A relatively new phenomenon among physicians over the past few years, blogging has gained momentum. Doctors are starting to read one another’s blogs out of curiosity, and the lay public is perusing these tidbits to glean more information about the real person behind that formal white coat.

All individuals who choose to express themselves on the Internet by creating their own blogs assume a certain amount of risk. But doing so as a physician poses specific dilemmas that you should carefully consider.

A key decision is whether to blog anonymously or use your real name. Your choice often dictates where you should draw boundaries between frankness and reserve.

“Blogging under your own name gives a certain sense of legitimacy, but you really can’t gripe about people you know,” says a family-medicine physician who prefers to remain anonymous. (See www.fatdoctor.org.) “Blogging under a pseudonym is freeing.” Nevertheless, she admits that at times she has considered “coming out” to her readers. She says consideration for her employer is part of what keeps her from doing so.

And although she doesn’t bring up politics often, this blogger makes no bones about being a Democrat, and she lists most front-running candidates in her writings. But she adds that general medical commentary that steers clear of advice is often a far safer topic: “I did one about the flu shot last year, cutting down all the usual arguments patients give me for not having one.”

What’s in a name?

Kevin Pho, a primary-care physician in Nashua, N.H., blogs under his real name. He says he launched his blog in May 2004 to give the public a doctor’s perspective on medical news, which he considers unfiltered and without context. For example, the Vioxx recall left many people confused. Pho suggested specific questions that patients could ask their own physicians. He says his blog has been cited multiple times in the mainstream media, including the CBS Evening News and The Wall Street Journal.

“Blogging under my real name is a little bit restrictive,” Pho admits, although he says that it also gives him added credibility. “It’s a way to pull the curtain back and expose some of the problems and frustrations that physicians face on a daily basis,” he says, citing declining Medicare reimbursement, the primary-care shortage, and rising healthcare costs.

Like Pho, many physician bloggers make the conscious decision to avoid discussing patients or dispensing advice. If they do, they alter any potentially identifiable information. Remember that HIPAA applies to your posts. You only have one reputation, so guard it carefully.

Think before you type

It’s also wise to remain judicious about mentioning controversial subjects like politics and religion. That’s unless, of course, you are willing to disclose your views to everyone, including your patients, says Dmitriy Kruglyak, CEO of Trusted.MD, a community Web site for healthcare bloggers. The company helped conduct a survey over the past two years evaluating the popularity of this genre of blogging.

“Physician blogging keeps growing unabated,” Kruglyak says. But it isn’t as simple as it may initially seem. “Creating a successful blog requires constant attention, true love of writing, and willingness to put your ideas out there. As to what topics to discuss and avoid, I recommend a common-sense test: Would you be willing to have your writings attributed to you on the front page of the New York Times, or for that matter, Physicians Practice, for everyone to know?”

And remember that blogging isn’t just a soapbox for your opinions. It’s also a medium that allows others to respond to your messages with their own thoughts.

“You have to be prepared for people to write back, sometimes not pleased with what you’ve said,” notes Robert Wachter, chief of hospital medicine at the University of California, San Francisco, who also has his own blog. “If you aren’t provoking that kind of response, you must not be saying much of importance. But I’ve been around the block a few times, and it isn’t for the faint of heart.”

Susan Kreimer is a New York-based freelance medical and business writer. She can be reached via bgabriel@physicianspractice.com.