Sunday, June 05, 2005

Confidentiality and Blogging

An article came out today on the LA Times website (and tomorrow in print) about doctor blogs, and this site was one of those mentioned. Perhaps that's why you're reading this now. During the interview with the reporter, she asked me if any of my patient knew about my blog. I said that I didn't know. Then she asked me if I would want to tell them about my blog. I didn't know what to say. It never occurred to me that any of my patients would want to read it.

My original intent when I started writing this was to tell other physicians and physicians-to-be what it was like to start a solo practice. I hoped that it might encourage some physicians who might be considering it, but felt apprehensive because of all the unknowns. That is how I felt when I made the decision to "leap" into solo private practice. Along the way, I happened to write about some of my experiences with patients (since it's hard to write about being a doctor without mentioning patients at least once).

From the beginning, I made sure never to put down anybody's name or any other "Protected Health Information", as stipulated by HIPAA. I am very careful to keep things vague enough so people cannot be identified. However, I realized, if any patient reads some of my entries, they might be able to recognize themselves. How would they feel about that? How would I feel if my doctor/lawyer/auto mechanic wrote about me and posted it on the internet? I think many of us enjoy reading stories about other people, but not about ourselves.

Other physician blogs, such as Shrinkette and The Examining Room of Dr. Charles have grappled with the issue of patient confidentiality, too. Some medical blog authors remain anonymous, probably for the same reason: to maintain as much confidentiality as possible.

In reading back over my past entries, I notice that I didn't start writing about patients until a few months ago. Prior to this, I mostly found articles pertaining to being a solo physician and commenting on them. I think this is because initially I didn't have that many patients, while lately I've had more people come to see me and consequently, more topics to write about.

I think it is unreasonable for a doctor to NEVER be able to write about their experiences. If that were so, then stories such as "The Use of Force" by William Carlos Williams could never have been written. But a physician's writings needs to be balanced with respect for patients' privacy. I guess I feel it is acceptable to share experiences about others as long as they cannot be identified. I believe that knowing what happens in a doctor's office can be educational for both doctors and patients. There is precedence for this in the medical literature in the case report, which presents an anonymous patient's usually enigmatic ailment and details the winding path that ultimately leads to the actual diagnosis. They can be thought of as a medical detective story with clues littered all over the place, and it is a test of one's diagnostic skills.

So after thinking about this for a while, I have come up with these thoughts:
1) In my professional life, the health and privacy of my patients come first.
2) I intend to continue writing my blog, but I will go even further to anonymize and remove any identifiable patient information.
3) If any of my patients recognize themselves in an entry and want any mention of them removed, then I will remove it.
4) I will amend my privacy notice to inform patients that I have a weblog and may write about them, but only anonymously with all identifying information removed. I think this is the fair thing to do, and what I would want my physician to do.

I hope that this blog inspires other physicians, residents and medical students to consider a solo career in primary care. It is not for everybody, but I believe it can be very rewarding for those who want a more personal interaction with their patients, and have the desire to control their own destiny. It can be wildly wonderful or extremely frustrating to be a solo family doctor. Most of the time, it's somewhere in between.

I also hope that non-physicians find this blog an enlightening view behind the scenes of a small town doctor's practice, and see that doctors are human, too.

And if any of my patients do happen to read this, I hope that you enjoy whatever you find here. And if not, I hope that you'll accept my apology if you feel that your privacy has not been honored. This is, after all, the work of a human and prone to (hopefully) infrequent errors and occasional truths.