Patient privacy and the end of a blogging era

It's a little hard to believe, but this month marks four years since I started blogging. Despite my occasional digressions (tornado liveblogging, etc.), I've mostly written about the process of training to be a doctor. Along the way I've written plenty about my personal experiences, but I've also tried to convey a sense of some of the larger issues, often by discussing some of the memorable cases and patient interactions I've had over the years.

I believe that writing about these topics is an important part of my being a physician, apart from any clarity or catharsis that it may give me personally. Most of the public's impressions of how medicine works are based on singular, overhyped news stories and misleading fictional portrayals onscreen; almost none of this reflects what it's really like when the majority of us die, lose loved ones, suffer major injuries, or just try to get relief from our ailments. Medicine is a huge, complicated, often impersonal system that interacts with people at their most vulnerable moments. It seems to me that illuminating the process of delivering health care is potentially beneficial for whatever small sliver of the public that occasionally reads this humble blog.

Generally, I've treated the most profound and significant interactions in short essays. I have always tried to do this in the most respectful way: I never reveal details that would identify the patient or situation to an outsider, I never present the situation as comedy (well, unless it's actually funny -- and even then I strive to stay respectful), and my motivation is always to share and illuminate profound experiences of our shared humanity. To the extent I have failed in this, I hope that it is due to my limitations as an author, and not because there's anything wrong with the concept of doing this.

However, a few weeks ago the risk management team from the medical center came to talk to the emergency medicine residents. Their concern is that any discussion of patient care in a non-scholarly context exposes the hospital to legal action (true, unfortunately, in the current “medicolegal” environment). Basically, the message is: don't share your healthcare experiences in a public forum.

Patient privacy is of huge importance; I certainly wouldn't want my private medical details showing up on Facebook. However, I don't think this is what I do. And although I'm certainly not in their company, I don't think that's what Oliver Sacks and Atul Gawande and Abraham Verghese and Lewis Thomas and other medical essayists through the years have done, either. I strive to make every essay that I write about a clinical experience pass this test: if the patient were to read the essay, would they prefer that I had not written it? In every essay I've posted, I believe that the anonymous people whose stories I have shared would feel that I had done them and my readers a service by illuminating the experience. Equally important, I believe that I have followed the first principle of medicine: do no harm.

In any case, the hospital administration has now prohibited us from writing about or discussing anything about patient care or clinical work in any public forum. It's backed by severe sanctions, more than a mere resident physician can really afford to risk.

In the end I plan to practice medicine in the best interests of my patients, and damn the legal consequences. I also believe that my essays matter in some small way to a small number of people, and that they are important. However, after much soul searching, for now I'm going to take down all posts relating to patient care. This is the first time I've ever been censored and what do you know -- I'm backing down. I feel a bit cowardly for caving, since I don't think I've done anything wrong, but I need time to consider the situation.

In the meantime, I'm going to focus more on the music blogging over at Notes from an Open Window. I'll keep writing personal posts here while trying to figure how to adapt to the new situation. And my apologies to the voiceless patients to whom I tried to give a voice.