This is a scary position I am going to take. Contradicting someone of Dr. Brian Vartabedian’s stature is bound to have some repercussions: I hope they are not too profound! Also, hat tip to the awesom @scanman for coming up with the “storm in a tweetcup” comment. I am using it!
Anyways. So here goes nothing!
I am an ardent fan of 33 Charts, which is, undoubtedly, one of the best medical blogs around. But today, he posted something which I had to disagree on. Before I lunge into the reply, here take a look at the following sample of tweets (read last one first – twitter chronology):
So, Dr. V believes that this constituted unprofessional behavior and vents his ire on his blog. I was surprised to see a lot of people actually go on a witch hunting expedition of @mommy_doctor on this issue. I have no clue of she has had any past history, as has been suggested, because I started following her just after Dr. V helped her to shoot to fame. So, I will consider everything around this post series that Dr. V has taken the arms up against.
1. HIPAA Compliance:
First things first: if you are going to quote it like the Bible, please try to spell it correctly first! The misspellings in the comments section drove me crazy!
(Hat tip: Fizzzy)
She claims to anonymize her patients, and protect their identities, and there may not actually even have been such a case, so this argument falls flat on its face. Dr.V actually concedes that there may not have been any violations in this exchange.
2. Tone of the Discussion:
I agree somewhat with Dr. V on this point. There may have been a bit of an irreverent, if playful tone in that matter, but I don’t think it would be anything super-bad about it. Medical humor, by itself, is dark. Look at what Des Spence has to say in a short article that touched the core of this issue:
I remember bursting through the doors to the hospital doctors’ mess to the sound of loud, repeated, almost stuttering swearing. Swearing was ubiquitous in theatre, in emergency departments, on ward rounds—under my breath, in my head, in my dreams. Swearing even has it own universal sign language. Swearing is an intrigue, part of the medical training and tradition. Indeed, if I could translate ancient Greek I would be surprised if swearing wasn’t part of the original version of the Hippocratic oath. Even those doctors who didn’t enjoy smoking and those with strong religious convictions enjoyed a good swear at 3 am during medical receiving.
This workplace swearing—unnecessary, loud, wanton, gratuitous, unprofessional, and, the very point of it all, therapeutic—is not to be confused with the aggressive swearing of personal attacks. It may not be big and not clever, but it is a highly effective stress buster and indeed strangely attractive, endearing, and often supremely funny.
On the best of days, we work through blood, gore and death, and if someone finds a little catharsis in a little dark humor, is it justified to take up the cudgels against them?
I am absolutely nauseated by the people who say that this is an inappropriate thing to say in public. What they mean is that it is alright if discussed privately, behind closed doors, as Des would say… this hypocrisy is what I abhor. If it is inappropriate in public, it is inappropriate behind closed doors as well. Just because the patient *may* not come across the closeted ramblings does not make that any lesser a crime (working on the assertion that it is a crime, that is).
Well, this is another thing I feel strongly about. When I started off blogging on this site in November/December 2010, I started off anonymously. Having had a bad experience with my previous blog on account of my stand on issues like politics, sexuality and caste-based reservations, I was wary when I started this blog. But soon enough, I realized as long as I do not lend a face and a name to the content, there is not going to be any credibility. Accordingly, I came out. And since then, the interaction and chatter on my blog has gone up markedly.
Also, I agree with Dr. V when he says a lot of people hide behind the façade of anonymity to vent unjustified ire over the internet.
4. Lack of Compassion:
Seriously, Dr. V, you think if we indulge in a bit of bantering, we are compromising on compassion? If anything, in my very, very limited personal clinical experience, I have seen a sense of humor goes a long way in comforting the patients and their families. Also, she shows her compassionate side when she says she would not let the man suffer from such prolonged pain had it been up to her. (please do remember the context: this was not per se her opinion of “managing” the patient – she was just replying to someone who was flirting with her!)
5. The Medical Issue:
Some of the commenters have raised the valid question that maybe bantering around the tumescence of any other organ would not have resulted in this post. 33 charts has been one of my staple reads and I have found Dr. V’s style to be very logical and enjoyable. I would like to believe that he did not single out this issue because of the priapism and was just pissed at the whole conversation…
6. Making mountains out of molehills:
Apparently the American health system is very good at it. That is why they spend billions managing lawsuits every year.
7. Discussing patients:
If the twitter bio is truthful, a lot of details have been changed, or maybe even the patients is fictionalized. Heck, we are not even sure is @mommy-doctor is a real doctor or a llama herder (as one commenter remarked). When the whole thing is so nebulous, I think the better thing to do is just enjoy the dark humor, or pass it up if its too much for you!
[On another note, I wonder what would happen to Dr. V if he were reading the #penisfriday posts @burbdoc posts! His head might explode!]
I find nothing to make such a hue and cry over this matter. It is probably a better idea to play it safe and not say anything that can get misinterpreted, but then again, if you are going to say something useful, from time to time, people are going to misinterpret you.
Overall, I think he over reacted a bit to this issue (as am I by writing this huge blog post in rebuttal!) and it is hard to believe that this is the same person who, just a few days ago, wrote this:
And do we really need to announce that our shared links don’t represent endorsement? Who in the free world really thinks that when I retweet a link or idea I’m formally endorsing the site on the receiving end? When was the last time a shared link lead to identifiable damages from the lack of the endorsement disclaimer?
I can understand disclaimers about medical advice. But we’re all waiting for that first big judgment against the ‘disclaimerless’ doctor brought to her knees by that loose tweet construed by the patient-victim as individual medical advice. Rest assured that when it happens you’ll hear it here first.
Ultimately I think this use of language is about fear. But I suspect that those interested in getting at us won’t be deterred by cut-and-paste disclaimers. Perhaps it’s time to rethink the practical utility of the disclaimer.