A Blog About An Asian Medical Student. Yes that's redundant.

Sunday, February 15, 2009

David Poon and the Road to Medical School: This One is Important

This one is important.

I am very upset. 

For those who follow my blog, you will know that I discuss many issues that I deal with at the hospital, and in medical school. To me, it’s a fun way of therapy to the hard life that I’ve been in for a few years. It’s shown to be pretty popular with my friends on Facebook, and actually has helped some of my classmates in facing their own issues with medicine.

So recently, I decided to post it public on ‘doyoupoon.com’

Now I realize not everyone shares my sense of humour. But many people do, and I like to think (as many people have confirmed) that my style of writing is very expressive, while also dealing with real important issues.

I used to hang out a lot on an online forum for premeds. They helped me out a lot in the two years of undergrad before I got into med. I made a promise to God that I would help anyone get into med if I got in.

I did. So I wanted to contribute back.

I put my blog there.

Inadvertently, started a very heated debate.

Many people there hate me now.


So at doyoupoon.com, I’ve received a lot of hate after going public. Fine. It’s an online world.

A commenter left me this link:


“Many would argue that physicians have both a powerful position and leadership role to fill in society, and must work that much more diligently and nimbly to acquire and maintain the trust of the public, including acting in a professional manner. Telling personal stories about individual patients poses the risk of eroding the public's trust in the particular physician involved, as well as in the relevant department, hospital and university, and in physicians in general.”

The authors argument begins with the idea that online journals, or ‘blogs’ (web logs) will erode the public’s trust in the particular physician involved. That may be true, and is not at all exclusive to those in medicine. The writings of a physician that are published are his or her own work, and therefore, the physician as an author is liable to the criticisms. To hide behind anonymity is cowardice, and anyone who dares speak behind a mask of the Internet has also abstained from responsibility of thought.

I write with my real name, and take complete responsibility in what I feel is a truly professional action in regards to publication. Anyone with a problem I will gladly debate – of course, so rarely do I see a real name shown to me am I able to properly rebut the claims made.

The author is accurate for these reasons; a patient, who with serious thought, has decided that the opinions of a physician are not congruent with their own, simply does not have to work with the physician. That is very reasonable.

Now, to extrapolate the physician’s opinion to the “relevant department, hospital and university” could also be argued as rather reasonable. If I, as a blogger, were to use department equipment to publish my blog on a university server, there may be some responsibility given to the said parties.  This is no different than liability transferred to say, a peanut company that sold salmonella infected goods, despite the problems spawning from the actions of one decision maker. So again, I agree with much of the above authors argument.

Where I take great exception lies in the authors’ assumption that the blog of one doctor, regardless of content or viewpoint, will affect the reputation of “physicians in general.” 

I remember reading about a Korean student in the US, who ended up killing many students on campus. What I found very interesting was in the comments section of the article, one person wrote (to paraphrase) “I am very ashamed to be Korean today.”

I’m sure many of us find the preceding statement absolutely preposterous. It is possible to take any single aspect of a person’s personality and telegraph it to the entire group. With that logic, should we be ashamed to be students because some students use illegal drugs? Should we be ashamed to be Canadian because some download illegal mp3s?

The actions of one representing the entirety of the whole?

Stereotypes are what truly are unprofessional.

At this point, I can only speculate what can lead to the assumption that publishing the thoughts of one physician, before even considering that physicians stance, will “erode the public’s trust” of “physicians in general.”

I consider, is it because we have a unified group representing us? Guaranteed you will not find a physician who will say our Canadian Medical Association (CMA) is any more important than the Nurses Union (Carna). Will you believe that the CMA is any more cohesive than any other professional union? Now take into consideration that there is no national Canadian physician union (which is why we don’t have scheduled lunch hours like other health care professionals, for example). Can one honestly say that Canadian physicians are so uniformly represented that the actions of one represents the whole?

I consider, is it because we work in the public eye? There are many public services, from police, to fire control, environmental services and everything in between. Your local water treatment lab technician, will you pull down his public Myspace account because him detailing his enjoyment of the Simpsons makes the public feel Canadian water is somehow dirtier?

I consider, is it because we deal with life changing issues? Our Royal Canadian Mounted Police (RCMP) are currently under investigation over taser use. A real, practical issue that does not delve into the realm of the personal or the subjective, but deals objectively with a problem that has concrete implications. As long as a physician is not using her diary as gauze, and likewise trying to make it a federal law otherwise, it is very difficult to show a direct correlation between a doctor expressing thoughts and affecting the health of her patients.

I consider, what makes it so wrong for a physician to express personal feelings on a public forum. What difference is it from any other large union, any other public worker, or even any other high risk profession.

I wonder… is it because it exposes us as human?

In short, do we wish to propagate the hierarchical illusion that physicians are somehow greater than the general public.  That we cannot discuss our feelings, be personable, be real, because we must maintain our image of superiority. That we are well above the trivial emotions and thoughts that the public is so burdened with.

The author of the above article asserts that we must not ‘erode the public’s trust’ because we represent all physicians in general.

I have yet to see it myself, so I cannot speak about its legitimacy. But I have heard that after large medical errors, many resulting in the death of a patient, after all legal issues are set aside to protect the hospital's image, the physicians involved get together during “rounds” (a meeting to discuss medical cases) and talk about the errors made that will never be revealed to the public. Again, this may be complete myth.

But in this world today, where we expect so much transparency from our business elite, trail our politicians like paparazzi follow Hollywood stars, and even investigate the religious leaders amongst us for some of the darkest crimes imaginable…

… why are the doctors so Holy? Why are we expected to be so perfect that any exposure of our humanity is staining the white coat we are to wear with inflated pride? Why does the public not get to access infection rates per hospital ward, why are they unable to see mortality data for medical interventions in their city, or at the very least, why aren’t they allowed to know that we in medicine are flawed.

Should we be ashamed to be human because we are doctors? Must we be so arrogant to accept the pedestal that has been offered and continue to to allow others to believe we are above any other human being? Is it not far more humble to accept our limitations and allow others to see our faults?

Is it not far more humble to act under the same standards as our colleagues in other professions?

Of course my discussions above are simply speculation on my part, and solely my opinion.

Which I have a right to.

The authors of the linked paper write:

“There are clear rules about posting or using patients' identifying information. However, limiting what physicians write about in terms of their experiences either in practice or in training, becomes at some point censorship. There is no law that requires one to enjoy one's profession and there is a law that is meant to protect freedom of speech. If patients have a problem with a physician complaining, some may argue that they could find another physician.”

So that is not their problem with people like myself clearly.

I have not forced anyone to read my blog. I consider my humour, my art, therapeutic. I have not violated any laws of privacy, and anyone who has been in a hospital elevator will tell you that medical information is freely spoken about – just never with patient identification.

Which I do not do.

If carefully read, my few readers will tell you that I mention no names (aside from obvious ones like myself, or an occasional pop culture reference) and I do not, under any circumstance break patient confidentiality. My discussions could very well be based in imagination, but still be relevant to my own psych to deal with the world that is medicine.

The aforementioned paper’s major issue is:

“Why would you, as a physician, put yourself in a precarious position by posting personal feelings, opinions, and attitudes on a public website? Material that may seem innocent enough at the time of posting may come back to haunt you at any point in your career, by any person you have or have not yet met — weeks, months, years or even decades down the road. And, you cannot know who may have — or develop — a grudge against you. The people you may be writing about are patients with illness. They may be emotionally vulnerable or even unstable. As such they may seek to contact or confront you outside the work place. Giving those people a permanent electronic record about yourself may allow them to pursue you in ways you will not like. Many online posters may consider Internet media as temporary; however, Internet content is still published, and should be considered permanent.”

They are correct. People will hate me.

Regardless of what I do, what I say, what position I take, what belief I choose, people will hate me.

I admit it. I accept it. It would be simple arrogance for me to deny it.

But this is the reality of any living human being. Of anyone who dares publish, of anyone who dares speak.

Of anyone who dares have an opinion and is willing to share it.

I have no problem with the paper that I’ve been analyzing. The authors have put out their thoughts, and have not come to me and asked me to change.

Many others have however. And I learned many years ago to not get involved with an online forum debate (colloquially known as a “flame war”) because online anonymity allows for the most ludicrous statements to be thrown by otherwise (hopefully) rational individuals.

But this comment got to me, when I was discussing not medicine, but my love of video games. On a blog that helps me cope with death, with a life I barely chose, and a world that confuses and scares me. On a website I keep public that many people enjoy, and many have told me helps them too deal with difficulties just by knowing someone else is with them at a personal, emotional, human level.

A person who wants to be so removed from me as a human being that despite admitting to knowing who I am, would rather avoid a conversation with me.

“At my medical school, (and yes you know me,) you would certainly be severely reprimanded. I guess i know how U of A rolls, and how they handle their unprofessional students...ie, not at all. I find you blogs offensive, highly unprofessional, and a disgrace to young medical students everywhere. I know it's your opinion, but when it comes to patients, medicine, and this career we will soon have, there are certain things that should be kept to yourself to maintain the integrity of our profession. You're ruining it.”

If anyone reading is offended, there is an ‘x’ on top of your web browser window ready for your input.

Of course, from what I can understand, some people would prefer that no one gave any input at all.

- David

Poon Blog Comedy

I'm trying to get into comedy. I gotta do something with my life.

Would love to hear your thoughts.





- David