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After a long day at work, Dr. Baker sits down to check her email and finds a forward from an old medical school friend. "I thought you'd enjoy...

Case: After a long day at work, Dr. Baker sits down to check her email and finds a forward from an old medical school friend. "I thought you'd enjoy this," her friend has written. The link takes her to a blog called "theGrouchyMD: musings of an overworked Texas OB/GYN resident." The first posts tells the story of "Jane," a 53-year-old woman trying to get pregnant. The blogger expresses the opinion that "Jane may be well-intentioned, but I can't help thinking that what she's doing is selfish and irresponsible" and posts some links to news articles on uses and misuses of reproductive technology. A lively debate follows among blog readers, who identify themselves as members of the public, medical students, and other physicians. Earlier posts are on topics ranging from health care reform to "war stories" ("Caught a twin vaginal delivery today," reads one post, "textbook! Now that's real obstetrics!"). Some posts are centered on readers' questions, like one explaining the differences between some types of oral contraceptive pills.

As she scrolls down, Dr. Baker becomes increasingly concerned; the patients begin to sound familiar, as do "Dr. B" and "Dr. H," theGrouchyMD's colleagues. The blogger apparently not only practices in the same hospital as Dr. Baker does, but appears to be in the same program. The next day, Dr. Baker confronts Dr. O'Connell, her fellow third-year resident. "You're theGrouchyMD, right?" she starts. "I'm concerned about what you're doing. I know you changed the names, but what if someone recognizes herself? Sometimes you say some pretty edgy things about the hospital and the residency. What if someone in admin gets hold of it? I've also heard of blogs getting used in malpractice suits. Did you think about that when you talked about the placental abruption Dr. H missed last month? And what about you giving people advice on there—I don't think that's very smart either."

Dr. O'Connell sighs. "Look, sometimes I just need to vent," she says. "I don't think I'm hurting anybody. I change all the names and identifying information, I always ask if I'm going to put up a picture, and I never give people advice about their specific medical conditions. I think it's really useful for people to get sensible general advice on their health from a real doctor, not just whatever junk is out there on the web."

Dr. Baker replies, "I don't really have a problem with your blog, I just don't think you should talk about patients or the hospital on there."

Clinical Case Anonymous Physician Blogging Retrieved from

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Analyze the case to deliver one question or statement for each of the thinking perspective Hats ' one page summary on blog'. Subject HCA 310

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