Monday, September 04, 2006

My blog persona and patient confidentiality

Well, it's been about two weeks since I started blogging. I'm still blogging. I guess that means I have the bug, and I am hopefully infected for the long term, rather than transiently.

Thank you to everyone so far who has been reading my blog and leaving comments! I am humbled by the notion that some people actually find what I have to say worth reading. It's not great literature--but hey, one of the reasons why I started to blog is that I figured it would improve my writing.

One issue I am struggling with is that I want to share stories about things that happen in the hospital, but I want to respect patient confidentiality even more. Because I am completely open about who I am in the real world,meeting both of these goals seems near impossible.

I can't really write about specific patient encounters as they happen, because that would make patients readily identifiable. For example, how many patients really come through the Northwestern emergency room with, say, a long QT-interval resulting in Torsade de Pointes (a specific, whimsically named type of arrhythmia)? I can tell you not many. (By the way, if you have, I assure you it is complete coincidence!)

If such a patient did come through the ER, and I blogged about it that day, he or she would be readily identifiable. Maybe if I changed things around enough, the only person who would know would be the patient himself. But I still think that person would feel that their confidentiality was breached-- if not by the letter of the law, then certainly by the spirit. If a patient of mine ever figured out that I was blogging specifically about him or her, I would feel terrible. I strongly feel that a patient's medical story is their business alone, and it is up to them to choose whom to share it with.

But at the same time, I think specific encounters with real people breathe life into stories. These are stories that involve some of the most fundamental experiences a person can have, experiences that transcend culture, experiences that transcend time itself. A family deciding to let a loved one go is something that can be appreciated here or in China. It can be appreciated now, a thousand years ago, or a thousand years from now. I really think these stories with patients are worth writing.

Trouble is, I haven't figured out how. Any suggestions?


Anonymous Moof said...

Dr. Kannan, some bloggers mix up the circumstances, the sexes, ages and living situations of the patients, and some write about things that happened long enough ago, with few enough identifying features to make it impossible for a patient to be recognized.

It's a toughie ...

Have you considered having two blogs? A personal blog ... and an anonymous medical blog?

4:53 PM  
Blogger Dr. A said...

This was a BIG concern of mine when I made the decision to start blogging. I live in a small town, and I knew everybody would figure out who they were if I talked about them in my blog. Then, the HIPPA people would come knocking at my door, and you don't want the Feds interfering your life.

As Moof said, people usually change demographic data and still talk about patients. In a large city that you're in, this would probably be enough. Some people wait to blog about a patient - sometimes a week, sometimes a month. But, I know that the best blogging is right when you're feeling what you're feeling.

The compromise I've come up with is trying to be "anonymous" and talking about patients. And, a second anonymous blog may be the answer for you.

But, when it comes down to it, you're really not that anonymous either. I see that you have site meter, so you can probably figure out where I'm logging in from, just by looking at your stats. But, I do the best that I can to keep under the radar and still talk about patients without compromising patient privacy. Hope this was helpful.

7:04 PM  
Blogger DrWes said...

Moof and Dr. A. are right on. If you choose to write about patient encounters, they have to be camouflaged somehow, be it an encounter long ago (but not forgotten) or through enough of a change in circumstance to make it impossible to tell what really happened. I tend to write in generalizations and avoid the personal. Finding the message about a greater human condition can avoid the personal, yet transcend cultures and still speak to many, just as it seems you hope to do.

What is clear from your writing is that you are articulate and well-versed, so whatever your voice grows to be, will be appreciated by many. Best of luck.

9:08 PM  
Anonymous difficultpt said...

I see you have already received great advice on this, but visit Dr. Charles and read his disclaimer . . .I think it will help you.

As a banker, I tried to start a blog based on all of my experiences, but I couldn't get past the confidentiality issue. Here is one of my posts on another blog:

9:50 PM  
Blogger Kannan said...

Thanks everyone for the great advice. Moof: I have thought of an anonymous blog, but for the reasons Dr. A discusses, I worry that I won't be totally anonymous, and therefore my patients' information will not be totally protected...

Dr. A: I see what you mean about sitemeter. A determined user could figure out a lot from that, maybe on an anonymous site, I wouldn't put sitemeter on it...

Dr. Wes: As always, great advice. Thanks for the good vibes on my blog so far, and thanks for getting me into this wonderful hobby. Thanks also for the great month up in Evanston-- you may make an EP doc out of me yet!

difficultpt: thanks for the links. I haven't checked them out yet (another busy night on call) but I will!

10:06 PM  
Anonymous cathy said...

Dr Kannan, You stated to Dr. A.

" I see what you mean about sitemeter. A determined user could figure out a lot from that, maybe on an anonymous site, I wouldn't put sitemeter on it..."

It doesn't matter if you have sitemeter or not. If the person you visit has sitememter, then they know where you are blogging from. If you had sitemeter right now you could go into the "details" option and see that my IP says I am in a smallish town in Ohio.

In addition to that, many people know who is at their sites just from their IP numbers. So it is possible that someone could tell from an anonymous post that you are actually Dr. Kannan because you and he have the same IP number.

The only way it could truly be anonymous is if you only posted on that blog but never visited or left any comments on anyone elses site. That would be no fun at all.

I think you should just switch details around and make them non recognizable if one of your patients were to find it.

BTW..I added you to my links.

4:51 AM  

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