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.
16 May 2007 |
They are pretty much all true. For me, too, in between the exercising, etc., is the little time I have for my time in Second Life. Hah…and my colleague wants me to play “World of Warcraft” and join his guild of physicians and nurses? No way.
I’m not really that good of a narrative writer, either. I’ll leave the writing to my friends, physicians or otherwise.
And Drs. Gupta and Groopman have way more power than I do at this time.
Thanks for writing.
Comment by DocMalk | 17 May 2007 @ 4:27am
Blogging strikes me as like journaling with feedback. It helps you process your experiences and make sense of them. Your description of blogging in the third to last paragraph in your entry today reminded me of cognitive therapy worksheets. You identified the specific situation, your feelings and thoughts, and your response. In looking back(and getting reader feedback) you considered other perspectives, other possibilities for action that you had not seen in the moment. It’s always a pleasure to read your entries. I hope you continue.
Comment by Jan | 17 May 2007 @ 6:06am
I am in the “baby having” season of my life and have found an OB’s blog and a L&D nurse’s blog. I have liked reading these as they do show the ins and outs of L&D. I have much more patience for my OB now because I see HOW HARD SHE WORKS! Those people are amazing. The nurses encountered in L&D are rarely thanked, though they are the ones checking on a person and doing the dirty work. I respect the professions much more now that I have read up on them and gotten into the heads, even if a little bit, of the professionals. It actually made me step back from my doctor too. I don’t want to overwhelm her too much with “my case” as I know she has a lot of people to deal with. I guess the reaction of patients reading blogs will be different, but for me, it has been good (and probably better for the medical professionals I encounter).
Comment by DawnML | 17 May 2007 @ 7:23am
wow, i guess i am now a physician-blogger. scary.
i have blogged through medical school because it often helps me see the humor and other sides to situations which were painful/uncomfortable when they were happening. i see things more clearly from reading my own entries, sometimes, and when i get comments back (though i certainly get a lot fewer than you do!) i get even more perspective. i also blog because my family and friends read it and it seems a way to stay in touch, even if it is a bit one-sided. the occasional rant is also somewhat therapeutic.
i am have many of the same fears as you listed but i think you have done an amazing job being very discrete and never nearing the line of HIPAA-evasion. your writing shows that it is possible to blog very intimately about life as a doctor while keeping private matters private. so — thank you!
Comment by sarah | 17 May 2007 @ 7:41am
I thought Flea was really dancing on thin ice. During the first week of his trial he put up two posts (which disappeared prior to his blog) which would have been very detrimental had they been discovered by the plaintiff’s attorney. If you read (past tense at this point) his entire blog clues to his identify abound, and he is not generally complementary to many patients or colleagues….he has “issues” and, I am sure, people who are not fond of him. On the other hand, if one tried, I am sure you could be identified as well (who has the time) but you seem to be genuinely respectful of everyone who floats in and out of your postings and I have never seen anything malicious or mean (Even B. Butterfly got into trouble on this score).
Comment by pat | 17 May 2007 @ 9:02am
You might be interested in a format/procedure for writing, in order to make more (personal) sense out of a situation, which I use in Organizational Behavior classes. Without going into all the details, you first write a page or so of just the concrete “facts,” what you felt, thought, saw, etc. The second step is to write about what the perceptions/perspective might have been, on the part of various persons involved, including yourself. The third step is to consider any theories/models/explanations that might nicely help to explain what happened. Finally, you write about new action/experiments you might choose to do, to see if you could transform what happens the next time, or in a recreated event, in a helpful or positive way.
This process always brings new awareness and understanding. I have used it often for myself.
Comment by Don Austin | 17 May 2007 @ 12:58pm
Blogging is a low/no-cost way of being published.
As I commented on someone else’s blog, I write for myself, maybe something along the lines of Dr. Gawande’s comment.
For years I’ve had an internal, low-level frustration about having some ideas I thought were interesting, at least to me, but until you begin to write them down you can’t see whether they even make sense to yourself, let alone anyone else.
But I find fame or notoriety from blogs a bit repelling, so I mostly stay away from hot-button issues, medical or not. The times have had more than one or two comments to a post, I’ve had a hard time getting in touch with why they were made, so in a sense they seem immaterial in large numbers. As the occasional isolated comment they seem more thoughtful. Paradoxical, or perhaps not.
Comment by Greg P | 17 May 2007 @ 1:51pm
Great post, it is a shame that people can be afraid to blog their opinions, but this applies to may more people than just doctors. Big brother is watching what you write! He may be a coworker, a disgruntled employee, maybe even one of those nefarious blog readers who leaves little notes that nag at you…Hope I’m not that type. You have a wonderful way of writing that shows the real person behind that medical degree. Please keep on letting us know what is going on in your world.
Comment by mary | 18 May 2007 @ 5:42am
Great Post. Hi. I’m Cary Byrd and I write the eDrugSearch Blog. I know that you’re a reader of Kevin, M.D. as I am, so I thought you might be interested in an interview I just posted with Kevin.
If you find the post of interest, any link love would be appreciated!
Thank you!
Cary
Comment by eDrugSearch.com Blog | 21 May 2007 @ 4:49pm
I started blogging four years ago (I’m a pathologist - initials of name, not degree!) and I really enjoyed it. That was it: I enjoyed writing and found the ease of self-publishing intoxication. I recently password protected my site for various reasons - caution (although, I have always been extremely cautious about what I write and rarely discuss medical issues. I mean, my mother reads my blog!) being the main reason. Time is another problem; I just don’t want to stare at a computer screen more than I have to.
The main reason I stay ‘anonymous’ though, is that when patients google my name I want my hospital affiliations and papers, etc, to come up first, rather than a random comment somewhere, although, with my natural caution it’s unlikely I would say something to offend. Never know, though. It’s a tricky world….
Comment by MD | 31 May 2007 @ 1:55pm
Er, that should be intoxicating, not intoxication. See, told you it was tricky :)
Comment by MD | 31 May 2007 @ 1:56pm