Each year when I renew my malpractice insurance policy, they look at my website and blog to suggest various ways to decrease liability risk. This time they suggested these items:
1. Take off all advertising. Any advertising on a site may be mistaken for an endorsement by me of a product, in which case I might have some liability for the products advertised. Thus, taking them off eliminates that risk.
Advertising on medical sites is also a potential conflict of interest. By accepting advertising and thus making money in this way, it hypothetically might tempt me to advertise and make money from products of questionable quality.
2. If I don’t take off all advertising, they recommended putting it at the bottom of the pages, below a bold line with a statement such as “Below is advertising. I do not endorse these products.”
3. Have a policy about confidentiality and advertising on the site. This is to increase “transparency” of sites, so devious practices such as collecting email addresses for other reasons, or making ads look like articles, aren’t possible.
4. Identify myself. Again, this is to increase “transparency,” and so readers can be sure that when I call myself a doctor, I am actually one.
5. Stop any individual contact with readers. “Practicing medicine” online is full of problems, so individual suggestions – which could be construed as medical advice – are discouraged.
These suggestions put me in a bit of a pickle.
Re #1 and #2, Advertising
Advertising pays for the costs of hosting my sites, the annual domain registration, and my technology partner who does all the background computer magic. This lets me focus on writing the content of the blog. Last year I figured that I made something like 1 cent for each hour I spent on my sites.
So having no advertising would mean I’d pay to provide what I consider a (hopefully!) helpful service. This isn’t very attractive to me.
Also, it seems there is no way to make it 100% clear that any advertising is just that – purely advertising – and not connected to the articles nor endorsed. While theoretically I could choose what advertising I accept, that would eliminate Google and other common forms of advertising, which automatically place ads on your sites. Choosing ads would also require me to spend time reviewing potential ads – a time-intensive options that doesn’t appeal to me. So it seems the no-advertising way is the only practical thing to do.
Re #3, Policies
I will be putting up a confidentiality policy, as this seems fairly straight forward to do.
Re #4, Anonymity
I made a purposeful decision not to identify myself on my blog for several reasons. First, I’m not interested in getting referrals to my medical practice through my sites. I’m writing solely to get more pain management information out to help people. Second, I occasionally talk about my own pain condition, and would prefer to do that anonymously. It lets me speak more freely. Lastly, although I’m very careful about patient confidentiality, I think having an anonymous blog adds in an extra protective layer of confidentiality when I talk about general patient-related issues.
Re #5, Interaction with readers
I can certainly see both sides of this issue. I would agree that practicing medicine through the sites wouldn’t be advisable for many reasons. However, I think I can make general comments in response to readers’ comments or questions, without crossing over the line into “practicing medicine.”
Overall, while I understand the reason behind some of the limits mentioned above, it saddens me to have to make some of these “either/or” choices. I think implementing some of them would lessen the effectiveness of my blog. So I’ll be considering my options to figure out what to do. While I still can ask 
, any thoughts on these issues?
9 responses so far ↓
emily // May 26, 2008 at 9:24 pm
i think it’s too bad you have to consider all these things….malpractice insurance is such a necessary evil for doctors.
Migraine Chick // May 27, 2008 at 8:37 am
Wow. That’s a very big pickle. I would have never imagined these issues even coming up. I appreciate your blog so much and you are doing so much good for people like me. I wish you could just be free to do what you want and not have to make all these choices!
How to Cope with Pain // May 27, 2008 at 1:57 pm
Emily and MC, thanks for your thoughts. When something like this comes up, I always wish life could be simpler, right!
Nickie // May 28, 2008 at 6:31 pm
Wow, I am sorry you’re being pressured in this way. Personally, I think your reasons for doing what you do are valid and I don’t think you’re doing anything wrong. You’ve never, in all of our interactions, done or said anything to make mme feel that you’re practicing medicine in our interactions. It’s information that you despense here, nothing more, nothing less. I think your personal blog is your personal business and they should respect that. Please don’t stop blogging, I would miss you greatly. That said, I will understand if that is what you end up believing is the best choice, I’d just hate to see you leave the blogosphere when you contribute so much.
How to Cope with Pain // May 29, 2008 at 4:19 am
Thanks, Nickie for your support.
I don’t want to scapegoat my malpractice company. From their position, they’d like to get rid of all possible risk. Let’s say someone did a relaxation exercise, was relaxed, got up and walked into the wall. Technically, they could sue saying I didn’t warn them of that risk. Or they try a cream that’s advertised through Google on my site. They get a rash, and again, could sue me saying they perceived I was advocating the cream.
Yes, both are far-fetched, but from a malpractice perspective, eliminate the blog and/or advertising, and you eliminate the risk.
They’re not interested in “helping” anyone – that’s not their role – so I’m the only one trying to balance goals. I’m not ready to give up blogging yet! Just trying to figure out what I can live with!
Esther // May 30, 2008 at 4:56 am
I think it’s sad that you have to limit your sharing information. It’s precisely because so little useful information is available that you host the website. Even so, if there are ways – not interacting with readers except marginally – for you to continue, that would be better than not blogging at all. Some websites limit the information available if one doesn’t have a subscription with a membership fee. I don’t like that idea but it’s the reality. There’s lots of unfairness and injustice in the world. I’m eager to see how your ingenuity positions you.
I’ve appreciated just about everything I’ve found on your site.
jeisea // May 31, 2008 at 5:44 pm
I’ve said before that your blog provides information that is not only helpful and relevant but also up to the minute in terms of latest thinking about pain. You not only help sufferers but also help the providers of pain by educating and promoting awareness.
Although I support you in any decision you make, I am sad that you are placed in this position. As you are aware I closed my google support group because of legal concerns. Sometimes personal security needs override the greater good. Thank you for all that you do.
jeisea
Bronnie // Jun 22, 2008 at 5:17 am
Ahhh, that’s rough. We have fewer concerns in NZ regarding legal stuff, but for a bunch of reasons I’ve decided to not accept advertising, be open about my name, and I do interact with people – but then again I’m not providing information on management…
Having said that, what you’re doing is of high value, full of integrity, and welcomed by readers. I hope you continue to publish, it’s worth it!
How to Cope with Pain // Jun 22, 2008 at 9:39 am
Thanks, Bronnie. I’ve changed a lot of advertising to I approve it first, and deleted those types of ads I can’t pre-screen. I wrote some new policies re privacy, etc.
The change I’m sorry to have to make is somewhat less interaction with readers. But hopefully I can still do some.
Thanks for everyone’s support over this issue!
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