Monday, April 09, 2007

Why Do Medical Bloggers Tend to be Anonymous?

Anonymity is derived from the Greek word, meaning 'without a name', and more originally meaning ‘without law’. Overall it’s thought that both anonymity and pseudonymity are concepts that are concerned with hiding a person's legal identity, others believe it’s the tradition of blogging that keeps the writer anonymous.

Some of the American weblog gurus (for example, David Weinberger) tell us that weblogs are all about identity and the contents of the blog is secondary to the self-expression of the individual who writes them. The exception to this rule he offers are bloggers who are “living in countries where they might face repression or political pressure if they posted under their own name.” Obviously it’s up to the individual if they want to put their name to their writing or not, but it’s noteworthy that the majority of UK medical bloggers choose to write under the cover of anonymity. Below is a list of medical bloggers, which is by no means exhaustive, whose blogs I read and enjoy:

NHS Blog Doctor
Dr Grumble
A Forunate Man
Hospital Phoenix
Dr K
Dr Rant, and his team Dr Cardigan, Dr Blue, Dr Brown, Rev Dr Green, Dr Mustard, Mr Orange, Dr Pink, Dr Purple, Mr Salmon, Dr White and Dr Informed
Life in the NHS
NHS Escapee
The Paper Mask
I don't have the answer to why medical bloggers tend to be anonymous, but merely highlight it as a matter of interest. Any comments or thoughts welcomed.


Anonymous said...

“living in countries where they might face repression or political pressure if they posted under their own name.”
You already have the answer - although you do a good job in sticking your head above the water! Please keep doing it.

Admin said...

Fear,the NHS is gonna get you someday,whatever mess it is in

Maalie said...

Maybe they simply prefer no avoid the risk of being identified by their patients?

The Angry Medic said...

Aw thanks for the mention, Dr Tempest!

I've spoken to many of my fellow medbloggers about anonymity before, and the med students at least fear reproach from their universities (with good reason). The danger to doctors would probably be even greater, I guess. We all have to toe the line somewhere :)

Dr Michelle Tempest said...

Thanks Oracle, I'm a big supporter of the NHS, and writing about the NHS and other issues is meant to open up constructive debate, so thanks for the comment.

Maalie, indeed this brings in the entire confidentiality debate.

The Angry Medic, thanks for the comment. I always enjoy reading and remembering my old student days... good luck with the revision! Michelle

QUASAR9 said...

You mean your name is Michelle
and you are blond???

Only kidding - But blogging is pretty anonymous even if you give your name (photo) and e-mail address ... to those who fly past

As to those who know you, or you know - well one probably told them the pseudonym one blogs under - and do the visitors visit us for who we are, or what we write ...
shall we ever really know - lol!

Dr Michelle Tempest said...

Thanks Q9 - are you saying your name is not Quasar9?! You are right, the web is big enough to keep some kind of anonymity... but this hasn't stopped two medical bloggers from closing down recently. I for one will miss Barbados Butterfly. Thanks Michelle

Dr Rant said...

The Dr Rant team members have already had at least one GMC complaint for publicly criticising colleagues.

Our colleage, Dr Peverely, has taken at least two GMC complaints for his column in one of the GP 'comics'.

We're not keen to take more complaints - especially now that the standard of proof required for censure is being dropped.

The GMC may be shite at stopping dangerous doctors, but they have a great track record of shutting up doctors that speak out.

Dr Michelle Tempest said...

Thanks Dr Rant, you and your tean have great pseudonyms by the way. Michelle

Dr Andrew Brown said...

I don't particularly like being pseudonymous, I must be a bit like Matilda's aunt:

"Her Aunt, who, from her Earliest Youth,
Had kept a Strict Regard for Truth,
Attempted to Believe Matilda:
The effort very nearly killed her."

I have this irrational urge to shout out "it's me! I'm really Dr xxx!", like a child who can't keep quiet in its hiding place. But the thing about anonymity is that once it's gone, it's gone. I'll seeing how the blogging goes and review the decision in a few months.

I'm not particularly worried about my job being threatened. I'm just a rank and file GP with less than a decade to go until retirement and no political ambitions. I don't expect to write anything sensational or vexatious. My reasons for using a pseudonym were to make my patients even less identifiable, and also because I may want to write about partnership problems in future. As practices go I think we are relatively trouble-free, but problems do arise from time to time and some of my partners might take it ill to see our "dirty linen washed in public".

Dr Michelle Tempest said...

Thanks Dr Andrew Brown - I shall look forward to reading about all the trials of a GP practice - I'm sure other GP practices will have similar problems all over the country. The reason that I used my own name, was that I set out to write a 'well-being blog' away from work... unfortunately, the MMC/MTAS has somewhat eclipsed that recently.
But I'll read your blog by any name... even your own. Thanks for the comment. Michelle

Calavera said...

Thanks so much for the mention, Dr. Tempest!! I appreciate it! I enjoy reading your blog too.

On the anonymity issue... I have no idea. I guess it just feels safer, somehow.

Despite all appearances, though, I'm not too bothered if people do rumble me and find out who I am.

I've not written anything that could get me into trouble anyway. I don't even have any patients who could identify me - I'm a third year!!

Thanks for the mention, once again!

Phoenix said...
This comment has been removed by the author.
Phoenix said...

Good topic, Michelle.

I have a very specific reason for my anonymity - I set up my blog with the intention of making posts about things I couldn't discuss in real life - mainly that of my manipulative, bullying boss.

The blog has been a great help to me, getting the thoughts and opinions of people who aren't in my immediate professional circle. So much so that it's helped me get a healthy perspective and to start discussing this issue with my colleagues in real life.

Outside the McBitch issue there is nothing I have to hide.

Phoenix said...

I wish the GMC would come and read my blog. Why are they concerned with the excellent humour over at Dr Rant, when there's an evil bitch making my life a living nightmare and trying her utmost to destroy my career?

David Anthony said...

I don't know why doctor's stay anonymous. I guess there is a lot more room for office politics in a place like a hospital, wit hso many different types of people and careers.

I'm glad you decided to 'out' yourself from the beginning, it's nice to put a face to a voice ... but not if it's going to damage you in the longrun.

Maybe it's too late to go by the name Dr. T now!

Anonymous said...

I must admit I had never given it another thought, are you sticking your neck out by revealing your name? Can you be googled by patients and stalked?

Dr Michelle Tempest said...

Thanks Cal, I think if people really wanted to find out who bloggers are then it's possible - as Guido found out. But as Q9 said, the www is so big that in itself helps provide anonymity.

Thanks HP - sounds like great sublimation, now you have an unmissable blog and everyone wants to protect you from your boss... GMC another issue!

David - thanks, perhaps I should change my name to T2 - I'll be back! As I am sure will be said many times as Arnold heads for the Tory party conference.

Overall though, as it states at the top the views on this blog are all personal.

Thanks to you all for your interesting comments certainly made this a good discussion.

Dr Michelle Tempest said...

Thanks Ellee - I guess we can all be googled... people's web footprints are actually easier to follow than one might think - anonymous or otherwise. The main thing is to enjoy writing and reading them. Michelle

Merys said...

I stay anonymous because I find it much easier to write without people knowing it's me. I just feel more comfortable that way, and yes, I am scared of what my medical school will say (not that I've breached any rules I know of)

simon said...

I have thought about this a lot before writing in my own name.

I guess there is a risk of "loonies" giving you trouble ( I have had one such case), But for me to feel that my blog is open and honest was the key.( I am not suggesting that by being anon means the opposite either!!)

Yet I can understand doctors/lawyers/politicians not wanting to be identified..or individuals, if revealing who they are cramps their style...

Anonymous said...

Interesting topic Michelle and one I have written about myself. I guess for me it is less about my being a nurse and therefore in a position to be reported to the NMC for some perceived issue, but really about my status as an employee of an NHS PCT. I do use my own first name, or else I might just get a little confused (not difficult for me!), and I don't think I would be so hard to track if someone wanted to.

jumpinginpuddles said...

ok have to ask do you ever go to anyone but other medical bloggers? or are you more comfortable in your own circle ? not meant derogitavely just curious

Anonymous said...

A small correction from a Greek medic: anonymity does derive from the Greek anonymos which means without a name but it is the Greek world anomos that means without law

Dr Michelle Tempest said...

Thanks meryvs - thanks for the comment and I shall add you to my list of links, on next update.

Thanks Julie and Simon - I guess we live in a world when transparency is often asked for and so why not on blogging as well.

Anonymous Greek - thanks for that. I'm glad to have learnt and you should tell wikipedia as well!

Jumpinginpuddles - I often comment on non-medical blogs, but with the MMC fiasco, the time dedicated to medical blogs has increased. I'm afraid the rate limiting step is the number of hours in the day. Thanks for your comments.

Phoenix said...

Jumpinginpuddles - medblogs only for me.

It may be a little cliquey, but I like to visit blogs where the bloggers' topics mean something to me, and where I 'know' the people making comments.

Yes, I have interests outside medicine - plenty of them in fact - but they're not really amenable to blogging!

Dr Andrew Brown said...

When I set up my blog I began with a Googlemail account, and didn't have to give any identifying details. No doubt Google/Blogger could work out who I am from the IP address of the computers I use to post to the blog, but I don't think anyone else could do that.

I think the main risk is giving yourself away by the details you reveal, not necessarily all at once but the amount of information will accumulate over time.

Or if someone to whom you have revealed your secret identity accidentally posts a comment that mentions your name.

OK, I admit it, I am really Bruce Wayne!

Sheepish said...

Thanks for the mention - my readership has suddenly increased about 20 fold (i.e. from 2 to 40 in the last day).

There is always an altruistic purpose to anonymity - as a doctor I don't want to risk exposing or identifying my patients or colleagues, and once my identity is out it is an order of magnitude easier to pinpoint specific people.

Then there is the CYA purpose to anonymity - I don't want to be sued, fired, or otherwise publicly shamed for saying something controversial on my blog.

I think, however, that the biggest reason is that it allows me to be a different person. It frees me of my real-life inhibitions. There are many fewer consequences to saying something offensive, inflammatory, or downright mean on an anonymous blog. I can adopt a different personality, say something that I haven't really thought through, or which I am still deciding upon.

As Barb once said to me - "I'm not my blog. That is not the whole me. It's just part of me that I like to express sometimes."

Inevitably, it's a pretty thin veil of anonymity. It's very easy if you are in the right (or wrong) circles to work out who is who. It's probably only a matter of time before a real identity is revealed - unless the blog is stopped, deleted and/or abandoned beforehand.

While you might not have your name tattooed on your forehead while scrubbed, if people spend enough time looking at or talking to you in the OR, they learn to recognise you outside the OR.

In fact, trying to hide behind an anonymous blog is like... wearing a Paper Mask.

Dr Michael Anderson said...

Personally, I think there are two compelling reasons for remaining anonymous.

Firstly, identifying the author would make it easy to identify who the author was writing about. This is not fair because the people being written about frequently don't give permission to be be put in my blog.

Secondly, it allows me to be much more honest about when things go right and when things go wrong. What's annoying me and what is pleasing me. It allows me to express my own insecurities and failings without fear of being judged by the peope I work with. You know how good the hospital grapevine is at getting gossip around! If I knew patients and colleagues were reading what I wrote, some of that honesty would be lost. My blog would be some thing like this:

"I went to work today. I really love my job. I helped some sick people get better. Now I feel good."

How boring would that be?

Roy said...

We discussed this some on a Shrink Rap post (When Worlds Collide, and also on My Three Shrinks.

The Little Medic said...

Very interesting post and interesting comments too.

I have to say I'm with Angry Medic on this one, the reason I choose to remain virtually anonymous fear of what my univeristy would say, they already don't approve of my complaining nature and I don't think they'd like some of the stuff that I say on my blog.

I could easily be identified and some people already know who I am, but I hope to remain as anonymous as possible as long as I keep blogging.

Dr Michelle Tempest said...

Thanks HP and Sheepish - and also for the comments on your sites.
The junior doc and the little medic - I can understand why you feel comfortable blogging under anonymity, and one day hospitals and Unis may even encourage people to express themselves via a blog.
Thanks Roy for the links.


Dinah said...

Oh, looks like Roy was here first, but I think we had another post on this called The Blogging Shrink:

Garth Marenghi said...


I think that anyone who talks of specific patients and specific cases at work does run the risk if they do it without anonymity.

I make the effort to avoid talking of any personal cases at work, so I don't have to be anonymous- however it's a personal choice partly out of paranoia knowing the culture of fear within the NHS and partly because I simply enojoy the anonymity; not sure why I do?

maybe there is some kind of freudian explanation?

Anonymous said...

I'd suggest 3 reasons:

1 - The NHS is something of a Stalinist employer, and conformity is expected, and they are scared.

2 - Contract clauses about "bringing the employer into disrepute" and so on. This could leave them vulnerable to being "passed over" or disciplary action for anything from revealing waste to Google serving ads aiming to take our Docs to Australia, depending on the mood and policy of the management.

3 It just makes life less complicated.

I have no problem with any of that except for people who engage in anonymous attacks on colleagues. Imho these bring the pseudonymous system into disrepute.

I am pseudonymous because I do some work for the public sector and 3 would apply. Even though I *never* blog about a current client, it just avoids buggeration.

Matt Wardman