Blogging and privacy

As some of you know, I am a regular blogger for Mothers in Medicine. Recently, there have been some issues about the posting of patient information on this blog, and a new blogger expressed concern about how many details you need to change to really "de-identify" a story. Naturally, I have a few opinions about this.

When I was a resident, I remember there was some scandal because a patient had an arm amputation and apparently a staff member took a photo of his amputated arm "inappropriately." I'm not sure what this means. I assume the photo was not taken for medico-legal reasons or for academic research purposes, because it probably wouldn't be such a scandal. We hypothesized the photo ended up on something like Facebook or MySpace or something, and didn't just stay quietly on the staff member's iPhone. I don't really know any details.

I'd hope it's pretty obvious something like that is inappropriate. I read a story about some nursing student who got kicked out of school for posting a photograph of a placenta, although was later restored. And then there was the med student who took a photo with a cadaver and got in trouble for that one.

So I think it's safe to say that you should never post any patient-related photos taken at work. That's the obvious part.

But how about patient-related stories, if several of the details are changed and disguised? Technically, I guess it's okay, right? HIPAA isn't being violated. I can't say I never did it, because I have. It's hard not to. I mean, that's a huge part of our lives.

However, I do think there's a risk. I think even with several details changed, there might be a small chance of the patient will discover the blog and recognize themselves. This risk is probably extremely small if you don't post many details and blog anonymously, but it's possible. I'd like to think that on the rare occasion I post about a patient (although I try not to do this), I'm safe in doing so because I both change details, don't post more than a few sentences on anyone, and don't post about any patient I've seen in the last 3-4 years. But is it absolutely 100% safe? I guess not.

You have to weigh the risks and benefits. Is sharing this story with the public worth the chance of being discovered? Maybe. Maybe not.

(Also, I think the risk of having someone discover your true identity is higher than you think. After posting one or two details about yourself, such as what state you work in and what field you do, it's not that hard to use google. Mention one of your hobbies and a personal detail or two, and that's the end of it. It's kind of the equivalent of Superman putting on some glasses and then being "unrecognizable." And some people outright post under their real names, which amazes me.)

And then there's non-patient stories that could get you in trouble...

Several weeks ago, I made a post about a student at work who was annoying me. Although this was just a student (so no HIPAA violation) and I changed details of the story so I think the chances of the student discovering the post were basically nil, this experience made me realize that it is a risk to post anything about my current job. To me, it isn't worth that risk. So I will never again be posting any specific stories about my current job or people who work there.

My weekly whine this week was supposed to be a story about a junior resident I worked with during residency who annoyed me A LOT. I basically wrote a manifesto about his unbelievable behavior that I thought was pretty entertaining. But I thought about it and I realized that the field I'm in is pretty small, and there was a small but reasonable chance that he might read it and recognize himself. And although I hated working with him, I didn't hate HIM. So I nixed the entry. Of course, there are plenty of residents or med students that I've written negative things about on here who I would LOVE to see the entry about them. I'm tempted to do some forwarding.

When I write an entry, I try to imagine what would happen if everyone I know read the entry. If there would be any consequence to this beyond a little embarrassment, I don't post the entry. (Well, usually.) I don't believe any blog is entirely anonymous and I think it isn't worth the risk. I think all bloggers are taking a bit of a risk, but obviously we get something out of it too. Blogging is fun! And it's way less risky than skydiving.