Medical Blogs: Who are They Good For?:My Answer on AMA News

There are a host of medical blogs on this internet blogosphere and a question one may reasonably ask is "Who are they good for?" Well, I was asked to provide my answer by the staff of the American Medical Association News, a publication which is said to be read by over 200,000 physicians. I did so and it was published in the Ethics Forum column of the September 1 2008 edition. I think that medical blogs can provide important education to the public but also to the physicians themselves. My multiple threads on patient modesty along with other patient concerns issues should awaken physicians to these patient issues and hopefully the patient concerns can be effectively mitigated.

Here is the link to the ethics column containing my writing but which also includes another article, the description of what the Healthcare Blogger Code of Ethics is and why it was needed, as written by one of its authors, Rob Lamberts, M.D. The link to AMA News, currently is available, however since after 90 days the link may no longer be available to non-AMA members, I have been given permission by AMA News to publish my entire article on my blog. Write here any general comments pertinent to this thread particularly regarding educating physicians about the needs and concerns of patients but return to the most recent Patient Modesty Volume to write about the patient modesty issue itself. ..Maurice.

Scenario: Can physician-written blogs meet legal and ethical professionalism standards?

Many medical blogs are anonymous and unedited, few contain reference sources for their authors' statements, and most are open to comments from patients. With these limitations on oversight and reliability, can medical blogs offer genuine benefits to the public and the profession?

Response:

Medical blogs can provide two benefits for the public. They can offer timely and accurate medical information as a supplement to what is available through other media. Perhaps more importantly, they enable members of the public -- often patients -- to express concerns about their health care experiences and to receive feedback from the bloggers and visitors who read their comments.

Writers to the blog can express their concerns fully because they are allowed to remain anonymous. Although many blog visitors comment on experiences they have had or anticipate having with their physician or physician's staff, most of them have not shared what they write about with their physicians, and, for their part, physicians rarely give patients the opportunity to talk about such matters.

There is no doubt that a lack of time and real and imagined power differences between physicians and patients, among other factors, contribute to inadequate communication. Medical blogs help compensate for the poor communication -- the anonymity, time and space to ask and say whatever one wants and the availability of immediate responses to one's comments make medical blogs a means of much-needed ventilation for many.

As an example of the role of medical blogs in the discussion of patient concerns, I'll tell you about my "Bioethics Discussion Blog," which, since 2004, has developed 600 topics related to the medical system, medical professionalism, medical education and ethics.

The most popular topic among visitors to my blog has been concern over violations of patient modesty. I have been aware of the importance of respecting patient modesty throughout my 50 years of internal medicine practice and never ignored it during many years of teaching the skills of physical examination to students. Only after reading more than 1,000 comments by visitors to my blog, however, did I become fully aware of the extent and magnitude of patient concern and distress.

Unfortunately, quantitative statistical analysis of blog responses is probably not realistic, but one can easily appreciate the qualitative aspects and nuances of patient concern for modesty. There are questions about respect for both unconscious and conscious patients during surgery, office procedures and physical examinations.

Visitors ask specifically how well the modesty interests of unconscious patients are respected in the operating room. What is the gender of the attendants who perform the surgical preps? What parts of the body must be exposed? Must genitals be exposed? What opportunities do patients have to express their concerns prior to surgery, and will their wishes be honored in the operating room?

In office procedures and examinations of genitalia, can the patient request that only attendants of his or her sex be present? Will that request be honored? The argument over right to choose the gender of physicians, nurses and technicians always arises. Most people feel that women are granted that right but men are not. Male visitors to the blog state that physicians either ignore their requests with seeming surprise or simply turn them down with an economic excuse or a "take it or leave it" attitude.

My visitors also have found that hospitals are generally uninterested or unable to change policies and employment practices to accommodate respect for patient modesty. Those who can't find a resolution for their modesty concerns write about postponing or disregarding necessary procedures or examinations.

Though my blog visitors are not my patients, and quantitative statistics are absent, I believe their concerns deserve professional and institutional attention. I tell them that, although ventilating on the blogosphere may be emotionally therapeutic, they may need to become more active in bringing about the changes they desire, and I encourage them to do so. At present, writers on the blog are discussing how to present their concerns to their doctors and hospital administrations. I have suggested they form groups of like-minded patients to advocate with those who can help change what they view as violations of their modesty. I think that my contribution of such advice is a legal, ethical -- and humanistic -- response. For professionals who moderate medical blogs, offering appropriate advice goes a step beyond merely providing discussion space.

Medical blogs, moderated with attention to civil and open discussion among the visitors and following guidelines for ethical operations, make a significant contribution to the medical education of the public and, I dare say, the profession.

--Maurice Bernstein, MD, assistant clinical professor of medicine, Keck School of Medicine, University of Southern California, Los Angeles; blogger, "Bioethics Discussion Blog" (bioethicsdiscussion.blogspot.com)