Welcome to the blogosphere: A brave new world of Web dialogue

A growing number of physicians are sharing their thoughts and opinions on online diaries known as Web logs, or blogs.

By Bob Cook, AMNews staff. April 28, 2003.

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Thursday, April 3, 2003

The subject at hand, blogs, is going to be unfamiliar to most of you. But more of your physician colleagues are creating them, so I figured it might be worthwhile to inform you about what a blog is, and who is doing them and why.

Here's a short definition: Blog is short for Web log, which is a term for an Internet diary or journal. A blog is a Web site, but it's a particular kind of Web site: one that is more active and interactive than other Web sites, with the writer, or writers, behind it updating content frequently, and inviting instant feedback. Thanks to the advent of free services, starting up a blog can be as easy as filling out a registration form online.

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Blogs tend to be a first-person account of whatever is going on in the writer's life or in the writer's head. If you have a blog, you can write about daily mundanity such as eating a cheese sandwich and link to a picture or an interesting article you found about cheese sandwiches.

Or, as your colleagues are doing, you can focus on a particular topic of interest. There are no restrictions as to what you write about and link to -- a big function of blogs is to compile links to stories and sites that pique the writer's interest. In at least one case, blogs are being used as a key tool in a project to improve the treatment of chronic disease.

I am writing this in blog style to give you a feel for how blogs look and read, although with the restrictions of print, I can't add links, nor can I put a link after each dated entry that gives you the opportunity to post a comment that would appear in conjunction with the blog itself.

Anyway, I will now share some stories, in descending order of date, of physicians who have entered the world known as the "blogosphere."

Posted by Bob Cook 4/3/03 12:01p.m.       Back to top.

Tuesday, April 1, 2003

It's tough to say who the first physician-blogger was, but it's safe to say Penny Marchetti, MD, a Stowe, Ohio, family physician, was one of the early adopters, starting her Medpundit blog in February 2002.

She was inspired by a blog called Instapundit, founded in 2001 by University of Tennessee law professor Glenn Reynolds, and another blog written by former New Republic editor Andrew Sullivan. Both are widely acknowledged kings of the bloggers thanks to their early adoption and their massive, for the blog world, popularity -- each site gets thousands upon thousands of visits per day.

When reading those blogs, Dr. Marchetti said she "started to think, there's nothing like that for medicine, that takes the news stories you read out and interprets them or gives an opinion about them. That's why I started [Medpundit]. I linked it to my practice site, which doesn't get much traffic. I just thought of providing an interpretation [of medical news] for my patients."

It turned out her patients didn't click through very often. But Dr. Marchetti does have an audience of 400 visitors per day, a mix of physicians and nonphysicians. Traffic has been up thanks to interest in SARS, the flu-like sensation that's sweeping many nations and is a hot topic in many physician blogs. Dr. Marchetti has linked to, and commented on, numerous articles about the subject, from the high-minded New England Journal of Medicine to the lowbrow, drive-in humor of Joe Bob Briggs.

Dr. Marchetti posts most of her content in the morning or squeezes it between rounds and office hours.

"It gets harder to do it every day now that I'm doing it for a year, [but] I guess if it got so it was hard to do, I would stop doing it," Dr. Marchetti says. "It kind of keeps me from ranting at home."

By the way, if you've seen Medpundit, you've probably never seen the name of Penny Marchetti, MD -- she writes under the pseudonym of Sydney Smith.

"The biggest thing that I didn't want my patients to make assumptions about I how feel about them based on what I've written," Dr. Marchetti said. "Like I'm pretty harsh on alternative medicine. I wouldn't want my patients to cover up the fact they're using it. The same thing with abortion -- I write about that. I'm definitely against abortion, but I wouldn't bring my politics in the exam room. I don't want a patient who's had complications from an abortion not saying that she's had one." Dr. Marchetti's partner in her practice doesn't even know about her blog. "It just never comes up," she says.

Posted by Bob Cook 4/1/03 12:11p.m.       Back to top.

Thursday, March 27, 2003

Like many physician bloggers, Bob Centor, MD, says researching and writing every day for his blog makes him more aware of news and clinical advances than he would be otherwise.

Dr. Centor's employer, the University of Alabama School of Medicine in Birmingham, believes his blog, DB's Medical Rants, would have the same effect on other doctors -- it offers one-quarter CME credit for reading it.

Dr. Centor, a professor and associate dean at UAB, has written his blog for about a year. DB refers to his golfing nickname, "Da Boss." Dr. Centor likes how having a blog makes it easy for him to pass on information.

"Like today, I found an article about the time it takes to do prevention," Dr. Centor says. "As a generalist and an internist, I'm disgusted with reimbursement in format and in money. This gives me a chance to talk about that."

Dr. Centor says blogging costs him a few hundred dollars a year in online fees, along with the hour or so per day he spends writing. Even though the cost isn't great, Dr. Centor, who estimates his site gets 1,000 visitors per week -- up to half of them nonphysicians -- is not sure he would recommend blogging for every physician.

"I haven't shown my students how to do this," he said. "I don't know who should blog. You have to have a fairly regular time each day you're going to do it. It's about discipline. And you need to make sure you have something to say that's interesting to you. It's like musicians saying they create what they like, rather than what they think an audience wants."

Posted by Bob Cook 3/27/03 2:34p.m.       Back to top.

Wednesday, March 26, 2003

In some way, a blog would seem to be an easy way to get information out to patients.

Craig Bradley, MD, of Nagodoches, Texas, used a blog to inform his patients about procedures for the closing of his solo family practice in February. Dr. Bradley, now working in an urgent care clinic at a local hospital, has another blog, Kill as Few Patients as Possible, aimed at a general audience.

But few physicians target their blog specifically to their patients.

"With patients it's hard -- a practice could use it to communicate to patients, like when doctors gave a lot of preventive medical advice and updates on use of estrogen and menopause when they found out there were lots of side effects and lots of people were calling them," says Richard Winters, MD, an emergency physician in Fresno, Calif., who has been blogging for two years. "A blog could be useful to communicate with patients and tell them what they think they should do."

However -- and physician bloggers really hate to be this way -- there's a worry that steering patients to a blog could come back to haunt physicians.

"There's a fear of someone using your Web log in a malpractice case or using it in the wrong way," Dr. Winters says. "There are censorship issues you think of."

As of yet, there have been no prominent cases involving liability and blogs that anyone in and around the blogosphere has heard of. But some experts say what physician bloggers should worry more about are issues of libel and privacy.

Sandra Baron, an attorney and director of the Media Law Resource Center in New York, says physicians should be OK blogging as long as they don't state information as fact that they know to be false, or that they were negligent in checking out.

"The law makes every publisher liable for everything they publish, and that includes [links from] third parties," Baron says. "This isn't like chatting with a neighbor over the back fence."

As to HIPAA, Dallas attorney Jeffrey Drummond -- who writes a blog devoted to the subject -- says its rules apply to blogs as they do everything else. Physicians cannot give out information that would identify a patient -- name, Social Security number, e-mail address, pictures. It also may be a good idea to take other precautions when blogging about an individual patient visit, something that happens from time to time in the physician blogosphere.

"For example, you can talk about somebody who had a liver transplant," Drummond says. "But if you talk about a baseball player who had a liver transplant in Dallas, Texas, that makes it pretty clear who you're talking about" -- in this case, the late Mickey Mantle.

Posted by Bob Cook 3/26/03 2:36p.m.       Back to top.

Wednesday, March 26, 2003

In Whatcom County, Wash., Marcus Pierson, MD, has an ambitious plan for blogs. In his mind, they can be an essential part of revolutionizing the delivery of care for chronic diseases.

Dr. Pierson's hospital, St. Joseph Hospital in Bellingham, Wash., is part of the Pursuing Perfection project, backed with $1.9 million from the Robert Wood Johnson Foundation. The project, which is administered with the assistance of the Boston-based Institute for Healthcare Improvement at various sites nationwide, tries to find ways to involve the whole community -- physician, hospital, patients and payers -- in improving the health care system.

"When you become a thinker about any business, including health care, the boundaries are completely porous -- the system of health care involves everybody," says Dr. Pierson, vice president of medical information and process improvement at St. Joseph, part of the PeaceHealth hospital system. "You need a medium to communicate that is not constrained by the typical organizational boundaries."

So it was decided the easiest way to do this was through blogs. Dr. Pierson has his own blog, and 25 others involved in the project -- along with patients -- have one as well, and more could be added.

"You try to have a technology to change the culture and a community by being open and telling stories ... [and] to be able to get innovators in health care to get a place where we can work together across organizational lines."

Posted by Bob Cook 3/26/03 10:16a.m.       Back to top.

Wednesday, March 19, 2003

Chris Rangel, MD, a hospitalist in Dallas, is six days away from his first anniversary as a blogger.

"We don't know where this thing is going to lead to," the internist says. "A lot of people have talked about blogging being the new media. Blogging to me is like amateur media. It's like creating your own e-zine. There's no proofreaders, there's no editors, and you have to take some blogs in stride with how accurate their information is. Me, I mostly get info from the Internet and my own practice.

"Most medical blogs are accurate and well-written. It doesn't mean other sites may be slanted. You really have to take stuff in stride."

Posted by Bob Cook 3/19/13 11:07a.m.       Back to top.

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