Stunning news. The Boston Globe on Flea, his trial and how his blogging ultimately led from a possible victory to settlement:

As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.

Was Lindeman Flea?

Flea, jurors in the case didn’t know, was the screen name for a blogger who had written often and at length about a trial remarkably similar to the one that was going on in the courtroom that day.

In his blog, Flea had ridiculed the plaintiff’s case and the plaintiff’s lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing.

With the jury looking on in puzzlement, Lindeman admitted that he was, in fact, Flea.

The next morning, on May 15, he agreed to pay what members of Boston’s tight-knit legal community describe as a substantial settlement — case closed.

There is no anonymity on the web. If you blog under a pseudonym, people will find out who you are if they really wanted to. So with that in mind, blog as if the whole world is reading and knowing who you are.

It’s unfortunate for all concerned. For Flea obviously. But also for the medical blogosphere. The strength of blogging is its inherent openness and allowing the curtain to be “pulled back”. Now, every post will be filtered through this question: “Will this ever come up in a malpractice trial against me?”

Flea, we’ll miss you and sorry to see things turn out this way.

Update:
Plaintiff attorney Eric Turkewitz called it correctly and has a roundup of the ordeal:

Finally, this case was a tragedy for two parents, and a nightmare for a doctor. If the parents had lost the trial, it would have added yet another layer of extraordinary emotional trauma. If Flea lost, it would no doubt been emotionally difficult for him. A settlement allows each to move on with their lives without the additional fallout of a jury’s verdict. The parents might feel they had their day in court and that the settlement was based on the merits, while Flea might feel it was based on his own carelessness with his writing and the concerns a jury might not like the way his legal team was trying to manipulate the jury. Neither won and neither lost. And sometimes that is all for the best.

MetaFilter comment:
“But when I look at this case, I wonder what we’ve lost. Expert analysis of issues in the pediatric and medical community. Transparancy into the behind-the-scenes aspects of our legal proceedings. Eloquent and insightful content, now gone because your opinion can be a legal liability.”

N=1:
“Bloggers have no real protections against the invasion of their privacy. The healthcare blogging community is the poorer for the loss of Flea’s insights, passions and wit.”

Update 2 –
The Boston Globe with blogger reaction, including mine:
“‘It’s a little bit sad in a way. The whole purpose of blogging is to be open and pull back the curtain to talk about how it really is,’ he said. ‘So the question is, how realistic is that? I think that’s what physicians and other health professionals are wrestling with right now. It’s part of the growing pains of the medical blogosphere.'”

symtym:
“Arrogance, ignorance, or both? Dr. Lindeman’s most potent defense was his character””a character the Flea so thoroughly impeached””case over and settled. Hosea 8:7. For they sow the wind And they reap the whirlwind.”

Mary Johnson:
“Anyway, a lot of people will be mulling this one over for a long time to come. The lawyers are already spinning it as a ‘win-win’ (I expect Flea doesn’t feel that way). Doctor-bloggers are bemoaning ‘the loss’ of expert analysis, transparency, insight, passion, wit (it’s a long list . . . for the physician known in the blogosphere as ‘Flea’ is a gifted writer).”

Althouse:
“Here’s a tip. Don’t blog anonymously unless you’re ready to accept all the consequences that would come if everyone suddenly knew it was you. Congratulations to the lawyer who figured out that she should ask that question on cross. You know, I love to support bloggers, but this doctor totally deserved what he got.”

Update 3 –
David Catron:
“Flea’s case wasn’t settled on the merits. It was settled because of a few intemperate posts on his blog. Now, there will be lawyers and paralegals all across the country trolling the web for blog posts by anyone connected with a medical defendant. Will they be doing so in states where tort reform has been enacted? I doubt it.”

#1 Dinosaur:
“Flea — and all of us — have a right to blog anonymously. This also means we should have the right not to be compelled to renounce that anonymity. Anonymous blogging didn’t have anything to do with the medical case at hand. What business did the attorney have bringing it up in court at all? Answer: she didn’t. So I repeat, where the HELL was Flea’s lawyer when that question was asked?”

OnThePharm:
“It saddens me when a case is settled not on the facts of the case, but rather on issues that are only tangentially related to the matter at hand, at best. That said, perhaps Flea was confident in his anonymity, but probably shouldn’t have been.”

Ami Chopine:
“It is you and it will sadly be the general public, who do not understand the nature of Flea’s blogging. He was anonymous. We could not check. But Flea’s articles, sharp as they’d sometimes been, had always consisted of sound science. Moreso, the frustration he often expressed was a mark of his compassion for the children under his care. In the blogging world, he was a model of integrity and compassion.

If you accuse of bloggers who defended him of ‘not having the whole picture’, you must accuse yourself of the same thing.

To the lawyer, Mulvey, who claims to have read his entire blog: where is your integrity? Is it truth or power that you love? Is it compassion or money?”

Update 4 –
Kinohi Nishikawa:
“. . . the prosecution was able to cast doubt on the Lindeman’s character — precisely because ‘Flea’ and ‘the real 3-D doctor’ turned out to be the same person, the same ‘cocky bastard.’ Here Lindeman’s metacommentary doesn’t realize its own ironic condition of possibility: that forcefully stating the difference between Flea and the ‘real’ doctor only serves to underscore their inextricability. (You know the type: ‘Really, I’m not like that — in fact, I did it just to remind myself how different I really am!’) This rhetorical move amounts to Lindeman denying his very real investment in Flea as both a cathartic release and an agent, however modest, of public opinion.”

Eric Turkewitz:
“Saltzman informed me during our conversation yesterday that Flea’s attorneys were unaware of the blog, which means of course, that Flea didn’t tell them and he wasn’t prepped by his attorneys on the subject on how to deal with it if it should come up.”

David Harlow:
“This takes the questions about propriety of physician blogging to a whole new level.”

Update 5 –
Orac:
“My bottom line on this is simple. The case of Flea is not the dire signal about the demise of the medical blogosphere that some have been making it into and that I briefly fell for. Rather, it’s a wake-up call about reality. The First Amendment guarantees us freedom of speech and allows us to speak with anonymity. However, just as it does not insulate us from being offended by other people’s speech, it also does not insulate us from the consequences of what we say publicly.”

Notes of an Anesthesioboist:
“The discovery process can’t stay the same after this – it hasn’t been the norm to request blogs, myspace pages, and such, but attorneys are now clearly going to have to take various types of records into account and adapt to the Internet age.”

#1 Dinosaur:
“Although a doctor’s personality, appearance and demeanor on a witness stand are seen as proxies for behavior with patients, I fail to see how actions (or writings) outside the courtroom or exam room have any relevance to the questions that come up in a malpractice trial. I know that’s how the world *does* work. My question is, should it? I say no.”

Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.

He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.

An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.

Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.