Doctors Dish on Their Patients in Anonymous Blogs

By Margarita Bauza
Detroit Free Press
Tuesday, March 20, 2007

As Internet blogging spreads across professions, doctors' observations and opinions about patients -- some expressed in graphic detail -- are now ending up on the Web for all to see.

Hundreds of doctors across the country are writing Internet diaries that sometimes include harsh judgments of patients, coarse observations and distinct details of some cases.

Medical blogging is so new that medical boards, schools and professionals disagree on what is acceptable. Critics say the blogs cross into an ethical gray area and threaten patient privacy while posing liability risks for health workers and their employers.

A medical blogger, for example, wrote this in discussing an 18-year-old who on Christmas Day had her third baby:

"I don't mind it so much when a young single woman comes in with her first pregnancy, because anyone can make a mistake. But when that woman gets pregnant repeatedly, time after time, she degrades herself and her children, by condemning herself to a lifetime of dependency and irresponsibility."

The writer, who identifies himself as a neonatologist working in a U.S. urban area, writes about his practice at

The anonymity provided by blogs has proved to be a powerful lure for doctors and other medical professionals, who, sworn to strict rules of confidentiality regarding patients, have few outlets to speak their minds.

Although many bloggers stick to innocuous subjects that don't involve patients, others make patients the focus of their writing. Critics say that's risky.

"One of the fundamental aspects of medicine is that patients have to feel free to tell doctors everything," said David Stern, a physician who teaches professionalism at the University of Michigan Medical School. "They're not going to tell us everything if they're asking themselves when they come in to see their physician, 'Is my doctor going to blog about me?' "

T.J. Bucholz, spokesman for the Michigan Department of Community Health, under which the state's medical licensing board operates, said he thought the "neonataldoc" blog stayed in bounds.

"I don't see a lot of blatant HIPAA violations," Bucholz said, referring to the Health Insurance Portability and Accountability Act of 1996, which established national standards to protect personal health information. "They're using first names . . . but from my perspective, if someone were to identify themselves in this blog, he is looking at very serious charges, not the least of which is losing their license."

Some of the comments posted by "neonataldoc" seem crude. In December, he wrote about defecation during birth and, separately, a 17-year-old who was giving birth in the nude.

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