The family pictures on the desk. The diplomas on the wall. A few magazine subscriptions, perhaps, or some sailing, tennis or golf memorabilia scattered around the office. In the past, a curious patient could only turn to these bits of evidence to try to know more about the individual behind the medical degrees, the white coat and the carefully scripted bedside manner.
The temptation is understandable. After all, when someone holds your life in his or her hands, it would be nice to know a bit more about what makes them tick. But today, anyone with an Internet connection can have access to the fevered, funny, angry and very human thoughts of these men and women who help us navigate the perilous shoals between illness and health. The vehicle? The doctor's blog. A blog is the name used to describe a weblog, the constantly updated platform for the idiosyncratic and highly personal musings (or rantings) of anyone who wants to set one up in cyberspace.
"It's a direct line to see what doctors think that you won't pick up in the office or from television shows," says Michael Ostrovsky, a cardiac anesthesiologist in Daly City, Calif., who blogs as medgadget.
He says doctors often want an outlet for discussing patient issues and the social and political problems they face on the job, or to gripe about HMOs or Medicare reimbursement rates. "They can vent their frustrations through their websites and learn from other doctors."
In one entry, Dr. Craig Hildreth, who writes "The Cheerful Oncologist," offers some tongue-in-cheek prescriptions on how to get your doctor to listen to you. Another blogger, Medpundit, dissects the hype around medical announcements. And still another, Gruntdoc, written by an emergency room physician, posts and analyzes news articles on subjects as varied as undocumented workers and stroke treatment in the ER.
Doctors could hardly be immune to the attractions of this swirling mass of confession, self-promotion and opinion. Although there are only about 300 doctors' blogs, these examining rooms provide a rare insight into the physician's world. They are personal and emotional writings from oncologists, family practice doctors, psychiatrists, emergency room physicians and residents. They have become so internally organized that every Tuesday morning a different doctor blogger is invited to host Grand Rounds, the "weekly summary of the best of the medical blogosphere."
Many of the blog names are funny, with plays on medical terms such as myoclonic jerk, a reference to involuntary muscle movements that happen in seizures or even during sleep. Blogborygmi is a variation on the medical term for stomach rumblings.
They also provide the most knowledgeable takes on medical news that one is likely to find anywhere, short of eavesdropping at the bar during a medical conference. Specialists and sub-specialists give patients and each other warnings, guidance on treatments, a dose of general common sense and interpretations of the latest medical news.
Tim Sturgill is an emergency room doctor in Sacramento who has been blogging for a year as Symtym, which he describes as " ... the meanderings of a board-certified emergency physician at mid-career
The winner of the 2004 best Health Policies/Ethics Medical Weblog award, Sturgill cuts and pastes articles on medical technology, ethics, drugs and devices, emergency medicine and other topics -- and comments on them.
"I try to present interesting articles and then try to group them," he says. "And give some macro view of them. I try to find the policy or ethical aspect of the post and then figure out what the impact is on healthcare and what the potential impact is on physicians. I started it thinking that only my mom would read it, and lo and behold, I have 100 hits."
Other doctors use their blogs as ways of recapturing a simpler, more personal tone in medicine. For some doctors, blogs became the treatment of choice against the cynicism, depersonalization and mistrust that have contaminated so many doctor-patient relationships.
And yet, curiously, most of the doctors don't tell their patients about their blogs. As Dr. Charles, a 30-year-old family medicine physician in Philadelphia who asks that his name not be used, says: "We have to maintain an air of professionalism in the office. But on the Internet we are much more candid about what we are thinking about healthcare and patient care."
His blog, the Examining Room, is one of the most popular physician blogs, with more than 2,000 hits a week -- a relatively small number in the world of political blogs, but a large one for doctor sites.