Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "anonymity"

Noon Conference, where Wayfaring sits in the back with her 2 besties, eating salad and pretending to pay attention…

Program Director: *talks some junk about recruiting season, blah blah* So it’s that time of year that we get our residency blog back up and running. And Dr. Wayfaring, our prolific blogger extraordinaire, would be glad to explain to everyone what the blog is all about.

Wayfaring

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**In my head**

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Wayfaring to bestie: Crap, does he know? How would he know? My blog is supposed to be a secret! 

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Hello, I wanted to ask you how you decided on your level of anonymity. I know some bloggers that don't reveal their location, program, or appearance, while some choose to make all three public. Are there any things to keep in mind when making this decision about my own blog?
wayfaringmd wayfaringmd Said:

I started out not anonymous at all, but I also started out not blogging about medicine at all. It depends on your subject matter. If you’re posting about patients or stuff at school that might not be well-received, it’s probably best to be anonymous. But if you’re not really posting much original stuff or patient stories, it’s probably ok to be a bit looser. Also, if you’re in a big city with multiple schools or residency programs, it’s a bit easier to be open about your identity than if you live in a smaller one-hospital (or one-residency) town.

When I started med-blogging, it was mostly just my Advice to Premeds series, which didn’t reflect anything on myself or my school. But once I started writing about patient stories, I decided I need to be completely anonymous. A few of my followers who have been with me from the beginning will remember those non-anon times ;). I decided that I didn’t want my school or residency program to be able to find me, and conversely I didn’t want my followers to be able to identify my school or residency program. I’m certainly not as good at being anonymous as Cranquis is, since he doesn’t share many details about his life or job at all. But I think I’m ok with the level of anonymity I’ve got now. 

Asker Anonymous Asks:
Is running a Tumblr blog worth putting on your med school app?
wayfaringmd wayfaringmd Said:

Ooh, be careful with that. If there is even ONE post on there that may put you in a negative light to the school, it’s a bad idea. It also really depends on your subject matter. If you’re just reblogging a bunch of science posts from other people, what does that show to the application committee? But if you’re running an original content blog that is innovative or research-based, it may be appropriate. I would not put a blog like mine on an application (because I share patient stories and personal stuff), but ones that probably would look good to admissions committees are ones like thebiopsy, in-training, and thedifferentialdiagnosis. Also be careful to research the school’s social media policy before you disclose a blog to them. 

Asker Anonymous Asks:
I am generally good at picturing what people would look like, but I honestly have no clue what you would look like
wayfaringmd wayfaringmd Said:

I have a general human look about me. You know, of the people variety. I’ve been told I have one of those faces. I have two eyes, nose, two ears, lips, and arms and legs that grow directly out of my head like first grade drawings of people. 

Don’t go tryna picture my lady parts, now. 

If you want specifics on what I look like, you’ll have to ask Cranquis ;)

Asker Anonymous Asks:
Where do you think Craquis is?
wayfaringmd wayfaringmd Said:

Cranquis and i have an agreement that allows me 3 guesses of his location per year. Unfortunately, I have used up my guesses for the year, so I can’t really venture a guess now. Also, my location guesses are based on my sleuthing of his blog and are between me and him (her?). 

But I’m currently working on states between New York and California, if that narrows things down for you any. 

Asker Anonymous Asks:
What's the best treatment for menopausal hot flashes?
wayfaringmd wayfaringmd Said:

Treatments your doctor recommends personally for you are always better than those recommended by anonymous internet doctors. 

Asker rohanshad Asks:
Could you write a post on how to stick to HIPAA guidelines online? Especially if you're not using an anonymous name for your blog? As a medical student in a country that's essentially lawless (lol) it's difficult wrapping my head around these new fangled restrictions.
wayfaringmd wayfaringmd Said:

Ok, #1: If you are outside of the US, you do not follow HIPAA. HIPAA is a US law. Other countries may have their own versions of patient privacy laws, and they probably differ from ours, so be sure and find out what your country’s standards are.

#2, if you are a medical person who is working or studying in a country that is not your own, you should adhere to that country’s guidelines for patient privacy. If that country’s guidelines are fairly loose, no one would blame you for following stricter rules. If the country you are in does not have patient privacy guidelines, the ethical thing to do would be to follow cultural norms there while also still protecting patient information. For example, when I travel, I do not share patient information (patient’s name, condition, labs, etc) with anyone other the patient unless the patient tells me I am free to do so. This is a bit hard when you work in hospitals that have large open wards, but it’s still possible.

And now a little summary of HIPAA: the whole point of it is to minimize the number of people who are given access to patient information and identifiers. Protecting patient privacy is a lot more than not sharing their name. It covers any information that could be used to identify a patient. For example, say my practice has a patient with an extremely rare congenital disorder. Now if I were to say what kind of disorder this patient had, or if I told you where my practice was, it would potentially be very easy to identify them, right? This is why in my own blog I often leave out specific details of patients’ stories, or I change their demographics in some way, or I change the time frame that the event occurred (yeah, most of the time when I say something happened “yesterday”… it didn’t) so as to blur the lines a bit and make them even less identifiable.

The easiest way to keep your patients’ identities secret is to keep your own identity secret. I say easy, but trust me, it’s hard to stay anon. I’m certainly no expert on this, and I flub it up all the time. Cranquis would definitely be the best model to follow for blog anonymity out there. That man (or is he?) is paranoid about being identified.

But total anonymity is not required to be HIPAA compliant online.

Here are some major guidelines to follow:

  1. Never share names, birthdates, social security numbers, addresses, special identifiers, or specific information about a patient’s condition online.
  2. Don’t check out patients to other providers via text or facebook message 
  3. Find out what your hospital or university’s social media policy is and be sure you stick to it.
  4. Make sure your blog is strongly protected by passwords and/or special browsers (like Tor) so that no one but you can access it—from your end or the other end of the intertubes.
  5. Do not link your personal information to your blog. For example, I created an anonymous email account that I used to sign up for this blog, so that I can’t be identified through my email address. And don’t link your personal and private blogs.
  6. Let your posts simmer a bit before releasing them into the world. I usually have mine in the drafts pile for several days before posting. This gives me a chance to review them, make changes, or delete them if I think on a second look that I went too far.
  7. If you’re not going to be anonymous, do not post anything that you would be embarrassed for one of your patients to read, or that you would be embarrassed to have published in a newspaper. 

I come across many med student/MD blogs. I know doctors are only human and need to vent or share their experiences too. Still, do you ever wonder if these blogs may affect the way patients view and trust doctors? -secondworldwarineurope

Well so far I haven’t had a patient ask me if I was “one of those blogger doctors,” so I can’t be entirely sure, but yeah, it probably does affect some people. You gotta remember though—most patients (mine at least) aren’t trolling the medblr tag on Tumblr to see if their doctor wrote something about them.

I can’t say that our blogs contribute to people’s perceptions of doctors any more than medical tv shows and tv docs like Dr. Oz do. I feel like those things give us just as bad reps as our blogs potentially could. My hope for these blogs is that they would help patients to see doctors as humans. For many years, doctors were seen by many as demi-gods, and were held to impossibly high standards.

To some degree, we still are. Some docs like to be seen that way. Personally, I don’t want my patients thinking I’m better than them in any way, because guess what? I’m not.

Medicine is SUCH a stressful career, and if patients hold us to a standard of perfection, the burden will become unbearable. But if our patients realize through our blogs that we are imperfect, stressed out, insecure, caffeine-addicted, relationship-challenged, quirky, but yes, very smart, people, then we have some hope of living somewhat normal, unburdened lives. 

And you’re right, docs do need a place to vent. Doctors have been writers for hundreds of years, and they were being careful about what they wrote long before the institution of HIPAA. Pastors write about congregants they’ve helped, lawyers write novels based on interesting cases, and cops shows and books are a dime a dozen, but for some reason the ethics of doctors writing about their day at work is always in question.  

I’m always worried that my blog will be found by my residency program or by my hospital. Honestly, I’m not nearly as careful with my anonymity as I should be. It’s very difficult to write about the things you really want to write about and still be completely anonymous. But my hope is that one day, we won’t have to hide. 

There’s a scene in Elementary where Dr. Watson is talking to her therapist and hesitates to talk about Sherlock, and her therapist says “my confidentiality protects your confidentiality.” Watson’s not technically Sherlock’s doctor, but I was wondering if that’s really true in the case of HIPAA. Could a medical professional divulge potentially identifying information about their patients to their own psychiatrist? Does their confidentiality really “protect” yours? -asortoflight

I’m not so sure about that. The rule is pretty much don’t give identifying patient information to anyone other than the patient or people who they permit you to share with. I suppose Watson could talk about Sherlock and not give away identifiers, though. But no, doctors shouldn’t be telling other doctors about their patients unless it’s a consult situation or a group practice type thing. 

Now in my (and Cranquis’ and all the other TOADS) case, our anonymity does protect our patients’ anonymity. Sure, we change demographic information, but even if we didn’t, it would be very difficult to identify our patients without knowing who we were or where we lived or worked. 

My question is if you know or know of places I can find some regulations in regards to posting medical-related materials such as photos of injuries or operations that i find educational. I’ve come across several tumblr and even photos on fb depicting an open heart surgery and would like some clarification on policies in regards this. Thank you! -foolstodustydeath

Hey friend, thanks!

So when taking or collecting photos of patients, a few rules apply almost everywhere:

1. You should not be able to identify the patient by the picture— all patient identifiers (numbers, dates, locations) and distinctive features (tattoos, scars, face, etc) should be covered. 

2. If you’re taking a picture of a patient, you should have their written consent to do so and to use it in an educational setting. 

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3. Many hospitals require you to call a hospital-employed photographer to take these pictures to ensure proper use of them.

4. Even if you’re keeping them just for personal use and studying, they have to be de-identified in case your computer/cell phone/whatever gets “intercepted”. If not de-identified, the data should be encrypted or password protected.  

5. Don’t post them on social media sites. Just don’t do it. You take a big risk in doing it. If you post patient pictures (even anonymized) on a site with your name on it, you could lose your job, get kicked out of school, get sued, etc. It happens, friends. 

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**For CTs, X-Rays, EKGs, and other imaging studies, I think you can generally use the images as long as patient identifiers are removed. I have my own personal collection of interesting x-ray and CT findings as well as a notebook full of EKGs to study by, but all have been de-identified. 

I’m not sure if the official HIPAA rules touch on this subject or not. They stay pretty general and mostly just talk about keeping information de-identified. For more specifics on what it means for something to be anonymized or de-identified, check those HIPAA rules above. Also check with your school administration or hospital legal department and find out the policies specific to your area. 

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Hi! Where did you go to medical school? Also, does what school you did your undergrad at matter? I'm going to a really difficult top-tier college and my peers at other less-rigorous schools are doing much better...!
wayfaringmd wayfaringmd Said:

You see, there’s that whole “anonymous Tumblr doctor" thing that I have going on, so I can’t tell you where I went to school. Sorry.

As for your second question, check this post

Any particular reason why you made yourself anonymous? (I remember when you weren't whoo!)
wayfaringmd wayfaringmd Said:

I simultaneously started posting more medical stuff and started rapidly gaining followers, so I just thought I’d be more free to tell my stories if I was anonymous. Plus Cranquis made me all nervous about the legal implications of not being anonymous. 

Asker Anonymous Asks:
Are we Tumblr followers ever going to receive the honor of meeting you in person one day?
wayfaringmd wayfaringmd Said:

Well then I wouldn’t be anonymous anymore, now would I?

Asker Anonymous Asks:
When you started this blog, were you anonymous? Because I remember you posting pictures of yourself.
wayfaringmd wayfaringmd Said:

No, I wasn’t. I’ve had this blog for 4 years and I’ve only been anonymous for the last 10 months or so. But I’ve very carefully removed all pictures of myself and references to my location & school from the blog. 

Why, you likey the pictures, anon?

Asker Anonymous Asks:
When you graduate will you disclose what medical school you went to?
wayfaringmd wayfaringmd Said:

prolly not.