Informed Commentary

Hey! National Blog Comment Week has come and gone -- though the news may not have filtered down to my readers.

One blog that is getting a bajillion comments is the ever-provocative CodeBlueBlog. His last Schiavo post has over 300 responses. The level of discouse is actually started quite high, too -- there was discussion about the criteria for diagnosing persistent vegetative state, the duties of radiologists vs. neurologists, etc, before it degenerated into a free-for-all about the husband's motivations, the judge's missteps, and the blogger's undisclosed past.

Alas... having comments enabled is a two-way street. I mean, it's usually a thrill to hear what readers think, and to see that I've made some connection across the ether. And it's a little disappointing when a post doesn't click with anyone (though I take comfort in speculating that, were I to blog about my social life, I could quickly accumulate an avalanche of feedback).

But to have your posts misinterpreted, or have your site used as a soapbox for those with an agenda, must be the worst outcome. Still, I think it's a worth it for medical blogs to allow public feedback. It's one way to avoid the perceived isolation and underaccountability of the mainstream media. It keeps us on our toes. And it lets us survey the audience in a way sitemeter cannot.

One of CBB's early comments in this thread explains his motivation for the CT scan challenge, and his CSI series:

One reason [CBB blogs] is because of the total horror I experience every time I read medical "news" in the MSM [mainstream media]. They always get it wrong. They never ask the right questions. YOU ARE ALWAYS IN THE DARK.

Why is that? Because those reporting the news (and managing your health care) have little regard for your intelligence. It is believed that the average American is so dumb that he or she cannot possibly manage this information -- so WE have to do it for you. And WE are leading YOU and the AMERICAN HEALTH CARE SYSTEM to the slaughterhouse on the way.

I am trying to WAKE YOU UP before you get there.

I bring this up every now and then, mostly because I'm not satisfied with the options. I'm sure the problem isn't simply, "the reporters have a disregard for the public's intelligence." There is a little dumbing down. But there's also a big discrepancy between the background education of the reporters covering medical stories, and some of us reading and critiquing them. Even the Columbia School of Journalism has acknowledged this gap and is taking steps to address it.

It's clearly important to give expert-journalists complete access in misreported issues like riot control deaths, and arguably important for cases like Terri Schiavo's. Yet even if every reporter had an MD, what's disclosed by various sources is still up to the patient's (and doctor's) discretion. And there are perfectly good reasons to keep some tests and procedures private: it may make the patient or doctors look bad, or maybe the public just won't understand.

Don't get me wrong, I'll never underestimate how quickly a "lay" audience can get up to speed on complex issues. Recently, for instance, a nonmedical friend of mine was in the hospital for choledocholithiasis, and within short order he was asking me questions about ERCP that I need to look up to properly answer.

Perhaps we should distinguish between lay readers, and the casual readers who just browse headlines and RSS blurbs before forming an opinion and spouting off. I think it's these casual readers that patients and privacy advocates worry about. And maybe they're right to do so.

When I last brought this up, I quoted a CBB post, and tackled some of the issues he raised about privacy, access, and news micromanagement. Then, a commenter skimmed the quotes, saw some famous names used as examples, and ignorantly accused me of despicable gossiping about celebrities.

Maybe I need to write (and blockquote) more clearly. Or maybe casual readers aren't ready for unfettered medical blogging.