The central part of medicine is patients - don't push them out of social media

Clinical medicine is disappearing fast as topic for blog posts

Something happened to medical blogs in the past 6-12 months. They now seem a lot less interesting, more industrialized and aggregated. They have also become "too safe", generic and detached for regular reading.

There seems to be a rise of group blogs, guest posts and semi-syndicated contents. Several "clinic-focused" health bloggers have retired due to a variety of professional and HIPAA-related concerns.

It looks like clinical medicine is disappearing fast as a topic for blog posts in the U.S., replaced by posts about social media itself. As a side note, "social media" is actually a plural noun (media vs. medium), but it seems to be used mostly in singular form nowadays.

The central part of medicine is patients - don't push them out of social media

The central part of medicine is patients. Yet, we tell doctors: "never, ever blog about patients". This somewhat misguided advice displaces the most important part of the equation - the patients themselves.

Some health bloggers claim that we have to "aim above HIPAA" to avoid privacy breaches and comply with the highest standard of professionalism required by our occupation as physicians. How high "above HIPAA" is good enough though? In most clinical scenarios, the compliance with omitting the 18 unique HIPAA identifiers strikes the right balance.

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just, as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011; my edits are in bold in the text above).

Different standards for individual doctors vs. health system conglomerates

There seems to be a discrepancy of the methods employed by doctors and institutions when using social media. We tell doctors: "never answer patient questions on Twitter". Yet, Cleveland Clinic runs regular Twitter chats soliciting patient questions which are then answered by doctors and healthcare personnel. Mayo Clinic and other institutions do the same.

A blog is your notebook for lifelong learning

Don't forget the most important thing: A blog is your notebook for lifelong learning. Doctors learn from their patients every day. Patients learn from their doctors every day too. Both groups must try their best to excel in the joint quest to achieve the best possible outcome.

Comments from Twitter

@scanman (Vijay): 3 doctors, @kmathan @razmohan & I, set up a twitter account @DrTamil to answer medical queries from Tamil tweeters.

@DrVes: You know the comment that you are going to get, right? "It will never happen here."

@DrVes: New trend: Hospitals tell doctors-in-training point-blank during orientation: "Don't blog. Don't tweet." Consequently, interns close blogs and Twitter accounts (confirmed via email from a trainee).

@macobgyn (MacArthur Obgyn) why do you think that is?

@SarahStewart (SarahStewart): I wonder if medical blogs are reacting to fear of litigation etc.

@DrVes: I'm sure they are. The community itself is not making things easier either.

@Skepticscalpel (Skeptical Scalpel): You're reading the wrong blogs. Try mine http://skepticalscalpel.blogspot.com

@CardioNP (Cardio NP): mirroring medicine in general? Agree w you re blogs; miss the early years ~2004-5. Agree skeptic that ur blog is a nice welcome addition

@marciovm (marcio von muhlen): will change as social media permeates society, informed consent will be feasible re: sharing medical info. Difficult to explain now.

@scanman (Vijay) This tweet - http://bit.ly/mpPL0P - by @DrVes, one of the most consistent medical bloggers, was meant for the Social Media Moral Police.

@vincristine (Vincristine): Who is 'we'? I imagine doctors will tweet what, where and how they choose to tweet, no matter what 'we' say

@laikas Laika (Jacqueline): A lot of interesting observations by @DrVes on the evolvement of medical blogs & social media use. I will take up my #FF habit #ff @DrVes

References

“The powers of medicines and the practice of healing - to exercise the quiet art” - Virgil, Aeneid http://goo.gl/5BUb3
The making of a modern physician - The Lancet http://goo.gl/SYfTu
Strictly speaking, “Doctor” is a word incorrectly applied to most medical practitioners http://goo.gl/wjA0S
Despite the dire warnings, use of social media among emergency physicians is unusually strong http://goo.gl/QlqnK
AMA Policy: Professionalism in the Use of Social Media, 2011.
Image source: Wikipedia, GNU Free Documentation License.

Related reading

Why I became an oncologist - by the president of the American Society of Clinical Oncologists - a patient defined his professional life. CNN, 2011.
Patients can teach us so much. We must pay attention. And yet some people want to silence their voice on blogs and Twitter.
Keeping all regulations in mind, a medical student soon finds there is nothing to blog about: http://goo.gl/541pj
HIPAA found in Hippocratic Oath: Keep the patients’ secrets a secret. Also: My colleagues will be my brothers and sisters http://bit.ly/pGObLI

Disclaimer

I am the Editor-in-Chief of several case-based curricula of medicine and related specialties. This is the information regarding patient data: There is no real life patient data on this website. Please note: we do not write or “blog” about patients. All case descriptions are fictional, similar to the descriptions you can find in a multiple choice questions textbook for board exam preparation. Case courses and descriptions do not follow real cases.

11 comments:

  1. It was an interesting and a thought provoking post, and the "tweets" added more flavor.

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  2. Thanks for attempting to inject some sanity into the mess, Ves.

    PS. I know that was an inappropriate & bad attempt at rhyme. Couldn't resist.

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  3. Thank you for sharing this view. I'm pleased with it.

    I don't see anywhere to bring in engagement with patients and other healthcare providers like pharmacists or nursing (or other allied fields in medicine). How is the conversation you wish to have about patients fitting in with all these groups?

    Clearly keeping the laws upheld is important, but there has to be space for conversation. I've seen it, and I've seen it work beautifully. I'm wondering how/if YOU see it working?

    Cheers,
    Melissa

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  4. Excellent ideas. This particular blog post started as a compilation of 5 tweets, then I added a few words to make it sound a bit more coherent. It is obvious that we need to expand beyond this brief text that is focused on a narrow topic from a single point of view.

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  5. Ves - Very important post. Dialog surrounding how we discuss patients publicly is needed by leaders like yourself. Each of us have different ideas regarding discussion of patients and there is, unfortunately, no consensus.

    With that said I think we have to always consider the difference between public platforms and more closed, physician networks. Our standards in the public space have to be centered around the fact that all of our patients are reading. So discussion has to protect the interests, feelings and rights of those patients. We always have to test ourselves in public by asking, 'how would this patient feel about this if they read it?'

    When I speak to residents and new docs using these public tools I suggest that they avoid talking about their patients. It's a general recommendation to keep them safe. Every doctor is at liberty to do as they please but they do so at the potential risk of alienating their patients and violating the law. I think it's doable in public but it's dicey.

    I think it's easy to talk about wanting to do it or a doctors freedom to do it, but the medical community needs firm guidelines that first protect the interests of patients and then keeps doctors safe.

    Concerning the concept of thinking beyond HIPAA, I'll take credit (or blame). I think that as physicians our accountability to patients isn't limited by the law. Again, just my opinion, but I think it helps us all think again the needs and interests of our patients need to first be considered when speaking in public.

    There's lots to cover and perhaps I'll follow up with something more thoroughly thought through.

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  6. Thank you for the thoughtful comment, Bryan. I agree completely.

    I often link to some simple words of advice for physicians who use social media. They fit nicely with your suggestions:

    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

    Doctors need to understand the basics, and address the irrational fear of using social media. This can be especially difficult for physicians in training who have so many other things to learn and master that are competing for their time and attention.

    More information on the topic is available here:

    http://casesblog.blogspot.com/2008/07/content-of-weblogs-written-by-health.html

    http://casesblog.blogspot.com/2010/05/doctors-should-blog-with-their-real.html

    http://casesblog.blogspot.com/2009/08/what-makes-blogger-go-on-in-field-where.html

    http://casesblog.blogspot.com/2008/02/how-to-write-medical-blog-and-not-get.html

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  7. Excerpt from shrink rap blog post:

    http://psychiatrist-blog.blogspot.com/2011/06/doctors-who-write.html

    There seems to be four general mechanisms: completely fictionalized vignettes, as we did in our book; anonymized real cases stripped of identifying details; completely factual cases written with the consent of the patient, as done in the New York Times, or the "literary non-fiction" approach of medical writers like Linde. In the literary non-fiction genre doctors write anonymized case composites based upon actual experiences. The "patient" in these publications are not a specific real person, but are build out of various aspects of real cases.

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  8. You've got it above but the comments on the shrink rap post are really very interesting... Particularly with regards to consent. http://psychiatrist-blog.blogspot.com/2011/06/doctors-who-write.html

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  9. ...and so the lines between sanitised self-expression, educational provision, patient confidentiality and literary provocation blur once more...

    Looking forward to watching the ensuing discussion/conversation on the open stage provided by the medium of social cyberspace...let the global interaction continue unyielded...

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  10. Well said.

    Yes, patients are central to clinical medicine. And we -patients, doctors, medical students and other interested people - can learn a lot from clinical cases. It just depends how those cases are communicated. If done in the way you and Mike Cadogan report them it is perfectly ok and educative.

    I'm very pleased that compiled your tweets into one post and that you have written this thought-provocative post. Thanks.

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  11. I would like to highlight your admonition to health care professionals to first approach the individual posting what you may consider to be inappropriate content. The implication, based on historical occurrences, is that it is highly inappropriate and highly unprofessional to pull together a mob to publicly attack another physician and beat them into submission. Your way is the adult way. It is the most appropriate and professional way. It is the way that respects the standing of ALL physicians within society. It is the emotionally mature way. I hope people heed your words.

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