Danielle Jones, over at Mind on Medicine, wrote a post about why she attaches her name to her blog. One of her main reasons being:
Without the mirage of personal protection anonymity brings I will never feel justified in writing snarky or compromising details about patients or using this public domain to vent my frustrations concerning colleagues or classmates. That is not to say that all anonymous writers use their space in that way, but I can think of at least a few prominent medical bloggers who abuse their anonymity as a method of personal protection in order to mistreat or poke fun at their patients.Bottom line up front: I blog under a pseudonym because I do not want Google searches of my given name to lead to this blog.
The reason I want my given name disconnected from this blog has nothing to do with escaping accountability or not believing in my blog posts. My major concern is that anyone who ended up on this blog after Googling my name is likely to be a) my mother or b) checking up on me for one reason or another (e.g. applying to residency).
I think it's tragic that I have to consider this, but the thing that worries me about someone checking up on me and ending up here is them merely skimming blog posts. It would be pretty easy to mistake or contort my recent post on rape apologia into something it is not. Moreover, such a mistake or contortion need not be the result of ill-will (see this blog's sub-hed). It would not be difficult to misinterpret many of my blog posts if they were merely skimmed or only read in part. For example, this post could easily be construed as a defense of giving opium to babies (it isn't, it's just an argument that it isn't that bad).
With things like residency matching in the near future, a few individuals' perception and judgement of me has the capacity to radically shift my entire future. It may be paranoia (in the words of Kurt Cobain, "Just because you're paranoid doesn't mean they're not after you.") but for anyone who wants to write honestly and straightforwardly about serious cultural issues it's impossible to know whose pet concern (and/or solution thereto) you might be discussing unkindly. While it would be fantastic if those individuals valued diverse opinions and intellectual curiosity, it has been my experience that such people represent a minority in graduate medical education (in point of fact, were my name on this blog I would not have included the last sentence, for better or worse).
To take the focus off of myself for a moment let me point out this stellar example of a blog post which I don't think could have been written in an identifying manner. In her post fizzle.med writes forthrightly about struggling with ADHD in medical school. Moreover, she manages to elucidate some very important medical/cultural issues through the lens of her own experience. I'll let her words speak for themselves:
[A]fter 6 weeks of waiting for an appointment, I saw an actual Psychiatrist, M.D. I was feeling good about it, and I was ready for her to help me (or tell me to suck it the hell up, one of the two). After a brief explanation of why I was there, she proceeded to tell me that she “wished I had been diagnosed when I was younger” and “usually sees people who have problems with time limits on exams” and “wondered if I had heard of the influx of people that are trying to obtain ADHD medications to study for exams”. Um. What?Now, I'm not fizzle.med and won't speak for her, but if I imagine being the person she writes about in that post it is unfathomable that I could write it with my name attached.
So from this point forward, I assume she thinks I’m just here for drugs. From this point forward, I filter everything I say by the rule “I need to make this true, but not use words that she thinks I Googled and I have to be careful not to say I have every symptom she asks me”.
I shouldn’t feel that way. I have a legitimate problem. Fuck all the drug seekers and the lazy ass people who want a last-minute bandaid to cover their months of not studying. You people will eventually pay for your deception. But how dare her make me feel like it is wrong for me to present my problems to a physician. I should be able to trust her and feel trusted. If she doesn’t want to trust me, that is fine, but she doesn’t need to make me feel that she thinks it’s super convenient I’m here right before finals.
She then gave me an “ADHD test” which, I’m sorry people, is bullshit. Anyone can google the symptoms of ADHD. Some of the symptoms I had, some of them I did not. But I had so many of them I started to say “no” to the ones which should have been “yes”. I was actually trying to blunt the severity of my problem so that she would believe me.
While there are many reasons I would never write a post like this with my name on it, I'll focus on one. It would be an admission that a) I had ADHD and b) was taking medication for it. To put it modestly, the US military does not have a… conducive relationship with ADHD. Until recently any past diagnosis of ADD/ADHD was disqualifying (one could apply for a waiver, but it was among the most difficult condition to get waived). At present ADD/ADHD is still disqualifying if someone has been treated within the past year, or has shown symptoms.
That said, it wasn't my experience. I bring it up because her later observations about feeling delegitimized as a patient could only be experienced and written about by someone who dealt with a small range of disorders. Were she in my shoes, and blogging under her own name, any such discussion could easily have repercussions.
Of equal importance is what a blog post like fizzle.med's does to an evaluator's perception of her. No longer is she judged in the same way as her peers on test scores, preceptor remarks, and so on… the evaluator's perception of those things will unavoidably be colored by his knowledge that she was on ADHD medication when she did them.
When I began writing this blog I wasn't entirely sure what I would write about in the future. I was encouraged by some friends and another blogger who I exchanged emails with regularly to start putting the stuff from those emails onto a blog (in more polished prose). I still don't know what I will write about next, but putting my name on this blog would remove a number of topics from discussion.
I'm proud of the essays I've written for this blog and I hope that they've been informative and/or interesting to the people who read them. I suspect that adding my name to the blog would do little to increase credibility, garner more pageviews, or whatever. While it's debatable whether or not it would truly close off writing topics, it's absolutely true that I would be considerably more reluctant (if willing at all) to write about those things. In the end it seems like putting my name on this blog would cost me writing freedom and possibly affect my future for little to no gain.
All of that said, I have a number of friends (both real life and twitter species) who know my real name. Perhaps that is why it seems easy to avoid many of the tempting hazards to pseudonymity.