Medical Blogs Can Help Promote Practices, Health Businesses

Medical blogs are emerging as the public face of health care, but bloggers should be aware that patient confidentiality rules still apply, according to authors of the first US study to look at medical blogs and patient privacy.

With more doctors and nurses becoming medical bloggers, researchers have identified a need for universities and professional organisations to provide instruction and guidance on how to blog in a way that maintains professional and ethical standards.

In the new study, the research team headed by the University of Pennsylvania’s Dr Tara Lagu looked at the burgeoning area of medical blogs to see if patient privacy was being respected.

Previous research into medical blogs has tended to focus on the benefits of blogs providing health information. The new study, recently published in the Journal of Internal Medicine, examined medical blogs and looked at how often blog authors commented on patients, violated patient privacy or displayed a lack of professionalism by not revealing conflicts of interest.

The team defined weblogs, or blogs, as a journal-style website with entries posted over time. With an estimated 70 million blogs on different topics and a worldwide average of 120,000 new blogs created every day, identifying all blogs created by health professional was an impossible task.

However, the team was able to identify a substantial medical blogging community from blog content. Medical blogs were defined as a web-based first-person narrative with some medical content.

Medical blogs authored by physicians and nurses can offer helpful health information and insight into their profession. However, medical bloggers also share their stories, knowledge and experiences by reporting personal experiences and clinical interactions.

While doctors and nurses spend their working day freely discussing patients’ conditions and care, it was health professionals sharing their private thoughts in a public forum that motivated Dr Lagu’s team to focus on medical blogging and patient privacy.

Finding medical blogs

To find the medical blogs, the researchers conducted a “medical blog” Google search which identified a number of blog aggregators, or websites that display many blog sites on the one page. Of 1434 medical blogs located, 271 were written by a doctor or nurse, had health related content and had at least one entry during 2006. Five content samples were taken from each blog.

“One of the more difficult decisions we made was deciding how to sample the blogs,” said Dr Lagu.

“Most medical blogs are not immediately revealed by a Google search, but Google search did reveal that there is a blogging community. The most popular blogs within this community are connected to each other and to medical blog aggregators. By following the links from these popular blogs, we were able to identify many blogs within the community.”

Patient privacy

Of the 271 medical blogs analysed, researchers found 56.8% contained enough information to reveal the supposedly anonymous author’s identity. Bloggers included personal information about themselves such as their location, subspecialty and other personal details.

In relation to patients:
# 16.6% of blogs described interactions with individual patients;
# 15.9% of blogs described patients in a positive light and 17.7% in a negative light; and
# 6.6% of blogs included positive and negative patient descriptions.

Researchers found that obvious violations of patient privacy by medical bloggers were rare. There were some cases where patients described in medical blogs may have been able to identify themselves from the information online. For example, recognisable photos of patients were included on three blogs with one describing the patient with links to photos.

Despite a higher percentage of negative patient comments in the blogs, Dr Lagu is a supporter of benefits of medical blogging.

“Health professionals face a lot of challenges,” she said.

“The health care climate in the United States – declining reimbursement and increasing demands on time – has made it more and more difficult, especially in maintaining good relationships with patients.

“A new medium that allows us to communicate directly with patients is a great opportunity to improve these relationships. Blogs can help educate patients and can connect geographically isolated health professionals.”

Professional ethics

Keeping in mind that medical bloggers can be considered part of the public face of health care, 50.6% of blogs commented on the medical profession and the health care system, with topics including insurance, malpractice and end-of-life decision making, while 30% of blogs had negative comments about the health profession.

In terms of medical ethics, the researchers found that some blogs allowed advertising and some promoted health care products. Of the 11% of bloggers that promoted health care products in their text, none followed the medical ethics standards by providing information on conflicts of interest. There was also no information on whether payment was received for product promotion.

As the researchers pointed out in their discussion, “medical blogs are public documents written in a diary style typically used for private thoughts”. The growing popularity of medical blogs means they are now part of the public face of medicine and part of the medical literature landscape. However, unlike traditional forums such as peer-reviewed journals, medical blogs do not have inbuilt checks and balances to ensure standards of content and professional decorum.

New rules needed

While medical blogging is an emerging area of the health care scene, Dr Lagu’s research has highlighted the need for educational institutions and professional organisations to prepare practitioners for health care online.

“I think that some bloggers do confuse the internet, which is a public space, with private spaces,” she said.

“In some of the most troubling cases, blogs display a sort of ‘locker room talk’.

“The profession has to develop universal standards that can then be taught in medical schools and made available to members of professional societies.”

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