Prima Facie

Most doctors, like most people, rely heavily on first impressions to guide their assessments, choices, and opinions. I have always been very critical of this dependence: I see it as a great and common weakness that prevents most people from reaching their true potential (with respect to analysis and comprehension). While trusting first impressions may offer speed, it does not necessarily guarantee accuracy or even efficiency (because of mistakes made, and the time it takes to make corrections). I think this is particularly troubling for doctors because many who deal with large patient volumes develop an ability to achieve decent or even excellent accuracy in diagnosis and treatment, and sometimes, a very inflated ego (about their ability). However, while some physicians often perform highly intellectual and complicated analyses (e.g. mostly likely those in academic medical centers and large hospitals), many practices mostly see their “bread and butter” standard profiles of patients. In other words, most cases fit common templates. These cases may not be particularly complicated, and that’s part of the reason why PCPs and FPs are grumbling about being replaced by nurse practitioners, physician’s assistants, and other “health care providers” who don’t cost as much (and might handle relatively simple cases just as well).

While some medical cases may be relatively easy to solve, public matters may not be as facile to comprehend to a meaningful degree: they may require more than a two-minute examination. This is my main problem with the medical blogosphere: there are a lot of people (including me) who think they know what they’re talking about, but more likely than not, they don’t. In many instances, it is clear that the people who are blogging have not taken a closer look at the issues they are writing about.

Fortunately for me, I’m just a medical student, so I have a fair amount of spare time to actually read multiple perspectives (including many I tend to disagree with) and incorporate information from multiple sources. I don’t have the ego-issues that would prevent me from deigning to do some background research and learn new concepts. If I’m wrong, it ’s relatively easy for me to admit it since I have little at stake, while that would be much harder for others. (It’s great, too, to be going through this educational process with fellow bloggers and friends with which to debate and discuss various issues.) For me, blogging is part of my education: it’s a learning experience and an exercise in reflection.

For many other medical bloggers, however, it’s a way to exert influence and a way to express their frustrations (perhaps with hopes of instigating or stopping change). Much of this is inspired by the very poor quality and integrity of health care reporting in the popular media: some doctors seek to better educate their colleagues and the public in the face of sensationalized, muckraker journalism. However, are bloggers any better than the reporters and editorialists they might otherwise replace?

Medical bloggers seem to work in a few different ways. Some do this through their own writing of their opinions and experiences, sometimes from the soapbox and sometimes through a creative anecdote. Others exert their influence and perspectives by posting links. I find these to be very much like a convenience store: you can get what you’re offered, but chances are you’ll find something better and less pricey (i.e. fewer ads, fewer sponsors, and no/less spin) if you do your own search. (i.e. “I’ll post up this link for you to read, but you can tell a lot about what I think and how I’d like to present the issue by the text surrounding the blockquote.”). As one who has been making websites and surfing the web since about 1996, I’m pretty old-school in my principles: if you’re an individual (i.e. not a business) with credibility and integrity, you don’t clutter your site with ads.

Other medical bloggers seem to take a more reflective and personal route, often blogging about other aspects of their personal lives such as family, hobbies, and more. While I’m not sure how interested I am in taking a voyeuristic look into some stranger’s life, some of these blogs do give off the aura of being more well-rounded in their views (like the best of physicians).

At this point (almost a year into the life of my blog), I’m feeling particularly critical about this medium and the way it is used. Blogging does not benefit from the experience, wisdom, and filtering capabilities of editors. Bloggers cross-link their posts and are encouraged to post in 250-word sound bytes (to “hold the attention of their readers”), and thus have little room (or impetus) to actually think about what they are saying and try to build a sound argument. Instead of reading a self-contained, well-researched and cited argument, readers are forced to follow blog writers as they ramble along a rant through a series of posts (or scores of mini-posts): some blog writers are more like talk show hosts interviewing themselves than thoughtful, talented essayists.

Does medicine, as a profession that prides itself on having more integrity than others, have room for a wildly undisciplined medium for public discourse? As the medical blogosphere experiences its growing pains, I wonder if the only public blog writers that remain after a number of years will be those who take the time to think about what they’re trying to say rather than those who just post on a whim.

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