More thoughts
Do you think it is better to have a list (as I have done in my last post) of guidelines, or should we back up and look more at principles. Clark’s question got me thinking about this. Maybe we should give some basic principles that all bloggers (doctors, nurses, other medical professionals, patients) can embrace. For example:
- Principle 1: Clear representation of perspective – readers must understand the training and overall perspective of the author of a blog. Certainly bloggers can have opinions on subjects outside of their training, and these opinions may be true, but readers must have a place to look on a blog to get an idea of where this author is coming from. This also encompasses the idea of the distinction between advertisement and content.
- Principle 2: Confidentiality – Medical bloggers must respect the nature of the relationship between patient and medical professionals and the clear need for confidentiality. All discussions of patients must be done in a way in which patients’ identity cannot be inferred.
- Commercial Disclosure – the presence or absence of commercial ties of the author must be made clear for the readers. If the author is using their blog to pitch a product, it must be clear that they are doing that. Any ties to device manufacturer and/or pharmaceutical company ties must be clearly stated.
- Reliability of Information - citing sources when appropriate and changing inaccuracies when they are pointed out
- Courtesy - Bloggers should not engage in personal attacks, nor should they allow their commenters do so. Debate and discussion of ideas is one of the major purposes of blogging. While the ideas people hold should be criticized and even confronted, the overall purpose is a discussion of ideas, not those who hold ideas.
I wanted to make something that would be easy for people to accept whatever their role and whether or not they are anonymous.
Better, worse, same??
Hi Rob,
Hsien Hsien Lei posted a list of 10 questions a while ago, these were meant to explore the scientific and ethical stance of blogs related to medical/medical-related issues. Some of these questions might be salient.
Of course, I’m not too sure that the code of conduct could be adhered to by an anonymous/semi-private blogger. You could certainly give an outline of your CV and qualifications but it wouldn’t be possible for anyone to verify it.
For some issues, it’s interesting how you might establish the scope of your knowledge. For instance, I just have a superficial knowledge of immunology and related fields. Nonetheless, recently, I was convinced that a recent (excellent) review of immunological techniques had been mis-cited in defence of provocation and desensitization as a treatment for allergy. This mis-cite gave the technique an imprimatur of respectability that I didn’t think was appropriate. This annoyed me because it was part of an ‘expert presentation’ to a committee meeting that was made up of people who would not know that.
I contacted the lead author on the paper to let him know about the way in which the paper had been used. I contacted the secretary to the relevant committee to let them know that I thought the paper had been cited inappropriately. I gather the author contacted the committee as well.
Would I not have the right to comment on the mis-citing of a technical literature that isn’t in my field?
I’m team-blogging on another blog that explores the claims of prominent nutritionists – mostly about the value of supplements, superfoods etc. None of us is a nutritionist or has completed even a module of food science as part of our university education. However, I feel that basic science is sometimes sufficient to allow you to question whether claims appear to be inflated. E.g., there has been a lot of excitement over the therapeutic value of curcumin as the active ingredient of turmeric. Ignoring a number of issues, and having read Abel Pharmboy on the matter, it did seem implausible that it would be possible to attain and maintain a therapeutic level in the plasma, short of having a box trolley as your faithful companion with an intravenous line in a convenient part of your body. I wrote as much in a piece criticising the promotion of the health benefits of curcumin as a supplement.
I can see how these codes of conduct are there to protect readers.
Regards – Shinga
I’m likin’ it. I think it’s important that doc bloggers drive the bus regarding this discussion, and you certainly have made an important first step.
Thanks for you efforts, Rob.
Could the confidentiality imperative be strengthened? An ethical blog creator should always write from the perspective that his or her name and institution might eventually become publicly recognized. If that occurs, the identities of any thinly veiled patients could become obvious to local readers. At some level, co-workers who already know the writer should not be able to visit the blog and easily identify the patient who is the source of the entry, especially if the information is confidential. This is akin to an overly loud conversation in the hospital cafeteria line.
Maybe a revision could include something like: “All discussions of patients must be done in a way in which patients’ identity could never be identified even if the identity and/or institution of the writer become public knowledge.”
This is a wonderful idea. Thanks for your leadership.
Shinga:
I have contacted Hsien Hsein and will await her comments. I think this is a very good summary and would like to see what she thinks these would apply to a specific medical blog.
I have no problem with comments coming from people without “official” credentials. We simply need to state our perspective. This should not alter the validity of the comments themselves, but there is increased weight if someone is the department chair in a field and if they are totally untrained. The latter can correct the former, but in medically related discussions, a certain automatic credibility should go to the one with the training.
I have learned plenty of medicine from my wife and from my patients.
Bruce: Agree 100%. I will let others comment before I make the changes.
Rob:
What you are doing is fantastic. I have the HON on my web site and plan on applying for it for my blog. The HON is rather general, having doctor driven principles/guidelines is essential for us to feel what we are doing has value.
I like the principles approach rather than the list. It doesn’t seem so one-sided; the code should apply to readers as much as it applies to authors. That said, all of the principles listed other than Courtesy are also HONcode principles. With the departure of many medical bloggers due to privacy concerns, a healthcare blogger code should also include principles to protect the author. I can see that with Principle 1 (Clear representation of perspective) – what other author protections do we want a blogger code to include?
As an aside, I don’t care much for the Courtesy principle. If I start flamming people, I’ll loose readers as well as the respect and acknowledgement of most, if not all people in the healthcare blogging community. I don’t need a code to define what I already do. Further, who among us doesn’t watch, respond and react to comments on our own blogs? If someone starts making trouble, I delete their comments. Don’t you? Do we need a principle to tell us what (I think) all of us would do anyway?
For this reason, I’ve had a problem with the name “Code of Conduct”. I’m more concerned with ethical standards than guidelines for conduct. A “Code of Ethics” may be more appropriate for the healthcare blogging community.
I believe we only follow the rules that we accept for ourselves. As a suggestion, any code that is drafted should be modular in nature (with some core principles that can’t be excluded), similar to creative commons licenses, so that individual bloggers can choose a level of values they want to assert.
I like the courtesy principle especially after last week’s events. Many of the medical forums have gone to having “rules” that do the same – just remind people of the politeness factor. It boggles my mind that people write some of the comments that they do but for some reason being “medical” we are open to more attack and that is not deserved. If having a stated principle wards off some of it, I’m all for it.
Walter:
Overall the purpose of this is to set ground rules on the blog that we all agree on. I am with you on the “code of ethics” vs. the “code of conduct” since they are more principles, not rules. The problem (in my eyes) with HON is that it focuses more on medical content than on a medical blog. What I mean is that the medical blogger is simply blogging about what goes on in the life of a medical professional, not necessarily about diseases or medical education pieces.
While I agree on the readers avoiding overtly flaming writers/commenters, to have something in writing gives something concrete a medical blogger can hand anyone who questions the intent/tone of the blog (employers, colleagues, etc). Perhaps replacing the word “courtesy” with “respect” would be a better way.
My hope was to get a list of common ground for every medical blogger to sign on to as some sort of treaty we can have within the medical blogging community. The more people who sign on to it, the more legit the code will be. I do see it somewhat like creative commons, but I don’t want to get into an a la carte approach. I can’t see someone not embracing these principles.
Gwen: I think medical bloggers are in a unique position in that we do have very strict professional rules and even laws governing what we can say on the blog. It’s really important for us to assure the public that we are not going to view the Internet as a place without rules. We will set up guidelines as a group that we will adnere to.
Once this all gets ironed out, it will be important that the list of medical bloggers who agree to this code is well published – not just in this space but on our own blogs with some sort of logo. This holds us all accountable to ourselves, each other, our readers and cyberspace.
Rob, we definitely see eye-to-eye on this. When I mentioned the HONcode, I was simply comparing it’s principles with the ones you suggested. I didn’t mean to imply we should use it instead of our own “Code of Ethics”. HON is clearly more focused on medical content than on a medical blog.
I was also trying to point out that we don’t want to simply reproduce the HONcode. A “Healthcare Blogger Code of Ethics” should also include protections for the author, principles that aren’t offered by the HONcode.
After I left comments last night, I thought more about the Courtesy principle and you’re right: having something in writing would be beneficial. Based on your comments, I can also see how a Courtesy/Respect principle may offer some protections to the author as well.
Hopefully we can solicit more feedback from other healthcare bloggers.
Hi everyone! It’s interesting to see concerns about blogging ethics reach medical bloggers. I think every physician, nurse, or healthcare provider must struggle with it from time to time when discussing personal experiences. The NIH 10 questions disclosure “meme” I circulated a couple of years ago at my old blog, Genetics and Health, was very much in line with this proposed Medical Blog Code of Conduct. Not only was it for our readers, it was a way for us as a community of healthcare/medical bloggers to get to know each other.
In the end, though, I think that every single post is probably a good snapshot of the blogger’s attitude and point of view. It doesn’t take much to see if someone is biased or less than honest. Having a Code of Conduct certainly helps to remind everyone that what we do may have a bigger impact than the average blog and it helps to have something to point to when someone “misbehaves.” When it comes to cases like Dr. Flea or Barbados Butterfly, however, I don’t think it matters whether they fully disclosed their name, rank or serial number. In the eye of the tempest in a teapot, they would still have been faced with taking their blogs down.
What I’m trying to say is that having HONCode certification and fully disclosing our biases and affiliations is always a good thing. And being considerate of patient confidentiality and other forms of privacy is very important. But we also need to look at promoting blogging as a legitimate platform which should be respected and not subject to anyone’s influence except the blogger’s own truth. As long as we are willing to stand behind our words, we should face no fear of repercussions.
Note: I hold a PhD, not an MD, but have been blogging about science and health since April 2005.
Walter:
I will make changes on the next iteration and agree that somewhere we will need a central list.
Hsien:
Thanks for you input. I am in no way against anonymous blogging. I think that a code of ethics would perhaps help anyone who questions the person, either on the blog or in person, as to the integrity of the blog, especially the anonymous blogger.
The thing about medicine is that there is significant legal and ethical consideration when it comes to putting forth information. Anonymous bloggers are all the more suspect (as Moof learned from an anonymous blogger who misrepresented herself as a physician and revealed personal information). I expect people to keep their identity hidden if that is what they prefer, and agree to stand behind the principles outlined.
Overall I see it as of moderate utility for those visiting the blog, but the biggest utility is when the blogger is questioned by those at the workplace (such as Fat Doctor or Barbados Butterfly) – they can show the rules by which they are blogging. It is by no means an airtight solution, but it helps to spell out the framework by which you are presenting information on your blog.
I like these principles… As a readily identifiable blogger (as opposed to an anonymous physician blogger), I’ve been following them for a while. We have to protect ourselves, and our patients.
I think this is fabulous! I think this med blogging code of ethics will help non-medical readers understand how we protect patient (and health care providers) identities. I also think that the last principle should be included because there is a lot of flaming, unfortunately, and perhaps stating up front to readers that it won’t be tolerated will help nip that issue in the bud.
I am currently collecting thoughts, posts, etc regarding health care blogging for my nursingjobs.org column, You’re Being (Web)Paged. I think this site would be an excellent contribution to the discussion.
I am very excited to see people seriously discussing the ethics of blogging about medicine. I had already determined that I would not blog at all about specific patients, not even with attempts to conceal their identity. I would welcome comments about my blog and how well it adheres to the code.
http://drbensblog.kruskal.com
I’m really pleased to be part of this community.
Benj