Ethical Aspects in Medical Blogging

Overall, blogs are the oldest, most established, and evaluated form of social media, with articles as early as 2004 noting their use in medicine and family practice.(1)

Maurice Bernstein (MD, assistant clinical professor of medicine, Keck School of Medicine) was asked if physician written blogs could meet legal and ethical professionalism standards. He replied that medical blogs could offer timely and accurate medical information as a supplement and also enable public and patients to recieve feedback from bloggers and visitors for their expressed health concerns and experiences. He also mentioned that medical blogs, moderated with attention to civil and open discussion among the visitors and following guidelines for ethical operations, would make a significant contribution to the medical education of the public.(2)

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David D. Perlmutter (professor in KU school of Journalism and Mass Communications) had drafted a special hippocratic oath for healthcare bloggers. It reads as:

I swear that:

  1. I will never reveal information about patients in my blog that allows readers to identify them in any way.
  2. If I blog under a pseudonym, I will still inform readers of my correct credentials and degrees so that they can assess my expertise.
  3. If I refer to controversial health care information, I will make sure to recognize opposing views and to provide my readers with adequate citations so that they can read more on the subject themselves.
  4. I will not blog to sell directly my services, my practice or a product in which I have any financial interest.
  5. I may state my opinions and ideas with passion and conviction, but I will not engage in personal attacks and the vilification of anyone in a way that would undermine the decorum and dignity of my profession.(3)

In 2007, a voluntary “Healthcare blogger code of ethics” without an official status was developed for healthcare workers writing online to encourage following:

  1. Clear representation of perspective – anonymous blogging is possible, but professional perspective must be shared.
  2. Confidentiality – patient’s identity must be protected in anyway.
  3. Commercial disclosure – commercial ties must be clearly stated.
  4. Reliability of information – sources must be cited.
  5. Courtesy – do not engage in personal attacks.(4)

The code was hosted in medbloggercode.com which seems to be down since past few years.

The Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. HIPAA has a list of identifiers that healthcare professionals must follow when discussing patient information. Revealing following information about patient must be avoided:

  1. Name
  2. Any geographical subdivision smaller than a state.
  3. Any date, with the exception of the year, that is directly related to the patient – including birth dates, admission and discharge dates, or death dates.
  4. Numerical identifiers like phone numbers, fax numbers, social security numbers, medical record numbers, health plan beneficiary numbers, account numbers or serial numbers.
  5. In relation to blogs, email addresses, web universal resource locators, or Internet protocol address numbers are also considered patient identifiers.(5)

References:

1. Grajales FJ 3rd, Sheps S, Ho K, Novak-Lauscher H, Eysenbach G. Social media: a review and tutorial of applications in medicine and health care. J Med Internet Res. 2014 Feb 11;16(2):e13. doi: 10.2196/jmir.2912. Review. PubMed PMID: 24518354; PubMed Central PMCID: PMC3936280.

2. Bernstein M. Medical blogs: Who are they good for?:My answer on AMA news. [Internet]. Bioethics Discussion Blog. 2008 [cited 2017 Dec 3]. Available from: http://bioethicsdiscussion.blogspot.com/2008/08/medical-blogs-who-are-they-good-formy.html

3. Perlmutter DD. Medical & health blogs: A special hippocratic oath for medblogs? [Internet]. OUPblog. 2008 [cited 2017 Dec 3]. Available from: https://blog.oup.com/2008/08/medblogs/

4. Lamberts R. Blogger code of ethics. [Internet]. Medpagetoday. 2008 [cited 2017 Dec 3]. Available from: https://www.medpagetoday.com/blogs/drrob/11107

5. Bernabei JL. Medical blogging: Defining the ethical boundaries. [Internet]. Pharmacy Ethics. 2007 [cited 2017 Dec 3]. Available from: http://rxethics.org/bernabei.pdf

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