Saturday, October 09, 2010

nonymous

Hey everyone, thanks for all the feedback on the last entry! Lots of good questions and issues, please keep contributing in the comments section if you're inclined. I might as well explain the background a little bit first, because I see no reason not to--at worst, nothing will come from it but it'll provide some interesting topics for future blog posts at least.

A few weeks ago, I got an e-mail from John at Glass Hospital (and an internist at the University of Chicago) who was interested in submitting a proposal for a panel discussion about the role of blogging in medicine at the Iowa Writer's Workshop's annual conference on "Writing and the Art of Medicine." I thought that sounded fun. So we (along with a third medical blogger--I'll not put his name here yet because I'm not sure that he's officially signed on though I hope he will) are working on putting together an abstract to submit. All credit to John who has done most of the research and who has written the first draft of the abstract. I just wanted to see what people would want to hear us talk about if we were to be lucky enough to be invited to present. (Also, I love corn. Corn is Iowa, right? Potatoes? No, wait, that's Idaho, Iowa is corn, definitely corn--I remember that from watching "The West Wing." You know, ethanol, government subsidies, Josh Lyman and whatnot. Sorry, I know a lot about certain things, but social studies is not one of them.)

I'll save some of the topics for later, especially in the event that we actually get to do this panel, but I want to address one thing, and that is the fact that I blog under my real name.

I started blogging way, way before the internet was the pervasive a social media force as it is now. And I started blogging under my real name because it never occurred to me not to. I think I really thought that the majority of people who would be reading my blog would be people I knew in real life, along with a random sprinkling of perverts or weirdos, because who the hell would read the blog of an unknown medical student except for people who somehow felt coerced into it? Obviously this was naive, but this was ten years ago, remember. We didn't know any better.

It's hard for me to say if I would have started blogging un-anonymously (nonymously?) if I started my blog now, in the age of the so-called "blogosphere" and Facebook and YouTube--but the truth is that by the time I realized that people were actually reading this thing, it was kind of too late. Short of shutting down this blog and starting a new pseudonymous one, there was no way to make people un-know who I was. And let's be clear here, that sounds way overly dramatic--I'm not a big-name blogger by any means, nor have I ever really tried to be. (I figured the more people that read this blog the more likely I would be to get in trouble, so I never really did all the blog-promote-y things like networking with other bloggers or linking to this that or the other guy or being super-active in other online venues. I just wanted to share my experiences as a medical student and, later, as a resident. If people wanted to read, fine. If people didn't read--also fine.) But anyway, I started my blog under my own name, and that's how I stayed.

That said, even if I could go back in time and could make the choice again, I don't think that I would blog anonymously. Obviously now it's more convenient for book promotion, but even that aside, I prefer to be out in the open about my life and my blog. I think it keeps you honest. And I think it holds you accountable for what you write. I've seen way too much "anonymous" action out on the internet, and though it is occasionally for good reason (for blogging in medicine I particularly understand the concerns), I've seen way too much craven sniping bullshit to want to be a faceless figure myself. What I put on my blog I want to be able to say to anyone to their face. I don't want anonymity to be an excuse or an alibi for any bad behavior that in which I'd be inclined to indulge--and believe me, I have inclinations towards plenty.

But obviously, blogging "out in the open" produces more restrictions on what I feel comfortable writing about. All of these restrictions are self-imposed. I don't talk about the fact that I have a blog unless people ask me directly (it's not a secret, I just don't want to be the dork blaring to people to OMG READ MY BLOG YOU GUYS!!!!) but I am totally open about the fact that I have one. If patients Google my name, my blog is the first (and second, and third, and fourth) link that pops up. As such, I feel the need to be accountable to my content as well. Long-term readers might notice that for the past, oh, at least five years, I haven't really talked about very much specific in terms of clinical content. Not much about specific patients or specific cases, and certainly any individual stories have been either significantly veiled or at least temporally displaced enough that it would be very difficult to identify anyone in specific. That's just my responsibility, and that's not negotiable.

I have been recognized, but believe me, it's not as glamourous as it sounds, nor is it a common thing. I've been recognized at the hospital, recognized at the supermarket, recognized heaving Cal in his stroller up the subway steps. But it's not a big thing. Usually it boils down to someone asking me, "Don't you write a blog?" or "Didn't you do those comics?" and me acknowledging. And then we move on. Sometimes people e-mail me that they recognized me on the street (this was more common in New York, where people actually walked on the street) but were too embarrassed to come up to me and say hi. You should not be embarrassed. I should be embarrassed, because I have scrub hat-head and am yelling at Mack to stop eating rocks. But you should say hi. (Hi!)

The people in my residency and the people at my current job are well aware that I write online. This has never been a problem for anyone, but I like to think that I have made sure that I write in such a way that no one should be able to have a problem with what I present online. I am well aware that I am representing not just myself, but the practice of medicine, my institution, and my colleagues. As such I hold myself to the same standards that I do at work. Discretion, honesty, and restraint where called for. I hope I've succeeded. I guess you guys will tell me if I fail.

When it comes to blogging about my family, this is well-tread territory for in the "mommy blogger" realm, so I'm not going to rehash too much, but I do talk about my kids and I do post pictures of them, despite what some (in my opinion, the more hysterical amongst us) warn me that this means people are going to kidnap and sodomize my children. Partially this is because my blog is part public, and part personal documentation--I like looking back on old entries, especially about my own kids, look at the pictures, and see how much all of us have changed. And partially, it's all coming back to the honesty piece again. I know that a good portion of people who read this blog are in medicine, and I feel a responsibility to represent my perspective on what it's like to balance a career in medicine and a family. Sometimes it's cute and fun, and sometimes it's tiring and difficult, and I want people to know that, or at least know one perspective.

So anyway, blogging in medicine. It's a big topic, and I'm sure it's only going to get bigger. I would love to hear your thoughts.

25 comments:

  1. I started my blog as a fashion blog about a month before I was accepted into medical school, and was doubting that I would even BE accepted. The 2 had nothing to do with each other. But because I was still waiting to get accepted, I did it mainly anonymously, going just by Cate. And now I'm semi-anonymous because I don't want my classmates to know that I blog- I think they'd think the outfit of the day part of it was weird, and because even though I don't write about specific patients, just general experiences in medicine and medical school, the patient privacy thing is on my mind. I also don't want residency program directors to google me in a year and half and have my blog come up. I don't ever write anything bad, but I definitely say things that depending on your politics you may disagree with.
    I read a bunch of clothing blogs, but my favorites are the med student and physician blogs.
    I was glad to hear your book would be available for kindle, by the way :)

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  2. It is Iowa that has the corn. I've biked across twice on two different occasions in two different directions and everywhere I went there was corn. For the record I enjoyed it thoroughly each time.

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  3. Anonymous11:08 PM

    It's been super interesting for me (as a resident) to be able to look back in your blog and see you evolve from med student to resident to attending. Thanks for your transparency!!

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  4. Very well said!
    I would own up to my blog if someone directly asked if it were mine, but at any other rate it's just sheerly to avoid implications.
    It's just my space to vent, recollect and to share experiences and thoughts with others. I'd hope that maybe someone else considering medical school would network, other student nurses, some nurses.
    I think medical blogs in particular also help me to learn about different health care providers. As Doctor Grumpy says - he could be a mongolian yak herder for all I know, but he does bring up legit points that I otherwise, wouldn't have thought of.

    Reading the pharmacy blogs has definitely changed my perception of their job and not that I wasn't nice before reading them, but I am surely very mindful of demands of their job and BS they have to put up with. I at least try to smile more around them and hopefully I'll be the one person out of their workday who treated them like a human being.

    I really like your blog and your writing style. I skimmed back through your med school years for insight into what it was like. I totally admire your ability to go through your professional education, maintain a marriage and have a family... and manage to maintain a blog.. and seem to pull it together like Kelly Ripa on those electrolux commericals. It all appears so well orchestrated.

    Almost daily during my down time I skim through the blogs on my bookmarks and it gives me a giggle and I enjoy it.

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  5. Goodness, where do I begin. Firstly, I found your blog around the time Mack was born and have been a reader since. From my perspective as a mother (my son is only a month older than Mack), the spouse of a medical student, and a future medical student myself, I'm thankful for your willingness to share and honesty about your life under the various hats you wear. Reading some of your archived posts, yes even your very first one way back when, I think you're doing a brilliantly splendid job in many regards.

    This is sorely belated, but congratulations on your book! It's obviously going to be a a perfect read for me and my career and family plans. :)

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  6. I started blogging about 6 years ago, and though I used our real first names and general information, I didn't use our last name. And I also avoided making it easy for The Creeps to know which house we lived in, for example (as a flight attendant I'm away frequently). But four years ago I quit that blog and started up anonymously, thinking that I'd be able to keep it a secret from certain people.

    I was successful for 2 years, but eventually they found me again. I decided to not start over, but it kind of took the wind out of my sails for a bit. Blogging today days means that no matter how clever you think you may be, or how anonymous, if you're going to be at ALL interesting, you'll eventually give away enough details that someone who wants to can find you. I don't think there's any such thing as anonymity online.

    I've loved reading your blog and comics for all these years as it gave me a peek into what my DH was about to experience as he quit his job teaching medical school, and jumped in to become an MD himself. It's helped me mentally to prepare for the grueling schedule, high stress and incessant demands that the process of becoming a physician entails. I've been able to be more supportive as a wife, and more sensitive to his situation because I have walked through the years vicariously through your blog, as well as a few other medical blogs I read.

    As a non-medical person (well, unless someone goes into cardiac on the plane. and you could argue that every mom does "medicine" from time to time, too.), I really enjoy the way you write. All of your topics are written so nicely for even the layperson. I'm looking forward to reading the book (after I give it to my Doc!) ♥

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  7. I started blogging when I was working full time at a time when I was feeling frustrated about my work. Blogging was an outlet for me to vent & write my thoughts down, much like how I used to write in a journal when I was younger. And because I often wrote about my day to day encounters with patients or about health care policies in my home country, I needed to remain anonymous for the sake of patient confidentiality (Singapore is a VERY small country) & I admit, also a fear of censure by the Powers That Be (although Singapore is a democracy, freedom of speech is not quite the same as that in the USA).

    And as a parent of two boys, much of my blog content was about parenting. And the content of my blog has changed as my own life has changed, from a full time clinician, to a full time administrator, and then to not working at all & enjoying a life of relative leisure.

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  8. Anonymous9:38 AM

    Hi Michelle Since you moved away from NYC, we've heard less about your parents/sisters. Can you tell us how they are doing?

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  9. I've followed your blog for some time now and love reading about your work and life doing both medicine and motherhood. As a psychiatry resident, I am often in awe of your ability to be so open about your life. I could NEVER write in an open blog under my true identity about my personal life. It would be considered a huge problem with boundaries and safety and whatnot.

    Just an observation of the limits of blogs and medicine-the ability to be "nonymous" depends on the area of practice I guess.

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  10. Thanks for sharing the link, Michelle. That looks like an interesting conference. I look forward to being there though it's on the weekend right before the Pediatric Academic Societies annual meet. Two back to back conferences. I wonder if I can get the CME days for that.

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  11. Anonymous5:51 PM

    To add to what CdnPsycRes has said... The ability to write openly is dependent on one's history and life story as well.

    While Dr. Au's assessment is correct in some cases (i.e. people choose to be anonymous to have license to write things that they are not brave enough to say and/or uphold openly), I disagree that this is the majority.

    Many people who come from fragmented families, difficult personal circumstances, history of abuse and/or trauma, etc. find it impossible to write openly. As someone who has lived a somewhat complicated life, I can assure you that while all of my experiences have contributed to my evolution and growth as a human being, and have added integral threads to the fabric of my character, some are simply too painful, too intimate to share openly. Some will argue that this is where self-censoring comes in, however, when you have to cut huge holes in yourself and hide large parts of what informs your views and decisions, the remaining parts often become bland, pedestrian, even meaningless.

    Being a doctor is like being a product on the market (in some ways, at least). You have to be mindful of the image you project.

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  12. Yes, I absolutely agree that everyone's situation is different, I don't mean to imply that everyone who writes under a pseudonym is a coward. The fact is that sometimes the situation demands it. For me and for my specific situation, however, I felt that writing under my own name would force me to put my best self forward, even if it means that I do filter what I write about to some degree.

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  13. Anonymous10:39 PM

    Just wanted to say, as an Iowa resident, and very long-time reader, it would be fantastic if you were to travel to Iowa for the conference. I know there would quite a few of us interested in your panel.

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  14. LisaFP11:26 PM

    I love that you blog under your own name. It's so different than what's normally on the internet now and so honest.

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  15. Anonymous12:35 PM

    I have been reading for a long time and am thrilled at the idea of you coming to IOWA ( I am an alum) . I am an Iowan and yes-- it is the land of Corn and midwestern politeness. Joe will let you know all about the Hawkeyes--which I know you sometimes confuse for the Buckeyes. (don't make that mistake WHATEVER YOU DO). You should come on a tailgating Saturday for sure (which happens right across the street from the med center--it is insane and wonderful). I suspect you both will fall in love with the area and sign up immediately to practice at U of I Hospitals and Clinics. I have had the misfortune of having my child there for ongoing treatment. If you have to be in the hospital this is the one to be in!! The physicians like it there because Iowa City is (aside from the university) a small town. The writers workshop is seriously a program you will fall in love with. I can't wait to hear what you think and see the kids wearing the black and gold & matching corn head hats. (yes, these do exist)
    Misha

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  16. I am, in fact, planning on being on the panel. I was excited to see you on the list as well. As to the anonymous vs. non-anon, I think being anonymous is too big a temptation. I see the restrictions as a means of keeping me in line, not writing about patients or colleagues in a way that I would regret later. I started out as "Dr. Rob," but didn't do much to hide my last name. Hopefully will see you in Iowa.

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  17. Anonymous2:33 PM

    I appreciate the West Wing reference, especially since I, too, remember basic geographical and political facts based on WW episodes.

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  18. I am a PA and I blog about medicine & the stresses of the Emergency Room. It helps me vent & get work off my mind. I started blogging 5 years ago before I went to PA school and I often re-read my own writing to see how much has changed. I found your blog yesterday, and thanks for all the laughs, inspiration and beautiful pictures too!

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  19. Nice Blog!!!
    Thanks For Great Information .

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  20. Anonymous8:19 AM

    I work in an anaesthesia residency program that already believes that women should not be given positions because they just leave to have babies. They can't ask you, but it comes up in different ways during the pre-interview for positions. e.g. I see you have a wedding ring. What does your partner do? At interviews, we all project an image that our program is great! (No jobs for people who don't say that...) But as the moms in my program (there have been three) have been advised by some well-meaning attendings, "If we ask you what you did on the weekend, please tell me you were reading Barash, or better yet the reference papers in Barash. If you want to get a job, don't tell me about making cupcakes with your kid." So that's why blogging under real name would be bad, very bad, if one wants job afterward in same place. Having said that, we also believe that it's important to share these stories, because how can change happen in this shroud of silence and misunderstanding? Should we not share these stories? As someone who's doing a great job balancing both and keeping your sense of humour in all of it, what are your thoughts on this? We are truly curious... as we are planning to start a blog and debating if it should be under pseudonyms or under our real names. And yes, our selection committee googles up potential candidates and even looks up their facebooks for drinking parties, etc....

    On flip side, have psych resident friend who constantly makes sarcastic comments of patients on his facebook. It's black humour used to keep himself sane, but I wouldn't refer any patient to him. Maybe we should blog with real names to keep ourselves in check.

    Any thoughts?

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  21. Anonymous8:24 AM

    Just an addendum to above, why are there women in the program... well, apparently if you are super stellar (i.e. lots of articles when they google you up), and you say on the interview that you don't plan to have kids at the time as are committed to career... they'll take a chance, although they continue to question the wiseness of it...because we women in the program, well we keep having babies. What a waste of government subsidized funding ! ... (I wish there was a font for sarcasm)

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