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.

http://www.premed101.com/forums/showthread.php?t=28359

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:

http://www.cmaj.ca/cgi/content/full/179/3/292?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=online+blogging&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT

“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


14 comments:

  1. Poon, I agree with you totally. I can't stand similar attitudes in Law. As long as you're not violating doctor-patient confidentiality (and your blog is so, so far from that...) what difference does it make that you're a physician?
    I've been very happy to see that even judges are now expressing their opinions, giving speeches, publishing etc. more frequently (as long as they don't talk about pending litigation or confidential information). I seriously don't think doctors should be held to a higher standard than judges! The student who's supposedly feeling superior to you and UofA med school is being ridiculous, and in my opinion probably suffers from some sort of inferiority complex which medical school is helping him compensate for.

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  2. People have always had opinions, it's only natural that we form judgments about the world around us and the people in it. Even when our species was living in tribes individuals had bias thoughts.

    All this technology - some people call it Web 2.0 - does, all it really does is make it easier to communicate to a wider range of other people. We now have the ability to converse on a global scale, instead of just interacting with the other members of your tribe.

    There is danger in communicating in such a massive way, especially when the people on the receiving end have the choice of anonymity. That danger has always been there though, even before we figured out how to make our own fire.

    There have always been two choices. You can choose to use your voice or you can hide in fear, both have their own draw backs.

    Not choosing the path of fear can lead us to learning things we might not have wanted to know. That's the price we pay and it's not too high a price if you ask me.

    David, you put it just fine yourself. There will always be people who hate you. Some of them might not even have a reason. That's true for everyone. Remember, we are all a part of the same compost heap.

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  3. Okay, David. I took a gander. There are a couple things I need to address:

    1. Speaking as someone whose job is essentially writing, you should separate the criticisms of your writing style and your content from the issue at hand. I bring this up only because of some of the comments on that forum. They're right, to some extent -- you've not got that naturally funny prose, and you tend to err on the side of verbosity -- but you're not a terrible writer. Practice makes perfect. Do your best to shorten it up, and treat your writer as a little more knowledgeable (stuff like saying 'colloquially, a flame war' is unnecessary. Either say 'a flame war' or an 'online argument').

    2. As to the previous commenter's thoughts, I'm of two minds. I don't think judges publishing under a public name is a good thing. Call me a naive fool, but I'd rather think that my judges are impartial and don't hold opinions in advance. Doctors, on the other hand...

    3. I guess where I come down on this issue is that it's a matter of public knowledge. I'm with you, Poon. The more the public knows, the better. So long as you respect confidentiality--and you do; I've read through your posts--I have no problem with you talking about your life. It may not be terribly interesting to me, most of the time, but I don't have a problem with it. Hell, I think it's in good taste, especially if you have a differing opinion from the main medical industries.

    The only thing I caution you on is having yourself tossed out of med school. If it's going to cause people to hate you* then you have to ask whether or not you're willing to take that sort of crap.

    * Online people are not real people.

    4. Why the hell are you in med, David? I've always thought this was a terrible career for you, and your issues with trying to be compassionate and still make money make me believe that you're really not cut out for it. I don't mean that in a cruel way, either. I just don't understand why you'd torment yourself. Life's too fucking short to do something that you don't absolutely love, and you're smart enough that you could do well at whatever it is you wanted to do; you're not exactly a prole destined to spend 20-life in a McDonald's.

    I guess that's my advice. Don't listen to assholes online. Find what you want to do and what you love to do and do it. If they kick you out for it, then you're in the wrong field, as simple as that.

    And for the love of all that is good and holy, man, relax. Life is short, but smiling and being happy with yourself is the best thing you can do.

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  4. Hey David, it's Ivy. I read the thread on your pre-med forum and could only think, why do you even care what a bunch of jackasses on a pre-med forum think? I remember reading a very similar pre-law forum when I was applying and all I could conclude was that these were the most frightened, desperate, and insecure people I'd ever come across.

    If your goal is to help others by putting your experiences out there on your blog, just do it. If it can help, then it will. But you can't expect nothing but praise in return, and if you're truly sincere in your desire to help then you'll have to suck it up when not everyone appreciates it. There will always be jerks - it's the INTERNET, fer crissakes.

    Rob's comment above did made me think... there are certain aspects of your personality that are incompatible with practicing medicine, and one that I've noted (perhaps I don't know you as well as Rob does) is your desire for attention, or minor fame even. Personally, I'd be nervous if I got the feeling that my doctor was treating me as potential writing material.

    I get that publishing under your real name lends credibility to your writing, but your interests (no matter how innocent) should never supercede that of your patients'. You have to understand that by using your real name and by writing about your patients, you could very well enable someone to figure out who you've treated. Your online credibility versus your patients' rights... that shouldn't even be a question.

    As you can see, I can't agree with the anonymous commenter, because I believe that even the appearance of bias, conflict of interest, or any kind of unprofessionalism can be just as problematic as the real thing. It's not a long shot for a patient to google your name and come up with your blog. Once again, if you're sincere in your desire to help others, there's no more powerful position than the one you're on track to. Don't jeopardize it for the sake of a blog - leave the patients out of it.

    And yeah, actually... the reputation of the profession as a whole is something you DO want to protect. Take it from a law student - med students get fawned over, law students get told such jokes as, "What do you call a busload of lawyers at the bottom of the ocean? A good start." And it'll only get worse for us. Trust me, you don't know how good you've got it. Argue all you want that stereotypes suck, but realize that they're working in your favor - others already do, and they're rightfully concerned that your rock star persona could be detrimental. Didn't you say you were considering law school? Maybe you should.

    I understand that you're a human being with thoughts and feelings and important things to say, but you're also a doctor. As a professional you have to accept that all the privileges of your profession come with obligations. Only you can decide if it's worth the trade-off.

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  5. give me til the end of the day to formulate a proper answer.

    something like this deserves more thought.

    just know that for everyone group of people damning you for doing and saying and participating for something you like or believe in, there's another who are insanely glad you have.

    back in a bit,

    -shae

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  6. David,

    I think you answered your own question. People do not want to know that doctors are human. They want to believe that doctors are infallible creatures that live at the hospital/office whose only role in life is to take care of their health concerns, much in the same way that a young child sees a teacher simply as a provider of information, not even considering that they have a life outside of the walls of the school. How shocking it is for said child to run into this teacher in the "real" world of grocery stores, ect. This dehumanizing doctors is something I've noticed even with family members of mine. Because they know me well I am not a medical student, but rather that member of the family that is going to medical school. This is very different than how people perceive their doctors - they are doctors first and not thought of as people. My family members will often criticize doctors they have dealt with/heard of in ridiculous ways. I always feel the need to play devil's advocate in such situations. I think that they do not realize that these individuals are real people just like the person that they know so well - me. I suppose the question becomes whether it is acceptable to shatter people's illusion that doctors are infallible. As a child, I thought my parents always knew best, that they were good and just and always had my best interests at heart. As I grew up, I became aware of their flaws and shortcomings. I was disappointed and angry. These were my parents. How could they be ruled by such terrible and unsound logic. As time passed, I began to realize that the only thing they were guilty of was being human - fallible and influenced by emotion. I'm not surprised by the reaction that you got in response to your blog. Someone was bound to say such a thing eventually. Truth is, not everyone is going to like you in this life. The only thing they can accuse you of is being too honest. I enjoy your musings, David. You expose to the reader very personal feeling regarding very difficult issues and I think often share what many think and feel but are too inhibited to say. I think it helps people to have something to relate to, to know that they are not the only ones feeling as they do throughout their training. I wonder if this individual gave any thought to how difficult is it to deal with death on such a frequent basis and to make decisions with such significant outcomes such as those doctor makes so routinely. Maybe if they gave a little thought to where you were coming from they would be more willing to simply avoid your blog if it offended them so in order to give you the outlet you need so that when their family becomes your patient you are in a healthy frame of mind in which to care for them. Just a thought...

    There are so many angles of this situation to explore that I know I barely scratched the surface. To tell you the truth it would be a very interesting topic for a panel discussion or just with a group over coffee. Haha. I can see it getting very heated.

    S.

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  7. Hey Poon,

    Interesting blog. I think that a lot of the article you cited doesn't apply to your writings. As you (and other posters) have said, you don't come close to crossing the line of confidentiality. That's more the worry of those authors.

    The other side of their article, however, does apply to you. That mere act of posting your thoughts and opinions in the role of a physician (even one being trained) is one that should not be taken lightly. People have [rightly] stated that there's sometimes a feeling of freedom with internet posting, and that in the overwhelming anonymity of the internet they forget that their writings are still considered their own. You don't suffer such delusions, haha.

    I think that if it helps you through med school, there's not really a problem with your blogging. However, the issue should be balanced with the importance of the profession. As your law student friend so aptly stated, the stereotypes of physicians are positive, and should not be taken for granted. Are you making the profession seem more human, or is your blog a bit too unprofessional? That's more for you to decide than anyone else.

    Society does paint medical students and doctors with the same brush, so if your blogs actually were wreaking havoc on the views of the profession as a whole, then I'd say you should make them private (to a select group, if you feel a need for catharsis - plus I enjoy reading them, haha). But really, that seems a very arrogant idea to me. Your blogs are good, but they aren't "shake the foundations of medicine" material.

    In short, I'd keep at it, but be cognisant of the impact, both present and future, of your writings.

    Chris

    PS. Ignore those comments in the premed forum. People rarely post positive comments when they can be anonymous. I'd view them more as people with their own insecurities who wish they could be where you are right now. Pre-med forums may not be the best place to lament over your being accepted into med, when they're trying so hard to get in...

    PPS. And as for the goof who posted that ridiculously arrogant comment about the U of A not doing anything about unprofessional behaviour - well, I don't want to start a flame war myself, but words just can't describe what an idiotic comment that was. I notice they didn't post what med school they were from...probably because they realized how poorly their comment would reflect on that school and the medical students they're training.

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  8. I haven't read the linked article, but my assumption is that the blog of one physician eventually leads to a number of blogs, a number significant enough that it might affect the profession. I completely agree with you. I see many advantages to a completely honest and open profession (sharing mortality statistics, infection rates...) that distances itself from the paternalistic views of the past, provided that rules of confidentiality are respected. To me, the most important quality to a doctor is how knowledgeable they are. I am sure I am not alone in not being overly concerned with whether my physician spends his or her time doing stand-up/blogging provided that confidentiality is taken into consideration.

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  9. Hi David,
    it's Alex. Like Shae, I also need some time to think this through and come up with an appropriate response.
    But thank you for posting.
    Talk to you soon.

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  10. David,

    like I was saying last night, people are stupid, and in some cases, these same stupid people feel the need to impose their stupidity upon someone else.. with the hope to inspire stupidity.

    Regardless, you have to look at what you've been doing. You're a pretty smart guy, and I'm sure you've thought about the consequences before doing this. You didn't walk into this blind. Do what you think is right, and if some select individuals are against that, than it's their own problem- in no way are you forcing them to read what you write. As for the perceieved 'consequences' of being so public, that's your problem and yours alone- meaning no one else should really have a say in what you choose to do. At the end of the day it's still your decision.. and if this is your way of blowing off steam and keeping yourself sane, screw what the premed forum says, just do it.

    :]

    Relax, m'dear, if these people have enough time to sit behind a computer screen and beak about the choices YOU make, they obviously have a touch too much time, don't you think?

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  11. Me speak no english goodFebruary 16, 2009 at 9:38 PM

    I think you have answer your own question: anonymity allows for the most ludicrous statements to be thrown by otherwise rational individuals.

    As a friend, all i can say is if you think blogging and sharing your experience can help you cope with your difficulties, then go ahead. But if you let some of these ugly-nerdy-four-eyed-med-or-premed-man-eating-anonymous-blogger to get to your head, maybe you should find another form of relaxation.

    We all love you, David, we all do. So much that we watch those youtube skid you did.

    - MSNEG

    p.s. After watching those videos, I think you should just stick to med. And please get a better suit.

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  12. Okay.

    Your writing may help you deal with issues you encounter in medicine, and, from what I perceive, you aren't losing the confidentiality you need to have as a medical student.

    You ask an interesting question; if expressing your personal feelings on a public forum might be unacceptable because it exposes you as human. True, there may be some "doctor infallibility" beliefs remaining from an earlier era of medicine. Or perhaps, members of the public would prefer to keep an emotional distance from doctors - for whatever reason. I don't want to go into all potential reasons right now because I'm sure they could be different for each individual. For example, I used to view doctors as bothersome pill-pushers. To me, they were no more than machines of the health care system.

    But yes, your writing does expose you as human. (Jokingly, I was surprised when I found out just how human you are!)

    From another perspective, ...
    I understand the point that if your writings enter the public domain, members of the public will have access to your thoughts. Although I do not believe (at all) that this fact will reflect badly on the medical profession, some remarks can potentially reflect badly on you. This (in particular) is what worries me.

    These people do not know you, and they might be incapable of determining if you honestly believe everything you write (including those off-colour remarks I know you best for). In my opinion, this is not directly *your* fault. But any person (or patient) can complain, and you could easily get in trouble if they feel uncomfortable around you after they experience your sense of humour. Be careful, David.

    And finally, the pre-med forum? Not worth your while. These people want to get into medicine, and they don't want to hear from people who are miserable and stuck in the program. I lost respect for those "people" (internet posters are NOT real people) a long time ago after reading similar comments on the forum.

    -A

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    ReplyDelete
  14. An interesting discussion is worth comment. I think that you should write more on this topic, it might not be a taboo subject but generally people are not enough to speak on such topics. To the next. Cheers

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    ReplyDelete

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