Anonymous blogging is needed for physicians to blow the whistle

Don’t ask me nothin’ about nothin’, I just might tell you the truth. 
– Bob Dylan

I just read an interesting post by Dr. Jennifer Gunter. Apparently, the entirety of what we are doing here at Dr. Whitecoat, and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training?

According to the British General Medical Council, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.”

Otherwise, if you don’t, what you are doing is wrong, and unethical.  Really?  On one hand, I agree that any physician that posts publicly should post with the assumption that their identity could easily be discovered, if desired. Therefore, never post anything anonymously that you couldn’t live with, if your name ever ended up being attached to it. We shouldn’t be mocking patients, using profanity, or blogging like drunken sailors.

Also, patient cases need to be devoid of all identifying information (18 HIPAA identifiers) or even fictionalized to the extent that no patient could ever read a post and say, “That was me!” (For this reason, anything I post that resembles a “patient case,” if inspired by real events, has all of those factors deleted or changed so drastically, that the final product bears almost no resemblance to the inspiring event. The “facts” are drastically altered to the level of fiction, without altering the essential “truth,” hence the disclaimer.)

Dr. Gunter, in her post, links to another blog with some very good points by Christopher McCann, where the need for some level of anonymity is essential for the needed role of whistleblowers. Just think of how many medical disasters, scandals and ethical horrors that could have been exposed or stopped if internet social media had existed in the past with the ability to retain a vague hope of at least temporary anonymity.

I think an outright ban on physicians posting under pseudonyms in the name of ethics, creates a chilling effect against speaking out against policies and procedures that may be harmful and unethical themselves.  Such a policy itself is an unethical policy, in my opinion.  In short, it suppresses free speech.  There are plenty of people in positions of great money and power, with a vested interest in enforcing such a chilling effect on free speech.

“Don’t dare question, that which you see. Don’t rock the boat. Get in line ‘little soldier’. Don’t get in the way of our immensely profitable status quo.”

Because one has a famous real name doesn’t make what he says, “Fact.” Just think of how much medical dogma in history, that has caused irreparable harm and was promoted proudly, authoritatively, and unquestionably by big “names” without basis in fact or evidence: bleeding patients with leeches, tapeworms for weight loss, lobotomies, smoking to treat asthmaheroin prescribed for the common cold in children, using mercury to treat syphilis, all the way to modern day unnecessary surgeries.

How could I forget the Tuskegee syphilis experiment, conducted by the US Public Health Service itself, where 600 African American men were allowed to rot with syphilis, and were never offered the cure when penicillin was invented? These were all treatments that were accepted by the medical community at the time and touted by doctors who weren’t afraid to use their “real” names.  Perhaps they should have been afraid, and perhaps if there had been an open and unsuppressed internet to facilitate blowing the whistle on some of these harmful and misguided treatments, many lives could have been saved.

I see more truth written by some supposed cowards that post under pseudonyms, than some of the unquestionable dogma spoken by those who are propped up by proudly displayed titles and names. What about the chilling effect on doctors afraid to speak out against patient satisfaction policies which are associated with higher death rates, due to fears of losing their job? What about doctors afraid to speak out about being pressured to admit patients unnecessarily and defraud Medicare, due to fears of losing their jobs?  What about the chilling effect on physician researchers who already don’t speak out enough about purposely suppressed clinical trial data which has led to dangerous medications being approved prematurely?

Perhaps anonymous and pseudonymous reporting amongst physicians on internet social media plays an important role as a check and balance on the medical field as a whole, which has a dismal track record when it comes to self-policing in regards to ethical lapses and dangerous missteps.

Is what we are doing here unethical and wrong, posting with pseudonyms? Need we change our screen names to our real names now, to comply with this supposed emerging ethical standard?  I think not.

“BirdStrike” is an emergency physician who blogs at Dr. Whitecoat.

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  • Anthony D

    “I just read an interesting post by Dr. Jennifer Gunter. Apparently, the entirety of what we are doing here at Dr. Whitecoat,and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training?”

    Well they have a good reason doc. In the U.K., the people are not properly protected by “The First Amendment” like in the U.S.! So they have to hide their identity before they loose their licenses to practice medicine and be charge for improper conduct for saying the wrong words!

  • buzzkillerjsmith

    Anon blogging or commenting is fine unless the physician (or the one who pretends to be a physician) gives medical advice more specific than “see your doctor.”

    • rbthe4th2

      Call my crazy, but I wouldn’t count anything a doctor did over the internet as “true” ‘medical advice’. I consider it all suggestions and research it like anything else and take it back to my doc “in real life” and go from there.
      Nothing wrong with ‘experts’ helping out. That’s what I would consider it is, friendly advice. Docs have different experiences, maybe one has experience and tells me about it, so I go to my doc & get helped. We do the same in IT. Professional courtesy in a way.

  • Suzi Q 38

    I like the blogs. I have learned what the doctors are thinking or going through. I thought all doctors wanted to be doctors and liked it.
    I realized, just as in any profession that anyone chooses, people make errors in choosing that profession. Some are just tired of their jobs and wish they had chosen a different career.
    Not all doctors want to treat me, as I am probably not the easiest patient to treat. I simply have too much internet information and ask too many questions, LOL.
    I have also been more forgiving, because I realize that not everything in medicine is easily explainable. Many conditions are difficult to diagnose and to treat.
    I think it is good for doctors and patients alike to “vent” on these boards anonymously. Psychologists and therapists are expensive.

    I have found out more about my condition from these boards than from my own doctors. The people are anonymous, and I know it. I have no idea if some of them are really doctors. Nonetheless, they still have been interesting, helpful, and sympathetic.
    This has not only been enlightening for me, but has saved me years of searching for the proper diagnosis.
    Some have been very helpful by telling me to see my neurologist NOW, or ASAP.

    I appreciate that.

  • http://cynicalpharmacist.blogspot.com The Cynical Pharmacist

    “..Christopher McCann, where the need for some level of anonymity is essential for the needed role of whistleblowers..”

    It sure is. We know what happens to many whistleblowers trying to do the right thing these days.

  • EmilyAnon

    Sometimes I read such amazing blogs and posts by anonymous doctors. As a patient, I wonder if they could be in my area. If they were, I’d probably make an appointment. I’m sure that doctors here don’t post to solicit patients, and might not want a patient that’s been exposed to their inner thoughts. But it’s frustrating when the patient thinks there might be a good connection, but we don’t know who they are. Of course, those inspiring doctors who do use their real names, beware, I’m making a list.

    • Suzi Q 38

      I am as well. It is nice to have someone good to recommend to others.

    • rbthe4th2

      I do this all the time. I get good ones, I tell people, mark them up publically, talk about them privately, and even tell hospital management/administration or whoever is in charge of the business end.

  • David Gelber MD

    I use my real name on my posts. I try to be thoughtful and not post anything that could come back and haunt me. this includes posts on my blog, sermo, on this site and everywhere else. Maybe I’m being foolish.

    • rbthe4th2

      No you aren’t. You chose a profession but you are still a human being who is still entitled to have an opinion. Others may like it or not, but that doesn’t mean you took a vow of silence. I’d rather people be honest – its something I don’t always get in medicine.

      • anon3

        wtf, why could or would you not be honest in medicine, let alone regularly?

  • Medical Revolt

    I post under Medical Revolt but as stated above, anyone interested in finding out who I am could do so easily. I find it easier to post about controversial topics and needed change anonymously so the discussion can stand on its merit alone rather than someone trying to see if I myself am an expert in that field. Also, it seems silly to let non-physicians post whatever they want anonymously yet keep doctors who actually have the education and knowledge to back up what they say from doing so.

    • rbthe4th2

      Any way to subscribe to your blog posts?

      • Medical Revolt

        I never noticed it wasn’t there before. I added it now. Its on the top right side to sign up for email subscription. Thank you

    • its my business

      You know what? Think about it … Anyone can post Anonymously. You did, by signing up as Medical Revolt, right? Right!

      You’re contradicting yourself there pal when you say, ” I find it easier to post … anonymously.” And then to go on and say, “Also, it seems silly to let non-physicians post whatever they want anonymously.”

      I’m trying to figure out your conundrum. Are you an Anonymous poster Medical Revolt?

  • anon3

    If you are blogging anonymously then you are by definition NOT blowing the whistle and you have already let things go too far. You do not reveal patient safety issues and misconduct into the ether!!! On a blog that might not even be read by anyone at all!! The reason for anonymity is probably because of the disgusting attitude and personality of doctors, as well as the fact that people would not want to see even the normal ones being normal, as they do have an actual professional reputation to uphold in the sense that they need to at least PRETEND to be as perfect as possible, and in fact I think most patients would want this and like to think their doctor is perfect, despite knowing better. When you get everyone on the internet pretending to be a doctor and nobody being able to tell who is and who is not qualified, you can see how it is taking a roundabout way to protect the reputation of doctors by making sure that people know the anonymous ones are most likely not real doctors at all. The real question is why would you be wanting to write or speak about the private lives of your patients? To blog about it online of all things? If that is the case, you should give up medicine and become a hairdresser, where you can gossip all day, freely, to your heart’s content. Medicine is supposed to be about other people’s needs, not yours, especially ones as minor as possibly impressing someone with their story.

    • its my business

      Don’t get me wrong, I think posting/blogging is a great way to exchange ideas … But if my Doctor(s) has or have time to blog all over this thing we call “the Internet” – then maybe he/she should step back and exchange a little more of that time with me during office visits that they limit 10 – 15 minutes per patient and stick to the topic @ hand. I’m just saying … Blog on the weekends Doc and stick to the topic @ hand.

  • Bestsmile

    Nobody is foolish enough to rely on info anonymously posted online by an alleged doctor. When pseudonames are used, it is intended for protecting the ID of the writer and of course the ID of those (patients/conditions) described by the writer. I really dont see any ethical issues arising from this. Docs should never post anything online with their real name bec somebody somewhere took your comment to apply to themselves —– disaster could happen when you did not intend. Yet bec you ID yourself there might then be some liability issue. Like many MD who ID themselves and give advise online should be equally liable for what they say online. Free chats are just as they intend — free chats ie no liability. Dont link it to your professional status or location then you should be free to chat.

  • SBornfeld

    Intent and context matter. I would not judge a doctor by whether he/she posts anonymously. In any case, most of the time it’s pretty easy to know who is knowledgeable and who is blowing smoke.
    OTOH, I think a potential whistleblower who wants to divulge usually has far better ways to do it than to post on a blog.

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