Anxiety, Ethics, and Blogging

Mi emailed me after reading comments and said, "I think it's so nice that people see themselves in your blog."

Well, yes. And no.

FD brings home throw-away medical journals and will occasionally cut out an article of interest. "Read this," he says, tossing me a shiny, neatly-folded page. "Tell me what you think."

This one's from Family Practice News.
Point/Counterpoint: Do physician bloggers compromise patient privacy?

I'm not a physician, of course, but all mental health professionals have an obligation to protect patient privacy . So the article is of interest. And it's about blogging.

Two docs, one a neonatologist, (talesfromthewomb.blogspot.com) and one a psychiatrist with a private practice, face off.

The psychiatrist believes that physicians should not blog. She argues that when medical bloggers write, they swing the power to expose patients, breach confidentiality. She cites an extreme case, a blogger MD who tells of an 18 year old patient who birthed her third child on Xmas day. The tone of the post is heavy on the musar (criticism or value judgement in Yiddish).

She is right about that case, for sure. Clearly the age of the patient and date of birth of a third child are identifiers, and it is likely that the young mother, albeit blessed, would be embarrassed and distressed had she read the doctor's judgmental words about her on the Internet.

Closing argument?
Patients should not have to ask their doctors if they blog before they feel safe to agree to treatment.

The neonatolgist, Tales from the Womb, counters nicely, making the point that he blogs under his real name because being anonymous would dilute his authority. That implies, to me, that what he's teaching really is important, and blogging is a way of disseminating that information to the public for the public good. It's not so simple, physicians should not blog.

Authority, by the way, is something Psychotoddler, also an MD, told me I would lose when I took my name off this blog, fearing home-invaders more than anything else. It's an anxiety thing.

Tales feels that using methodology that carefully disguises detail in the enactment of a case adequately addresses the psychiatrist's complaints. Teaching begs examples and good teachers find them. So he takes snippets of old case material, changing every identifier including, but not limited to (a) biological sex, (b) time, (c) gender, (d) age, (e) race, (f) marital status, (g) political preferences (h) sexual preferences, (i) geographical region, (j) occupation, and (k) socioeconomic status. We have MANY demographic qualifiers to play with.

Family therapists can manufacture fictional demographics for everyone in an example, changing great-grandparents into adoptive gay uncles if necessary to make a point. It's not too hard to do a rewrite with a little imagination and still not sacrifice verisimilitude.

Writers enjoy this effort and professionals who blog, face it, are writers. We're professionals first, however. It's in our blood to protect you. Ethics are mother's milk. We spend hours of classtime digesting them.

So. You can see whose side I'm on. And to reiterate, when you read a case on this blog, it's never a real situation except perhaps when I talk about myself and my family, and even that can be hyperbole except for me liking a good sandwich. And who doesn't?

To teach a decent class about health or mental health, however, we need more than our families of origin in the credits. There's just so much pathology in any one clan.

The point though, is that you have and will continue to have many good professional blogs out there to choose from. But when it comes to this one

. . . even if a situation feels VERY familiar to you

. . .even if it feels I'm speaking TO you

. . . even if it feels that surely I have written a post BECAUSE of you . . .

It's not about you.

And on that note, can we please get back to work?

About six months ago a publicist sent me Dancing with Fear, a book by psychologist Paul Foxman. I agreed to post on it only if I liked it, but warned her that a book like this is at the very bottom of my list of things to read. Like I want to read another book on anxiety when I could be drooling over Vogue? Come on.

So for months the book occupied a place in a heap of journals and books on the floor next to my bed. And every time I looked at it I felt guiltier and guiltier. It got to the point that the guilt just got to me.

What could I do? What would you do? I sucked it up and gave it a good skim, enough to recommend DWF to those of you who need more on those cognitive-behavioral techniques that I feel are so key to emotional management.

Dr. Foxman has lovely discussions on anticipatory anxiety and the must have coping strategies that you need to cope with excruciating anxiety. And he's not afraid to talk about sex, the natural tranquilizer.

You'll find those shoulds and what ifs, the obsessive thoughts that undermine your rational thinking, and pages and pages on proper breathing, yoga, diet, and muscle contraction/relaxation. Some of these things (breathing and muscle contraction for sure) should be taught in elementary school. How are kids supposed to get through test anxiety without them?

Dr. Foxman takes on everything from the biological events that define our anxiety, to psychological defense mechanisms, sleep, food, and drugs. He may discuss visualization, too, but I could be imagining it. And if you like self-disclosure from your therapydoc, you'll like his candor about his own disorders.

I didn't see What Goes Up, Must Come Down, my theme song for anxiety, but maybe it's in there, too. Coasting through a panic attack, just breathing normally is the way to go, rather than fighting it. Knowing that you'll eventually resume your regular programming is the key.

But I'm pretty sure he does emphasize that therapydocs are not so into control, to quote the psychiatrist in the movie, Ordinary People, because needing control makes us more anxious, and it's elusive.

Enough about fear and the movies. Check out the book next time you're spilling coffee at Borders.

If you also want a book that's truly gripping, a page turner that scares you yet keeps you in it because you know it just has to have a happy ending, read Lori Schiller's biography about her struggle with schizophrenia, The Quiet Room, written with Amanda Bennett.

I couldn't put it down. Here's a link to a blurb from Lori that she wrote while working on the book.

Oh, wait. There's just one technique that Dr. Foxman's encyclopedic paperback forgets to mention. This coping strategy really does quiet the brain, requires no meds, but is quite psychologically addictive, caveat emptor, so I recommend it in small doses, one or two games at most (sure, start 'em over again until you win).

Yes, it's that computer game, Spider Solitaire. Before you reach for the stupid Tylenol PM or whatever garbagey over-the-counter sleep medication you use,

Go to the Start menu. Find Accessories. Click on Games.

OR go out and buy a couple of books. Go to bed, lie flat so the blood flows to the reticular formation in the back of your brain, and read.

You'll never look back.

therapydoc