How doctors can write about clinical cases online

Recently, Kevin Pho wrote about a physician, Alexandra Thran, who was disciplined by both her hospital and the state medical board for writing about a trauma patient she had seen. Although Dr. Thran hadn’t divulged the patient’s name, enough information was conveyed that allowed others in the community to identify the patient in question.

That story really freaked me out. Because, as you know, I sometimes write about my adventures in general surgery. Am I a dead man? Is the Ohio State Medical Board going to give me the Bradley Manning treatment? Am I destined to working the night shift at a CVS minute clinic in five years?

As with most ethical issues, there is a lot of gray and nuance. But in general, I think you are safe writing about personal cases from your practice if you exercise a certain degree of reasonable restraint. Write about your experiences, not as a form of personal aggrandizement, but as an attempt to share, educate, and converse with laymen and other professionals about disease processes and treatment options in the open forum that is the Internets.

Here of some general rules of thumb:

1. If someone famous comes under your care, just don’t write about it. If the patient is famous enough, some aspects of his/her clinical condition will leak out. There may be understandable angst and resentment that Celebrity X’s privacy isn’t guarded as well as anyone else’s. If you write about the celebrity’s case, even if you conceal it, there’s too great a risk that details will overlap with leaked information from other sources. Then a giant HIPAA target forms on your back. So don’t write about how the back up center for the Bulls came into the ER at 3AM with a sex toy stuck in his rectum, thinking that simply using pseudonyms gets you off the hook.

2. Strive to present cases for educational purposes. Ramona Bates is the exemplar for medical blogging when it comes to case presentation (how she has the patience to type out full bibliographies just kills me). I’m not so regimented but I try to at least provide a little pathophysiology and surgical dogma background. Compare a write up of cecal bascule in a peer reviewed journal here with my post on the same topic. My post was certaintly a little less dry and stuffy, perhaps a little too irreverent, but that’s why you won’t be reading much of my work in renowned journals. Conversely, my cecal bascule post was read by a lot more people that the one in Applied Radiology.

3. When you post images/scans, make sure you have removed all identifying data.

4. Let the case marinate in your mind a bit. Don’t rush immediately from the OR/ER to the laptop. I usually give the cases several weeks/months to mature.

5. Review the literature to make sure your management correlates with standard of care protocols. You don’t want to write about that APR you did on an early stage squamous cell anal cancer, and then have someone point out on a public blog that you ought to have sent the patient for an oncology consult to discuss the efficacy of the Nigro protocol (chemo/radiotherapy) as sole treatment.

6. Don’t be a jackass. Don’t brag or write things like “the patient was in good hands that night.”

7. Make sure your operative consents contain a section about “using images for educational purposes.”

8. For cases that involve detailed, individualized descriptions of the operation, post op events, and eventual recovery phase — discuss your plans to blog about it with the actual patient. Even let them read the post before you publish it.

Jeffrey Parks is a general surgeon who blogs at Buckeye Surgeon.

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