Fear and the Online Physician.

To fol­low up on my last post I had intended to write some­thing that fol­lows the style of an FAQ:

  • What if your patients read your blog?
  • What if your boss reads your blog?
  • What if your patients ask you for med­ical advice through your blog?

Fear under­lies all of those ques­tions, though, and it seemed to make more sense to address that fear.

If you are a physi­cian and you are con­cerned about the vul­ner­a­bil­ity of hav­ing an online pres­ence, what do you worry about? Do you worry that patients will learn to hate you? That your boss will find a rea­son to fire you? That ran­dom patients will “bother” you?1

Would you do some­thing on the inter­net that you wouldn’t do “in real life” as a physician?

All the peo­ple you inter­act with as a physician—your patients, your col­leagues, that per­son who works in the sys­tem, but you see him only every few months—already have opin­ions about you. You build your rep­u­ta­tion with the lit­tle things you do every day.

If you think patients are lazy, your behav­ior will reveal that belief. If you tell some­one (a col­league! a friend! another patient!) that you think patients are lazy, that will even­tu­ally become com­mon knowl­edge. If some­one con­fronts you about that, you’ll man­age it the way you man­age it… and peo­ple will observe that, too.

Record­ing your belief on the inter­net that patients are lazy seems like a bad idea (because it is). Stuff stays online for a long time and peo­ple will find it. If that scares you, it should. But if you’re not doing things like that “in real life” now, why would you sud­denly start doing that on the internet?

You might think that the lack of an online pres­ence (or hav­ing an anony­mous pres­ence2) will pro­tect you because if they can’t find you, they won’t talk about who you are, what you think, and what you do.

That’s not true. Peo­ple already talk about you.3

And these are peo­ple who know what you look like, know where you work, and have expe­ri­ence inter­act­ing with you. Patients who don’t like you will con­tinue to dis­like you. They’ve prob­a­bly told some­one why they don’t like you. Who knows: They might’ve even shared their opin­ions about you on the inter­net. (As I have noted else­where: Hav­ing an online pres­ence gives you the oppor­tu­nity to shape your rep­u­ta­tion on the inter­net. You already take active steps to shape your rep­u­ta­tion “in real life”: Maybe you make a point of greet­ing every­one at work with a smile. Or overtly wash­ing your hands in front of patients.)

The inter­net may be dif­fer­ent medium, but the mes­sages we send are the same. It’s also a place to learn and exchange ideas: What are other med­ical pro­fes­sion­als learn­ing? What do patients want? What prob­lems are we try­ing to solve? How can we make things bet­ter? We’d like you to join the conversation.

As a physi­cian you’re trained to dis­cuss risks, ben­e­fits, and alter­na­tives about inter­ven­tions with patients. Hav­ing a pres­ence online has its own risks and ben­e­fits. If you do decide to step into the online arena, know that you aren’t alone: There are many physi­cians who write on the inter­net. Join us.


  1. Why do some physi­cians worry that patients will find them online and “bother” them? What low opin­ions we must have of patients if we auto­mat­i­cally assume that they will “bother” us! And what lit­tle faith we must have in our­selves to estab­lish and main­tain bound­aries should that hap­pen! And how grandiose we must be to believe that patients want to expend the time and energy to “bother” us!
  2. It may be true that physi­cians, under cloaks of osten­si­ble anonymity, can report and dis­cuss prob­lems in med­i­cine with greater can­dor. Whistle-blowing can be a good and nec­es­sary thing. How­ever, anonymity is ulti­mately short-sighted: It is dif­fi­cult to main­tain true anonymity on the inter­net. More impor­tantly, if peo­ple know who you are, you have greater power and cred­i­bil­ity to iden­tify and solve prob­lems.
  3. Yes, peo­ple are talk­ing about you, but let’s be real­is­tic: They don’t talk about you all the time. Or even all that often.