Reminder: Hosting Dr.A. Radio Show

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Just a quick reminder that I’ll be hosting Dr. Anonymous’ show tonight on BlogTalkRadio at 9EST/8CST. You can find more details from DrA’s promo today and a video version from Tuesday.

I know I haven’t posted anything since Grand Rounds on Tuesday, but I had to catch up on “real life” things and then get ready for tonight, so it’s been a bit hectic! I promise I have some cool stuff in the pipeline, so when things slow down this weekend on the “more popular” blogs (heh), come on back and I’ll have goodies for ya.

Hope to see you tonight! If you can’t make the show, don’t worry–the archive of the show will be available later tonight at the BlogTalkRadio site about an hour or so after the show ends.  Download it to your iPod and enjoy!

Grand Rounds 5:11 – Death and Transfiguration

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Welcome to Grand Rounds! I am privileged to be your host for this week’s edition of the best posts of the medical blogosphere. As in the previous two times I’ve hosted, I will integrate music into this edition, but unlike before, I will focus on one piece of music: Tod und Verklärung (Death and Transfiguration) by the German composer Richard Strauss. I said when asking for contributions that adherence to a theme was not necessary; moreover no single theme could really encompass the excellent variety the medblogosphere has to offer. Since this musical selection is quite long–over 20 minutes at least–I have decided to present only excerpts so as to tell the basic story as we go along, placing musical interludes in the list of posts. Hopefully I still keep to the spirit of the piece while not detracting too much from the excellent contributions.

Death and Transfiguration is a “tone poem,” literally, a musical literary depiction. In this case, it is of a dying artist on his deathbed in his last moments, and what is experienced up to, including and after death. A patient in a bed knowing it can be the end is certainly scared, and perhaps even confused. Mother Jones of Nurse Ratched’s Place learned how to comfort a confused, hospitalized elderly woman in a very significant way in the early years of her career. In another mental health story of an elderly lady, Sara at My Sad Alter Ego appropriately rails against a fellow clinician pointing out that depression does not equal lack of competence.

The patient lies in his bed, breathing heavily, his heartbeat marked by syncopated triplet rhythms in both the strings and timpani. Falling sighs contrast against a flute and clarinet asking a wordless question in unison. There is not yet struggle, but there is certainly no peace.

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The near-code-blue status of primary care has received so much press recently, but in the end what has been done? What needs to be done? DrRich of The Covert Rationing Blog has some excellent insights and advice.

Dr. Val shares her insights at the dubious practice of Fecal Transplants (yes, you read that correctly) at her site, Getting Better with Dr. Val.

Mike Cadogan of The 28 Hour Diet shares his feelings on the general trend towards open peer review in scientific and medical publishing. I think he’s spot on.

Another spot-on editorial, and a shocking discovery for me, was Ramona Bates of Suture for a Living on the subject of medical method patents and the dubious practice of legally patenting something as ephemeral as a surgical technique. Is, say, a left-handed version of one safe from infringement?

Medical costs are skyrocketing, and since many of us are involved on the patient-end of healthcare, it’s sometimes alarming to read and be reminded that not all providers may act in the best interest of the patient, as a sobering post by InsureBlog indicates.

Violence in the ED is a disturbing and increasing problem, particularly in urban settings, as Marjan Siadat of Detroit Receiving writes.

Giving addicts sterile needles and a safe place to inject may seem like enabling on the surface, but Sam Solomon of Canadian Medicine shares there are quite a few good reasons to do so.

Suddenly he is startled awake with agony, struggling. The low strings groan with his pain. Driving rhythms, piercing brass motifs indicate his torment. The timpani, once quietly beating a halting rhythm, now pounds forcefully as though his heart will leap out of his chest. Relief is temporarily granted as he sighs back, exhausted.

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Jolie Bookspan of The Fitness Fixer in her post 14,000 Miles On a Bike reminds us that most intervertebral disc problems happen over time, and so too over time, they can also be repaired sensibly without invasive intervention.

How to Cope With Pain gives tips on how to be a “Computer Athlete” by showing sensible ergonomic suggestions.

Medicine for the Outdoors’ Paul Auerbach with a post entitled Sawyer Water Filter shows how a simple micron filter attachment to an ordinary bucket allows a pure gravity-enabled water filtration system that makes water from almost any source potable. It’s truly amazing, elegant technology.

Walter Jessen of Highlight Health shares remarkable new research indicating we might be closer to unraveling the genetic basis of autism. Not surprisingly, vaccines are not mentioned in the article. ;)

Ves Dimov at Clinical Cases and Images Blog is one of the pioneering physicians using Twitter to share conference proceedings in real-time, as he did at the Annual Meeting of American College of Allergy, Asthma & Immunology. Likewise, Twitter can also be used for USMLE Step 1 board preparation. Med students, this is an invaluable resource, since now First Aid can quiz you!

Nancy Brown of Teen Health 411 shares tips on teen oral health that may not be obvious.

Robin from Survive the Journey shares some new research that indicates Cushing’s Disease has a higher prevalence than common wisdom indicates.

At Sharp Brains, Dr. Rabiner talks about a quantitative EEG method for screening ADHD as opposed to observational/behavioral methods. The improvement of this new method is astounding and shows great promise.


Dinah from Shrink Rap talks about how simple medical jargon can be taken the wrong way by patients who don’t have the context clinicians do.

Christine at Corn Allergic shares a story where a conscientious nurse made a simple blood draw less of an anxiety-producing event (and not for the needle, either) by both being resourceful and non-judgmental.

Our patient begins a reverie, remembering his youth. theme. The strings’ rhythms drive forward, so full of exuberance they’re practically tripping over themselves. He must be thinking of a past love, unable to contain the rush of his passion, emotionally climbing higher and higher — until the brass for the first time fully states the “Ideal” theme in the piece (1:44). This represents his soul, the totality of his being, his essence. He has found himself through this 6 note theme, and having done so, can finally move on, secure in himself and who he is, ready to face whatever fate is to come with pride and dignity.

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Cris Cuthbertson from Scalpel’s Edge shares a personal letter spelling out her point of view on the differences between non-MD researchers and physician-scientists. (she also has great tips on preparing medical presentations)

Doctor Anonymous shares his thoughts as part of yesterday’s official observance of World AIDS Day. It is, as he pointed out, the 20th anniversary of the event, and we have made incredible strides in that time.

Bongi at Other Things Amanzi shares a story from his past about not looking down at people on your way up–they just might do the same to you when it’s their turn!


Barbara Kivowitz In Sickness and In Health shares how Gratitude Can Change You. Read how there is transformational power in giving thanks in a tangible way.

ADHD isn’t a disorder, it’s a personality type. That’s what Dr. Rob of Musings of a Distractible Mind writes in “The Doctor is Distracted.” ADD/ADHD confers its own strengths and weaknesses, and just like everyone else, each individual has their own unique aptitudes. The key is adapting and transforming “liability” into leverage.

In Reflections in a Head Mirror, Bruce Campbell shares a beautiful story about how love transforms perceptions, making the previously impossible possible.

Jacqueline at Laika’s MedLibLog really took off with the theme, so I’m saving this for last. She writes a very thorough review of a symposium on fear focusing mainly on a speech by an Israeli lecturer showing many neurological elements in fear processing and response. Post-traumatic stress disorder is featured prominently as an example of how extreme fear eventually can transform a person into someone else. She offers another German composer, J.S. Bach, to accompany her piece as well.

Finally we arrive at the end of our patient’s mortal journey: a pause, another short, violent struggle, and after his last agonal breaths, death arrives (0:52). However, no sooner than the tam-tam signals this event than the harp, low strings, brass, and winds indicate the soul’s release, loosed from his mortal coil, floating finally free. Sumptuous, almost agonizing pedal points stretch out like harmonic taffy as the “Ideal” theme transforms, grows and is passed around the entire orchestra. A final victorious flourish at our triumphant final key of C major (6:06) and our fully transfigured soul now rests quietly in peace.

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One may be wondering why I chose this rather heavy musical topic. For one, it fits in with a healthcare theme. Death and end-of-life issues are ever-present challenges in healthcare. Paul Levy just spearheaded a blog cause on this very issue. Facing our mortality isn’t easy for anyone. However, the main reason I chose it is because, metaphorically, it represents what I’ve gone through this last year. I decided not to tie in my own story along the way so as not to detract further from the contributors, but regular readers and friends know about the limbo status of my scholastic endeavors, unforeseeable health issues that took me out of commission for 9 months, and a divorce forced upon me in the middle of it all. One can allow dreams, relationships, etc. to simply die, or be transformed in the crucible of experience into something new. I hear Strauss and it reminds me I must do the latter. I have to believe this–like the musically idealized portrayal–is how things will turn out eventually. I invite those not already readers to join me in searching for my “C major chord,” speed bumps and all, and I’ll be there to share yours.

Finally, I do want to offer a small dedication to those that lost their lives in the tragedy in Mumbai last week. I think this post is an appropriate place to offer that, even though the topic was already conceived when the horror of those events unfolded. May the souls of the departed as well as the families and friends that mourn them find peace.

Thank you for reading! I hope that beauty and catharsis was found in spite of a weighty topic. I also want to thank Dr. Val and Colin Son for their work on keeping Grand Rounds what is is and giving me the honor to host once again. One of the things that makes Grand Rounds special is the variety of hosting topics and personalities one gets each week. So with that, I pass the baton to next week’s host, Sharp Brains. I look forward to their edition. Cheers and good health to all!

Video Post: Hosting Dr. Anonymous show Dec 4th

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The Dr. Anonymous Show on BlogTalkRadio (this Thursday at 9pmEST)
Grand Rounds 5:11 – Death and Transfiguration

Update 03December: Confirmed panelists are Ramona Bates, Mother Jones, Val Jones, and Bongi (schedule permitting). It’s a star-studded event, ladies and gentlemen! Even Dr. A. is jealous! hehe

Stating the obvious

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Just to make sure people landing here today know they are on the right site, YES, I did update my theme. :) I originally thought I’d like the split 3-column look of the other one but found that the eyes would need to scan extremes of the page to find things.  So then I decided that one column would be all bloggy things and the other social media meta stuff, but I was struggling getting the theme to do anything right. The CSS was beyond insane.

Finally, I installed this one in time for tomorrow and will continue to make tweaks. I’ll replace the mountain graphic with something more personal and start populating the sidebar with all the things I couldn’t in the other theme. I wanted to have it ready all at once, but reality and the 80/20 rule set in.  If you have any comments or suggestions, let me know!

Quilt Auction for Cancer Charity

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Surgeon-blogger extraordinaire Ramona Bates is kicking off an auction of a newly-completed quilt for the Childhood Brain Tumor Foundation – MD. Bids can be sent via a variety of methods and updates will be posted on Twitter–see Ramona’s page for more details. 

The starting bid is $200, and while that’s out of my poor student price range, I am hoping there’s a reader or two out there for whom that might not be, or at least can forward this to others in a position to help. Remember it’s for charity, and as a recipient of Ramona’s work, I can assure you first-hand that the craftsmanship is outstanding. Thanks!

GR: Don’t forget your submissions!!

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Just a reminder about the Grand Rounds submission timeframe ending this evening! If you haven’t given me a post and want to be included, time’s running out!  I might consider a post later than the posted time today, but tomorrow will be too late so don’t delay!

Grand Rounds 5:11 here on Dec 2 and Happy Thanksgiving!

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Happy Thanksgiving to everyone!! I realized just a bit ago that I neglected to have a “ready” post to formally accept submissions for the upcoming edition of Grand Rounds next Tuesday, December 2nd.  I apologize profusely, and can only offer as my excuse the craziness of two family birthdays, Thanksgiving, and all the family coming and going that occurs during this time.  Mea culpa!

Before I continue, make sure you go see the excellent current edition at Canadian Medicine, featuring last week’s content.  If you submitted a piece that wasn’t included in Dr. Solomon’s edition, re-send to me for consideration.

Please have all articles submitted to me no later than 18:00CST/17:00EST Sunday, November 30th (00:00UTC Monday December 1st) for inclusion by sending an email to enrico -[at]- Please put “Grand Rounds” in the subject, and in the body text include the URL and a sentence or two of summary. That summary is important because not everyone’s URL is descriptive, and when I have a table of URLs, etc. when planning the edition, a blurb really helps. 

I do have a tentative theme in mind but don’t want to reveal too much (and want some flexibility to change it ;) ) but these words should be applicable: renewal, metamorphosis, change, transformation. That should be enigmatic enough for everyone. :)  Do not feel constrained by these, however. There is no judgment about whether to include or not based on any theme; each article is reviewed on its own merit. 

Thank you for your cooperation, and I look forward to reading everyone’s entries!  Good health to all, and for those traveling here in the US this holiday season, be safe.

Trial lawyers are more important than doctors

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When I saw this article (h/t DrCris) I thought it was a joke, or at least a ‘teaser’ headline with a more reasonable qualification in the body text. I read on, slack-jawed at this arrogant, delusional, and megalomanical opinion piece passed off as serious reporting. I don’t know what grotesque acts the other CAOC Lifetime Achievment Awardees had to peform but this Gerry Spence has certainly got them beat:


“We are the most important people in America. There is no other profession in America that fights for freedom, that fights for what America is about, that fights for justice for ordinary people. I want to ask you which would be more important: If all of the doctors in the country somehow disappeared or all the trial lawyers in America somehow disappeared? We can live without medical care, but we cannot live without justice.”
I laughed. I cried. I threw up a little bit in my mouth. Lawyers don’t dispense justice, lawyers represent clients and their interests. Period. If lawyers were involved in the dispensation of justice, killers caught red-handed would have no trial lawyer. Ken Lay, Enron’s CEO, wouldn’t have spent one day in court, and on and on.  As a Lifetime Awardee of the legal profession, I’m sure Spence knew this at one time before he got caught up in a God complex about himself and his vocation.  
As one commenter put it, “You’re stranded on a desert island. Who would you rather want with you, a doctor or a trial lawyer?” Another hypothetical: what percentage of people have never been in a courtroom as a litigant (ie, needing a trial lawyer) versus what percentage of people have never been in a doctor’s office?  How this frilly-fringe-wearing blowhard wasn’t laughed off the stage makes me shudder in awe for the power of mob mentality at work in this “swanky” hotel ballroom.
Far be it from me to actually wish someone harm, but should Mr. Spence get hit by a bus outside a county courthouse, bleeding internally from blunt trauma and finding it difficult to breathe from a worsening hemo/pneumothorax, I wonder what he’d say when, as trial lawyers trip over themselves to hand him their business cards to sue the bus driver, the bus manufacturer, the tire company, and the city that improperly paved the street, his deoxygenating brain thinks, “Thank God I was hit in front of a courtroom instead of a hospital!”

Hostile HIPAA

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Adding to my new experiences as a patient, I have now run into heretofore unforeseen side of the HIPAA monster. As a patient, it should be protecting me, right? Of course not! Legislated in part to protect privacy, HIPAA is one of the most misunderstood and abused laws by healthcare personnel, particularly clerical staff at the front lines of the patient-physician records interface who may not have much of a healthcare (or all that much educational) background to boot. 

In my case, I called wanting a report from a minor surgery a few weeks after I had it done. I had already called the surgeon’s office and they said that while they did have a copy via their electronic medical record (EMR), the actual operative report was the hospital’s property and they couldn’t give me a copy; they just had viewing privileges, I was told. In the past, I’ve received every copy of everything I’ve ever wanted. This “ownership” business was nonsense–after all, this was my surgeon and the paper copy was in my chart. As long as I was there and asked for it, a simple copy had always been made for me to walk out with said report in hand. To be clear, I’m talking about post-HIPAA, not some wistful recollection of the way things were back in the “good old days.” Said surgeon recently moved into a brand spanking new office, has a ton of new staff, and I just thought that this was just a miscommunication–escalating to a supervisor or the like should resolve the problem.

Obviously it didn’t, but the fun was just about to begin. My instructions–reasonable, I might add–were to contact the hospital’s medical records department since they “owned” the information, and they could help me further. It was speaking to the medical records (“MR” below, because I like the double-entendre) office that thing became unglued. Below is a faithful transcript of our conversation, edited only for general length and idle banter:

Me: [explain my needs] So what procedure do you have for me to get a copy of the report?
MR: You need to come by–in person only with a picture ID–fill out some paperwork and pay a processing fee that starts at $42.50 for first 10 pages.
Me: $42-what?! The report is just one page, I think–maybe 2 at most. I mean, it’s on the screen–just hit ‘Print’
Me: Doesn’t matter if it’s 1 page or 10; it’s the same price.
MR: But wait, my family doctor’s been FAXed records from here–did you charge his office too?
MR: No, we don’t charge physicians because the request is for continuation of care. If we give a copy to you it’s not for continuation of care, it’s for your personal use.
Me: But the same work is being done, you just aren’t charging the doctor but are charging the patient? So it’s not a cost recovery, you’re penalizing the patient.

MR: We give it to the doctor electronically [not true, only applies to affiliated doctors in same med center]. We charge you or an insurance company because we have to physically process the record [what, press "Print" from the screen interface?!?] If it the report is for a doctor, they can access it electronically.
Me: But the doctor is in [my home city, 35 miles away], he’s always gotten records by fax.
MR: Well, we just went live with our new system in October.
Me: But if your system wasn’t live, you’re still saying you would charge me and not him.
MR: That’s correct, but slightly less than $42.50.

Me: OK, but I’m saying my doctor I know has no login credentials to your hospital, no privileges, nothing. So how can he get a copy?
MR: I’m guessing he’ll have to apply for access, but–well–I don’t know–I’m not the one that handles that, but in the meantime if he can’t get to it online, someone will have to pull the records, process it [again, this is just a quick computer search that takes 5-10 seconds], and send him the records–
Me: –which is my point: you’ll have to send him the records manually, but you aren’t going to charge him for the same work you’re going to charge me–
MR:  –That’s right! [Proudly, as though she's won an argument b/c I'm agreeing, which was most disturbing]
Me:  –someone is going to have to physically process this–
MR: Yes sir! [again, defiantly]
Me:   –and send it to my physician without charging him.
MR: Yes, because it’s for continuation of care [emphasis theirs, spoken slowly] and that’s something very different.
Me: [previously explained about my having been in Mexico, do have a "continuation of care" issue for my own recordkeeping] I already told you, I need the records for a physician in Mexico.
MR: If you can provide us with the name and address, we can release the records to him and mail them.
Me: To Mexico?!?!
MR: Yes sir, we can mail them.

Me: You have no idea what mail is like in Mexico; it will take a month at least if at all. I doubt you’ll pay the $30 for FedEx for that one page. Besides, are you sure all these fees are consistent with HIPAA and state regulations concerning access, etc?
MR: Yes sir, I can even provide you with a fee schedule.
Me: Can you fax that to me?
MR: Of course, let me get your fax number.

And with that deliciously ironic ending, the “labor” and “pulling records” was equal to the fax of that one page which they were all too willing to perform for free so their fees could be proudly shared. The 10 minute phone converation could have pulled at least 5 records and faxed as many copies. This is robbery, plain and simple.

HIPAA was crafted for portability (change in jobs, location, etc. doesn’t make one “start over” in terms of coverage) and security/privacy above all. It is, in spirit, supposed to be protective of the insured at the unfortunate and unfunded responsibiity of the healthcare provider caught in between trying to both comply and do right by the patient. I sympathize with this, but to selectively push costs back on the patient and not a physician–or more to the point, another business entity capable of absorbing said costs as the price of doing business–is predatory and in stark contrast to the spirit of the law. Moreover, HIPAA left way too much open to vague enforcement with language like “reasonable fee.”  It’s no wonder that individual state agencies and other entities are pushing the envelope with what’s “allowable” at the patient’s (ie, the person most exploitable and vulnerable) expense.

In the end, I got my report–not by paying $42.50 to the hospital, but at my next surgeon’s visit, I simply asked him if I could get a copy.  Without hesitation, he said “Sure!” and directed his nurse to go up front and make a copy for me on my way out.  Done. Piece of cake. HIPAA be damned.

Medical Blogs: Social Contract?

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In the October 2008 issue of the American College of Emergency Physicians’ (ACEP) Journal, an op-ed was posted entitled “Medical Blogs: Communication Vehicle or Social Contract?” (if the link takes you to a sign-up page, close the window and click it again–there’s a strange cookie that’s set that will bypass the registration screen) As I read it, the first thing that struck me was the comically dated language and information. The death knell of this article’s significance was already ringing in the first paragraph (all emphases below are mine):

According to the Internet phenomenon Wikipedia, blogs (short for Web-logs) are Web sites, usually maintained by an individual, with regular entries of commentaries, descriptions of events, or other materials such as graphics and video. They can serve as online interactive diaries where bloggers pour out ideas, feelings, and opinions, and invite readers to respond with comments of their own that are often equally fascinating and spontaneous.

Technorati, a blog searching service, reports there were 112 million blogs in 2007.

Wikipedia is relegated to a “phenomenon?!” Someone needs to tell these folks at ACEP that they don’t need to qualify what a blog is with enumerated reference; it’s not 2005, and wasting a paragraph on the obvious made me want to stop reading altogether.

Moving on, any person in the blogosphere worth their salt knows the once mighty Technorati has long since lost almost all of its relevance. Nobody uses it for anything useful, its continued existence being somewhat of an anachronism. However, the ACEP authors cite 2007 data from it in July of 2008!!(as referenced in the footnote) WTF?! They aren’t even trying to appear as though they care at this point.

The painfully protracted exposition continues:

[Other blogs] serve largely as public journals, providing authors’ insights and anecdotes without the peer review or editorial vetting that occurs in more traditional journal venues. However, the personal nature of many blogs lends them an intimacy and an immediacy that is often missing from mainstream outlets. Arthur Caplan, a prominent ethicist, compared blogs to an extended form of chatter and conversation.

I noticed here already a condescending tone that would get more and more pervasive throughout the article, that the notion of a peer-reviewed journal is the pinnacle of scholarship and a blog being gossip and nonsense. Wrong and wrong–it’s a comparison of apples and oranges. No one would argue that “big” journals get their gravitas from their editorial boards, but even peer reviewed journals suffer from bias, politics, and other non-scientific factors, and published studies often come under fire after publication for being extensions of corporate/non-scholarly interests. On the flip side, many blogs can honestly stand against some of the giants of the print world in terms of their solid content–far from idle prattle–the “peer review” being the entire world of reading scholars, all free to leave commentary, positive or negative, in an open forum.

It is this point in particular where the “good old boy” stripe of physician is most chafed. There’s a strong sense of “you kids get off my lawn!” as a new medium threatens to tear away the fabric of order and control as seen through the eyes of these authors. The very notion that a patient or layperson has a potential standing of equivalence to published physicians is the fundamental reason behind why this article is being published in 2008 without embarrassment: the ACEP still doesn’t “get it.”

Most of the above is petty quibbling compared to what I’m going to quote here, though:

Dr. Rita Charon, a physician and a leading authority in narrative medicine [whatever the hell that means], believes patients own their stories, and she takes the strong position that physician-writers must have patients approve narratives written about them before publication. Two other writers and experts in literature and medicine – Dr. Jack Coulehan, internist and poet, and Ann Hawkins, Ph.D. – invoke the argument of relational ethics. What will happen if particular patients discover that they were featured in an article, story, or blog? Will they find such attention beneficial, perhaps therapeutic? Or will embarrassment or betrayal boil their blood?

“Patients own their own stories?” Well, yes, in a fundamental ethical way, no one would argue that it would be wrong to publicly share that which is private between doctor and patient. In today’s world, HIPAA guarantees*cough* that their information is kept confidential, and every medical blogger I know goes well out of their way to mask any indentifying features of a story so that any semblance to the original would either be complete coincidence or not specific enough to be unique (“a woman came to the ER last night” would apply to potentially half the emergency patient population, for example, even if it were found to be true). However, the authors aren’t even bringing up confidentiality or legal concerns; they are ridiculously invoking the idea that in a doctor-patient encounter, the patient is the “owner” of the encounter’s narrative.


There isn’t ONE story, but TWO stories, at least: one from the point of view of the patient, and one from the POV of the physician. The ACEP doesn’t seem to be concerned with nurses, techs, etc. but the reality is that everyone in, say, a trauma bay (this is the ACEP after all, and ER environments are hardly ever private one-on-one encounters), could feasibly walk away from that encounter and have something to write about and each would be unique representing a distinct POV. You can’t equate or assign ultimate ownership of the experience of any one person, the different jobs being performed, etc. It is the height of arrogance to say that any one person actually “owns” the unique narrative of another. It’s sickening, in fact.

You have to hand it to bioethicists, though. I love that they exist, and like the ACLU, you’re happy they’re there for the “big stuff” that require their unique talents, but like this they’re often involved in issues more for the intellectuo-ethical masturbation debate than for yielding something tangibly better for the patient.

There’s a lot more as the article continues about what kind of “tone” the physician-blogger should strive for, and other paternalistic drivel from authors who have already demonstrated their incompetence on the subject matter. It’s insulting enough as a physician reading this to be told they “should aspire to a voice that is respectful and professional,” much less by these authors who can’t even utilize the very tools they are professing to teach.

Ultimately, however, the relevant question is raised, “What kind of ethical code should be used to protect patients’ confidentiality?” Had this not been the article of two online amateurs, the last section could have served as a wonderful teaching tool. Instead, it turned into yet another demonstration of hubris demonstrating, “Look how I’ve offered a solution to this problem!”

The solution for a “code of ethics” had already been actively addressed, voluntarily, in the medical blogging world, without the need of paternalistic mandates from out-of-touch organization chairpersons. The Heathcare Blogger Code of Ethics (HBCE, also knowns as “Medblogger Code”) was created by communal referendum with each blog’s participation vetted beforehand. Nowhere in the HBCE will you find paternalistic directives like “Wait one week before posting [clinical encounter] material to your blog.” We (and I say ‘we’ because I’m an active member in this community) assume that bloggers who care enough to announce due diligence with the HBCE badge don’t need to be micromanaged about their own posting habits, timing, or frankly judgment on any subject.

In fairness, I’d love to see what these two ACEP bioethicists would make of the HBCE and even the sibling patient-focused community, the Patient Blogger Code of Ethics (on the same site above). Perhaps that can be the subject of a future article, once the authors get this whole “blogging” thing down.

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