Should medical bloggers be anonymous?

Google “anonymity medical blogs” and you will find many takes on this. Some anonymous med-bloggers advocate the value of sharing real-life stories, but to me that comes loaded with layers of conflicts of interests. We all have the right to be anonymous, but is it always a good idea to do it just because we can?

  • Why do you want to be anonymous?
  • Who does it protect? And from what?
  • Does it promote or hinder dialogue?
  • Does being anonymous affect one’s behavior?
  • Should anonymous people be regarded differently?
  • Should being a healthcare professional tie us to a common standard of blog-ethics?

The 100% anonymous comments that people leave all over the web tend to vary in quality. I’m talking about ones that really say “Anonymous” next to them. Some blab without thinking too hard, and I can’t deny that I sometimes enjoy rebutting them within my limits of decency. Other times, they add really insightful feedback and I wish I could address them properly to carry on the conversation. I still take such comments knowing that I can always just delete an occasional bad apple.

Many on Twitter or blogs stay pseudonymous. Some of these people have advanced their online presence such that they meet anthropological, sociological, and psychological criteria of a productive community member. They often have extensive online networks and a reputation built on participation. With these people I tend to be a bit more cordial because they stake their feelings and commitments to what happens around them. You can collaborate with them. But again, this falls in the grayscale.

Recently at TEDx Maastricht, Simon Sinek spoke about trust. He said a mom looking for a babysitter is much more likely to trust the 14-year old neighbor with zero experience, but not the adult with lots of childcare experience who just moved in next door. That’s human community. So, does anonymity work against participants who discuss health, policy, ethics, etc? Let’s shamelessly cite myself on Twitter:

Should medical bloggers be anonymous?

Dr. Akerkar asked a great question, which I believe was rhetorical. Although the vast majority of people mean well, I also think those who stay 100% anonymous tend to:

  • worry about their online identity due to some lack of knowledge
  • be casual passers-by who don’t want to stay engaged in the conversation
  • not want to take credit for their own comments
  • or they might be just new and are trying to get their feet wet before jumping in (some evolve to be “pseudonymous” or start using real names)

Anonymity definitely has its place, but total anonymity? Apparently, not if you want to matter.

Jin Packard is a medical student who blogs at Fresh White Coat.

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  • http://twitter.com/BlackZack2 Fernando Roque Rojas

    I believe, without any kind of doubt, that anonymity absolutely hinders communication, which is the goal of any blogger. Be it an opinion or a divulgative article, I believe it to be necessary that a person should be noted as the author. And it acquires special relevance when patients may be the readers.

    A vast majority of the alternative medicine and pseudoscientifical health care providers gain their clients from patients who do not trust their doctors and, by extension, traditional medicine. It is the image of a patronizing paternalistic figure in a white coat that evokes distrust, so I think blogger physicians (at least those concerned with the importance of doctor-patient relationtship) should take a simple step giving readers (and possible patients) someone to ask their questions to, giving them trust, so they can give back.

  • Anonymous

    In my opinion, anonymous physician bloggers are shooting themselves in the foot. The point of a blog is to communicate to others what’s on your mind and to create a space where the reader learns both from posts and comments. If the doctor doing the blogging isn’t violating HIPPA regulations and is factually correct in his posts then why not own up to them. This reminds me of a West Wing episode where a new lawyer form the opposing party joined the staff. She was bullied by some coworkers (for doing her job by the way) through a pot of dead flowers with an unsigned nasty note. One of the main characters immediately knew who it was and fired the bullies through a whiteboard signing his name at the end. The lesson was that we should own up to what we say or write both good or bad.

    Why prevent potential clients in getting closer to you? Is there a reason you choose to dissociate from your content? Stop creating fear in your patients that it could be because you are simply wrong.

  • http://twitter.com/USMLENotes Free USMLE Notes

    I’d like to be anonymous in order to protect the identity of my patients.

    • http://www.freshwhitecoat.com Jin Packard MS/MPH

      I’ve thought about that. I do agree that there are some things worth discussing, where if I know your identity, I could reasonably narrow down the identity of a patient you are discussing, no matter how hard you try to anonymize him/her. But I question the need/wisdom of conducting such case-specific discussions online. If you want the entire web audience to participate, it makes sense that your subject matter be general and applicable to a wide number of people (ie. not rare/unique). The rare/unique anecdotes are better discussed at professional or members-only forum.

  • http://twitter.com/Skepticscalpel Skeptical Scalpel

    This is a very simplistic view of anonymous blogging. I disagree with all of you closing points. You say, “I also think those who stay 100% anonymous tend to

    “worry about their online identity due to some lack of knowledge.” Knowledge about what? I think my knowledge base is just fine.

    “be casual passers-by who don’t want to stay engaged in the conversation.” I’ve had many lengthy exchanges with Twitter followers.

    “not want to take credit for their own comments.” I take credit and stand by everything I’ve written.

    “or they might be just new and are trying to get their feet wet before
    jumping in (some evolve to be “pseudonymous” or start using real names).” Please! (By the way, all anonymous bloggers use pseudonyms. Also, “100% anonymous” is not a correct term. Anonymity is an all or none phenomenon. )

    I choose to remain anonymous because I want to be on the edge a little bit. Since patients now Google us, I would prefer they don’t find my blog. Some things I write about could be misinterpreted by a patient. I think I communicate fairly well. For example, I’ve had over 4000 page views for a post I wrote about statistics (Statistical significance does not always mean clinical significance). And I almost never write about specific patients.

    I’m not trying to gain the trust of my patients via tweeting and blogging. I doubt that it works that way. If they’re smart, they won’t believe most of what they read on the internet.

    • http://www.freshwhitecoat.com Jin Packard MS/MPH

      My perspective on anonymity has shifted somewhat since I wrote that post (months ago). Even then, I qualified all my statements in this post because I knew I was generalizing. But the fact remains that there are tons of garbage floating around on the web, fueled by a vast number of anonymous commentators who have little at stake, professionally.

      To some extent, readers decide the weight of our comments/posts by 1) the quality of our thoughts and writing, as well as 2) any clearly established identity/credentials. You could be anonymous and still pump out great posts that positively impact a huge devout following. But statistically, I think you are the outlier.

      Lastly, I didn’t mean to suggest that we should blog with real names just to “gain the trust of our patients”. “Gaining trust” and “fooling the masses” are both essentially the same achievement, except the latter requires misinformation. But if two medical bloggers both contributed the same quality of thought/information, one anonymously and the other fully disclosing all credentials and interests, which one would YOU likely take more seriously?

      • Anonymous

        “… if two medical bloggers both contributed the same quality of thought/information, one anonymously and the other fully disclosing all credentials and interests, which one would you likely take more seriously?”

        As a patient, the answer is obvious.

        One thing I noticed about a couple of the docs who blog anonymously here (if indeed they are docs) is that they freely post snarky, mean comments when replying to someone they don’t agree with.  They usually preface their put downs with  “Umm” or “err”….. 

        Not exactly a mark of a professional.

        • http://twitter.com/Skepticscalpel Skeptical Scalpel

          Emily, I find it interesting that you criticize my anonymity using a pseudonym yourself.

          And to Jin and Emily a question: How do you know that a blogger who discloses his credentials is telling the truth?

          • Anonymous

            Skeptical Scalpal, I wasn’t criticizing ‘your’ anonymity. I respect your comments here and am a reader of your blog.  It’s just a couple of other anonymous regulars on Kevin’s blog (commenters, not thread  starters) whose only contribution is to rebut with put-downs and snarkiness.  It makes me wonder if they interact with their patients the same way. As for my anonymity, I’m just a patient with a chronic illness. I don’t have the power or knowledge to sway medical opinions. Anything I have posted here is nothing more than a personal reaction to something I have read. I have to admit, though, that if I had to use my full name, I’d be too shy to comment.

  • Anonymous

    As a person who does not blog anonymously here, I can say that physicians are under a tremendous amount of scrutiny all the time. Moving the “wrong” idea forward can pose risk, depending on who is viewing it. If you are particularly vocal about, lets say: the ineptness of medical societies, for instance, this can have substantial impact. Not everyone is as open minded about freedom of speech as we are…one of them may be your employer.Snarkiness is a potent tool which should be used wisely.  

    • http://www.cheapinsurance123.com/ Insurance for All

      I’m very interested in this post. 1. I’m not a doctor, 2. I blog anonymously and 3 I feel a little queasy at time writing about technical issue on insurance even though I have a business background.

      One important thing about blogging using your name: your reputation is at stake every time you click publish. Blogging is basically a spontaneous writing effort even with the edit function at hand.

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