From the abstract:
Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Individual patients were described in 114 (42.1%) blogs. Patients were portrayed positively in 43 blogs (15.9%) and negatively in 48 blogs (17.7%). Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves.
That implies that unless you’re anonymous any case discussion is problematic in terms of patient privacy. The last sentence lumps all medical bloggers who discuss cases and are not anonymous. Since many open bloggers provide more than adequate disguise of patient identity the statement tells us little about how many bloggers actually divulge inappropriate detail.
The authors send a vague and confusing message regarding confidentiality. While appearing to recommend anonymity, at least one of the sources they cite as a standard bearer (Clinical Cases and Images) posts clinical content and explicitly recommends against anonymous blogging.
Why couldn’t the authors have told us how many case discussions were appropriately stripped of the 18 HIPAA identifiers? Moreover, we know nothing about how many bloggers in question got permission from patients.
The authors did not gauge their findings concerning patient postings against any agreed upon standards of confidentiality (e.g. HIPAA regs). Readers are left with the authors’ opinions on how often bloggers inappropriately divulge patient data.
The discussion section of the paper contains what may be a factual error:
Even when the author is anonymous, detailed descriptions of patient interactions and conversations have the potential to be recognizable by the parties involved. For example, the anonymous blog author “Flea” revealed details of a patient’s death after a malpractice case was brought against him. The lawyer for the plaintiffs recognized the description of the case, and shortly thereafter, the case was settled out of court and the author removed his blog from the Internet.
I followed the Flea case closely and that is not what happened as I recall. Bloggers build disguises into their posts and I have never seen reported an instance of anyone recognizing a patient from a case description. The authors’ only citation regarding the Flea case is a Boston Globe piece which gives no indication as to how the blog was discovered. Unfortunately, Google’s cache of Flea’s blog has been deleted, but my distinct recollection is that clinical information had nothing to do with the discovery of Flea’s blog. Rather, what tipped off another attorney (who subsequently contacted the plaintiff attorney) was not a detail of the case, but an image Flea reproduced from one of plaintiff attorney’s PowerPoint presentations. It was that image that the other attorney (who had apparently viewed the presentation) recognized!
The paper covered other aspects of professionalism besides confidentiality. From the conclusion of the abstract (italics mine):
They also risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions.
(Translation: They show their human side). More from the conclusion:
The health professions should assume some responsibility for helping authors and readers negotiate these challenges.
(Translation: Look out for the Thought Police and their agenda to sanitize our blogs). Finally, from the discussion section:
Physician-leaders and medical educators should consider curricular development and educational forums that address the challenges, opportunities and responsibilities that medical blog authors face, and the place of this new medium within norms of medical professionalism.
The norms of medical professionalism these days are increasingly defined based on public perception. Conformity of medical blogs to a sanitized notion of physicians runs counter to an essential purpose of blogging, articulated more than once by Kevin MD: “The whole purpose of blogging is to be open and pull back the curtain to talk about how it really is…”
Clinical Cases and Images weighs in with an excellent post here.