Dr. Wes has recently undergone some trying times associated with his blog. He’s wondering whether it’s worth it to continue the effort:

There is no question that placing one’s online self in the world for all to see adds vulnerability and potential liability. When I told a colleague Friday about my recent predicament he responded, “Why the hell would anyone want to blog?”

To this end, he asks some relevant questions. Here’s my take on them.

What rules for commenting should physicians impose?

Comments should be moderated. In the early days of this blog, the censorship argument got the better of me and I pretty much let anything go.

In retrospect, that was a mistake.

Discussion has to be controlled to alleviate personal attacks and trolling. The downside is that some legitimate comments may get accidentally moderated out, and some will disagree with what gets deleted.

After seeing the potential legal risk that blog comments can bring, it’s better to err on the side of moderation.

Should only anonymous commenters be restricted?

That’s one option. Many mainstream media blogs do not allow anonymous comments. The risk is that it suppresses discussion, as many insightful comments are submitted anonymously.

This is moot if discussion is moderated.

Should all comments be reviewed before publishing them, risking the perception of censorship?

Yes.

Risking the perception of censorship is a small price to pay, especially when the alternative is enduring possible legal action stemming from an anonymous comment.

Should a blog be pulled underground, accessible only by registration?

No.

Part of the appeal is that blogs are read by the mainstream. They are essential in expressing physician opinion and capturing the attention of the media.

Health reform is an ongoing debate that has the potential to drastically affect our profession. Medical blogs play an essential role in shaping the debate.

For instance, it would be unlikely that I would have the opportunity to express my ideas on mainstream media platforms (like the USA Today and CBS Evening News) if it wasn’t for my blog.

Should one blog anonymously or non-anonymously?

I do not support anonymous blogging. It adds credibility and conviction when your real name stands behind your blog posts.

There are legitimate patient privacy concerns, which are constantly harped on by the media. I don’t recommend blogging about patients until the controversy has been resolved.

I also would add a prominent legal disclaimer to any physician blog.

How important are these blogs, really, to patients?

I can’t speak for all patients, but I have received feedback that people appreciate the “behind the scenes” insight that physician blogs provide.

It also serves to provide on-demand, informed commentary to a dizzyingly array of daily medical news and studies.

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Best of luck on your decision Wes. It would be a tremendous loss if we lose your voice in the blogosphere.