Despite numerous reasons that have kept health care professionals from the social media, health care blogs are becoming increasingly common. With that come concerns over confidentiality, personal safety, and legal involvement. My biggest concern has to do with self-disclosure. Steve Frankel, an expert in law and ethics in mental health, once presented a case in which a clinician was sued because of too much self-disclosure. How much is “too much”? While we can make a conscious effort to keep that to a minimum in 1:1 interaction, it becomes almost impossible when you write in public.
We do not lose our freedom of speech in public, regardless of whether we are a physician or physicist. That doesn’t eliminate the possibility that blogging will affect our relationship with our clients, their loved ones, and coworkers who may have read what we write. Even when confidentiality is not compromised, What they know about our general beliefs or interests can still impact the working relationship. If our client knows that we have a soft spot for the homeless population or that we disagree with certain health care policies, it may affect their expectations on us as a professional, ally, and advocate.
Irvin Yalom has written quite extensively on self-disclosure in the updated edition of “The Gift Of Therapy.” One of the cases he presented was a woman who had read his book and felt that he was writing about her. Yalom’s anecdote ended on a good note. Perhaps the “damage” isn’t something that can’t be undone through open and honest communication. Yet, it’s unclear if we should make others aware of our writing from the beginning or only when it “naturally” creeps up.
This concern has kept me from blogging for a very long time; and continues to fuel my tendency to self-censor. As some health care writers have astutely stated, presentation of cases and personal anecdotes can be a very effective means of driving home a message about policy and practice. Let’s hope that I will be able to strike a better balance as this blog continues to grow.