Don’t ask me nothin’ about nothin’, I just might tell you the truth. 
– Bob Dylan

I just read an interesting post by Dr. Jennifer Gunter. Apparently, the entirety of what we are doing here at Dr. Whitecoat, and on internet communities and blogs like Student Doctor Network and Sermo, is unethical, according to the General Medical Council in Britain. How dare we not use our real names on social media as physicians and physicians-in-training?

According to the British General Medical Council, “If you identify yourself as a doctor in publicly accessible social media, you should also identify yourself by name.”

Otherwise, if you don’t, what you are doing is wrong, and unethical.  Really?  On one hand, I agree that any physician that posts publicly should post with the assumption that their identity could easily be discovered, if desired. Therefore, never post anything anonymously that you couldn’t live with, if your name ever ended up being attached to it. We shouldn’t be mocking patients, using profanity, or blogging like drunken sailors.

Also, patient cases need to be devoid of all identifying information (18 HIPAA identifiers) or even fictionalized to the extent that no patient could ever read a post and say, “That was me!” (For this reason, anything I post that resembles a “patient case,” if inspired by real events, has all of those factors deleted or changed so drastically, that the final product bears almost no resemblance to the inspiring event. The “facts” are drastically altered to the level of fiction, without altering the essential “truth,” hence the disclaimer.)

Dr. Gunter, in her post, links to another blog with some very good points by Christopher McCann, where the need for some level of anonymity is essential for the needed role of whistleblowers. Just think of how many medical disasters, scandals and ethical horrors that could have been exposed or stopped if internet social media had existed in the past with the ability to retain a vague hope of at least temporary anonymity.

I think an outright ban on physicians posting under pseudonyms in the name of ethics, creates a chilling effect against speaking out against policies and procedures that may be harmful and unethical themselves.  Such a policy itself is an unethical policy, in my opinion.  In short, it suppresses free speech.  There are plenty of people in positions of great money and power, with a vested interest in enforcing such a chilling effect on free speech.

“Don’t dare question, that which you see. Don’t rock the boat. Get in line ‘little soldier’. Don’t get in the way of our immensely profitable status quo.”

Because one has a famous real name doesn’t make what he says, “Fact.” Just think of how much medical dogma in history, that has caused irreparable harm and was promoted proudly, authoritatively, and unquestionably by big “names” without basis in fact or evidence: bleeding patients with leeches, tapeworms for weight loss, lobotomies, smoking to treat asthma, heroin prescribed for the common cold in children, using mercury to treat syphilis, all the way to modern day unnecessary surgeries.

How could I forget the Tuskegee syphilis experiment, conducted by the US Public Health Service itself, where 600 African American men were allowed to rot with syphilis, and were never offered the cure when penicillin was invented? These were all treatments that were accepted by the medical community at the time and touted by doctors who weren’t afraid to use their “real” names.  Perhaps they should have been afraid, and perhaps if there had been an open and unsuppressed internet to facilitate blowing the whistle on some of these harmful and misguided treatments, many lives could have been saved.

I see more truth written by some supposed cowards that post under pseudonyms, than some of the unquestionable dogma spoken by those who are propped up by proudly displayed titles and names. What about the chilling effect on doctors afraid to speak out against patient satisfaction policies which are associated with higher death rates, due to fears of losing their job? What about doctors afraid to speak out about being pressured to admit patients unnecessarily and defraud Medicare, due to fears of losing their jobs?  What about the chilling effect on physician researchers who already don’t speak out enough about purposely suppressed clinical trial data which has led to dangerous medications being approved prematurely?

Perhaps anonymous and pseudonymous reporting amongst physicians on internet social media plays an important role as a check and balance on the medical field as a whole, which has a dismal track record when it comes to self-policing in regards to ethical lapses and dangerous missteps.

Is what we are doing here unethical and wrong, posting with pseudonyms? Need we change our screen names to our real names now, to comply with this supposed emerging ethical standard?  I think not.

“BirdStrike” is an emergency physician who blogs at Dr. Whitecoat.