Sunday, October 5, 2008

On Disclosure


About a month ago I decided to reveal my true identity on this blog. For a year I had been known simply as "Buckeye Surgeon". I didn't make a big deal of the change. No announcement. It just happened that one day I published a new post with my name and picture in the upper right hand corner of the screen. Now why would I do a crazy thing like that?

There are a variety of reasons, actually. On a personal level, I just felt that if you're maintaining a blog and you're taking strong stances on certain issues, whether it be the politics of medicine or management strategies of certain disease processes, then you owe it to yourself, and your readers, to stand behind that stance with your identity. One of the biggest criticisms (and entirely valid, I might add) of the blogging endeavour is that anonymous blogging can lead to an undisciplined, hypercritical, sneering style of writing that devalues the oftentimes valid points you're trying to make. There's no hiding when the cloak of anonymity is removed. That's my name up there in the corner. If I write something snide or uncomplimentary, or if I come at an issue with a poorly thought out line of reasoning, then I have to live with the consequences. In essence, you put yourself on the firing line without the shield of anonymity. There's a higher standard of accountability. So you better bring the goods.

Also, I have found (via sitemeter) that people are visiting my blog for answers to their medical questions. If you google "anal fissure" or "hartman's procedure" or "fournier's gangrene" or "jackson pratt drain", a post from Buckeye Surgeon will usually be on the first page of the search. Maybe I'm being naive, but I think this modest little thing of mine can potentially be a useful source of information, especially as we move deeper into an era where patients rely on the internet more and more often as a "second opinion" with regards to their individual health issues. If that's the case, perhaps the knowledge that I'm a real general surgeon, and board certified at that, will allay the fears of some anonymous visitor from Malaysia of whether I'm reasonably trustworthy and legitimate.

Furthermore, I still think we are in the infancy of med-blogging. I think the sky is the limit. Barack Obama's intuition of this fact allowed him to trounce the seemingly unbeatable old school Clinton political machine via online fundraising. The failure of Revolution Health notwithstanding, I think that web 2.0 will play more, not less, of a role in the way Americans approach their personal health; we just haven't figured out the intricacies of how that's going to work. Nevertheless, having an internet presence will be crucial for physicians as we move forward.

Beyond patient care and education, I think medbloggers have a role to play in how physicians represent themselves as a group in the political realm. Listen, the AMA has been the only real representative body we've had for the past twenty five years and look where we're at: more infighting, worse pay, less professional satisfaction. There has to be a new way to make our voices heard. And if medblogging is going to part of that "new way", then the fastest way to legitimize it is by publishing with our real names and locations. Why perpetuate the stereotype that doctors are "always trying to hide something" and "are out for themselves"? What effect on American politics would Slate or the National Review on line have if all the opinion pieces were published anonymously? Would anyone pay attention? Look at Kevin Pho from KevinMD. He's now a member of the USA Today's board of contributors and frequently writes op-ed pieces. I don't think that happens if he's FacelessMD.com.

We all blog for different reasons. I'm not going to sit here and moralize on how it ought to be done. But I think we underestimate our ability to to change public perception via the internet. This is the new media. This is the forum for idea exchange and it's wide open. Imagine a interconnected network of physician blogs, maintained and vetted by physicians who are open and completely legitimate. It's like California in 1848! The Wright Brothers at Kitty hawk! Neil Armstrong on the Moon! Yes we can!

Anyway, that's enough bombast; those are my rambling thoughts on anonymous blogging. My obscure blog does what it can. Go Bucks.

9 comments:

Anonymous said...

A couple questions out of curiosity:

Have any of your colleagues or patients mentioned anything about your blog? That would be one thing I would always find uneasy. I'd always be thinking, "I wonder if he/she has seen my blog
on this topic" And then there's always the aspect
of wondering who might think what, whenever you
write something. This isn't an issue with journalists because that's their primary job. But
for a professional, whose bound by hardcore ethics and regulatory oversight, writing about your experiences as a sideline can be frought with land mines I would think.

Could any of your patients recognize their own cases? I always wondered how you and other bloggers anonymize the descriptions without changing major details, but then the case would be more hypothetical than real. Obviously you can't just make minor changes (like gender, left vs right, etc) or the patient would see through it.

Thanks

Buckeye Surgeon said...

Anon-
I've had patients and co-workers mention that they've read my blog. It's not awkward at all.

I don't think anyone who reads this blog would think that any of the case studies I write about are at all exploitative. As my disclaimer states: "the cases presented are a fictional creation..." The way I go about creating the story is off limits to the general public. Besides, anyone can go to the public library, check out a few issues of JAMA or Archives of Surgery and read case studies that aren't at all altered, accompanied by real-live, colored pictures of limbs/scars/xrays etc...

Health Train Express said...

I agree with you Jeff (Buckeye)
My blog content does not have much to do with patients.
SERMO offers a more private venue for discussing cases..You have to be an MD to log in..the writers are authenticated through the AMA database.

Health 2.0 is the beginning of the networking we will see.

Are you EMRed?

Jeffrey said...

you might be interested in a code of practice developed by healthcare bloggers:
http://medbloggercode.com/

Rob said...

I am with you on this one as well. I have always felt that there was a little air of fear in those who post anonymously. Plus, the accountability of posting as who you are gives readers some reassurance.

The only reason I have kept the title "Dr Rob" is that it has a bit of a persona to it - it is kind of like putting on another hat.

Good post.

rlbates said...

I have had a couple of patients mention finding and reading my blog. They like the information they find there. Good post, Buckeye.

Bianca Castafiore said...

Dr. Parks! An excellent musing -- not exactly a gauntlet thrown on the ground, but you offer an optimistic and rigorous take on the potential of medical blogging. As a non-medico, I am definitely more likely to trust your mini medical presentations as places to start any research of my own -- precisely by the manner in which they are couched and by the trustworthiness you are cultivating by consistency over time. Lord, I am drowning in vagueness. You said it best, and in a way that I hope your compatriots will consider:

"One of the biggest criticisms (and entirely valid, I might add) of the blogging endeavour is that anonymous blogging can lead to an undisciplined, hypercritical, sneering style of writing that devalues the oftentimes valid points you're trying to make."

Oh. And as for my own anonymity? Is it a grand experiment in a life less and less cohesive with each passing day? Is it laziness, an unwillingness to pursue topics to logical conclusions? As the kids say, "whatever." Ar!

-- The Retired Educator, in for La Belle Bianca Castafiore

Bianca Castafiore said...

Excuse me popping back in so quickly. I just read one of your earlier posts on the "internet stalker" you acquired. *That* is one huge reason, perhaps, NOT to engage in full disclosure. I am very sorry that this happened.

JD said...

Hi thought you made some great points this week in grand rounds, and I have linked to your post from my blog. Please let me know if this is an issue, and I will remove the link.

-Josh
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