A Nice Way of Saying….
As you can see from the comments when you read the linked post on the blog "ER Stories - Shocking, Hilarious, Bizarre, and Sad Tales from the Emergency Room", it struck a nerve with the Cushie community. Frankly, I'm appalled that these so-called professionals talk this way openly on the web. I read quite a few posts. If I were one of their patients, I'd be suing the socks off of them. And I've never sued anyone.
Where does one draw the line with medical blogging? Is this a violation of HIPAA? Will other medical professionals condone this or condemn it? It's a gray area and one I'm afraid will become an issue if blogs like this continue. I am not for regulation of blogging, medical or otherwise. In my rose-colored world, professionals are professional in all aspects of life, including their blogging. But I am of the firm opinion this is unprofessional and inappropriate.
Physician, heal thyself.
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FYI, if you want to read some ER doctor/nurse blogs which I think are good blogging:
http://edwinleap.com/blog/
http://gruntdoc.com/
http://www.emergiblog.com/
http://www.impactednurse.com/
http://edwinleap.com/blog/
http://gruntdoc.com/
http://www.emergiblog.com/
http://www.impactednurse.com/
At the very beginning of the hippocratic oath -- do no harm.
ReplyDeleteCan you imagine the emotional distress of the doctor's patients if they knew that their medical needs were the fodder of global derision because of the postings of the very doctor from whom they sought help??
Shouldn't one be able to go to the ER without having the specifics of one's penile fracture be made the butt of a worldwide joke??? The doc complains of TMI -- the whole blog is TMI. Do we need to ask our doc if they have a blog before getting treated so that we can make sure that our personal pains don't get broadcasted -- do we need to make them sign a contract not to try to profit by exposing us to ridicule before we even beging to discuss our symptoms?
I've been thinking. Maybe it's an ER doctor thing. How many of us haven't had a bad ER experience? Is the ER the last stop before doctors get booted out of the profession?
ReplyDeleteThis doctor, and his or her colleagues who comment, are despicable.
In reading this Doctors blog, I was shocked and disappointed by the callous posts and comments left by health care professionals in which we entrust our lives.
ReplyDeleteI don't think making fun of obesity is particularly professional of a Doctor. Especially since obesity can be caused by Endocrine and Hormonal disturbances that are beyond the control of the patient.
I can almost excuse a lament for such atrocities, but a medical Doctor? In a public blog no less? Inexcusable
Thanks for the kind reference to my blog. I think it's certainly a fine line. Lots of emergency physicians are angry, frustrated and overwhelmed. But they shouldn't make cruel references to their patients, and they shouldn't do anything that makes them recognizable. However, sometimes a story bears telling; so one needs to change details a bit. I like the saying 'It may be that the entire purpose of your life was to serve as a warning to others!' Honestly, if you worked in a busy emergency department, you'd understand what I mean.
ReplyDeleteI find it intriguing that we live in a culture with almost no boundaries in terms of what is appropriate. Facebook and MySpace are forums where people reveal enormously intimate details; and they're mild. Granted, they choose to do it themselves. Television is rife with 'reality' in which humans degrade themselves most foully. The Internet contains untold amounts of personal pornography posted by individuals who are showcasing themselves for the world.
Perhaps a generation or two of physicians have simply been desensitized to boundaries. Maybe they're simply following the culture. I don't excuse their behavior by saying so, but it may be a factor.
Of course, the other thing is what I mentioned above; they're frustrated and overwhelmed. You have to remember that emergency physicians operate under a law called EMTALA, or the Emergency Medical Treatment and Active Labor Act. This law says no one can be compelled to pay, or show proof of payment, prior to care. That's a great idea on the surface, and when it was enacted it was necessary. But like so many laws, it has grown ridiculously large, and has resulted in emergency departments being overwhelmed by patients who often know that they can't be forced to pay, and coming anyway for even the most inane reasons.
Imagine if everyone, in their work, could be compelled to do their job at all hours, for anyone who came through the door, with no promise of payment and no end in sight. Remember that most docs are paid by what they collect, not by the hospitals where they work.
What if they mechanic could never turn anyone away, but couldn't expect payment. Or the computer programmer, advertiser, realtor or contractor. They'd probably write bitter blogs.
Still, I agree with your premise. We needn't be ugly. We can and should write about our struggles; but not with cruelty or bitter invective against our patients.
However, silencing physicians is a dangerous game; physician honesty sometimes contributes to better policies, because it addresses issues from 'the trenches,' where hospital administrators, insurance companies and government functionaries are seldom to be found.
Sincerely,
Edwin Leap, MD
The point is that what a patient says to his or her doctor in a hospital is not the same as a coctail party. Physicians legally bound to behave with decorum and confidentiality so that patients will confide the information that physicians need to know in order to treat their patients. That is not less a "law" than emergency room access and in fact is a much older one. See for example this description of the privilige in a case involving Jersey Shore Medical Center when they permitted television filming on the premises:
ReplyDeleteN.J.S.A. 2A:84A-22.2 provides that any confidential communication between a patient and physician that either the patient or physician "reasonably believed . . . to be necessary or helpful to enable the physician to make a diagnosis of the condition of the patient or to prescribe or render treatment therefore" is privileged. N.J.S.A. 2A:84-22.1 defines a confidential communication between a physician and patient to mean "such information . . . as is transmitted in confidence and by a means which, so far as the patient is aware, discloses the information to no third persons," except those reasonably necessary for the communication between the physician and patient or for medical treatment.*fn3
"This obligation of confidentiality . . . applies not only to physicians but to hospitals as well." Estate of Behringer v. Med. Ctr. at Princeton, 249 N.J. Super. 597, 632 (Law Div. 1991); see also Unick, supra, 107 N.J. Super. at 125 ("While hospital records are not specifically mentioned in the privilege statute . . . it is apparent that these records are encompassed by the privilege.").
"The purpose of the patient-physician privilege is to enable the patient to secure medical services without fear of betrayal and unwarranted embarrassing and detrimental disclosure in court of information which might deter him from revealing his symptoms to a doctor to the detriment of his health." Piller v. Kovarsky, 194 N.J. Super. 392, 396 (Law Div. 1984)
Kinsella v. NYT Television, 887 A.2d 1144, No. A-3308-04T5 (N.J.Super.App.Div. 2005)
In this instance, the doctor/blogger had advertising on the site and was profiting from the unauthorized disclosures of patient information. Nearly every entry discussed in a derogatory fashion, a patient, often graphically, and in a manner to titilate, not educate. I think that any person who knew the name of the institution at which this person practiced would not want to go its ER -- when because they would be afraid that their visit there would be the fodder of an installment, whether slightly altered or not. And that is really the test of when the doc has gone too far -- if you are afraid to put your name to what you write as a physician because you are worried about the consequences, well, that is a warning that you are well over the line.
I do question the "therapeutic" value of the blog as well. The blog works by dehumanizing the patients as objects of scorn. It seems to me that the more the blogger does this, the less likely the blogger is to see what is human, and therefore common, with the people who cross his ER threshhold. The stirring the hate begets more hate, because one cannot help but view each new patient as blog fodder. Gardening would frankly be a much better strategy.
One other comment. I practice a profession as well. In my profession, access to services by the marginalized in society is an issue as well. Virtually every large practice has a dedicated program to provide free services to those in need. The local professional association dues fund referral hotlines for those in need and clinics. Most professionals donate some measurable portion of their time to help those who can't afford help (not reducing fees to existing clients, but actually finding people in need) and they are proud of it. They view it as a badge of being a professional, rather than practicing a trade.
ReplyDeleteWhy does the medical profession seem to be so differnt? Why don't the doctors with the more cozy practices donate 40 hours or more of their time to provide access to medical services to the needy? Pick up a bit of knowlege on addiction practice, so that maybe not so many addicts are showing up in the hospital. Maybe have the local medical society fund some detox centers and staff them -- trust me, that is not a service available in the inner city and I bet that if it were offered to the "drug seeking" annoying patients -- some reasonable percentage would take up the offer. Maybe some of y'all could volunteer to help out at the local, overwhelming ER on weekend nights. To me EMTALA should be viewed as a terrible embarrassment to the medical profession, not a horrible annoyance.
Dr. Leap,I would like to thank you for posting your comments here. As I said in my post, I do not want blogs (medical or otherwise) regulated. I do believe there is a wonderful purpose/use of them for awareness and hopefully, change.
ReplyDeleteBut there is no excuse for certain "behavior" when posting about patients. Many of us are angry, frustrated, and overwhelmed in jobs which we would otherwise love. But two wrongs do not make a right. And yes, there ARE other jobs for which there is work done with little/no compensation. I know it's hard when in the medical profession to see beyond it. But sometimes one needs to expand horizons.
All the above to say the following:
We "Cushies", as patients (and some of us as both patients and medical professionals) realize SOMETHING needs changed. We will benefit from that as well. It would behoove both sides of the equation to work together instead of belittling each other.
There are multiple posts on this blog and on Dr. Rob's blog (distractible.org ) to that end. And I'm sure on other blogs, also. So, I'd like to see us work toward that end, all of us. Animosity does not a good bedfellow make.
Robin