Wednesday, October 08, 2008

So Now What?

Given the events of late, there are questions I have to address, the biggest of which only I can answer: should I continue this blog? Certainly from an economic standpoint to date, this blog has been more of a liability than an asset. So now I have to be realistic and really ask myself, why continue?

I’m not sure. There are many arguments to support blogging as a physician: marketing yourself or your practice, advertising and making a buck, education (both for yourself or your patients), working with an online community of like-minded souls, or creating an online presence getting your voice heard on a national and international level. It all sounds so great, doesn’t it? I mean, I had it all figured out when I started! (Not.)

But blogging, as I’ve found, also exposes one to malicious verbal attacks and subpoenas. As such, it is risky. There is no question that placing one’s online self in the world for all to see adds vulnerability and potential liability. When I told a colleague Friday about my recent predicament he responded, “Why the hell would anyone want to blog?”

Good question.

I hope my experience makes every physician consider this question carefully.

But perhaps the question is not as simple as that. Perhaps physicians who choose to blog should ask ourselves how best we should maintain our increasingly economically important online presence while minimizing our risk to do so. In that vein, what rules for commenting should physicians impose? Should only anonymous commenters be restricted? What would that do to the quality and content of information discussed? Should all comments be reviewed before publishing them, risking the perception of censorship? Or should a blog be pulled underground, accessible only by registration? Should one blog anonymously or non-anonymously? How important are these blogs, really, to patients? All I know is that patients have found me repeatedly because of my online presence, but I have to question if the vitriol demonstrated by a few makes it worth it.

I’d appreciate the blog-o-sphere’s suggestions and commentary. I am certain that what is here will stay in its current form. But as I move forward to my next iteration, whatever that might be, it’d be helpful to hear your thoughts – even from anonymous commenters, although now, unfortunately, comments will be reviewed before posting.

-Wes

49 comments:

beadnik said...

Dr. Wes, I think your blog is a wonderful example of quality medical blogging. I always look forward to the EKG's Du Jour, which are mostly above my level of understanding but always a learning experience and I value your tales of patients and your viewpoints on political and social issues. That being said, it's YOUR blog and if you want to censor comments, why not? Also, a registered readership is a not unreasonable tack to take, but what about new readers? Where would they come from? I suppose it all comes down to your particular risk tolerance. Thanks for the fascinating ride so far!
(I'm an LPN of 26 years, IV and ACLS certified, working in small town ER (or ED if you like), and follow many medical blogs. As far as I'm concerned, yours ranks among the best.)

The Lunchlady said...

Wes,
Love your blog and hope one crackpot won't scare you into quitting. I have no problem providing my real name and real email address when commenting on other blogs. Maybe this could be part of your new blog commenting policy? The Blog Herald has a good article that you may find helpful: http://www.blogherald.com/2008/06/02/nasty-blog-comments-human-nature-on-blogs/. Also, do you have enough info to RDNS the IP address and notify the abuse team of the commentor's ISP?

For the record, I am: Sherry Scurlock
Email: sherry@scurlocksystems.com

Static Mom said...
This comment has been removed by the author.
Anonymous said...

Well you're gonna have to do something you fucking money grubbing cunt aren't you? You sure are motherfucker! Thankyou for DOING AS I COMMANDED and turning comment moderation on. The thing to remember about that is, I don't get thwarted in any way by you turning it on... I am satisfied that you are reading this, so I still got to you, and I got to you in a big fucking way. Next time, instead of being an arrogant ignorant white coat mafia cunt maybe you'll talk to the 'little people' and offer them what they fucking ask for. If I chose to, give up my time, I could infiltrate and annoy the shit out of you no matter what changes you make to your blog.

I have means of proxying my ID details to any nation state in the world.

You've been targeted specifically because of something you did. Believe me. It would have taken a couple of seconds out of your day to avoid crossing me. This isn't an attack, it's a retaliation.

I'm satisfied you read this. And this is the price you fuckin pay.

emmy said...

Dear Dr. Wes:
When I started blogging in 1998 I was in the middle of a nasty divorce and it was a place to vent my emotions where my teenage children wouldn't catch the brunt of them. Since then I have blogged about my son's tours in Iraq, my diagnosis and treatment of breast cancer; my return back to corporate America afterward and my experiences as a patient with many health issues. I blog mainly because it keeps me sane. Blogging has also shown itself useful in my family as a method for us to communicate with each other with a world of distance between us. I started reading medical blogs because I was having trouble communicating with my doctors and understanding the assumptions they seem to base a lot of their oppinions on. Things such as, if I go into the emergency room and hand them the Arizona CERTS list, why they immediately decide I must be seeking drugs. I like your blog because you actually would know why it may be important to give a copy of the Arizona CERTS list to an emergency room doctor. Your blog is interesting and informative. I enjoy reading it and I hope that it would serve some valuable purpose for you. It is extremely unfortunate that there are vicious and opportunistic people out there who seem not to understand the intent of blogging and are making the exercise a dangerous thing for you and others. I would selfishly hope that you would stand firm and exercise the freedom you should have to write here. I certainly understand why that idea is less appealing to you. Whatever you decide, I wish you the best with it.

Jared At The Doctor Job said...

in case you missed it, Buckeye Surgeon had a post very similar to yours three days ago and tries to answer some of those questions.

http://ohiosurgery.blogspot.com/2008/10/on-disclosure.html

I, for one, hope you keep writing!

The Happy Hospitalist said...

Screw you. Just kidding. Great blog. Do what you think is right for you.

Happy

DrWes said...

I appologize for offending the sensitivites of those who read this blog when I decided to publish the comments of the anonymous poster at 12:18, but I offer it for all to review and understand the vitriol underway. If for no other reason, it's illustrative.

I may be wrong, but I have no doubts this relates to the issues related to my post of 6 Oct 2008.

The Happy Hospitalist said...

Natural selection has failed us, just this once.

Anonymous said...

Sounds like a schoolboy sitting on a public high school library computor who has just learned a bunch of big new words that he overuses for effect. Run along now little boy back to math class grade 9 and let the grownups talk about the real world :).

Shauna said...

Dr. Wes,
As a patient I enjoy reading medical blogs. As a person I enjoy reading personal takes on medical issues from the people on the front lines.

I hope you keep blogging even with the idiots out there.

S.

Selena Horner said...

Sad that the 2% create issues for the 98% of us.

As you are contemplating, Dr. Wes, this was a site I found that seemed helpful a few months ago. http://www.cybertriallawyer.com/technologylawyer

A few physical therapists had cease and desist letters sent to them due to what was posted as a topic on a blog and the comments generated. A Pennsylvania attorney also posted on a forum and on the same blog the "threat" to these individuals. Unlike you, the physical therapists didn't choose to fight the complaint. I'm sure it came down to legal costs.

It's too bad you are put into the existing predicament.

Anonymous said...

Dr. Wes,
I truly appreciate your blog. I have learned a lot from it and would hate to see it gone.
You educate with your EKG postings and case presentations. Your insightful commentary on current events in the cardiology field is greatly appreciated. I've even found many useful links to current guidelines that you've posted. (I still search for the Circ article re: abx prophy on your blog cuz I know I can find it there :-).
If you restricted it to registered guests then that would be okay.
I feel that I need to stay quasi anonymous given my employer as I don't want anything to be misconstrued as being representative of my employer.
IMO yours is one of the best all around blogs for clinical/cardiac info.
Many thanks for what you do and my sympathies for your recent foray into the legal system.
CardioNP

emmy said...

Well, it does seem like anonymous is upset by something. To bad he is too much of a juvenile to communicate with you on an adult level. What did you do, cut him off in traffic or something?

lostonthefloor said...

Doc,
Whatever you do, please don't pack and leave. Your blog has been a great source of both entertainment and education (love the EKG Du Jours...they've made me read EKGs better!). Like someone else commented above, it's YOUR blog and you can run it how YOU want. If that means reviewing comments, not allowing anonymous comments, or even needing usernames and passwords to even view the articles it is your decision.

I'm sorry that you've been drug through the mud and had to pause to reflect on where your writing should go. Sure, we don't know the details of the situation, but based on your writing and history, I would expect nothing but honor and responsibility in the way you deal with the public.

Carry on.

rlbates said...

Just want to add my support on the side that I hope you remain and continue to write. You would be truely missed. Take care.

Allen said...

Dood, you have to stay! Trolls need target, and as long as you're out there I'm relatively safe.

Seriously, you're one of the best medbloggers, with actual content.

Sorry some moron is mad at you. Don't quit, then the moron wins, and the rest of us morons enjoy your writing!

GruntDoc

Anonymous said...

Oh, Dr. Wes. I am so sorry to hear about all of this. I am not alone in treasuring your blog. I truly value your insights and appreciate you sharing your wisdom and perspectives. You help and educate more people than you may realize. But I also completely understand how you feel. Been there many times. I doubt most people realize the enormous costs to one's career and livelihood that blogging can take. The internet, and the healthcare industry, can be surprisingly cut throat, especially to anyone who speaks out and stands up for patients and the profession, just as you do. Having experienced 300+ vile commenters and threats a day, I've had to simply turn off comments and not give the nuts a platform as they feed off of it. Of course, that won't stop whatever interests you cross from resorting to other nasty internet attacks, and they can do some incredible and icky tricks, but it might be one option to consider.

Why blog? Except for those selling stuff, the only reason for medical professionals to blog is because they want to help people. And you do, each and every day.

I personally hope you'll continue to blog, but will understand and support you in whatever decision you need to make.
Sandy

LISA EMRICH said...

Dr. Wes,

I will echo Shauna's comments. As a patient (not with any cardiac issues), I benefit from reading your opinions on health, science and policy.

Thank you for sharing a bit of yourself with the medical blogosphere.

Lisa

SteveC said...

Hi, Doc!

I'm Steve, 42, born with Tricuspid Atresia, and love reading your blog! I hope you decide to keep it up, but considering that post at 12:18, I would understand if you wanted to retire your typewriter.

Thanks for all you do;

Steve

Marco said...

I greatly appreciate your blog for all your stories and wise insights. I'm very sorry to hear that you're being harassed by these cowardly losers. But, such folks will always be with us - I remember a funny story where our swim club worked the phones at one of those televised pledge nights for our local TV stations. As the evening wore on, we'ed get obscene phone calls!

Please, please don't quit blogging! I hope that you will find an incarnation that works for you. Perhaps making it by subscription-only, or at least filtering comments before posting would help.

Thanks for all your good posts,
Marco

Rob said...

I am with you as well. Reading your material, I find it hard to understand why you would be attacked so badly. Yes, you are critical, but not nasty at all.

I suspect this is just a storm to weather until they get bored and find somewhere else to infest. Think of it as a toddler throwing a tantrum. What's the thing they want? Attention. Don't give it to them and they will stop.

You would be sorely missed.

Anonymous said...

Just want to add my support Wes. If someone wants to get at you it won't matter if you blog or not. Sorry you're having to go through it though. Ian.

Anonymous said...

Wes.
I could tell you exactly how to avoid the pesky little interruptions brought on by the less than genuine members of the legal class - you could legally and quite easily continue on with you blogging hobby and render the notion of being subpoenaed or deposed so implausible and counter-productive that most attorneys would simply walk away. But, I believe you will find what you seek in Sun Tzu - Art of War. Hit them where they are most vulnerable and force them to wage war on your terms. Don't pursue them and war on their terms. You will always lose. Rather, commandeer their resources and exploit them. He who has the best intelligence of his opponent and the wisdom of how best to use it will always prevail. Lawyers exploit the convoluted nature of the battle field they themselves created. Why fight in a place where you know nothing?

Anonymous said...

I read your blog everyday and love it. Where will I go now?

TBTAM said...

Add my vote to the "Keep on blogging" column. Your blog is shining example of the very best that medical blogging can be. Honest, informative, interesting, warm, well-written, always timely. Don't quit blogging - we need your voice.

But I say take back control of the conversation. Minimize your legal exposure by moderating comments. Allow the conversation, but control the tone and tenor of the discourse.

After all, it's your party.

http://theblogthatatemanhattan.blogspot.com/2008/10/every-blog-needs-bouncer.html

Jay said...

Wes,

No good deed goes unpunished.

I just want you to know that you have my support and encouragement. I hope you're able to keep this up. I've enjoyed this thoroughly. I'm sure you do what is right and necessary.

I have to say though, that losing Fake Steve Jobs AND Dr. Wes in the same year might be more than I can handle.

Jay

Anonymous said...

Wes,

An article for you which will help explain some of your rights and responsibilities as a blogger:

http://www.nydailynews.com/opinions/2008/10/08/2008-10-08_bloggers_must_learn_a_new_world_order_to-2.html

That's a nutshell, and more info is needed, but it's a good start.

keckardt13 said...

Goodness, there is some hate going on there! I am sorry you are going through this. I hope you stay, if only to show that hate cannot spoil what we enjoy.
Knowledge is power and that my friend is what you spread, lots and lots of power to everyone who takes the time to read it.

saf said...

"How important are these blogs, really, to patients?"

I'm a patient. Not one of yours, just a layperson who has found herself lost in medworld and went looking for useful insight. And I found it, in a number of blogs.

I appreciate many of the medblogs I have found - they've helped me feel better about my decisions, and about the folks that I have entrusted my life to. (Orthopedic surgeons and endocrinologists, mostly.) I've learned much about those who I find myself relying so heavily upon.

I am grateful to all of you who chose to share in this way. I truly am.

Bruce said...

We are all pulling for you and hope that you can continue sharing your stories and insights.

Zoe Brain said...

I run a blog that deals with Space Science, Software, some Politics, and also with Transgender issues.

The latter can get very contentious.

But I've had nothing that compares with the incoherent and psychotic (and I mean that in the literal sense) ranting you gave an example of. In 5 years I've deleted only 2 comments, and they were disguised spam.

You have my sympathies, but I'm at a loss to explain why you're plagued with venomous trolls.

Enrico said...

Dr Wes,
From a longtime lurker (I've commented a fingerful of times, I think) all I can say is you gotta stay in the game if you have something to say. And the fact that Mr Numbnutz above is so rankled means that there is a message that makes a difference, even if it's to addle less stable minds while enlightening the vast majority of ours.

As long as you write, you WILL have an appreciative audience, and I really, really think this one individual is not representative of any meaningful statistic (ie, more blogging will not lead to more), just one unhinged person with an axe to grind. He'll find another tree to bark at eventually.

Jen said...

Another vote for the "keep on blogging" side.

As a long-time reader of both autism and medical blogs, I think that I would be tempted to disallow anonymous postings unless there is a very good reason for people to post anonymously (mental health issues, children etc). At least in the autism world, it's generally "Anonymous" who comes to a blog, spews hatred, and then leaves. If people are not brave enough to put their name (or online identity) to a comment then I'm not sure that they should be part of a conversation- at least that would be my take if I was posting something controversial.

Good luck to you, and I hope that everything works out so that you are comfortable remaining. I think that medical blogs do a very good job of showing patients not only the "human" side of doctors, but explaining a bit about what it's like to be on the "other side".

Kim said...

I vote for you to keep blogging. Just moderate the comments - if someone wants to be "anonymous", that's fine unless the post is full of vile language or threats. You aren't obligated to air those types of comments.

Debates will still go on and people may disagree, but the conversation will be civil.

stevewhitemd1@mac.com said...

I'm a physician and moderate a blog (not medical, focused on the WoT). I can tell you that it's the 1 to 2% of commenters who make life difficult for everyone else. Most everyone respects the rules and plays nicely. But those who don't coarsen and cheapen the commentary, and that over time works to bring down the blog.

My advice: no anonymous commentary. If I had my way (and I don't :-) I wouldn't even allow nyms. I'd make everyone blog under his/her own name. Funny how being known by what you write tends to change what one writes.

As it stands, requiring a nym and tying that to the posting IP goes a fair ways to fixing the problem as demonstrated by your anonymous 12:18 pm poster.

And when that doesn't work at our blog, we ban. That means you have to screen your comments, and if you have a lot of comments it ends up taking up more time than you'd like. That's one reason why I work with a group blog (we have eight moderators and we all stay busy). But banning offensive commenters by banning their IP usually fixes the problem.

More importantly, it makes clear to other commenters that you have standards and that you won't allow others to denigrate your blog and your writing. I think that's a powerful message.

Blogspot has some tools available to you and you might check into it. But for sure I'd ban anonymous commentary. Just a thought, and good luck.

Artemis said...

I agree with the majority of comments above - you do a great job, and I find it appalling that one individual feels the need to sully your site with his vitriol. As I've told you in the past, I've always admired your willingness to identify yourself in the blogosphere.

While you'll be sorely missed if you close up shop, I understand the exhaustion and frustration you must face after reading the example you left.

A

Karin, RN said...

Dr. Wes, it's my first time on your blog. It is easy to say but my thought is this: an anonymous commenter attacking you is just trying to manipulate you for whatever reason. For fun comes to my mind but I may be wrong.

I hope peace for anonymous.

Please don't get bothered by this, Dr. Wes.

(Or you can both waste your time-- with anonymous posting angry comments and, you letting him get through you). I hope not because you have a great blog going here.

God bless to everybody who still believe.

Anonymous said...

The contagion has spread:

http://aebrain.blogspot.com/2008/10/little-boxes.html

Zoe Brain said...

Looks like I spoke too soon... the same guy whose incoherent rants you put on display just migrated to my blog.

The commentariat there are trying - not very hard - to not be entertained by him. You know, how people would visit Bedlam to laugh at the loonies? Same thing.

He needs help, not laughter though. To state the obvious.

Also, I have some practice in dealing with rabid opposition. I don't have 5ARD or 17BHDD, but something comparable. One of the more spectacular and socially embarrassing medical oddities.

Please keep blogging. We need some sanity and medical knowledge out there.

Christian Sinclair, MD said...

Wes,

You have a great blog here. I appreciate you sharing this with the medical blogging community as iot gives us all pause for self-reflection. I post on some pretty contentious issues (life and death, palliative care) and dealing with comments has been nowhere near what you have gone through but still given our team blog some heartburn.

Keep up the good work (and thanks for the link the other day)

DrWes said...

Thanks for the tremendous outpouring of support and advice (legal and otherwise) offered both here and by e-mail.

Zoe Brain said...

Hi Doctor W!

"Yosemite Sam" as we've named this anonymous poster is really quite harmless, and doesn't mess the place up too much with scatalogical obscenity.

The more OTT he is, the more rational you appear. He adds to your credibility. Now you may not have a credibility problem, but TS and IS people certainly do. Thank You Jerry Springer. Not.

Lurkers can soon see who's sane, and who isn't. Apart from the fact that he's need of some serious professional anger-management therapy, not a laughing matter, it's best to consider him harmlessly entertaining.

Anonymous said...

Dr. Wes, please don't let some psychotic knuckle-dragger stop you from blogging if you want to continue. (Your readers would *like* to see you keep blogging, though!) Jerks like that just prove that the gene pool could use some chlorine, and that some people shouldn't be allowed out in public without a keeper.....

Keep up the good work, Doc!

Todd said...

I am a patient (again, not one of yours) and a medical student, and I find medical blogs invaluable from both perspectives. I agree with many of the posters here: Don't hang it up. Obviously there are obstacles, and all kinds of ethical, privacy, and other issues to juggle, but I think it's worth it. We can't let freedom of speech and the exchange of ideas be hijacked by some nutjob (that's a medical term we learned in week one of med school :). After all, he clearly values HIS freedom of speech enough to take the time and energy to hack your blog and hide his identity. At least you have the courage to attach your name to what you write.
By the way, he sounds like an ICD-9 -CM 301.22

SeaSpray said...

Dr Wes - I am sorry those things happened. Shame on them.

You have have a great blog here and no doubt have blessed many readers with what you write.

Don't quit when your down...quit when you're ahead. I say that because if you go out now because of them...then they win.

Goodness will prevail.

In the end...do what's best for you... but don't do it because of the few rotten apples in the bunch.

You have a quality blog. :)

SeaSpray said...

Also since you don't have comments open on your post about the elderly couple...I just want to tell you I enjoyed it and was also encouraged and inspired that in our 80s we can still look forward to these things. How sweet! :) It made me laugh too. :)

Ummm... I am one of THOSE patients with the "just one more thing" at the end of the visit. Actually... I am that way with everyone. Someone joked once that my epitaph could say "Just one more thing..."

:)

P.S. I am going to link that post.

Teresa said...

Just proves the free speech is not really free in this country.

I'm sorry for your troubles. I've learned a lot from medical blogs, but at what cost to the bloggers? I'm probably a better patient for having read these blogs, but that helps my own doctors, who don't blog, rather than the bloggers.

Jobbing Doctor said...

Dear Wes,

Personally I think that blogging is one of the great liberators of the professional in the 21st Century when faced with increasingly intrusive statist intervention (both in USA and UK).

I am recent to blogging and try to anonymise important but less relevant detail without distorting the essential message.

This debate is also going on in the UK, I remain anonymous although around 30 people know who I am.