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Medical Bloggers Enjoy Pluses, Avoid Perils

In the past, the path to publication in the medical profession has involved exhaustive research and peer review. Now medical bloggers can do it with a few mouse clicks.
 
Blogs are online journals written by anyone about any subject, and there are millions of them. They can be set up at no cost and allow anyone to publish their thoughts on the Internet to be read worldwide or by only themselves. Some are highly informative, and some are profane rants. And slowly but increasingly, medical practitioners are beginning to produce them.
 
According to Tara Lagu, MD, an assistant professor at Tufts University School of Medicine and the first author of an article on the subject published in the Journal of General Internal Medicine last year, the medical profession has not responded quickly enough to this emerging reality.
 
In a 2006 study whose results were published in the article, Lagu and her co-authors reviewed 271 blogs written by physicians and nurses. Among their findings: More than half of the bloggers either identified themselves or provided enough information that would reveal their identities, and 45 of them included enough information that patients could identify themselves or their doctors. Patients were portrayed negatively in 48 of the blogs. Most surprising: Of the 31 bloggers they found that included advertisements, none included a conflict of interest statement.
 
At the grassroots level, two codes of conduct – the Health on the Net Foundation and the Healthcare Bloggers Code of Ethics – have arisen in which bloggers can be certified that they adhere to standards of professionalism, accountability and privacy. However, Lagu said that beginning bloggers may not be connected to those networks and may not intuitively understand how to apply professional standards to their posts. According to Lagu, blogging can be a valuable tool for medical providers to share information and can allow them to shed their white coats and reveal a little of their humanity. She hopes to see medical societies and medical schools address concerns of privacy and professionalism without attempting to govern the blogosphere. "Nobody wants the blog police," she said.
 
Medical News of Arkansas spoke to or corresponded through email with four active Arkansas medical bloggers –R.W. Donnell, MD, a hospitalist in Rogers who publishes "Notes from Dr. RW" at doctorrw.blogspot.com; Elizabeth Schneider, MD, a Baptist Health pathologist in Little Rock who publishes "Methodical Madness" at www.gizabethshyder.blogspot.com; Ramona Bates, MD, a plastic surgeon in Little Rock who publishes "Suture for a Living" at rlbatesmd.blogspot.com; and Victoria Powell, RN, a nurse consultant in Benton who publishes a blog on her Web site, www.vp-medical.com.
 
They write about a variety of topics. Donnell's and Powell's are almost always healthcare-related. Most of Bates's posts are also healthcare-related, but on Fridays she writes about her quilting hobby. Schneider's is the most likely to focus on nonprofessional topics.
 
They started writing for different reasons and use their blogs in diverse ways.
 
– Donnell started his blog in July 2005 after stumbling upon blogs by other medical practitioners. Deciding he could do it as well, he clicked on blogger.com, a site that helps writers easily create blogs. "Ten minutes later I was hooked," he wrote in an email.
 
– Bates was a regular blog reader who was interested in the well-known case of a physician blogger, "Flea," who revealed details about a patient's death during a malpractice case – revelations that the plaintiff's attorney then used against him. Unwilling to simply leave comments on others' blogs, Bates decided to start her own. She also thought it would enable her to disseminate good medical information for her patients, encourage her to research various issues, and teach her about current technology. "There were multi reasons for starting it, some of them maybe grandiose, and I'm not sure if I've lived up to them, but I've tried," said the 52-year-old surgeon. "And I certainly have learned a lot."
 
– Schneider, who won some creative writing contests in high school, started writing on election day 2008 after 10 years in the exacting world of medicine. Dubbed "Lizzie of the Long E-mails" by one friend, she wrote in an email that it was a way for her to release some creative energies after a day of "looking through a microscope and diagnosing tissue all day long."
 
– Powell, a trained nurse who is a full-time consultant, started her blog in October 2007 to complement and ultimately to be incorporated into her Web site. Blogging enables her to educate readers about healthcare issues she cares about while helping market her services. "It allows me a commercial opportunity without shouting from the rooftop, 'Hey, look what I can do,'" she said.
 
Three of the four clearly identify themselves either in the blog or in the domain name. Only Schneider's maintains a hint of anonymity by slightly altering her name in the blog title, but she wrote in an email that it's pointless to try very hard to hide who she is. "I don't think anything you put on the Internet is really anonymous," she wrote. "Everyone who reads it knows who I am, and I take measures to protect the info I should."
 
None accept advertising on their site. However, Bates is a member of Better Health, a network of blogs that selects certain posts from its members for online publication, accepts advertising, and shares profits with members – which she clearly discloses on her blog.
 
To keep from running afoul of patient privacy laws, neither Donnell nor Powell write about specific patients at all. Schneider changes names and fictionalizes characters, particularly patients, by exaggerating characteristics and combining multiple experiences into one. Bates usually changes enough details or writes in general enough terms that patients could not be identified, although for one post she did obtain a waiver.
 
The four say they have received numerous benefits from blogging. Bates, a solo practitioner, said she has made friends from around the world, some of whom she plans to meet at the Blog World Expo in Las Vegas in October.
 
Donnell said it helps him keep his reading current on clinical medical topics and public policy issues. "If others benefit from what I post, that's a bonus," he wrote in an email. "I don't have a big enough audience now to have any influence on public issues I'm passionate about, but I can dream."
 
Schneider, who initially feared she would be too obsessive and self-critical, has found blogging to be "like a safe zone" and has enjoyed writing articles for fun.
 
Powell said, "It allows me to put my voice out there and teach, which is what I really like to do, and hopefully somebody enjoys it."
 
The four are having an impact without trying particularly hard to market themselves. Sometimes it's personal, as when Schneider wrote posts to entertain her brother after he underwent surgery. And sometimes it's professional. Bates said the comments section of some of her posts have turned into virtual patient forums, and one post about inverted nipples surprised her in how popular it became. "I would never have guessed that that would have been such a concern, but apparently a lot of people go looking for it, and they end up on my blog, and I don't know what to say about that," she said. "That's not one I would have found most interesting. If somebody asked me what my top 10 favorites were, that's not one that would have ever been in the top 10. But it is for the patients."
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