By Margarita Bauza
Detroit Free Press
March 20, 2007
As Internet blogging spreads across professions, doctors' observations and opinions about patients -- some expressed in graphic detail -- are now ending up on the Web for all to see.
Hundreds of doctors across the country are writing Internet diaries that sometimes include harsh judgments of patients, coarse observations and distinct details of some cases.
Medical blogging is so new that medical boards, schools and professionals disagree on what is acceptable. Critics say the blogs cross into an ethical gray area and threaten patient privacy while posing liability risks for health workers and their employers.
A medical blogger, for example, wrote this in discussing an 18-year-old who on Christmas Day had her third baby:
"I don't mind it so much when a young single woman comes in with her first pregnancy, because anyone can make a mistake. But when that woman gets pregnant repeatedly, time after time, she degrades herself and her children, by condemning herself to a lifetime of dependency and irresponsibility."
The writer, who identifies himself as a neonatologist working in a U.S. urban area, writes about his practice
The anonymity provided by blogs has proved to be a powerful lure for doctors and other medical professionals, who, sworn to strict rules of confidentiality regarding patients, have few outlets to speak their minds.
Although many bloggers stick to innocuous subjects that don't involve patients, others make patients the focus of their writing. Critics say that's risky.
"One of the fundamental aspects of medicine is that patients have to feel free to tell doctors everything," said David Stern, a physician who teaches professionalism at the University of Michigan Medical School. "They're not going to tell us everything if they're asking themselves when they come in to see their physician, 'Is my doctor going to blog about me?' "
T.J. Bucholz, spokesman for the Michigan Department of Community Health, under which the state's medical licensing board operates, said he thought the "neonataldoc" blog stayed in bounds.
"I don't see a lot of blatant HIPAA violations," Bucholz said, referring to the Health Insurance Portability and Accountability Act of 1996, which established national standards to protect personal health information. "They're using first names . . . but from my perspective, if someone were to identify themselves in this blog, he is looking at very serious charges, not the least of which is losing their license."
Some of the comments posted by "neonataldoc" seem crude. In December, he wrote about defecation during birth and, separately, a 17-year-old who was giving birth in the nude.
Other blogs are equally candid:
"I got called to the ER to deal with a man who had placed a piece of plastic tubing (an aquarium pump tube to be exact) up his urethra, and it was now stuck inside and neither the patient nor the ER physician were able to retrieve it." (That's from http://urostream.blogspot.com.)
"I informed a patient's parents that we would call them when their child was off the heart bypass machine and back in the intensive care unit. That went down like a lead balloon as the child was in fact having spinal surgery. Oops." (From http://mediblogopathy.blogspot.com.)
Critics find the trend troubling, not only because of the risk of compromising patient privacy but also because of potential liability for hospitals.
"We're talking about professions that have legal and ethical obligations regarding privacy that are governed by federal statutes," said Terry Bonnette, a labor and employment lawyer in Detroit. "You should assume when you're blogging that your anonymity is not absolute.
"Employers should be very careful about this. They are the ones who have the most to lose, really. A hospital has every right to protect its image and reputation."
Some blogs give advice on how to comply with HIPAA. The site http://www.geneticsandhealth.com has an "honor roll" of blogs that do well at abiding by privacy laws and disclosing biases.
"I just felt sites were not upfront about their affiliations," said Hsien Hsien Lei, who has compiled this list. (Not a physician, she has a PhD in epidemiology.)
"The line is very fuzzy," Lei added, when it comes to maintaining patient privacy. "Every single doctor who blogs kind of defines it for themselves."
The only acceptable way to blog safely about patients is to ask for their consent, said the University of Michigan's Stern.
"Absent that, you're on shaky moral ground," Stern said. "The only way you can totally protect confidentiality is to not say anything." ?