Google “anonymity medical blogs” and you will find many takes on this. Some anonymous med-bloggers advocate the value of sharing real-life stories, but to me that comes loaded with layers of conflicts of interests. We all have the right to be anonymous, but is it always a good idea to do it just because we can?

• Why do you want to be anonymous?
• Who does it protect? And from what?
• Does it promote or hinder dialogue?
• Does being anonymous affect one’s behavior?
• Should anonymous people be regarded differently?
• Should being a healthcare professional tie us to a common standard of blog-ethics?

The 100% anonymous comments that people leave all over the web tend to vary in quality. I’m talking about ones that really say “Anonymous” next to them. Some blab without thinking too hard, and I can’t deny that I sometimes enjoy rebutting them within my limits of decency. Other times, they add really insightful feedback and I wish I could address them properly to carry on the conversation. I still take such comments knowing that I can always just delete an occasional bad apple.

Many on Twitter or blogs stay pseudonymous. Some of these people have advanced their online presence such that they meet anthropological, sociological, and psychological criteria of a productive community member. They often have extensive online networks and a reputation built on participation. With these people I tend to be a bit more cordial because they stake their feelings and commitments to what happens around them. You can collaborate with them. But again, this falls in the grayscale.

Recently at TEDx Maastricht, Simon Sinek spoke about trust. He said a mom looking for a babysitter is much more likely to trust the 14-year old neighbor with zero experience, but not the adult with lots of childcare experience who just moved in next door. That’s human community. So, does anonymity work against participants who discuss health, policy, ethics, etc? Let’s shamelessly cite myself on Twitter:

Dr. Akerkar asked a great question, which I believe was rhetorical. Although the vast majority of people mean well, I also think those who stay 100% anonymous tend to:

• worry about their online identity due to some lack of knowledge
• be casual passers-by who don’t want to stay engaged in the conversation
• not want to take credit for their own comments
• or they might be just new and are trying to get their feet wet before jumping in (some evolve to be “pseudonymous” or start using real names)

Anonymity definitely has its place, but total anonymity? Apparently, not if you want to matter.

Jin Packard is a medical student who blogs at Fresh White Coat.

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