Every tragic hero succumbs to a fatal flaw. Consider the hubris on the part of Flea, aka Dr. Robert Lindeman who was, until a couple of weeks ago, the defendant in a med-mal trial who was blogging about his own case (and his take on opposing counsel, the jurors, and his own defense) — until his lawyer finally must have made him stop.  On cross-examination, he acknowledged his nom de blog, and the case settled the next day — an outcome presumably preferable to having his blog posts read to the jury.

This takes the questions about propriety of physician blogging to a whole new level.

And while we’re on the subject of physicians and their on-line behaviors, let’s stop and think for a moment about the epochal AMA-Sermo deal.  Fascinating idea: let physician share notes, including notes about patient drug reactions/side effects (anonymized, of course) in a physician-only online community.  The service is free to physicians, thanks to sponsorship by financial services firms and industry analysts — who have access to the physician postings, and presumably expect to be able to use the information gleaned from the postings to their benefit.

There’s the opportunity for benefits to physicians (particularly those in solo and small practices) and to medical care generally thanks to the communication tools available through Sermo — including, for example, the world’s biggest journal club.

There is also the potential for unintentional release of personally identifiable health information (through a combination of potential physician error, other human error, and hacking), and also the propagation of anecdotal reports on a larger scale and faster speed than has been possible in the past.

A better pathway to sharing of data in a meaningful way for the benefit of patients — i.e., sharing information so as to develop new or revised protocols for care (evidence-based medicine) — may be the broad dissemination of EHR systems and the use of data collected through EHRs.  Thomas Goetz presents this point succinctly (and pooh-poohs some of the privacy concerns outlined above) in a recent post on his blog, Epidemix.   

Update 6/13/07: Goetz’ related opinion piece in the NY Times (promoting VistA Lite) was pooh-poohed in turn by Micky Tripathi and Matthew Holt.

David Harlow