Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Blogging and Anonymity

CCC – Captain Chair Confessions writes anonymously.[1] Is that bad?

Are we so incapable of assessing the content of the blog, that it only becomes relevant when we can attach a normal looking name to the blog, no matter how fictitious that name might be?

I don’t put my name on my blog.

Does that change the validity of the research I write about?

What about when I criticize someone? Is that criticism less valid than if I put a name on my blog?

I criticize some big companies. None of them have contacted me about any kind of libel suit, or any kind of slander suit for any of the podcasts I have been on.

My email is right there in the upper right of the blog. I have always has been.

People think that attaching a name to something gives it accountability.

Oprah Winfrey has made a career of giving a stage to frauds – Deepak Choprah, Jenny McCarthy – even Dr. Oz is promoting nonsense. There are plenty of others.

We know their names, but they are frauds.

Where is the accountability for all of the fraud that has come from her show?


Deepak Chopra is one of the highest paid entertainers in the US.

There is a lot of discussion of Mitt Romney and Barack Obama. They use their names. Does anyone think that both of them are trustworthy?

What about Michael Moore and Rush Limbaugh? They are both famous liars, who will distort anything to make a political point. Having their names on their lies doesn’t seem to encourage them to behave ethically.

Requiring a name on a blog is like requiring a medic to make the magic phone call to a medical command doctor. It has the appearance of making things better, but none of the substance.

This is a salve for the people who are not capable of determining what is real – people who think that a good argument for something is, What if somebody sues?

Does the blog identify an employer?

Does the blog portray that employer in a negative light?

Is the blog encouraging people to abuse patients?

There are many similar questions that may be asked.

There are a variety of ways of answering some of these questions.

The most important question is does this blog get me to think about what I do, so that I want to be better at patient care?


The problem is not anonymous blogging.

The problem is people who want to discourage views, but don’t have any valid criticism of those views.

Medicine and EMS are very traditional. We need to destroy those traditions and start doing what is best for the patients.

Organizations that harm patients in order to do what they think protects them from liability need to be criticized.

During the creation of the United States of America, there were plenty of discussions about the way the government should be set up. The Federalist Papers were written under the pseudonym Publius.[2] We still do not know who wrote some of the essays. The contrary position was taken in the Anti-Federalist Papers, written under the pseudonyms Cato, Brutus, Centinel, and Federal Farmer.[3]

If an anonymous blog is not good enough for you, buy some tissues and go whine somewhere else.

I am proud of my fellow anonymous and semi-anonymous, bloggers.

I am embarrassed by people incapable of substantive criticism, who resort to sniveling about anonymity.

It is not about agreement, or disagreement, but about getting ideas out there to move medicine, and EMS, forward.

By the way, I seem to have pointed out that anonymity is traditional. Darn, I wrote something positive about tradition.

Anonymity IS free speech.

Free speech is progress. Obstructing free speech is bad for patients.

Lead, follow, get out of the way, . . . .

Creative destruction is progress.[4] Without creative destruction we would not be communicating with computers (and your cellular phone is often a computer).


[1] A blogger outed
Captain Chair Confessions
September 7, 2012
By the anonymous CCC

[2] Federalist Papers

[3] Anti-Federalist Papers

[4] Creative destruction


Blogging and Privacy and Competition for Dr. Deborah Peel

J Gen Intern Med. 2008 Jul 23. [Epub ahead of print]Click here to read Links
Content of Weblogs Written by Health Professionals.
They make it seem as if you get the free full text, but you don’t. On the other hand, you are not really missing anything.

The research cited in this article is pretty poor. They start by assuming that they can identify most of the bloggers, but do not demonstrate that. Here is their big chart of proof:

Blogs n (%)

Reviewer agreement kappa

Blog author identification

First name

139 (51.3)


Last name

95 (35.1)



117 (43.2)


Identifiable photo

60 (22.1)



197 (72.7)


Patient privacy

Patient images

3 (1.1)


Patient radiographs

8 (3.0)


Patient laboratory studies

0 (0.0)


Other privacy information

1 (0.4)


Patient depictions

Any comments about patients

114 (42.1)


Negative comments about patients

48 (17.7)


Positive comments about patients

43 (15.9)


Commentary on health profession/heath care system

Comments about the health care system

137 (50.6)


Positive comments about health care profession

108 (39.9)


Negative comments about health care profession

86 (31.7)


Product endorsement

Blog posts promote health care products

31 (11.4)


What do they agree on the least? “Positive comments about health care profession.”

They make a lot of unreasonable assumptions about being able to identify the person writing the blog, based on the initial assumption, they look at the information presented about the “patients” mentioned in the blogs, presuming all of the information to be correct, they jump to the conclusion that there are HIPAA violations.

Over half of the 271 blogs had identifiable authors; 89 (32.8%) authors provided both first and last name and 43 (15.9%) gave enough information about their name, subspecialty, or location to be identifiable. A recognizable photo was displayed by 22% of authors. Of sampled blogs, 206 (76.0%) were written by physicians, including 23 interns and residents, and 59 had nurse authors (21.8%). The remaining six blogs (1.8%) were written by groups of health professionals including both doctors and nurses.

The fixation on HIPAA also ignores the patient’s right to privacy. Patient privacy did not begin with HIPAA. Dr. Deborah Peel and these clueless researchers do nothing to improve patient privacy. Claiming that you are accomplishing something and actually doing it are not at all connected.

There is much good that may come out of blogs. That is one of the reasons I read and write blogs. I can’t guarantee that no medical blogger is inappropriate with privacy information in a blog, in a book, in a radio interview, or at a cocktail party. Condemning medical blogs will not change any of that.

These researchers looked at only 19% of the medical blogs that they found. They cherry picked the ones they thought most likely to have violations of privacy issues. Out of those 19%, they found 17% that they claim had privacy issues.

This is only 3% of the medical blogs they found. But wait, where do they identify any actual patients based on the information in the blogs?

They do not. They mention the case of a doctor sued for malpractice, who blogged about the experience. The lawyer for the plaintiff recognized the information as being about his client and apparently used that to get a large settlement. This is not somebody with no knowledge of the patient, but someone intimately aware of the medical details of the patient’s medical records. Then you add the unusual identifier of the details of the malpractice case and it is not at all surprising that the lawyer was able to recognize the patient. This is the only case, of a patient being identified, that they mention. They draw some conclusions below, but do not demonstrate that they were actually able to identify anyone.

Forty-five blogs (16.6%) that described interactions with individual patients also included significant identifying information about the blog author. Three blogs showed recognizable photographic images of patients, and one provided an extensive description and links to pictures of a patient. Eight blogs showed patient radiographs without further identifiable information.

Yeah, that X ray, that looks about the same as every other X ray of that part of the body – that one is mine؟

They do not mention if these patients gave permission for their information to be used on these blogs. This is something that is relevant to the topic. Is this information able to be used to identify a patient? If so, did the patient give permission?

RM – Mr. Rectal Bleed, I’m going to make you a star.

Mr. RB – A star! Wow, wait until I tell the little hemorrhoids. What do I have to do?

RM – Just sign this standard disclosure form and smile for the camera. I’ll try to get your good side.

Mr. RB – Who would have thought that anything good would have come out of my sphincter?

There is also some concern that a patient might recognize him/herself in the description of a patient encounter posted on a blog. This is possible. The patient may be the person most familiar with their medical history. The patients described on blogs may be described with the permission of the patient, may be composites, or may be completely fictitious – used to demonstrate a particular concept (ethical, economic, political, educational, . . .).

A patient may read a blog and conclude that he/she is the patient described in a blog. What if the patient knows that the blog is by their doctor and they have a rare disease that is not the doctor’s specialty? Then it is likely that the patient has found information about their particular case. The doctor should have received some permission to write about the patient, first. What about the doctor who specializes in rare diseases? It is not unlikely that a doctor, specializing in some rare disease, has more than one patient with a similar presentation.

What if a patient believes that they have located personal information about themselves on a blog?

The person probably needs the services of a psychiatrist, rather than a lawyer.

Why do they believe that this is about them and not some of the hundreds, or thousands, of similar patients?

Why do they believe that the information presented is not a composite of several, or even dozens, of patients?

It’s not all about you!

Unless you are reading EE’s blog and call 911 for any one of many extremely stupid reasons. Then you need to contact me, because I certainly cannot identify you from the information she puts in her blog, you moron, and I will attempt to engage in some behavior modification for all of the system abuse you are guilty of. Of course, these are people who are having their stupidity violated – if you can ever identify them. This has nothing to do with medical privacy.

Another thing that they criticize is doctors making negative comments about patients, other doctors, or the profession of medicine. It is unprofessional in their opinion. Apparently all problems should be addressed with a false smile and more respect for social graces than for improving health care. Augh!

As far as product endorsement is concerned, they highlighted one blog entry. A response by the author of Medicine and Man, a seemingly respectable and not controversial blog, who points out that he was misrepresented and only wrote about an article in the New England Journal of Medicine. His response is On “Content of weblogs written by health professionals”. According to them I would be endorsing a lot of products, since I have written about many products described in peer reviewed journals. The post in Medicine and Man was not an entirely positive post, so their claim that it was advertising, rather than a literature review, is quite a bit exaggerated.

In the discussion they are a bit more balanced, but there are so many conclusions drawn from so little data – data that has been intentionally made misleading – that we should ignore the scary headline numbers completely. The discussion was only hinted at in the article. There are some people, who have probably been a bit careless with patient identifying information. I think that it is unlikely that they will avoid getting pointers from other bloggers about appropriate posting of patient interactions. Making this out to be more than that is just being silly.

Maybe Dr. Deborah Peel is using a pseudonym to publish her HIPAA hysteria.

Below is what I posted in the comments to the LA Times article. Imagine, limiting me to 650 characters. The nerve.

17% blogs included enough information to identify patients. They located 1,434 medical blogs, but narrowed it down to 271 “journal style” blogs. This cherry picking means that 17% of medical blogs is inaccurate. They only looked at 19% of the medical blogs they located, but selected the ones they felt would be most likely to be indiscreet. If they were good at cherry picking: 3%. They do not mention being able to identify any patients. They mention one case reported in the news. 1 case out of over 1,000 blogs! If only actual doctors, taking care of real patients, had such a good record. Rogue Medic http://roguemedic.blogspot.com/
Submitted by: rogue medic
10:55 PM PDT, August 5, 2008

This is also written about at On medical blogging codes on
DB’s Medical Rants.


CNN is Selling Snake Oil – All You Have to Do is Believe.

CNN has recently run two stories that seem to have nothing to do with journalism. Rather, they mock journalism.

Brain-dead baby recovers trumpets the news that a baby who was brain-dead really recovered. In the story, not that anyone reads details any more, they only mention that the baby was pulseless. Nowhere in the story is there any mention that he was brain dead.

Should CNN change the misleading and unethical title?

No, this brings viewers and CNN can do anything to make more money.

In the more recent story, Man declared dead, says he feels ‘pretty good, in the article CNN claims that the man was brain-dead, but no medical staff are quoted. No mention of attempting to obtain comments from the doctor in charge of this man’s care.

His father, Doug, said he saw the results of the brain scan.

“There was no activity at all, no blood flow at all.”

Maybe I am a cynic, but I’m guessing that this is the first “brain scan” that he has claimed to have seen. We might want a second opinion, maybe from someone trained to interpret them.

Not if you are CNN or Associated Press – the attributed source of the story.

What happened to at least two sources?

What happened to common sense?

What happened to medicine?

It seems that CNN has become jealous of the ratings of reality TV shows and want to join in.

Well, reality TV is as much about reality as homeopathy is about patient care.

Maybe I will vary my patient pseudonym between CNN and Dr. Deborah Peel – two peas in a pod.

Happy Equinox!

The equinox is a much less common celestial event than a full moon and we all know just how crazy things become during a full moon.

If the volume and severity of patients presenting to the ED are based on the mystical effects of the monthly full moon, the predictable union of the 13th day and Friday, or the utterance of the words slow or quiet – then why not the equinox?

Why do we believe that there is any God willing to punish these future patients for the sole purpose of teaching someone in EMS the evils of the words slow and slow?

What kind of godforsaken lunatics do we have in EMS?

It is as if Dr. Deborah Peel has joined our ranks.

Here are only some studies showing the lack of effect of a full moon –

Trauma and the full moon: a waning theory.
Ann Emerg Med. 1989 Jul;18(7):763-5.
Coates W, Jehle D, Cottington E.
PMID: 2735596 [PubMed – indexed for MEDLINE]

The full moon and ED patient volumes: unearthing a myth.
Am J Emerg Med. 1996 Mar;14(2):161-4.
Thompson DA, Adams SL.
PMID: 8924138 [PubMed – indexed for MEDLINE]

Effect of lunar cycle on temporal variation in cardiopulmonary arrest in seven emergency departments during 11 years.
Eur J Emerg Med. 2003 Sep;10(3):225-8.
Alves DW, Allegra JR, Cochrane DG, Cable G.
PMID: 12972900 [PubMed – indexed for MEDLINE]


Deborah Peel is the antidote to HIPAA


Well, I goofed. I originally wrote this about a non-existent Jane Peel. That will teach me to pay attention. It is Dr. Deborah Peel, who does exist and is the target of this satire. My apologies to any Jane Peel who might be offended by my mistake (for the stigma of being mistaken for Deborah Peel) and to any readers for the confusion I may have caused.

From White Coat Rants comes a pair of posts that are, well, inspiring.

I Am A Professional and the follow up Caught In The Middle point out some of the silliness that those outside of the medical establishment cause by imposing their good-intentions-paved roadway on everyone else.

The good doctor, Deborah Peel, is a psychiatrist. With her boundless experience and unquestionable ethics she has decided that anyone who writes medical blogs that describe any patient in anything less than the most glowing description possible . . . . (wait for it) . . . . needs psychoanalysis.

No conflict of interest in recommending your treatment to thousands of people you haven’t even examined.

Imagine what she thinks of you reading this.

What if you both write a blog, that does not put all patients on a pedestal, and you read other blogs?

I am truly doomed!

I need her help!

Only someone so astute that she can mass diagnose without any patient contact is good enough for me.

Or, maybe, I should treat myself.

Rogue Medic, roguishly heal thyself.

I shall use art therapy and write to heal myself.

All of my patients shall be named Rumplestiltskin.

No, even better, as White Coat Rants wonderfully demonstrated in his blog – Deborah Peel is the perfect universal patient pseudonym. I think WCR took it a little too far in performing a sex change operation on good old Deborah by making the male a John Peel. This appears to be without Deborah Peel’s consent. We must treat her with the respect she deserves – all patients are now Deborah Peel. Maniac Ted Kaczynski, you are now Deborah Peel. The adorable psycho, Chuckie Manson, you are now Deborah Peel. David Berkowitz, you are no longer Son of Sam – try out being Son of Deborah Peel. Go with it. Feel the healing power of Deborah Peel.

To further my self-directed art therapy I adapted Alice’s Restaurant to Deborah Peel and posted this in the comments.

You know, if one person, just one person does it they may think he’s really sick.

And if two people, two people do it, in harmony, they may think they’re both faggots.

And three people do it, three, can you imagine. They may think it’s an organization.

And can you, can you imagine fifty people a day, I said fifty people a day blogging, using Deborah Peel as their universal patient pseudonym.

And friends they may thinks it’s a movement.

And that’s what it is , the Deborah Peel Patient Privacy Protection Movement, and all you got to do to join is substitute Deborah Peel for your patient’s name the next time it come’s around in your blog.


My apologies to Arlo Guthrie for my lyrical butchery.

I, Deborah Peel, was inspired by Deborah Peel to heal myself.

Further information on Dr. Deborah Peel.