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I recently started using Posterous as an annex space from my blog, instantly uploading pictures, sound files, stories, and videos from my phone. Where I would have had to wait until I returned home from a party or event, hooking my camera up to the computer, downloading and sizing the photos, slowly uploading them individually to my blog, they now are sent instantly and I return home with the whole night already blogged and commented on from people reading at home.
Same goes for using Twitter or Facebook while on the road. These three pieces of software are but a few of the options out there for creating a lifestream rather than a static blog.
It's a wonderful and scary new world.
The wonderful part is obvious--thoughts popping up in all corners of the world are accessible and exchanged in real time as events unfold. There is something raw about lifestream writing, unfiltered, unedited.
The scary part takes into consideration a larger picture. Whereas Tweets disappear into the ether and do not show up in a Google search (Twitter does have its own search engine) and Facebook status updates are somewhat protected, sites such as Posterous are not only open to the public unless set otherwise, but these posts are Googleable in the days, months, and years to come. They operate in the same way as a blog, but provide the immediacy of Twitter.
Therefore, when the circumspection afforded by the drive home to get to the computer or the emotional cooling off time after something hurtful has been said now ceases to exist, there is room for regret both on the part of the writer and the object of their wrath.
Doctors, nurses, clinics, and agencies have plenty to fear from the power that live-blogging affords. The online world has become the equivalent of the backyard fence, with bloggers constantly exchanging advice and opinions with one another. It can be a frightening thought in a consumer-driven area of medicine such as fertility treatments or in the area of adoption agencies, knowing that the information once contained between two people at the backyard fence is now accessible to anyone Googling for information before making a decision about a doctor or agency. And they are receiving that opinion out of context, without knowing anything about the speaker other than what is shared online. Get enough angry patients stating their thoughts online and the reputation of a clinic or agency can be sullied for future patients.
This, of course, has been true for years with the advent of blogging, but it is the immediacy of sites such as Posterous coupled with the Googleability of those sites that changes the playing field. Prior to this point, if a patient had a bad interaction with a doctor or nurse, that information was tempered with the time it took to get from the clinic to the computer. In that time period, the person may have the emotional clouds part to examine how their actions can affect another person. There are things I'll consider doing while upset that seem simply hurtful in retrospect when I have time to calm down. Posterous removes the cooling off zone.
And while this may not seem like a problem for patients and therefore none of our concern (after all, it's hard to feel a lot of empathy when you just ate $10,000 on a failed cycle), it is when you consider it through the lens of HIPAA. Just as these laws have been set up to protect the privacy of patients, to ensure that doctors are giving the people they care for respect, the impulse needs to flow both ways if patients and doctors want to continue having a respectful relationship. I am not talking about the micro-level--your relationship to your personal doctor--but an overall climate. Doctors need to know they can trust patients in order to do their job well.
I think of it in the same way as traffic cameras. They sound like a good idea in theory--making sure people obey the speed limit--just as stating your opinion online sounds like a good idea in theory--you could protect someone from receiving the same crappy treatment you received. But the reality of traffic cameras and speed traps is that they cause more traffic accidents because people are focused on not getting a ticket rather than driving well. Doctors need to focus on practicing medicine and not protecting their reputation.
