Kevin, MD posted an entry today entitled, “Black Wednesday: A dark day for the medical blogosphere“, in which he reports of several medical bloggers closing their blogs—some with explanations, some without. He also argues that because “medicine is one of the last adopters of technology”, they are “slow to adapt to the openness that defines the heart of the blogosphere”. He also touches upon recent major media coverage of medical blogs and concerns of patient privacy.

I don’t entirely agree that the reaction towards blogs is primarily due to resistance towards technology. This may certainly contribute to the general dearth of physician bloggers, but there are more significant factors that contribute to our small population, such as

• Time. In the midst of call schedules, variable work hours, and maintenance of general life (eating, sleeping, exercising, attending to relationships, etc.—ideally this is part of a physician’s routine), doctors (presuming that they have the desire to write) may not view blogging as a high enough priority to pursue. There are only so many hours in the day and the last thing extroverted physicians may want to do is spend time on the computer, sharing their experiences and opinions to a faceless and nameless audience.
• Fatigue. Often, the last thing doctors want to think or talk about is work when off duty. To write about medicine requires that one thinks about medicine.
• Maintaining the Order. And by “order”, I mean “secrets of the trade”. That phrase sounds more pretentious than I intend, but I believe there is an element of truth to it. Like any other profession, physicians may hold opinions about their work and the people they encounter that may undermine the image they want to project. Despite reports of unscrupulous physicians, disturbing malpractice lawsuits, and personal anecdotes that induce wincing, physicians are generally held in high esteem. (Ask your male friend who is a doctor if he’s ever used the line “I’m a medical student” or “I’m a doctor” to pick up women!) Is it okay to share ideas, thoughts, or opinions that may mar our sparkling image? What harm will we cause if we actually show our humanity? What are the consequences if we reveal that we are indeed fallible?
• Lack of interest. Doctors are people. Some people don’t like to write. Hence, some doctors don’t like to write. (There’s the transitive property in action.)

Fear, however, may be the most potent factor: What if someone construes what I write as medical advice? What if one of my patients reads this? What will my patients think of me? What will my colleagues think of me? Will the medical center view me as a liability rather than an asset? And on and on and on.

As an odd coincidence, the New York Times recently printed a piece, “Doctors Who Wield the Pen to Heal the Profession“, that describes the increasing number of publications by physicians in the general press (for example, articles in the New York Times—I personally envy Elissa Ely!—or pieces in The New Yorker, etc.). From what I can tell, the content of these “major media” pieces is not dissimilar to that on medical blogs—these authors critique the profession, provide commentary about the practice of medicine, and share patient stories. So what is it about writing online in independent blogs that differs from writing in major media? Have hospital administrators frowned upon Jerome Groopman for criticizing the thought processes of physicians? Did the chair of the neurosurgery department chide Sanjay Gupta for the opinions he provides on television? I imagine that the medical centers that employ these published physicians are rather proud that they are affiliated with these writers. However, no-name—nay, anonymous!—physicians who write online are somehow more threatening to institutions.

Maybe it’s because we just don’t write as well?

Graham recently wrote about a conversation he had with Atul Gawande. He expressed disappointment upon realizing

everything he writes he writes because he wants to understand it, and writing is his way of thinking his way through things. He doesn’t write to make change, more because he has found an interesting paradox that he wants to understand.

I confess that instead of feeling disheartened, I felt surprised because that’s the exact same reason why I write. It was a feeling of (imagined) kinship. When I first started blogging near seven years ago (!), I read something from Evan Williams (one of the founders of Blogger) that said something along the lines of “if I write better, I think better”. I absolutely agree.

The beauty of blogging is the near-immediate feedback, both from myself and from others. Many of my more “literary” pieces stem from clinical situations that left me feeling perplexed or distressed. Writing about them helps me understand how I perceived what happened, how other parties may have perceived what happened, how things could have gone differently, and what details I may have missed at the time of the situation. Different ideas may blossom in my brain that may help me view the issue from different perspectives, allowing me to perhaps be more empathic in the future. All of this—and usually more—happens as a result of retelling the story.

And then there are the comments that readers leave. Though I have abandoned my previous practice of responding to each comment, I (like other physician bloggers, I presume) read each one and often learn from the perspectives of others. It’s easy for us all to get caught up within our own frame of references and forget how our thoughts and behaviors may be (adversely) influencing a situation.

So, I agree: It is sad and unfortunate that members of our cohort have had to abandon their weblogs due to unelaborated forces. The diversity of information and opinions available on the internet is what makes it astonishing, educational, and stimulating. The muting of these distinctive voices in this arena is a loss not only to our peers, but also to the general online community.