02 May 2010

Advice to bloggers

Young people are not at all cautious when it comes to posting things about themselves on the web. People as old as Dr Grumble seem more wary and more aware of the risks. But even Dr Grumble has made mistakes. After all it is only relatively recently and very late in life that he started blogging. We all have to learn and if there is nobody to teach you you will get things wrong. At the request of the Angry Medic, Dr G has cut and pasted a comment he made in reply to The Girl which he hopes other bloggers or prospective bloggers may find useful. Here it is totally unmodified (apart from a link):

If you blog on things that actually have happened recently people will work out who you are and when you start blogging you fail to realise how hard you must work to keep your identity secret. There is no end to the number of ways you might inadvertently reveal yourself. Only recently I found my real name in some of the html code as a result of dragging and dropping from my desk top. If your identity has got out or partly got out that can be quite healthy because you are then more careful about what you say. But then you are always holding back which limits the vibrancy of your writing.

Crippen's real strength was that he was not afraid to touch a raw nerve and did not hold back. He often said what I thought but would never dare write - even anonymously. Some of these things were about extremely important issues such as the folly of turning nurses into doctors without sending them to medical school. I tend to skate around such issues. It is not good having issues that are too sensitive to talk about.

There some issues that are just too much trouble. Attacks on certain patient groups are much too hot for me to handle and a public approach in a blog seems somehow not right and unprofessional. I have a post in my head (where it will stay) about the only two patients in decades of work who have walked out of a consultation with me. Both had the same condition and in both I hadn't got beyond thorough history taking focussing on exactly what they noticed wrong before they decided that I wasn't the right sort of doctor for them. There is a small group of patients who will not deal with a doctors who cannot be speedily manipulated. The trouble though is that you cannot help a patient who won't engage. The alternative approach is to play along which is also no solution for that particular sort of patient. That's as far as I am going to go on that one.

I have been quite properly accused of filtering my opinion. You must always avoid any criticism of your immediate employer (Christian Jago, known to me as Potentilla, pointed that out to me). You can criticise health care as a whole but it is unwise to focus on your own hospital. Even criticising the NHS purchaser/provider divide can risk trouble because there can be powerful local vested interests or you may be seen as 'not committed'.

You are right that blogs do go through phases. When you start out you do not think your blog will be found or read. As a result your guard is down and there is even the temptation (and I have seen this in other blogs) to give little clues about who you are. In my very first post (now offline) I described my family and dog and that was enough to be recognised by people who work with Mrs Grumble. I don't know how my students identified me.

Expressing your views frankly does involve causing offence. Have you noticed that politicians tend to be very thick skinned? Crippen's bog was characterised by robust replies. People get particularly angry when you have rumbled them or when they don't really have arguments that stack up against yours. That's only something I have come to realise quite recently. People who are right when you are wrong or partly wrong put their argument for you to consider. They don't need to be angry.

You take a risk if you criticise things such as infection control which is very much a motherhood and apple pie thing. No member of the public will be sympathetic and certainly not employers. You will see that Dr Grumble's post on this particular topic states very clearly that he fully complies with all the regulations and the post itself is essentially innocuous, boring even. But somehow the raw nerve was still hit because there were over 30 comments. I am sure Crippen would have done it better but, as he said to me privately, his position was safer than mine.


The Angry Medic said...

Thanks for the plug Dr G! This is - as I thought it would be - a great post.

Also, I was kidding when I asked you to get a neighbour to write your blog - I didn't think you'd ACTUALLY go and do it!

Fuddled Medic said...

If you figure out who I am due to logical reasoning or even which medical school I go to, then drop me an email and let me know

The Girl said...

It is great advice.

Dr Grumble said...

The other thing is that you must not tell a soul. Never even mention you have a blog. And be very careful when you log in to websites that there is no evidence on that site of your real identity. I made a comment once and the name Dr Grumble came up with my home town alongside it. Clever things computers.

Once the cat is out of the bag it is difficult to set up again and appear to be completely different. Bloggers are easily recognised from their writing styles.

Belle de Jour was spotted as having a similar style to that of Brooke Magnanti.

Dr Da Vinci said...

Hi Dr Grumble, was extremely flattered that you read some of my blog. Have been a HUGE fan of yours for years!

It's very good advice, although of course my blog isn't anonymous and it's pretty easy to find out who I am as it doubles as my company blog.

I no longer work for the NHS or anyone for that matter, so I pretty much say what I like although I agree I don't have the balls to take on the patient groups like Dr Crippen. What a veteran!

Northern Doctor said...

All very good advice indeed. I decided early doors that it was probably almost always possible to work out who a blogger is and I think everyone should bear that in mind.

I started anonymously and quickly gave it up as I was concerned it was providing me with false reassurance.

I also think it is good advice to stay away from specific patient contacts. It's just a disaster and I cringe when I see it done - even with the 'names and facts have been changed to protect identity' statement. It would be great if it could be done as it is such a rich source and the temptation is great. One just has to make the effort to pick out the wider issues from the narrow focus of a consultation.

Some GPs on Twitter scare me rigid with their comments just after a patient has left the room. They can be quite disparaging and I feel it is only a matter of time before the GMC haul someone over the coals. Most likely it won't be a primary issue - but it could easily be an additional factor in some GMC case in the near future.

Dr Grumble said...

I agree that real patients presented in a blog are just not on. My original plan was to post clinical vignettes but I soon realised that changing names, ages, times and sex just didn't work well enough to disguise the patient. As you say, Northern Doctor, it is a real shame.