The Flipside of Empowerment...

We've blogged a lot here about transparency and consumer empowerment. And those are key components in the drive toward more consumer-centric health care. Mostly, of course, we talk about availability and cost of services, versus medical necessity and consumer driven health plans.

We also tend to post about our own experiences: with clients and carriers, both good and bad (mostly the latter, since they tend to be more interesting). We're always careful to anonymize the "innocent," because names aren't nearly as important as circumstances.

And we're not alone: the "medblogosphere" is lousy with health care providers (doctors, nurses, surgeons, you name it). And they, of course, have their own resources and places to post about difficult cases or patients. But what if they post what my daughters call "TMI" (Too Much Information)?

Good question:

"Hundreds of doctors across the country are writing Internet diaries that sometimes include harsh judgments of patients, coarse observations and distinct details of some cases."

That's quite a thin line: too little information, and you're not going to get much helpful feedback. Too much, and you've breeched confidentiality. So where is that line? Who draws it? Who decides whether or not it should be drawn at all?

We've got it pretty easy here at IB: since we post about cases simply as examples of either good or bad behavior, we're not really looking for advice on how to handle a given scenario. Mostly, they're just ways to illustrate a particular insurance principle or plan.

But the doc's often use their blogs as sounding-boards, and this can be a problem:

"One of the fundamental aspects of medicine is that patients have to feel free to tell doctors everything," said Dr. David Stern [ed: no relation], who teaches professionalism at the University of Michigan Medical School. "They're not going to tell us everything if they're asking themselves when they come in to see their physician, 'Is my doctor going to blog about me?"

When we get mail asking about a particular concept or problem, I usually ask for permission to post the email and my response, and I scrub out identifying details (they're really not necessary to make my points). Most of the time, the answer's yes. Sometimes, there is no answer, which I take as a tacit "yes." So far, no one's told me "no," but I'd certainly respect that it if came up.

Something to think about.