Content of Weblogs Written by Health Professionals: More Bad than Good?

It seems like there are few (if any) positive news stories and studies about medical blogs nowadays. Most of the coverage focuses on breaching patient privacy and inappropriate product endorsements rather than on the way blogs can be used for medical education and interactive learning. As a regular reader of 30-40 medical blogs and author of 3, I am first to admit the medical blogosphere has its problems. John Sharp from the IT department of the Cleveland Clinic and I worked on institutional guidelines for medical blogs in 2005-2006 and I gave it quite a bit of thought during the years.

The most current negative story is from the Journal of General Internal Medicine and, as you may have guessed it, none of the authors seems to have a blog:

Content of Weblogs Written by Health Professionals (full-text PDF hosted by Pharmalot).

Tara Lagu, MD, MPH, Elinore J. Kaufman, David A. Asch, MD, and Katrina Armstrong, MD, MSCE.

The authors identified 271 medical blogs. Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Individual patients were described in 114 (42.1%) blogs. Patients were portrayed positively in 43 blogs (15.9%) and negatively in 48 blogs (17.7%). Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves. Healthcare products were promoted, either by images or descriptions, in 31 (11.4%) blogs.

The authors concluded that blogs risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions. The health professions should assume some responsibility for helping authors and readers negotiate these challenges.

They give plenty of examples and link to 16 blog addresses. Somehow the study authors missed some of the most popular medical blogs such as Kevin, M.D., Medgadget and GruntDoc. May be because they used commonly acceptable language or were not controversial enough but, really, how can you write about medical blogs and miss Kevin, M.D.? The guy is on the front page of Google results for both "medical blog" and "medical blogs" (we are a little bit down the list but still there). Update from 07/26/2008: Dr. RW pointed out that the authors quoted one of my posts as an example to follow in the article references: How to write a medical blog and not get fired? I guess I could be considered one of the "good guys."

These are a few quotes chosen by the study authors to highlight the content of medical blogs:

“The unwritten definition of proper patient: attached to a
breathing machine, a lot of wires and completely sedated
or even paralyzed.” Adrenalin Rush

“She was a stupid, lazy, selfish woman all of which
characteristics are personal problems, not medical
issues or barriers to care” Panda Bear MD

The quotes are obviously taken out of context but they still sound troubling. However, there are many stories of great patient care, self-sacrifice and compassion published on medical blogs but somehow they escaped the search strategy of the study authors.

Tips for Medical Bloggers

- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA
- List your name and contact information
- If your blog is work-related, it is better to let your employer know
- Inquire if there are any blogging guidelines. If there are, comply with them strictly
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."
- Get your blog accredited by the Heath on the Net Foundation

References:
Content of Weblogs Written by Health Professionals. Journal of General Internal Medicine.
Doctor Blogs Reveal Patient Info & Endorse Products. Pharmalot.
Why Physician Blogs Close Down?
Topics Discussed During the Medicine Consult Service Rotation at Cleveland Clinic in March/April 2008
Dr Flea Blogged His Malpractice Trial, Settles When Outed
Using a Blog to Build an Educational Portfolio
Medical Blog Closed Down by Request of Employer
NPR: Doctor Blogs Raise Concerns About Patient Privacy
Simply Fired - How NOT to Blog About Your Job. Especially If You Are a Doctor

Related:
Should physician blogs be held to a higher standard? Kevinmd.com.
Medical blogosphere subject of Journal of General Internal Medicine study. Notes from Dr. RW.
Another medical journal piles on. Notes from Dr. RW, 08/2008.
What is a blog? Robert M Centor, 08/2008.
As A Busy Physician, Why Do I Even Bother Blogging? http://goo.gl/fSF3 - Excellent summary.

Updated: 08/07/2008

11 comments:

  1. As a patient who reads med blogs and have since the day when there were only 2 or 3 of them, I have been very disappointed in the quality of many of the newer blogs over the last two years. There has been an influx of the negative against patient med blogs, particularly in the last year that just wasn't there in the beginning. Many seem to be blogging as a way to trash society in general. There job is so hard, everyone is a drug addict and they get so abused. They hate little old ladies, dirty old men, kids who whine, the homeless, the wealthy and on and on it goes...

    We are in a medical crisis in this country. I don't think it helps their cause, when there is this large group of professionals talking every day about how much they hate people. Nor does it help when their refusal to even imagine that any Doctor, any where, at any time, could actually have been in the wrong pertaining to mal-practice.

    I think the general public, that reads blogs, are losing respect for a profession that they previously had great respect for. It's a shame.

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  2. There is no fundamental reason why there can't be high quality, HIPAA-compliant and medically sound blogs. In fact of all blogging, medical blogging should be somewhere in the top 50.

    We need a Seth Godin of medical blogging (you could be one).

    There are many understandable reasons why blogging, and social media in general, isn't represented as well as it can and should be represented.

    Medical or nursing blogs aren't just for the public at large either; I think that healthcare professionals could benefit enormously from reading quality medical blogs.

    Furthermore, the process of blogging is a great way to keep up-to-date with the latest advances.

    It's a big sell to facilities who worry about privacy confidentiality and litigation. But I think it's a sell worth the effort because there really is tremendous ROI, even if it's not quantitative.

    I just wish blogging were seen in light uncluttered by bad memes and the MSM's narrow view of the field.

    If social media has a useful place on the web, it's in the medical field.

    Health is social. Social is health.

    I'm glad you're blogging!

    Phil Baumann, RN

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  3. Thanks for the post. I have just audited my blog against the HON principles as per your suggestions. It may be a little overkill but still a useful exercise: http://tinyurl.com/5cvjv8

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  4. Hmmm. How can you be so sure that none of the authors blog? Don't you think that if any of them did blog, they would be ANONYMOUS? Isn't that the whole point of the article?

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  5. Problems.
    I would love to fulfil your requirements but if I revealed my identity I would also risk allowing my patients identities to be revealed.
    If I let my employers know about my blog I would have to stop highlighting issues within the service. Believe me my working life would be made intolerable. Whistle-blowing is not appreciated.

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  6. I've been audited by HONCode ever since I first started blogging. Provided that there is a disclaimer indicating that the comments are personal opinion, I think blogging about 'whistle-blowing' is fine.
    Regarding comments about patients - my personal view is that we are all patients of someone else, so our comments reflect ourselves also. Having said that, negative comments about patients possibly arise because of the consumer-driven society that has raised patient 'rights' well and truly above patient 'responsibilities'. For every 'right' there is an equal degree of 'responsibility' - on both sides of the interaction.
    And maybe for some patients it would be a good thing to hear about just how challenging this work is - and how hard health professionals work to present a professional persona while working with someone who may well be quite disagreeable. It seems that patients are quite well supported to complain about health providers, but health providers have no mechanism to manage inappropriate patient behaviour.
    My reading of health blogs? More of them are written by patients than health providers, very few are by providers for providers, and most of them are of reasonably good quality.

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  7. I was very interested to read the article you are talking about because I was/am (when I have time)thinking about doing similar research. In my post 'Knickers in a twist' I have talked about a score that I developed with colleagues in order to look at the content of emails. My plan is to do a similar thing with blogs. If anyone is interested, do come and have a look and tell me what you think of it - is it a reasonable tool or could it be improved some how.

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  8. As a 10 year employee at the Univ of Penn I found it disturbing that a doc (my boss) would pursue a career in the VA given his lack of compassion for his patients and employees. It's disgusting, UNETHICAL, and pathetic that such a person could continue his tenure and remove the ONE CHIEF that SUPPORTED AND promoted him along the way. Penn needs to get THEIR ACT TOGETHER!

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  9. As for the article you blog about here: Yawn.

    I can imagine the 'wild west' of medblogging would be very upsetting to the staid world of General Internal Medicine, and wonder what world they live in with statements like "The health professions
    should assume some responsibility for helping authors
    and readers negotiate these challenges."

    I have a couple of professional societies, and they don't tell me how to read books or make decisions, but for some reason medblogs need to have guidance from an Ivory Tower Professor of Medicine. Phoo.

    I'd like to point out that a patient who reads a blog and can say 'that's my doctor' is only a good reader. There's no breach of confidentiality in a patient recognizing their physician.

    This is yet another article asserting there are medblog posts that would allow a patient to identify themselves, and maybe a third party to identify them, but like the others, No Links. In a hyperlink world, no links to 'this is an example'; why? There's no reason not to give a direct link (it's already public and indexed in a bunch of search engines, it's Public and therefore no harm is done by linking it). This exclusion is done, I think, to slyly make the assertion (medboggers are violating patient confidentiality) without offering any proof. They therefore get to yell about the sky falling without clouds in their hands as evidence. (I haven't read a blog post yet where I said 'I know who that is' or 'wow, way too close to the edge of description', and like most bloggers I will mix and match gender with a change of the history so that it's not a patient's story, it's a tale based in medicine).

    These are being published by Journals which are the next victims of a disseminated market of information (see also, newspapers), braying about a communication medium not controlled by them, but which is an indirect threat.

    Tough. Blog on, medbloggers, proudly and loudly.

    GruntDoc

    PS: Thanks for naming me in your post. I've been left out of all the 'slam' articles so far, and wonder why.

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  10. Thank you for your thoughtful comment, Allen.

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  11. I wrote a blog post early on asking about why some bloggers denigrate patients and write to stereotype. I was subsequently pilloried, ridiculed and then was cyber stalked by an organized group of medbloggers.

    There is indeed a need for ethics around medblogging when the bloggers hold themselves out as licensed providers. That, in my perspective, changes the ball game, and it requires a higher standard than that of general opinion in which the author makes no claims of professional affiliation.

    In the helping professions, specifically, one of the foundational underpinnings is that of trust by patients that providers will act on their behalf in a beneficent manner and with their well-being as the aim.

    Med blogging which violates that trust is unethical, in my view, and who knows what the potential and actual risk of harm is?

    In my case from my professional and patient experiences over the years, what I suspected about the unethical tendencies of physicians and nurses has left me bereft of trusting any physician and nurse in just about any capacity.

    The first, do no harm aspect of practicing medicine and nursing has been breached by the broken, commercial aspects of healthcare and now in cyberspace by bloggers acting out their worst behavior.

    GruntDoc and many of his emergency department based blogging compatriots are drowning in a sea of unfunded mandates, of addressing the door-always-open inundation of patients which don't meet ED criteria, and of dealing with deaf and blind boards of directors and senior administrators in employing patient care institutions.

    But they cannot take out their frustrations, valid as they are, on public view as blogging tantrums and patient denigrating tirades and expect that they will not be called to account.

    ED professionals must have venues in which they have seats at the table in which real sustainable and significant remedies are being planned, adequate and appropriate resources appropriated and control over their practice (autonomy) is supported instead of undermined. Blogging, as far as I'm able to ascertain, hasn't served as that sort of venue for ED providers.

    But it is evolving as an area rife with unethical and demeaning detritus served up for the public, and so in doing, I think that they are undermining their own purposes.

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