cases mentioned do not appear to be very de-identified… still could be a liability, even though it is behind a wall.

  • Paul Levy

    N-1 says: “As for Levy’s blog – he censors everything that is revealing about his hospital. It’s a marketing gimmick for him.”

    Ah, yes, posting how many people get infections in my hospital is excellent marketing! That’s why everybody else in Boston has followed my lead….

  • Mary Lu

    (Disclosure: I am a former hospital administrator, but don’t hold that against me. I’m more like Paul Levy, who has grown to rock star status in my eyes.)

    You know… I’m not quite as controlled as Kim, Rita , Dr. Kevin and a couple of other healthcare bloggers who’ve voiced their concerns about Fat Doc and the other fellow healthcare bloggers sites going dark because if ill informed, jealous individuals who have not got a clue about blogging or open comments made about healthcare when doctors and nurses use their real names.

    For years… YEARS papers have been written, with loaded patient information making them anonymous to the readers. There was never a problem with that. It was considered the standard of learning via Medical Journals worldwide. A majority of the healthcare bloggers are intelligent, articulate people who have also made patient information anonymous as well. So what in the hell is the difference? “Because someone could de-identify information”? Give me a break!

    For years anyone within 200 yards of a journal writer could with little effort “de-identify” a patient if they knew anything. But the journal reader 200 miles away is clueless on identity.

    So why if everyone is so up in arms? Pretty simple: Plain and pure stupidity.

    It’s time to rip off the veil of silence in healthcare. It can be done intelligently. Paul’s done that with his posts, I know others as well, including myself when something catches my radar. The rule of thumb is to use common sense.

  • Anonymous

    Have you ever considered killing all of the lawyers? It’s okay with us. Perhaps you could do something about the HMO/Insurance people too?

    Your Patients

    (former-can’t afford it now.)

  • EMR Software Guy

    Yes, these developments are unfortunate, but I’m optimistic that new bloggers will fill the void soon.

    I’ve just stated a new blog about electronic medical records and health IT, and hopefully it will flourish with lots of visitors, good content and tons of comments. We’ll see, I guess, right?

    Cheers,

    EMR Software Guy
    http://www.electronic-medical-record.blogspot.com/

  • Dr. Gary Rothfeld

    Great website