Medical Ethics and Blogging: Think Before You Post

- David Harlow, HealthBlawg

“The blogging medium has an effect on the writing of physicians — and all bloggers. Where the most popular exemplars of this new medium are often posting almost instantaneously upon thinking of something, thriving on controversy, and often, writing anonymously, all physician bloggers are drawn away from the conservative, peer-reviewed model of medical literature and into the more dangerous territory. It takes great discipline to steer clear of HIPAA, state law concerns, and breaches of medical ethics while ‘shooting from the hip.’ Many a blogger has posted something he or she wishes could be pulled back out of the blogosphere. Medical blogging has its own special overlay of concerns, but all bloggers would be well-advised to think for a moment before posting.”

Ethics in medical blogging has been a hot-button issue in the healthcare industry as of late, due in large part to the attention that has been drawn to medical blogs as a result of one physician’s conduct during a highly publicized malpractice trial. MDNG contributor Fard Johnmar in July wrote about the trial of Robert P. Lindeman, MD, who found himself in a bit of hot water after being discovered as “Flea,” his online persona, who had been blogging about the trial in less-than-complimentary ways.

In the end, Lindeman chose wisely in settling his case out of court, as the contents of his posts were sure to have irritated members of the jury, amongst others. He also gave up his blog following the trial, which triggered a chain reaction in scaring off several other physicians.

This has led to “growing pains” for the medical blogosphere, as Maragarita Bauza puts it in her June 11 Detroit Free Press article, which can be viewed via the popular medical blog site, KevinMD. In Bauza’s estimation, the origin of medical blogging began “six to eight years ago with a handful of physicians offering perspectives on medical news,” and now amounts to “between 500 and 1,000 blogs.” Bauza points out that not everything written in these blogs is black and white medical advice; many of these blogs rely on a combination of news about recent scientific developments, comical observations on the patient-doctor relationship, and, in some cases, even “frank and disparaging observations” of patient encounters to attract visitors.

Thus begins the debate about whether medical blogging should be more carefully policed—having a moral standard and ethical code by which it can be monitored. Cue the Health On the Net’s (HON) Code of Conduct for medical and health websites, and the recently compiled Health Care Blogger Code of Ethics (HCBE), which has been garnering much attention on the Web in the last month or so, popping up in articles and blogs everywhere.

David Harlow, former president and current chairman of the Metropolitan Boston Emergency Medical Services Council, and founder of The Harlow Group, LLC, has recently touched upon the issue of these ethical codes on his health care/law blog appropriately titled HealthBlawg. In regards to the Health Care Blogger Code of Ethics (HCBE), Harlow writes, “Truth is, I’m not sure there’s a need to reinvent the wheel. HON’s code, for example, includes the HCBE principles and is similarly free and self-enforcing (or, rather, community-enforced). It also clearly requires an up-front assessment, which HCBE hasn’t clearly committed to requiring.”

When asked to elaborate on what he perceived to be the differences between the two sets of codes, Harlow stated, “The [two codes] are reasonable and consistent with each other. Third-party certification, a la HON, may be overkill for bloggers, but the question of the moment is whether it is reasonable to expect self-policing (or peer-policing, a la the bloggers code) to work in the blogging space, especially among anonymous bloggers.”

So the question remains: should physician bloggers, including those who anonymously post, be required to meet certain standards in their postings, just as they are required to meet certain standards within their practice? If so, who becomes the upholder of these ethical guidelines? As Johnmar appropriately warns in his article, no matter what additional legal and ethical issues arise in the world of medical blogging, “doctors thinking of starting blogs or currently maintaining them should understand and investigate the impact of blogging on their careers and reputation.” Sound advice for those waiting for the medical blogosphere to get through its “growing pains.”