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The “Butterflying” of the Medical Blogosphere

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As foretold in Revelations, the apocalypse draws nigh; two highly-read blogs have gone down. Although I did realize what was happening at the time, “Black Wednesday” was literally the day before I was preparing to leave back to Texas for my most recent trip (below) and had no time to comment on it. At the risk of being pointlessly late, I do want to offer a few comments and points of view.

Fat Doctor, a family practice physician, closed down her blog (although it seems to have the potential to spring anew) as did Flea, an anonymous pediatrician on the East coast. I read FD’s blog religiously, and I never once saw a post that was mean-spirited towards anyone. Sure, she’d go off on a rant about things that annoy her–which may have included a co-worker’s actions–but they were comments on the actions of someone, not against the person. Moreover, they were usually understandable annoyances that would frustrate anyone in that circumstance; never did I get the feeling that FD used her blog as some kind of cathartic vent-fest as others do, (although that would be her right), and her appeal was her kindness, wit, and insight into the everyday. Her all-too-human struggles with her strokes, her heart-wrenching sentiments about possibly leaving her only son motherless, showed a person about as complete and as “well rounded” (ha!) as one could get while still being “anonymous.”

Flea, on the other hand, was always a tell-it-like-it-is writer, and we had all have been living the incredulity, the sorrow, and the resentment of his malpractice experience. It was only a matter of time before he’d have to do something given ongoing litigation and that he’d openly talked about the case. You don’t have to be a lawyer to understand that such a situation can’t yield anything good whatsoever. If I were Flea, I’d have done exactly what he did, though I would have left at least a “goodbye for now” message, even if I didn’t hint as to why. In some ways, I’m less worried about Flea’s blogging situation because it’s so obvious and clear-cut, not that it makes it any less of a loss for the medical blogosphere. His sharp wit, his direct style, and his obvious love of his field–particularly his dedication to the patients and families in his under-served Brazilian community–earned my respect long ago.

And even though it was some time back, who can forget Barbados Butterfly, the Australian surgery resident who got suspended for her blog? Her scalpel was the only thing sharper than her writing, particularly when she unabashedly would go to town on fellow co-workers who wasted her time. The most memorable posts for me were the ones about her internship, the fear she had going to the ICU, the witty banter she’d recount between her and other members of the surgical team, the visceral sleeplessness she’d make you feel as she wrote of her pager going off at some obscene hour yet again. Unfortunately, it was this very topic in which she so openly wrote about the violations of work hours that probably got her in trouble. There have been a few Barbados homages in the last couple of Grand Rounds, and well deserved. A worthy role model for so many under her, silenced. In honor of Barb, I hereby coin the term “Butterflied” (a la “Dooced“) whenever a medical blogger is forced to shut down his/her blog against their will.

KevinMD’s article seems to foreshadow a slow dropping-off of medical bloggers as the ironic consequence of increased visibility leading to greater scrutiny. While I think that is 100% accurate, I predict it’s only an acute phenomenon that I believe will be balanced in time. When the stodgy “old guard” medical community (can you think of a more stick-in-the-ass “we’ve done it this way and so will you” group of individuals) slowly get dragged, kicking and screaming, into the 21st century, decisions will hopefully not be punitive as much as they would be opportunities for mutual gain and exposure (assuming of course, responsible writing on the part of the blogger).

There needs to be less barriers between physician and patient, and blogs can serve that purpose admirably. First, it allows both parties freedom of distance. As a doctor, if I want a “close” relationship with the blogging (patient) community, I post as myself and make no pretense about obfuscating daily events as long as it doesn’t involve patient information, etc. On the other end, as a patient/community member, if I want to feel closer to the medical community, I simply comment and make myself known; I may even start my own blog where information might even be interchanged in like fashion. As long as the proper basic legal disclaimer/groundwork is covered (ie, nothing construed as advice, all accounts fictionalized, etc.), what better way than blogging for a patient–for anyone on the “outside”–to see what goes on in the clinician’s head, what we feel, what motivates us, what frustrates us? This can only lead to more informed, more meaningful doctor/patient encounters. Of course, there always needs to be some non-negotiable professional distance, but nothing about blogging responsibly endangers that. In other words, responsible blogging can only help; it can’t hurt.

Unless of course, you are a malpractice lawyer or someone else with an axe to grind and attempt to use words written outside one’s place of employment on a server outside their own state (perhaps even country) against them in court. Unfortunately, while there are far too many of these types in the world, erring on the side of caution and shutting down blogs is not the solution here; knee-jerk reactions fueled by risk-management/”damage control” legal counsel can’t trump all these situations every time. Sooner or later, the tail has to stop wagging the dog.

So let’s talk about HIPAA, that gnarly beast that nobody really knows anything about–at least not in its entirety–because that’s what immediately gets cited every time. Like a mating call for attorneys, this Frankenlegislation could be three separate laws and each still be a fistful. The executive summary of the privacy section is more than 20 pages! (cut to visual of attorneys going after said executive summary like bonobo monkeys) Congress proved again, as always, that the road to Hell is paved with good intentions.

Here’s the thing: I know a few things about HIPAA, but not from a clinician’s POV. I was preparing to sit for my CISSP exam (that’s another post) and was attending a training in Monterey, CA in 2004. This was before full HIPAA compliance was to take effect, obviously, but the point I’m making is that 1/3 to 1/2 the class was composed of IT security professionals specifically responsible for maintaining healthcare data integrity, security of telecommunications, backups, etc. (gotta love unfunded mandates) Even hospital CSOs were in attendance, and what was pushing the envelope to get those 5 letters after their names was the increased legal scrutiny of being asked, “Who is in charge of your data?” At different times before I went to medical school, I shadowed several doctors at three different hospitals. I could have easily stolen patient data whether it was from folders on physical desktops to unattended terminals still logged in. I lost count of the number of monitors with post-it notes with bits and pieces of patient information (and God forbid, passwords) ripe for the plucking. A little social engineering (ie, me in the hallway calling the nurse to attend to something in room #314, to round the corner to get a chart) is all it would take for grotesque violations. And I’m not even close to a network/computer intrusion specialist–imagine what a real “pro” could do.

The point (which I apologize is so long in coming) is that security–namely HIPAA compliance–is only as good as the weakest link. As long as you have dim-wattage bulbs manning key areas of medical records, minimum wage front-desk personnel, and the like, as a hospital CEO/CIO, you have bigger problems to worry about in terms of HIPAA infractions than a way over-educated physician maybe not being perfect about obfuscating some minutiae of patient data on Blogger. Provided that they exercise understandable responsibility, physician bloggers are a resource asset–even a potentially profitable one, under the right circumstances–to the healthcare community, not a liability. I hope that the medical establishment sees this soon.

UPDATE: Fat Doctor is back up at her new domain! Weebles wobble but they don’t fall down!

Blogging/Web2.0, Medical and Health | enrico | May 25, 2007 7:15 pm

By JC Jones, May 29, 2007 @ 11:24 am

Thanks for letting us know FD is back! What would weblife be without her, or you, or any of us? jc
By twitch124, June 1, 2007 @ 10:15 am

Flea’s situation made the Boston Globe yesterday.

http://www.boston.com/news/local/articles/2007/05/31/blogger_unmasked_court_case_upended/?page=full
http://www.boston.com/yourlife/health/blog/2007/05/fleas_fall_1.html
By Mike, July 23, 2007 @ 10:34 pm

It is having said that until today 2007 many of healthcare organizations are unaware of what exactly the HIPAA rules and regulations are and/or they don’t want to invest their money to get HIPAA compliant. With the growing incidence of privacy breaches the compliance authorities should need to put more efforts bringing awareness about the HIPAA compliance and should try to make it easy and cost effective for organization to get HIPAA compliant. Very recently I came across one tool which I really find more helpful. This tool will help many organizations for multitask compliance achievement. A crosswalk between different regulations poster from Symantec is a very useful tool. This poster is crosswalk between: Sarbanes Oxley, HIPAA, Payment Card Industry (PCI), GLBA, NERC standards CIP and PIPEDA (Canada) http://www.compliancehome.com/symantec/