His identity was secret. He was known online as Flea. Flea was a pediatrician involved in a malpractice suit and a regular blogger. On his blog, drfleablog, he unloaded pent up emotions concerning his lawsuit. Flea disparaged the jurors. He revealed details of his conversations with jury experts. Flea criticized the plaintiff's attorney and gave away the strategy of his defense team. After all, "On the Internet, nobody knows you're a dog." (1)
Dr. Robert P. Lindeman, a pediatrician practicing in Boston, was being sued for failure to diagnose diabetes in a 12-year-old boy who ultimately died. The plaintiff's attorney, Elizabeth N. Mulvey, had posted slides on the Internet from a lecture she had made to a group of law students. The physician-blogger, Flea, found those slides and posted a link to them on his blog. A colleague of Mulvey read Flea's blog and saw the link to the slides. (2) When Mulvey was told of this, she read Flea's blog and found postings about a case very similar to the one involving her client. She also read derogatory statements about a female plaintiff's attorney. (3)
What happened next was described by The Boston Globe as "a Perry Mason moment updated for the Internet age." During cross-examination, Mulvey asked Dr. Lindemen if he was the blogger Flea. Under oath, Dr. Lindeman admitted that he was Flea. The next day, Dr. Lindeman settled his case for what The Boston Globe reported as a substantial amount. (3) "The morning after, drfleablog.blogspot.com was no more." (4)
Flea thought his identity was secret, but anonymous bloggers can be identified. Both Whole Foods CEO John Mackey and Los Angeles Times journalist Michael Hiltzik had their blog identities revealed under embarrassing circumstances. (1) The lesson here is — think before contributing to a blog.
A short history of blogs
The first blogs — described as online diaries — appeared in the early 1990s. Justin Hall, called the "founding father of personal blogging," started one of the first blogs in 1994. His online diary lasted until 2005 and featured postings about his personal life. (5) Hall's online diary was like most others — a high-maintenance hobby written by a "techie."
In 1997, Jorn Barger first called his online diary a web log. It featured random posts about his James Joyce research and his observations on popular culture. The words "web log" were soon shortened to blog. (6)
Around this time, the number of blogs exploded. This was due in part to the appearance of several blog hosting services such as WordPress and Google's Blogger. Since 1997, the number of blogs has increased greatly. The number grew to 4.12 million in 2003 and to 35.4 million in 2005. (6) Blog hosting programs required less technical knowledge to start a blog, so people with a greater range of expertise could write blogs. Thus more commercial and professional blogs began to appear.
Along with the increased popularity of professional blogs came an increase in the number medical blogs. While the current number of medical blogs is unknown, a study recently found that 120,000 Americans are visiting medical blogs to learn about their illnesses. (7)
Why physicians write blogs
With the growth of medical blogs also comes a greater number of physicians contributing to and hosting blogs. These doctors have become strong advocates for this emerging medium.
Charles Meyer, MD, editor in chief of Minnesota Medicine, believes that blogs can be used to greatly broaden accepted opinions in the medical community. "Too often opinion in medical circles is restricted to the oracular word of the New England Journal of Medicine or shoot from the hip 'authority' in the doctor's lounge," wrote Dr. Meyer. "Medical blogs have the potential to offer a national dialogue." (6)
Another vocal proponent of physician blogging is Nicholas Genes, MD, PhD. His own blog, Blogborygmi, began as a diary of his experience as a medical student. After a year, Dr. Genes began a site linking other physicians' medical blogs, calling it Grand Rounds. "Grand Rounds has grown so popular that some bloggers have recently begun calling for it to stop listing every submission." (7)
Grand Rounds allows a new host blogger to choose a new topic each week. The topics are as diverse as the hosts, ranging from discussions about political views to a hypothetical conversation with Star Trek's Dr. McCoy about medical marijuana. (7)
Dr. Genes encourages physicians to use blogs to record their thoughts. In an article directed to medical students, he writes that blogs are places to "record your feelings, vent your frustrations, and register difficult experiences." He also states that writing in blogs can help physicians "chart progress through the years" and "open up educational frontiers" by referencing "archived clinical cases and school lectures." (8)
Allen Roberts, MD, another advocate of physician blogging, started his blog in 2002. An emergency medicine physician from Fort Worth, Dr. Roberts relates that the state of medical blogs has never been better. (7) In a telephone interview (August 22, 2007) Dr. Roberts said that blogs are a great place for physicians to voice their opinions and to explain to a lay audience what they do. He also said that blogs are a great place for doctors to market the services they provide.
The key to a successful blog is posting often and regularly. For an emergency medicine physician like Dr. Roberts, time is limited. So on Dr. Robert's blog, his posts range from a few each day to one every three days.
Risk management considerations
While there are many positive aspects to physician-written blogs, "... Internet writings are not particularly anonymous and these online postings could put them at risk of violating patient privacy, angering colleagues, or facing a malpractice lawsuit." (4) While blogs have the potential for good, physicians should be mindful of the risks.
Anonymity
Physicians — and bloggers in general — should remember that on the Internet, there is never a guarantee of anonymity. "It may be tempting to post to a blog as if you were anonymous," says Jill McLain, senior vice president of claim operations at TMLT. "However, using blogs as a place to express frustrations can be very risky. Physicians must be cautious since a plaintiff's attorney can comb the web for any information that would give him or her an advantage in a medical malpractice suit."
Patient information
Physicians who contribute to blogs should avoid identifying patients. Craig Hildreth, MD, an oncologist who hosts a blog, says he always, "change(s) identifiable information such as sex, age or even type of cancer." (4)
Physicians must also follow HIPAA rules. "HIPAA stipulates that physicians must protect their patients' identifiable health information. Physicians must obtain a signed authorization from the patient before using any information that could identify a patient in a blog," says Stacey Agnew, manager of TMLT's risk management department.
Disclaimers
Physicians who write books about patient care often include disclaimers that the content is for information purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This protects the author from readers who may consult the book instead of their physicians and later decide to sue the author. Physicians who host blogs should also include a disclaimer. "The disclaimer should alert readers to never substitute information from a blog for a physical exam by a physician," says Agnew.
Physicians should also be aware of the risks involved when patients post their symptoms or medical concerns on a blog and expect to receive a timely answer about treatment. "Physicians should consider disclaimer wording that makes it clear that a reader should never rely on a medical blog for around-the-clock-care," says Agnew.
Writing about a claim
When a claim or lawsuit is filed, TMLT advises policyholders to not discuss the case with anyone except a TMLT claims representative or their defense attorney. In this instance, discussion includes posting a comment on a blog. As stated earlier in this article, even anonymous postings about a claim would be considered imprudent and could be a violation of the policy conditions. Additionally, it would be prudent for physicians to follow this same advice in the event of an adverse patient outcome or if there is a concern that litigation might occur in a specific case.
Guidelines for bloggers
For physicians considering starting their own blogs, American Medical News offered the following advice:
- "Be careful about what you say, even if you aren't using your real name. Never assume that you can't be identified.
- Never disclose information or details that identify patients. Tell readers you're masking identities and consider including a disclaimer to that effect.
- Remember that whatever you write will be permanently online and could be read by potential employers or others.
- Ask your hospital, practice, or other employer about its policy on blogging.
- Post a disclaimer that the views you are expressing are your own.
- Advise readers that you are not offering medical advice. If readers ask for a diagnosis, tell them to consult their physicians.
- Don't insult another doctor or patient. Don't type anything you wouldn't say in person." (7)
Sources
- 1. Regan J. On the Internet, everyone may find you're a dog. Christian Science Monitor. July 18, 2007. Available at http://www.csmonitor.com/2007/0718/p17s01-stct.html.
- Booth B. Internet won't protect your secret identity. Am Med News. August 13, 2007. Available at http://www.ama-assn.org/amednews/2007/08/13/prca0813.htm.
- Saltzman J. Blogger unmasked, court case upended. The Boston Globe. May 31 2007. Available at http://www.boston.com/news/local/articles/2007/05/31/blogger_unmasked_court_case_upended.
- Dolan PL. Blog at your own risk. Am Med News. July 2, 2007: 14-15.
- Harmanci R. Time to get a life — pioneer blogger Justin Hall bows out at 31. San Francisco Chronicle. February 20, 2005. Available at http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/02/20/MNGBKBEJO01.DTL
- Meyer C. Down the rabbit hole. Minnesota Medicine. November 2006; 89.
- Chin T. Blogger's grand rounds. Am Med News. January 15, 2007:16-17.
- Genes N. Get the word out: Communication vital in healthcare business. www.medscape.com. January 31, 2007. Available at http://www.medscape.com/viewarticle/551145.
William Malamon can be reached at william-malamon@tmlt.org.
