Who would ask an anonymous blogger for medical advice?

I'm often asked why I use a pseudonym. When I first started blogging almost 4 years ago, I was still in practice. Some of my posts are a little edgy and my sense of humor is not for everyone. I didn't want patients to google me and have my blog come up on the first page of hits.

Now that I've been retired for over a year, I still have not revealed my true identity. You may ask, "Why not?"

I like being anonymous. I feel that I can be more honest because I am not worrying about what someone is going to think. A quote from Oscar Wilde says it all: "Man is least himself when he talks in his own person. Give him a mask, and he will tell you the truth."

Some people have questioned my credibility. They say how can anyone believe what you write when they don't know who you are? I've been referred to the UK General Medical Council's rule #17, which states "If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name. Any material written by authors who represent themselves as doctors is likely to be taken on trust and may reasonably be taken to represent the views of the profession more widely."

Regarding the previous sentence, I agree with the first part about trust and strongly disagree with the second part. How could anyone think that what a single doctor writes is representative of the profession more widely? I am reasonably certain that is not the case in my situation.

You want credibility?

A single post of mine called "Appendicitis: Diagnosis,CT Scans and Reality," which I wrote about three weeks into my blogging career, has received almost 14,000 page views.

In the comments section of that post or via email, more than 50 people have asked me questions about their own or a family member's abdominal pain. I've had to add numerous disclaimers over the years reminding readers that I could not give medical advice without examining the patient.

Despite the disclaimers, the questions keep coming with the most recent one submitted two days ago. I can only guess that they are either reluctant to ask questions in person or not getting satisfactory answers from the doctors they are seeing.

Premed and medical students and residents frequently look to me for career counseling. Last week I even got a question from a high school student who was thinking about becoming a doctor. The students and residents occasionally preface their questions by saying that they didn't want to ask someone from their school or residency program for fear it would reflect poorly on them.

I have been amazed at how many readers seem to trust me enough to ask personal questions about their health or their career. To be able to connect with so many people despite my use of a pseudonym is rewarding.

Patients and aspiring doctors—that's who would ask an anonymous blogger for advice.

Sleep Deprivation, Blogging, and Anonymity

Last week a guest post on KevinMD by Felicity Billings, MD suggested that attending physicians should have restrictions on the hours they work. She recounted a story about a presumably tired cardiac surgeon (“Dr. Lewis”) who had been awake for more than 24 hours. An anesthesiology fellow, she wanted to tell his next patient how tired he was but did not. Fortunately, the case went well. She stated, “All the research has shown one thing: sleep-deprived doctors are bad doctors.” This elicited several comments including one from me pointing out that all research has shown no such thing. In fact recent papers have found that there is no difference in the outcomes of complex cardiac and thoracic cases done by sleep-deprived surgeons.

Today amednews.com posted a story entitled “Anonymous posts: Liberating or unprofessional?” by Kevin B. O’Reilly. It’s an interesting look at the controversial subject of anonymous blogging and tweeting. I was interviewed for the piece and explained why I prefer to remain anonymous. 

So what do these two events have to do with each other?

I Googled Felicity Billings, MD and found out many things. She works at Brigham and Women's Hospital in Boston. She blogs at “One Case at a Time.” She has written many other posts with rather detailed patient information which she apparently feels she has de-identified adequately. In one instance and to her credit, she obtained permission from a patient and his sister to write about his case.

When I first started blogging, I expressed my concerns regarding such detailed posts involving patients. I pointed out that a smart plaintiff’s attorney could ask a physician if she blogs or tweets. If she says “yes,” I believe everything she has written would be discoverable. Just imagine for example that a patient who had the heart transplant surgery had a late complication and in the deposition phase of a malpractice suit, it came to light that the subject of her post, “Dr. Lewis,” had been awake for 24 hours before doing the surgery.

I choose to blog anonymously for the reasons stated in the amednews.com article. I have avoided writing patient-specific blogs and tweets, because even if de-identified, they may come back to haunt me.

Medicolegal Musings: Physician Posting on Social Media & the Internet

You are in the middle of a deposition. Plaintiff’s lawyer asks, “Do you blog or tweet?” Before you answer, consider this. If you blog or tweet and respond in the affirmative, I believe anything you have ever posted would be subject to discovery by the plaintiff. Oh, you post anonymously? Would you then lie under oath and say you do not blog or tweet? For many physicians, admitting that you blog or tweet might not be a problem. But in my short career as a blogger/tweeter, I have read some things that frankly would not enhance a malpractice defense if projected on a large screen in front of a jury.

I will allow that I am skeptical and sarcastic, but I do not think I have posted anything that is derogatory to a patient, either generally or specifically. There are some very popular anonymous doctor-tweeters who post some scathingly negative comments about patients. Even if a patient could not be identified, the tone of some of these posts implies a deep-seated resentment of patients and their problems, not to mention many are vulgar, sophomoric or both. OK, some of them are funny as well, but the humor would be lost in a courtroom. Some of these tweeters disseminate prodigious numbers of posts per day perhaps suggesting that they are not always focused on their work.

I have followed several medical bloggers who post clinical anecdotes, which are essentially case reports. Despite disclaimers stating they are not about real patients, it seems obvious that they are. If the subject of one of these case report blogs decides to sue, it might be difficult to convince a jury that the blog was about a fictitious case. And this type of publication might be considered a HIPAA violation especially because it is unlikely that a blogger would have obtained institutional review board permission to publish the case report.

By the way, if you blog or tweet anonymously and answer falsely that you don’t, you better never have told anyone that you do. A lie under oath that is discovered tends to undermine your credibility quite a bit. [Defense lawyer, “Your honor, may we have a short recess while I talk to my client.”]

As far as I know from an attempt to search for medicolegal references to Twitter and blogging, this perspective has not been brought up before. What do you think?