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Do Physician Blogs Betray Patient Privacy?

Munasque, Angela

doi: 10.1097/01.EEM.0000357574.70825.9d
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Everybody's blogging, it seems. If you're not producing your own blog, you probably at least read someone else's.

Many mainstream media outlets host health blogs, like the Wall StreetJournal, which weighed in on ED crowding and swine flu. Some medical organizations, like the American College of Physicians, run specialty-specific blogs; others rely on individual contributions, like the Health Care Blog, which covers health policy issues.

Individual emergency physicians, too, have taken to the Internet, sometimes revealing insights about their clinical experiences, sometimes posting about life outside the ED. With the physician blogging boom, however, comes criticism that patient privacy is being compromised. A recent University of Pennsylvania study, however, found 16.6 percent of blogs by physicians contained enough information for patients to identify their doctors — or themselves, leaving bloggers and critics to ask, Is blogging the next HIPAA?

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HIPAA and Ethics

As physicians venture into new technological terrain, they'll have to wrangle with issues of privacy, but experts claim there is no need to panic. Physician-written blogs offer many “positive possibilities,” said Tara Lagu, MD, MPH, an assistant professor at Tufts University School of Medicine, who led the Penn blog study as a Robert Wood Johnson clinical scholar. (J Gen Intern Med 2008;23[10]:1642.) Blogs provide a space for “human elements” not always enabled by clinical interactions: the physician's point of view, humor, and the like.

The downside is that bloggers may reveal too much. “The majority of bloggers really are quite professional, respect patient privacy, and set a good standard for what blogging by doctors should look like,” Dr. Lagu said. “Then there are these occasional individuals who may be entering the realm of invading patient privacy.”

Few instances of overt privacy violations were found by the study, and researchers said bloggers who reveal too many details about geography or subspecialty are running into trouble. For rural doctors or specialists, this could be a particular concern.

But the danger of violating patient confidentiality when keeping a blog isn't news to many physicians. “In my observation, physicians are very careful to be protective” of patient information when blogging, said David Kibbe, MD, MBA, a senior advisor to the American Academy of Family Physician's Center for Health Information Technology.

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A blogging doctor, for example, may describe a patient who is 35, female, with a rash and a fever, but omit information regarding where she lives, he said. “That information is not necessary.”

Dr. Kibbe, who contributes to the Health Care Blog, likened these blog entries to case studies in academic journals or specialty newspapers. “You're talking about a new form of publication essentially,” he said, of blogging, online forums, and social networking sites. To that end, he suggested doctors participating in these newer media be “just as careful in protecting the privacy of their patients as they would be if they were writing for the New England Journal of Medicine.”

Allen Roberts, MD, an emergency physician at Texas Health Fort Worth who writes the award-winning Grunt Doc blog, said he blogs less frequently about patient encounters than when he began in 2002. Writing on the Internet doesn't exempt physicians from the Health Insurance Portability and Accountability Act (HIPAA), he noted.

“Just because you're on the Internet doesn't mean you're exempt from HIPAA,” Dr. Roberts said. “Just because it's okay under HIPAA doesn't necessarily mean it's ethical to blog about some patient interactions.”

Dr. Roberts adheres to the Healthcare Blogger Code of Ethics, which stresses patient confidentiality and professional courtesy. Not only does he exercise prudence when writing about individuals, he said every medical blogger he reads goes to great lengths to protect patients.

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Why Bother?

If it's so much trouble to blog about a day in the life of an emergency physician, then why bother? For Dr. Roberts, the answer is simple: “For fun.” He writes about whatever strikes his fancy, whether ranting about some medical policy or musing about something in aviation — he was previously a physician for the U.S. Marine Corps.

He views himself as a “doctor with a blog,” rather than a medical blogger. “If nobody read it, I'd still do it,” he said. “It shocks me that anyone other than my mom reads it. It's just cheap entertainment for me, and when it's not entertaining anymore, I'm going to quit it.”

For other physicians, blogs provide a necessary outlet for open discussion. “Blogging is probably one of the last hopes for free speech,” said Edwin Leap, MD, an emergency physician at Oconee Memorial Hospital in Seneca, SC, who writes a column for EMN and his own blog. “It's a great place for physicians to talk about frustrations, about troubles, and talk about them honestly.”

His concern is that physicians who express dissenting opinions on hospital policy will be quieted by their employers — or even lose their jobs. “I'm aghast that physicians who are generally important parts of the operation of a hospital should be told ‘hush up or move on’” when it comes to voicing an unpopular opinion on patient satisfaction surveys or protocol for drug users, for example.

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But Dr. Leap said blogging isn't a free-for-all. He also ascribes to the Healthcare Blogger Code of Ethics, and uses old-fashioned good sense to guide him. “You have to think about it this way: Do you want to be sued or not?” he said. “If you don't really care, then say whatever you want to say, however you want to say it, about whomever, but you'll go to court, and you'll lose money or prestige.”

Some may be concerned over a 2007 Texas lawsuit against an anonymous blogger and nine anonymous blog commentators filed by Essent Healthcare, which claimed the blogger defamed its hospital, Paris (TX) Regional Medical Center, resulting in financial losses. The appellate court ruled in favor of the blogger and commentators, but it serves as a reminder for the threat of legal action.

It's not all negative from Dr. Leap's viewpoint. Smart practices, he said, will use web sites and blogs to market themselves by listing available services, patient volume, and physician training. Knowledge comforts patients, and because there are many Internet-savvy retirees in his community, online information about local medical facilities benefits patients and the physicians who gain their business.

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Future Directions

To navigate this new terrain of medical blogging, Dr. Lagu recommended guidelines by professional societies and training in medical school, not more formal policing. “I certainly don't think we need regulations, which is what people really get scared about,” she said.

With patients flocking to the Internet, doctors don't have much choice in adapting to new media platforms that include Facebook, Wikipedia, and Twitter, but also electronic medical records and online patient groups, said Dr. Kibbe. The Journal of Participatory Medicine, a new publication, will try to answer the question of how physicians can learn to be comfortable with these new activities.

“Physicians can't just turn their backs on a revolution in communications that involves all sorts of new behavior among their patient population,” he said.

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© 2009 Lippincott Williams & Wilkins, Inc.