Thursday, May 19, 2011

Rules for Case Blogging

Last week Kevin Pho wrote about a physician in Boston, Alexandra Thran, who was disciplined by both her hospital and the state medical board for writing about a trauma patient she had seen. Although Dr. Thran hadn't divulged the patient's name, enough information was conveyed that allowed others in the community to identify the patient in question.

That story really freaked me out. Because, as you know, I sometimes write about my adventures in general surgery. Am I a dead man? Is the Ohio State Medical Board going to give me the Bradley Manning treatment? Am I destined to working the night shift at a CVS minute clinic in five years?

As with most ethical issues, there is a lot of gray and nuance. But in general, I think you are safe writing about personal cases from your practice if you exercise a certain degree of reasonable restraint. Write about your experiences, not as a form of personal aggrandizement, but as an attempt to share, educate, and converse with laymen and other professionals about disease processes and treatment options in the open forum that is the Internets.

Here of some general rules of thumb:

1) If someone famous comes under your care, just don't write about it. If the patient is famous enough, some aspects of his/her clinical condition will leak out. There may be understandable angst and resentment that Celebrity X's privacy isn't guarded as well as anyone else's. If you write about the celebrity's case, even if you conceal it, there's too great a risk that details will overlap with leaked information from other sources. Then a giant HIPAA target forms on your back. So don't write about how the back up center for the Bulls came into the ER at 3AM with a sex toy stuck in his rectum, thinking that simply using pseudonyms gets you off the hook.

2) Strive to present cases for educational purposes. Ramona Bates is the exemplar for medical blogging when it comes to case presentation (how she has the patience to type out full bibliographies just kills me). I'm not so regimented but I try to at least provide a little pathophysiology and surgical dogma background. Compare a write up of cecal bascule in a peer reviewed journal here with my post on the same topic. My post was certaintly a little less dry and stuffy, perhaps a little too irreverent, but that's why you won't be reading much of my work in renowned journals. Conversely, my cecal bascule post was read by a lot more people that the one in Applied Radiology.

3) When you post images/scans, make sure you have removed all identifying data. Duh.

4) Let the case marinate in your mind a bit. Don't rush immediately from the OR/ER to the laptop. I usually give the cases several weeks/months to mature.

5) Review the literature to make sure your management correlates with standard of care protocols. You don't want to write about that APR you did on an early stage squamous cell anal cancer, and then have someone point out on a public blog that you ought to have sent the patient for an oncology consult to discuss the efficacy of the Nigro protocol (chemo/radiotherapy) as sole treatment.

6) Don't be a jackass. Don't brag or write things like "the patient was in good hands that night.."

7) Make sure your operative consents contain a section about "using images for educational purposes".

8) For cases that involve detailed, individualized descriptions of the operation, post op events, and eventual recovery phase---- discuss your plans to blog about it with the actual patient. Even let them read the post before you publish it.


rlbates said...

Actually, Buckeye, I've always wished I could write more like you and Bongi. Thanks

Lucky Jack said...

Hey - This response is totally unrelated to the above post (sorry :), but I read your post on JD Salinger and future docs (of which I am one hopefully), and it was truly beautifully written. I have been thinking about the medical profession a lot recently, and doing much introspection, and your post was inspiring. I wanted to see if it would be OK if I quoted you in my personal statement for AMCAS. You just said a few things that I have been trying to put in to words for weeks. I promise to credit you of course! (though not by name if you prefer). Thanks for the inspiration. - Axl

Anonymous said...

As a frequent surgical patient (not by choice, I assure you), if I don't want my images used in a blog do I cross out the part about consent for use of image for educational purposes? Must I specifically refuse consent to be blogged about? (not actually worried about this - but it's good to know in any case).

And, is the publishing of xrays showing patients with large penises really an educational purpose? Lots of bloggers like to post those. (Demonstrating Throckmorton's sign doesn't count as educational). So immature. Some adolescent idiocy just shouldn't leave the hospital. Can't get much more personal than that.

Jeffrey Parks MD FACS said...

Use what you like.

I agree, pictures of "large penises" are unlikely to serve any real educational purposes. In fact, it's fair to say that rule #9 ought to be: NO Headshots of Genitalia.

Anonymous said...

"Large Penises"???
I resemble that remark...

Patient confidentiality's why I had to pull the plug on my Blog that has/had more profunditity in one paragraph than 50 volumes of the Koran/Torah/Bible.
That and my Wife finally looked at it...

Frank Drackman M.D., P.W.

PS I know its only May but the Tribe's* lookin prety good

*Cleveland Indians

Anonymous said...

Here's what you wrote in 2008:

"I don't think anyone who reads this blog would think that any of the case studies I write about are at all exploitative. As my disclaimer states: "the cases presented are a fictional creation..." The way I go about creating the story is off limits to the general public. Besides, anyone can go to the public library, check out a few issues of JAMA or Archives of Surgery and read case studies that aren't at all altered, accompanied by real-live, colored pictures of limbs/scars/xrays etc.."

So I was alway suspicious about how you could create these fictitious stories, and suspected rightly that they were actually real.