Doctors Shouldn’t be Socially Anonymous

September 22, 2010

I don’t think doctors should be socially anonymous.  We need to be seen.

Here’s why going underground isn’t good policy for physicians:

Anonymity makes you say stupid things. When you’re shouting from the crowd it’s easy to talk smack.  Come up to the podium, clear your throat and say something intelligent.  You’re a physician, not a hooligan.

It’s 2010 – anonymity died a long time ago. You think anonymity offers shelter?  You’re funny, you are.  Anonymity is a myth.  You can create a cockamamie pseudonym but you can’t hide.  And if I don’t find you the plaintiff attorneys will.  They found Flea.

Being a weanie is no excuse. Just as you’re unlikely to consult a lawyer before speaking at a cocktail party, commenting as Dr. You is unlikely to kill you or land you in court.  Just a couple of pointers:  Don’t talk about patients, help people out and be nice.  Trust me, I’m a doctor.

We need you, dammit. There are like 12 doctors in the free world with regular blogs.  And all the rest are either working or peeking from under their desks hopin’ this social stuff all goes the way of the hula hoop.  If we all just spoke up we could change the world.  As for me, I’m typing as fast as I can and I’m tired of doing it alone.

Anonymity soils credibility. We need to be out there helping to keep check on the nonsense circulating in the infosphere.  I think it was Dr. Val Jones who once said that the Internet needs lifeguards.  Of course patients can swim.  No one needs to be rescued but there’s nothing wrong with a few strategically placed lifeguards to blow the whistle every now and again (mind you, these aren’t paternalistic lifeguards but lifeguards seeking a partnership with empowered, engaged swimmers).

“I’m not a doctor but I play one on the internet.” In the end, no one trusts a lifeguard in a ski mask.  Unless we know who you are, you don’t count.  If you’re anonymous I have to assume you’re actually a disgruntled medical assistant with an axe to grind.  Show your face and create a digital footprint that we can all see.  Look at me.  Look at my blog.  Cross-check me with Texas Children’s Hospital, Baylor College of Medicine the quarter million other ventures I’ve been engaged with.  I’m real.  Those links are real.

Go and be real so that your voice can be credible.

What am I missing here?


{ 46 comments }

Chukwuma Onyeije, M.D. September 22, 2010 at 11:15 am

Fantastic post. Both laugh out loud funny “When you’re shouting from the crowd it’s easy to talk smack” And poignant at the same time ” Don’t talk about patients, help people out and be nice. Trust me, I’m a doctor.”

My addendum to the “We need you, dammit.” clause would be that the other folks with the non-medical, non-evidence based, non-sanity based ideas have beat us to the microphone and the megaphone. We (as physicians) need to bring the conversation back to a reasonable discourse.

This applies to so many different things, but I’m specifically thinking about the Goetz Law and conversations regarding vaccinations.

http://twitter.com/chukwumaonyeije/statuses/10726329691

DrV September 22, 2010 at 12:44 pm

Thanks for the kind words, Chukwuma. We have been beaten to the punch. But if you look at the number of pediatricians in the US, this group alone, if active, could rule the search engines

Peggy Polaneczky September 22, 2010 at 11:30 am

Speaking as a doc who blogged anonymously and then came out so to speak, I can tell you that the positives from being out there so far outweigh the negatives it ‘s almost not worth blogging if you’re anonymous.

Patients love knowing who their doc is, and 15 minutes once a year doesn’t cut it. But with a blog, they can hear your voice (and your advice) all year long. Given what we know about how docs can influence patient behavior, it even makes me wonder if docs with blogs have better patient outcomes.

Medbillsos September 22, 2010 at 12:02 pm

GREAT post, we need more outspoken such as yourself. I have been a tech (internet etc.) fan/user for years but lately the overwhelming amount of data available and subsequent commercialization of aforementioned gives me pause.
We need more verification of information and your proposition is right on target !
At 61, I coach and instruct seniors on computer and internet use and would be more comfortable in encouraging them to use it if there was more transparency (overused these days, I know) and verification of information.
Bravo
Why so little exposure on twitter ?

Bunny Ellerin September 22, 2010 at 12:14 pm

Bryan – I know you think there are few physician bloggers, but I disagree to some extent. How many marketing execs out of the huge universe of marketers blog? Not that many. I suspect this holds true for most professions. Even the universe of Mommy bloggers to mommies is probably pretty low. On anonymity, you make valid points that hold true for any person. On the other hand, I would not be reading @burbdoc or @angrypharmacist, and not only do they crack me up, but they convey a tremendous amount of information about the state of affairs in our healthcare system. Sure they could make these points in other ways, but I have to say their Twitter and blog posts do make me think far more than some of the less controversial ones.

DrV September 22, 2010 at 12:49 pm

Yes, I may be off base but I just have the feeling that we’re markedly underrepresented in the infosphere. I don’t have objective data, however. I think that the alter-ego, sans frontal lobe approach to the anonymous blogger can be amusing, you never know if its a poseur. I’ve seen these anonymous voices be quite cruel as well. But I agree with on on a certain level.

Thanks for your thoughtful comment, Bunny.

Cristhián Carvajal Mery September 22, 2010 at 12:30 pm

I’m a medical student. I started blogging using a nick, you knew that was not my name, then I changed it to a pseudonym, something more serious, normal, something that looks like a real name. I felt more responsible for what I was saying as you said, but that was not enough. I’m going to be a doctor, if I want to be taken seriously, hiding behind a fake name won’t help. Posts like this help me realize I wasn’t wrong when I made that decision. I hope more people, doctors, students start blogging. In my country (Chile) almost every doctor and medical student who blogs (10 aprox) are writing for the same website (I’m one of them). We need more people, that’s for sure.

Gene Rossano September 22, 2010 at 12:53 pm

This was a stroke of luck tripping over this little exchange. I am the brother of a three and a half year survivor of cancer on the tonsils. Through my website, http://www.BestDryCleanersFL.com/Cancer.aspx, and through my postings using , geneatbest, on Insight – Oral Head and Neck Cancer Alliance Support Community, Facebook and Twitter I am trying to bring greater awareness and support to all cancer survivors.

It is my most sincere wish to encourage and to see greater participation by the “professionals at every level”, in all areas in the process of survivorship, from “pre-diagnosis” to forever”. This of course includes active participation by the “professional” in local, regional, national, international and web based support communities.

It would seem that doctors and nurses blogs would be perfect vehicles for tie in to web based support communities and social networks as well as digital connections for the individual survivors.

Certainly the needs of so many millions of scared, terrified, panicked, shaking, hurting, beautiful human beings. their families, friends, and work associates deserve the time and attention of the “professionals”.

Why not make a conscious commitment to help make “it” happen now?

Rob September 22, 2010 at 3:26 pm

You are spot on. We enjoy reading anonymous bloggers to some extent, as they can say things we wouldn’t dream of, but it quickly crosses the line in most every case I have seen. I know of very few med bloggers who have remained anonymous and have not ended up bashing patients in a way they would never do under their own name. Some employed physicians (and med students) are compelled to do so because of employer/school wishes. Still, I’d far rather see someone do so with their own name.

DrV September 22, 2010 at 9:01 pm

There are times when I wish I were anonymous but typically its at times when I’m feeling a mean streak. Almost never productive at those times.

Doug Duffee September 22, 2010 at 6:32 pm

I have found patients slow to adopt e-communication but it is catching on. I agree that we as physicians need to prepare to embrace new paradigms for communication and practice.

Jeff Livingston, MD September 22, 2010 at 6:39 pm

Great post. I agree with everything you said. I love the concept of the internet needing lifeguards. This is so true in Obgyn world where there is tons of info online and most of it bad, poorly written, not scientific jibberish.

Daphne Swancutt September 22, 2010 at 6:44 pm

Gosh, but I love this. I love it so much, I’m actually speechless. I’m not even a doctor, and I love this so much. Now, I’m just babbling and incoherent.

Anyhoo…way to go, doc :-)

DrV September 22, 2010 at 9:02 pm

(pointing finger – one eyebrow higher than the other) I release you…

Gregg Masters September 22, 2010 at 6:52 pm

Hi Bryan…

I echo Daphne’s comments; though not speechless since you know where I stand on the need for docs to step up and engage in this medium. May I add http://doctweets.com to your blog since we will be hosting the first US domiciled physician hosted ‘doc chat’ soon.

Cheers!

Gregg
aka @2healthguru

DrV September 22, 2010 at 9:05 pm

Yes you may. You just did. And you never need to ask. Mi casa is su casa

Kevin O'Toole September 22, 2010 at 6:59 pm

Excellent, excellent indeed. I have to agree with Daphne, love it! Kudos to you and others like you that do not hide behind or under their desk!

RichmondDoc September 22, 2010 at 7:28 pm

My only reason for using a (very weak) pseudonym on Twitter and on my blog: I worry about anyone taking what I say and associating it with my hospital. Yes, I have a disclaimer on the sites. Yes, it would be very easy for someone with 5 minutes to figure out who I am and where I work. But I think it at least separates me a little bit from my employer.

I’m not trying to hide my opinions. And, despite Rob’s concerns, I don’t bash people. And if you look up either my blog or my Twitter account, my name is right there. Does that make me anonymous or not? I guess not really, but I can appreciate docs who choose to use a pseudonym if they need to move themselves away from their employer for some reason. And if we want docs to engage on-line, that may need to be one of the trade-offs (at least for now).

mark

DrV September 22, 2010 at 9:12 pm

I understand that entirely. In 2006 during the first month that I was writing for Parenting Solved I posted on a sensitive issue and a commenter said “I don’t believe a doctor from Texas Children’s Hospital would ever say anything like that…” I was very upset for the very reason you talk about. And the post was very reasonable, actually. But people react in different ways.

Your reticence is really valid but keep in mind that you may loosen up with time.

RichmondDoc September 22, 2010 at 10:09 pm

I agree–posting in such a way that my real name doesn’t show up automatically is something I may feel is less important. Or, if/when my employer develops some guidelines as to how employees can represent themselves on-line (or helps formulate a stronger disclaimer), I can see myself loosing up.

In the meantime, I trust and hope that by providing reasonable comments and contributing to discussions in reasonable ways I hope that people will realize that I’m legit and have no axes to grind.

mark

Phil Baumann September 22, 2010 at 7:39 pm

What you said. :)

Mary Pat Whaley September 22, 2010 at 8:22 pm

Ditto Daphne.

Nicholas Fogelson, MD September 22, 2010 at 9:23 pm

Great post! I really agree with what you are saying, and made a post along similar lines a while back at my blog. Docs who blog anonymously undermine their own credibility, but more importantly they miss out on the opportunity to control their online brand. Most docs google themselves and see a page full of doctor review sites. Docs that have a successful blog with their own name will see an entire page of links directly to their content, and usually the top link will be their blog. That is controlling one’s brand.

Thanks

http://academicobgyn.com/2009/11/23/what-is-it-with-anonymous-medbloggers/

Vera September 24, 2010 at 7:33 am

I was going to post a link to your blog post!

Great topic, and I agree.

As for talking about patients… just because you blog anonymously about a patient, doesn’t mean you can’t land in jail for violating HIPAA. It’s the patient whose identity must be hidden (and HIPAA’s definition of identifying is pretty strict, including for example date of service as a patient identifier), not the doc’s. The FBI (who investigates HIPAA criminal cases) can prooooobably figure out who you are, even if you blog as Dr. Anonymous. So anyway, my point is – you’re absolutely right!

Regina Holliday September 23, 2010 at 5:02 am

Excellent post. It adds credibility to patients and doctors to use their real names. And Nicholas is right about the branding. The blog lets you control your image and lets others hear your real voice. Thank you so much for posting this.

DrV September 23, 2010 at 10:18 pm

Yes. Yes. Yes. Docs just don’t understand the digital footprint. Thanks for chiming in.

Dr Synonymous September 23, 2010 at 10:30 pm

I enjoyed reading your personal opinions. I tend to agree with about half of them. Each individual physician blogger on the web has their own style and strategies. I like that. Peace

DrV September 23, 2010 at 11:44 pm

I just wish I knew which half. I’m with ya on the power of variety. Peace out girl scout.

Wendy Sue Swanson, MD September 24, 2010 at 12:47 am

You’re not alone, DrV. But like you, I feel like I’m typing as fast as I can. And it’s still never feels like enough.
I have really disliked anonymity in the (social) medical world….mostly I see it used in abusive ways. Not helpful ways. And all the anonymity in the world (under the HIPPA excuse) will never make up for the patient that figures out they have been spoken about when they crack the anonymous code for their doc.
Speak the truth, be helpful, tell us what you really think; tell us the real story. That is what we all (patients) want to hear.
And we will change the world. Particularly as the numbers grow…

DrV September 24, 2010 at 10:22 pm

Thanks, Wendy. Truly, your energy inspires me.

Natasha Burgert, MD September 24, 2010 at 2:32 pm

Love the post. You have provided encouragement for early med bloggers, like myself. My personal experience prior to starting an online presence includes over 1 year of explanation, education, and negotiation with my senior partners in order to have the opportunity to participate. And in the brief time we have been visible online, our office has already seen the impact. A blog/SM plan facilitates the ability to spread the same information to multiple patients, leading to less phone calls for the nursing staff. It allows patients to “help themselves”, focusing nursing calls on more complicated issues (no more calls about Tylenol dosing). Blogs can increase revenue. For example, a post about flu shots reminds our patients to come to us for the vaccine instead of using an urgent care or pharmacy-based clinic. Most importantly, a good online presence is beneficial for the patients. I agree with the comment made by Polanecsky, “15 minutes once a year doesn’t cut it.” With how fast medicine is changing, I owe it to my community to keep them educated and informed for the other 364 days a year. I hope all of med bloggers can serve our communities with authenticity, honesty, and accuracy. Not being anonymous is part of that dynamic. Thanks to the other med bloggers, including yourself, for providing a good example.

Mark Harmel September 24, 2010 at 11:07 pm

Great post and I love how it generated comments. One thing I could see that is missing is an invitation to join on your site. Some other docs may wish to put their toe in the water first with a guest post. That may be their level of engagement or they may wish to create their own blog.

If is right for you it may help you rest your fingers for a while.

Nicholas Weaver September 25, 2010 at 12:36 am

Lots of great thoughts and perspectives. Seems mostly from longstanding physicians. Nonetheless, being a current med student and someone who never thought of doing something like blogging anonymously, I struggle with why anyone would consider the idea. Please keep in mind I do understand why some may feel the need to separate personal thoughts from one’s profession. I will do my best here to keep my thoughts in context with the posts. :)

Lets just be open and honest here, the main reason for doing anything under a guise or anonymously is to blur the lines between who you are/what you do/what your believe and so on. Even better, it gives physicians less accountability/responsibility for the content they are sharing, creating, debating, etc.

I come from a generation who are developing and creating innovation on the web and looking for ways of integrating it into every aspect of our lives. Sure Facebook, twitter, blogging, live streaming, and chatting are all great and new for many physicians, but the best part about being online or using these platforms are all the new ways we are able to communicate, find information, create content, and use it to solve problems and hopefully achieve the goal of curing disease, combating poverty, and on and on.

From my perspective, why wouldn’t you be online as a physician. You can create boundaries, take breaks or even throw in the “online/social” towel if find it doesn’t work for you. If you choose to be online think of all the possibilities, to me they almost feel endless. What I am asking and hoping physicians will start or maybe in your case, continue to do, is to figure out how you can integrate all your passions with your physical presence, your online presence, which ever medium you choose to be involved in, and be consistent. Each individual can figure out how they would like to position themselves, we all don’t need to do it the exact same way. Simply put the benefits outweigh the risks as I see them.

As a doctor you wouldn’t give a patient in your waiting room a fake name, address, phone number, or fake prescription, so why do it online. If you are giving advice, sharing your feelings, put your name on it. If you are writing it, why would you want it to be associated with anyone or anything else.

This conversation is much bigger then what there is space for here, but I think an important one.

DrV September 25, 2010 at 7:08 am

Nicholas. Your insight is amazing. We need to hear more from you, the next generation of what we’re all trying to do here…

information technology September 26, 2010 at 3:01 pm

Great information! I’ve been looking for something like this for a while now. Thanks!

Tony Fish September 27, 2010 at 9:58 am

Very good blog. Have done a cut and paste to here http://www.mydigitalfootprint.com/ and changed doctor to professional. As a chartered Engineer C-ENG and a Fellow of the IET and CIM – the same issues are prevalent.

Joyce M. Kocher, MD September 28, 2010 at 8:01 am

Your points are well taken. As a psychiatrist, I am always trying to preserve those arenas that are private and only for me. There are things that I want to talk about and I don’t want my patients to follow me or be a part of that world. I am a professional and yes, I do have a valid opinion, but I want to talk to many people on many different subjects. I tweet as @drmoxiecitygirl, because it feels good to hang up the white coat. I don’t think every anonymous doctor is slanted or cruel. Again, my opinion and I hope it hasn’t offended anyone.

DrV October 4, 2010 at 9:29 pm

I always forget the unique position of the psychiatrist during this argument. I believe I’d do the same thing. It seems like the mean spirited anonymous folks ruin it for the rest of us. Thanks for commenting.

Zubin Damania October 3, 2010 at 11:56 pm

Excellent discussion and commentary! As a hospitalist new to the social media game, I initially viewed the whole prospect with a mess of trepidation. Especially in light of my intent, which was to post satirical, medically-oriented videos and songs online, with the goal of spreading an educational message while hopefully making people laugh.

Now it’s darn near impossible to hide your identity when your face is all over a video (even if one is wearing a pirate eye patch). And I think trying to do so would create a sense that there is a mean-spirited underpinning to the comedy, such that the creator is compelled to disguise his true identity. And credibility is one of our greatest assets as physicians, so why undermine it? It would sabotage the strength of the message, I feel (and it seems many here agree).

The thing is, I happen to work at a large academic institution, and am also part of a large private multispeciality group…so what I say under my own name directly or indirectly may be construed to reflect on these organizations–no matter what you say in a disclaimer. And I’m pretty convinced my academic institution can easily have me killed, without the body ever being found.

The issue is compounded further by the satirical nature of my content, which must always be balanced so as to drive a point home and make people laugh without being overtly offensive or unprofessional. I think I succeed in general (my wife is a good external frontal lobe when mine fails) but this is always a subjective matter, as previous commenters have mentioned.

So as a compromise I “vlog” under the tongue-in-cheek pseudonym ZDoggMD. I don’t advertise my academic affiliation or organization. But anyone who searches at all (or watches my graduation speech video) can figure out who I am and where I practice. And that setup is OK with me–I like having a thin, slightly permeable membrane between my professional sphere and the “character” through which I blog. I think in my particular instance I prefer that if my anxious hospitalized patients google my real name, the first hits are professional credential sites and my hospital organization, rather than a music video called “Pull & Pray — The Safe Sex Song”.

Thanks for the chance to write down stuff I’ve been mulling in my head since I started doing this in May. And if I disappear and no one finds the body, you guys will know what’s up!

DrV October 4, 2010 at 9:27 pm

I work in a large medical school so I understand the dilemma. Clearly you make an excellent argument for anonymity given your setting. And the academic world isn’t quite ready for ‘creative messaging’.

Keep up the good work. You earnest effort to do the right thing surpasses the shortcomings of anonymity.

And if you disappear, I know where they bury the bodies.

Mark Braxton October 4, 2010 at 9:59 am

“What are you missing here?” As a doctor, you should know what you are missing — HIPPA and patient confidentiality. Social media media introduces new pitfalls for physicians and increased risk of legal action. Also, I would rather my doctor spend more time with me and his patients than online writing a blog.

DrV October 4, 2010 at 9:21 pm

Mark – Thanks for commenting. I might invite you to take a peek around 33 charts. I make no reference to specific patient cases and I deeply respect patient confidentiality. I routinely speak on the matter of ethical physician conduct in the social space. You’re suggestion that I’m somehow missing something is misplaced.

The evolving presence of individuals on social networks is a reality. This includes physicians. While I don’t think that there’s a patient anywhere who would prefer that their doctor write over spending time with them, the two are not mutually exclusive.

Jackie Fox October 4, 2010 at 2:55 pm

Just saw this as the top-billed story in Ragan’s Health Communications newsletter (http://www.hmcnews.com). I have nothing much to add to all the thoughtful comments that have been posted, except how much I love the line, “No one trusts a lifeguard in a ski mask.”

DrV October 4, 2010 at 9:15 pm

And you have to admit it’s true….

Greg Smith MD October 10, 2010 at 3:19 pm

Bryan,

Wow.
Was this one written after an especially frustrating day, or were just a little more forthcoming than usual?
I agree.
I think that overall, being who I am online (good and bad, blazing insight along with terrible faux pas) is the best, most genuine way to go.

Greg

Connie Bristol October 14, 2010 at 10:27 pm

Nurse practitioners as well until some idiot calls in narcotics in your name you did not authorize. In Tennessee, providers have 3 days to report someone for doctor shopping or we could possibly be charged with a felony. WHY?? Because we are number one for hydrocodone abuse in the USA! Go TN Yeah, we’re number one…. soooo proud of my state….NOT. here’s an idea, move hydrocodone up to schedule II so idiots cannot call it in and medicaid or here, TENN care stop paying for narcotics…

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