Friday, March 10, 2006

Friday Intern Topic of the Day VII: Is the Doctor Displaying Ethical Behavior?

I love comments. Yes, I agree, I do tend to be less “responsive” to commentators than other bloggers but I certainly read each and every comment that’s left here. So if you ever have something to say please take the time to leave a comment, I do love to read them.

There are, however, comments that go in one ear and out the other and others that make me think. Earlier in the week I posted an entry about Ian Thorpe. I speculated that based on the information available to me, that Ian Thorpe may have HIV. I gathered the information from press releases released by Ian and from whatever I could gather that was released by the general media. I even submitted the post to Grand Rounds. Where, somehow amid the thousand and one entries this week, it managed to get a certain amount of attention.

There was one comment left by a certain Dr. Steve that I’ve been thinking about for quite some time now and I would like to comment on it. And, I would like to hear your comments on it too:
As a fellow physician, I think it is marginally unethical of you to openly speculate, based on extremely thin second-hand guesswork that a prominent figure like the "Thorpedo" has HIV. I don't think you would like that if the tables were turned (especially if it turns out that the guess is wrong).
I actually thought it was a great comment. It didn’t contain any foul language or derogatory remarks and yet drives the same point home. Everyone, I would like you to take this as the perfect example of how to display dissatisfaction with a certain post without displaying lack of taste. Wonderful stuff and it made me think. Am I being somewhat unethical in speculating about Ian Thorpe’s condition openly on the internet?

Lately I’ve been contemplating the purpose of blogging. Other than the occasional sharing of something creative that I wrote is there really any other benefit to what I’m doing, and by extension, to blogging at all? (I contemplate too much, I know)

Here’s what I concluded:

If there is anything that we as bloggers can contribute in the big spectrum is that we are all experts at something. Likely, our level of expertise far outweighs that of the reporter who writes the column for the big media conglomerates whom we are all reading. These reporters don’t know what questions need to be asked because they are not lawyers, doctors, cops or accountants. They are reporters and that is the only thing they know.

Ian is not my patient. I took an oath to protect the privacy of my patients. It would be unlikely that, Ian Thorpe being who he is, other doctors have not already discussed the possibility on big media in Australia. In addition, Ian’s condition is being discussed everywhere, last I checked, 300 articles around the globe this week alone.

But boy does he have a point and I mean that honestly. I can totally see what he means and a certain part of me is still contemplating if I should continue this. But I really do enjoy trying to piece the information together. Is it unethical?

What do you think?


Anonymous Moof said...

1) Ian Thorpe is a public figure.

2) You didn't make an accusation, you made a speculation.

3) Physicians have as much right as anyone else to speculate about whomever they will - even (and especially) when the subject matter is in their field of knowledge.

4) The only problem that I can see isn't one of ethics, but perhaps one of indiscretion (gossip?) ... depending on how you see 1) public figures and 2) the nature of the speculation.

You asked ... ;-)

6:50 PM  
Anonymous Graham said...

It's definitely rubbed me the wrong way since you first started posting about it. If you were speculating about something a little more benign, I don't think I'd mind. But you're speculating about something serious and terminal; I'd feel the same way if you were speculating about something like cancer or ALS, I think I'd feel the same way. (Not to mention all the stigma that comes with HIV.) I think as a physician you're automatically able to know more about some people from your training--perhaps something that a non-physician would call strange or different or normal variation, you would know it to be disease.

9:51 PM  
Anonymous Anonymous said...

I'm a physician too. so we can share a similar ethical outlook.
I think ethically you have to ask yourelf several questions:
1)In publically speculating, did you bring harm to the patient's character? ( gossip)
2) If so, do the needs for society to know outweigh the respect for an individual's privacy?
3) By virtue of your M.D., do your speculations have greater weight, and therefore carry more potential for grater harm?

6:10 AM  
Blogger Dreaming again said...

Personally, not being a physician, I didn't see anything wrong with it.

I think that you have asked some interesting questions, and like Moof said, he is a public figure.

You did not say he did have it, you asked if he did, and questioned the reality of what was being told to the public.

Anyway, that's my 2 cents. But, I'm not a doctor, just a mom of a future (obsessed)one. ;)

8:42 AM  
Anonymous Ali said...

Anonymous above asks the right questions. None of us can answer those for you, but I admit it did give me slight discomfort that you were speculating in this way. If not unethical, I did feel it was a bit unprofessional. But that's just my non-doctor opinion.

8:54 AM  
Blogger Maureen said...

I noticed many medical folks speculating on Ariel Sharon's diagnosis before the official diagnosis announcement. I didn't see any comments about ethics or gossip.

I think it's time that we let some of these diseases out of the closet and feel free to discuss them.

This is an opportunity to educate and maybe start to remove some of the stigma that is associated with AIDS, cancer etc.

Keep speculating...

1:07 PM  
Blogger dgm said...

does anyone get uncomfortable when plastic surgeons speculate about whether certain celebrities have had work done, or whether michael jackson actually has a skin-bleaching disease?

or is this only a problem because hearing "HIV" makes people think about thorpe's sexuality and/or needle-using preferences and that adds another layer of discomfort for some?

sure, everyone is entitled to their privacy--even public figures--but it's not clear to me that that right has been invaded here. as other commenters have noted, you've speculated, not accused. you haven't breached any patient-doctor confidentiality.

regardless, i'm sure thorpe wouldn't be too happy if he knew. do you care about that?

5:44 PM  
Anonymous Anonymous said...

I suppose it's a poor point to make but according to the traditional Hippocratic Oath, you as a doctor are charged to: "Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about."

To you or I it may seem funny or harmless to speculate, but the reputation of a man is at stake here. Your and other doctors speculation is unprofessional at best and at worst slander. I enjoy your posts as they are often informative, but this stuff about the swimmer does not seem aimed at helping anyone saying a man has aids when even you admit the facts released don't fit your initial diagnosis. You are not addressing a problem in the system, but the life of a man. A man named Ian Thorpe. If you wanted to truly discuss the case you could have just posted picts, data, and your diagnosis as usual. I only draw you attention to this because you are normally so good at protecting your patients and cases online. I would not have posted this if I did not have so much respect for you as a doc.

8:27 PM  
Anonymous Anonymous said...

Yes, I realize we don't pledge to the gods any more, but my point is docs have a responsibility to use their knowledge not just skillfully, but wisely too. That includes not fueling gossip. Silence is hard.

8:34 PM  
Anonymous Anonymous said...

And the oath doesn't just cover YOUR patients.

8:39 PM  
Blogger Dreaming again said...

I just came from another blog, where the most seething comment was made by an annonymous blogger ...why is that always the case?

So much respect for him as a doctor that you can't state who you are?

9:10 PM  
Anonymous Anonymous said...

Happy to, name's Dara. I don't have a blog on this service so it only let's you post anonymous. I wasn't trying to sound angry, but the doc asked for feedback and if he took the Hippocratic Oath as he seems to be claiming then he would appear to be breaking it simply for a little gossip. I followed him from his last blog and this isn't typical for him. I'm critizing the post not the author.

8:38 AM  
Anonymous Amka said...

I don't think your MD, your expertise, makes it any more or less ethical than anyone else talking about it, but like others have said, it IS gossip.

Personally, I think you have more interesting things to say, but that is just because I could care less about sports.

12:15 AM  
Blogger Echo Mouse said...

Jeez, I take some time off and the blogosphere blows up! Just kidding :)

My view is that blogging is personal unless it's part of a business or organization. You don't affiliate your blog with your hospital, private practice or any other agency. So I view your blog as a personal blog, despite the fact that you are a doctor.

Now, when it comes to expertise, everyone has enlightenment on certain things by virtue of their occupation. A blog is a place to express personal viewpoints. Your personal views include your training as a doctor. So while speculation about someone's health might be considered wrong in your capacity as a doctor, you are not at work here, you are blogging here.

Based on all of this, I don't see that you have broken the H.Oath or spread gossip. You mused on something of interest to you. On your personal blog. Granted, HIV status can kill a career but you have never claimed to be an expert on HIV nor are you being consulted about this person's health. You're just stating your thoughts. That's okay as far as I'm concerned.

One of the reasons I took a break from blogging was because it was seemingly too political for a while there. People need to stop and think. Your blog is not the NY Times nor do you work for Reuters or the AP. If they stop in to read, they need to remember it's the same as stopping in to have coffee or tea with you. You're entitled to your opinions. Trying to limit that by throwing your profession at you is the sort of thing society does to shut people up, which definitely goes against free speech.

11:47 AM  
Anonymous enrico said...

Obviously, ethics is a continuum involving morality, justice, beneficience, etc. and not a hard-rule thing. I think other commenters made excellent points that I would have made had I come earlier, such as the speculation of HIV being treated differently than Sharon's stroke or Cheney's heart attacks, for example (Kevin MD has done this as well).

My personal opinion is that it was not unethical but questionalbe, perhaps done with less-than-benficial motives. Was it your intent to present a potential teaching case on the differential of HIV/ARC or was it done knowingly to attract a viewer into a "National Enquirer"-type headline/subject that otherwise might have not paid attention? Or was it simply done without any malice of intent because you just typed out what your brain, always on and wheels turning, happened to be thinking about when you saw certain clues in an article?

I too understand that this a personal blog, but with the title "Doctor" and an unambiguous theme of medical opinion/news/etc., I think it carries a different tenor to speculate about someone's condition than if you were Joe Random blogger who happens to be a doctor identified in an "About Me," for example. Having said all that, you certainly didn't pull a Bill Frist, diagnosing Terry Schiavo from a videotape in a public forum as the nation's top congressional leader, superseding the expertise of dozens of specialists who actually had her as a patient, so don't worry. :)

7:20 PM  
Blogger Kim said...

I had a feeling when I was putting Grand Rounds together that this was going to be a bit controversial.

And I have no idea who Ian is.

Hopefully healthy and/or recovering.

1:41 AM  
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5:41 PM  
Anonymous Lene Petite said...

Well, sometimes even speculations may lead to some gossips and then nobody will know how much truth is in the information they've got. So I think that speculations also may be of two types:bold and ordinary(I do not know how to name them)

6:06 AM  
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