For physicians of a certain age, the weekly teaching session known as grand rounds is a ritual steeped in formality and tradition. Presided over by the profession's graybeards, grand rounds are attended with white coats on and clinical details in hand.
Here, young physicians learn to accept their elders' old-school admonishments with reverence and humility.
Grand rounds on the Internet, however, is another thing altogether. A weekly compilation of the Internet's best medical blog postings, it is part classroom, part locker room, part group therapy session and part office party -- a free-wheeling collection of rants, shop talk, case studies and learned commentary (along with the occasional recipe, movie review or vacation slide show).
This rotating Internet roundup, hosted each week by a different medical blogger, is the center ring of a colorful and growing circus of blogs written by medical professionals and posted for all to see. It is making the practice of medicine more transparent to patients and, at the same time, raising ethical questions about safeguarding patient privacy.
"Medical blogs have the opportunity to be such a benefit to patients," says Dr. Tara Lagu, author of an article on the subject published online last week in the Journal of General Internal Medicine. "By revealing the struggles we have, they can really open patients' eyes to how to interact with doctors, they can connect patients and nurses who can be isolated from each other and they can be an important source of information for doctors as well as patients."
But as physicians increasingly use blogs to talk shop and vent their frustrations online, patient privacy has become an issue, says Lagu, who is a Robert Wood Johnson Foundation Clinical Scholar and an internal medicine specialist. "It's time for us to take some responsibility and really think of how we can maintain the integrity of this process."
The Health Insurance Portability and Accountability Act, or HIPAA, gives patients strong privacy protections, but the 1996 law predates the medblog phenomenon, leaving gray areas for bloggers who write about their patients.
In a 2006 study, Lagu and her coauthors found 271 blogs written by physicians or nurses. Roughly 42% of those blogs included descriptions of interactions with individual patients, and almost 17% "included sufficient information for patients to identify their doctors or themselves." Three of the blogs showed recognizable photographic images of patients.
