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Flea speaks out about his fall from grace

"No wonder when doctors write, they write namby-pamby noncommittal crap -- it might get you in trouble someday,” Dr Robert Lindeman told me recently.

Dr Lindeman (pictured right) is the Ivy League-educated, Boston-area pediatric pulmonologist and erstwhile blogger (under the alias “Flea”) whose electronic exploits led to a large settlement in a malpractice suit brought against him last year in the case of a 12-year-old who died of diabetic ketoacidosis. The prosecutors discovered Dr Lindeman's blog, where he had been chronicling his not-so-polite thoughts on the trial, and Dr Lindeman’s attorneys decided to settle the next day for an undisclosed sum of money. (For more about the case, read .)

Dr Lindeman’s ”namby-pamby noncommittal crap” comment has set off a small flurry of excitement among medical bloggers -- a group that tends to revere Dr Lindeman as a martyr for physicians’ freedom of speech. First, Dr Kevin Pho, a New Hampshire-based physician and the author of the , mentioned Dr Lindeman’s comment on his site. Not long after, another doctor-blogger, Dr Mary Johnson of North Carolina, for refusing to publish a comment she had written in which she accused him of writing “namby-pamby noncommittal crap” himself, in deference to his “corporate sponsors.” Dr Johnson wrote:

“[...] it is my opinion that Kevin M.D.'s brand of white-washed, fence-sitting, corporately-sponsored, sell-out, NAMBY-PAMBY medical blogging should NOT define the genre for the rest of us. It should not be rewarded. We doctors have to be braver and bolder than that. We owe that to bloggers like Flea.

“We owe that to ourselves.”
I spoke to Dr Lindeman as part of my research for an article that appeared January 15 in the National Review of Medicine, entitled “.”

The following is an abbreviated transcript of our conversation.

Sam Solomon: If your blog hadn’t been discovered by the prosecution in your malpractice trial, do you think you would have won the case?
Dr Robert Lindeman: Yes. I didn’t lose, by the way -- I settled. I think its pretty clear the reason for the settlement was that there were too many of what are kindly referred to as ‘prior inconsistent statements,’ which is legalese for statements making the defendant look like a schmuck. They tried to make me look like a schmuck and we tried to make their witnesses look like schmucks. That’s how this game is played. One of the purposes of blogging about this was to tell the story that some doctors know, but most folks don’t know this story. Most have misconceptions about what malpractice is. The process of adjudicating malpractice is basically an exercise in trying to make the doc look like a schmuck. Anytime you write something in print, you need to expect someday it is going to be read to you in court. The most innocuous thing I ever wrote -- it was a description of the immunization schedule, on my official website -- was read to me by the attorney to make me look like a schmuck. How much more so something incendiary, then? No wonder when doctors write they write namby-pamby noncommittal crap -- it might get you in trouble someday. Another reason I blog is because medical writing is a horror show -- it’s embarrassing.

SS: Do you regret blogging?
RL: If I had the opportunity to do it again I wouldn’t blog anonymously. I think certainly the tone and some of the content would be different, but nothing I wrote was fiction. Enough details were changed so patients were not identifiable. One thing that surprised me was I wrote an article on my website and in a magazine about ear infections, and one on Flea
[his blog] and when I compare them side by side, I actually pulled some punches for the blog.

SS: You say you wouldn't blog anonymously if you could do it again, but it seems to me, especially with your situation in mind, that there may not even be such a thing as true anonymity online in the first place.
RL: In principle it’s possible, but it’s difficult. I might suggest that my experience has made it more difficult for a doctor to remain anonymous. I think the lawyers are sitting at their desktops trolling, to use a blogging term -- looking for stuff. The way I was discovered was a most circuitous route. Some guy called somebody else who called somebody else. A guy in Louisiana caught me.

SS: You sound concerned that you’re still at risk because of your blogging.
RL: I try not to think about it. Three hundred and fifty-eight days a year I take care of patients for a living so I cant really think about the 300-pound gorilla in the corner. If I do, I’m not going to be able to do this job. Conscious or unconscious, the thought of malpractice is in our minds the whole time. The reason I blogged about it was to bring the id out into the public, to explain that this is something we are consumed with. To pretend this is not going on is foolish and possibly dangerous and possibly harmful to your health. One of the really awful ironies about this whole episode is now the story won’t be told. The world will still never know what the experience of being sued is like for a doctor. If more folks did know about this, maybe the landscape would change. Maybe people would think differently about doctors, or maybe that’s naïve. If we maintain our silence the opportunity to change hearts and minds is zero. Malpractice is shameful -- we’re ashamed of it. We don’t even talk about it amongst ourselves.

SS: How much did you settle for in your malpractice case last year?
RL: I’m not allowed to say. I can tell you the plaintiffs would very much like me to slip or tell someone like this [a journalist] because the lawyers would like to publish the amount to advertise their services. They’re not allowed to unless I divulge the amount. They’ve been out there combing to see if I am going to slip. This is not paranoid fantasy, Sam. This is about money. This is not about making whole a family who lost a child. This is about getting paid, alright? The issue is that as long as I’m alive and can still take interviews from newspapers, these guys will be out there looking to see if I am going to slip.

SS: Do you think your story has had a chilling effect on doctors’ willingness to express themselves online?
RL: The scuttlebutt I have been hearing is that it has had a chilling effect, and that makes me feel terrible. I try not to think about it, it makes me feel so bad that I am responsible. I’m inclined to think it is true, but I desperately hope it’s not true. Kevin Pho immediately pulled down some posts from his blog and he’s the über-blogger. Kevin was a real mensch -- he emailed me a few times. I thought, “My god -- if Kevin, who is not anonymous, took stuff down, I wonder what everybody else is doing.” I am afraid it may be true.

SS: Any words of advice for other doctors who blog, or who want to start blogging?
RL: Don’t blog anonymously. The reason not to do that is because you probably will be more restrained in the things you say [if you write under your real name] and aware things you say can and will be used against you in court. One of the reasons I blogged anonymously, as odd as this sounds, is that I knew that, and this was a protest. It turned out it was a really stupid protest. Who knows how the trial really would have turned out? Probably we would have prevailed. I recommend -- if at all possible -- that my colleagues avoid going to trial if they can.

SS: This is all pretty gloomy talk about doctors blogging...
RL: I suppose doctors could blog to advertise for themselves or to provide information for their patients, but I think blogs like Flea are a bad idea and there probably won’t be any more like those, for the sake of the blogger. I think the content was interesting -- “thought-stimulating,” in words of the plaintiffs’ lawyer -- and I think my readers thought so too, but there has been a certain amount of blunting of messages that are difficult for a doctor to say. For a pediatrician to say most visits to a pediatrician office is unnecessary. It’s a stupid thing for a person practising medicine to say, but Flea could say it and explain why and make an argument. I think the blog is a great thing. I hope it doesn’t go away.

SS: You’re saying it’s dangerous, legally speaking, for doctors to blog about their opinions at all?
RL: It’s dangerous, period. Anything a doctor writes is potentially going to be read back to him or her in court, from the most innocuous to the most inflammatory. One solution is not to write at all. I’m not sure if it’s possible to be careful -- that’s the reason why I told you about the immunization schedule. I bristle at the suggestion that there’s a way to do this that is right, if by right you mean safe. Writing as a physician is a dangerous activity, and that’s a shame. That’s a message I’d like the folks to know. For physicians, writing is dangerous and there is something really messed up about that.

SS: Do you have any plans to start blogging ever again?
RL: No. It’s been a real sudden about-face. I have turned away from it and don’t have plans to return to it. I don’t read the blogs anymore. It was fun. I had a really good time. I love to write and I don’t have an opportunity now to write like I did. I think a physician has to make a decision as to whether he will write at all. That answer may be that it’s too risky to write, but I hope not.

Photo:

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Israel recruiting Jewish Canadian doctors

Young Canadian, British and American Jewish physicians are the target of a new, $60,000 USD "absorption package" provided by the Israeli government, intended to attract physicians "in the Diaspora" to immigrate to Israel.

Haaretz :

Physicians under 40 who have completed their medical studies in either North America or Britain will receive $25,000 upon arrival in Israel. Over the next few years, they will be paid between $1,000 and $1,500 a month.

Applicants are promised shortened procedures to receive their medical and driver's licenses. In return, they must commit to work in Israel for at least nine months a year. Over the coming months, Nefesh B'Nefesh plans to launch a campaign among Jewish doctors in the Diaspora to promote the program.
The effort was prompted by dire predictions of an Israeli doctor shortage. Compared to Canada, however, Israel's situation is hardly dire at all. Israel currently enjoys a ratio of 3.4 doctors per 1,000 people, compared to just 1.9 per 1,000 in Canada.

The news story has generated some controversy among readers of Haaretz. (You can read their comments below .) Here are some of the most interesting responses:
"if you pay peanuts you get monkeys" - Specialist Doctor, from Netanya, Israel

"Let me get this straight - the Israeli absorbtion and health ministries are trying to lure doctors to Israel - but only from the US, UK, and Canada? Whats so wrong with Jews from other areas - Russia, Poland, Germany, Greece, Algeria, Iran, Ethiopia?" - Steve Katz, Miami, USA

"While this plan may have good intentions will not result in a massive influx of Jewish doctors to the Holy Land. We all know that 60k is pocket change for most US doctors. This might recruit young doctors but they will still have a hell of a time paying back a 150k student loan even with this package. Not all but many doctors have lots of money, or assets like expensive houses that they can cash in on before they make Aliyah [immigration to Israel]. Why should they get a handout?" - Aaron, Florida, USA

"If Israel anticipates a future shortage of physicians it might as well offer incentives (however insignificant) across the board. In trying to lure physicians specifically from English speaking countries, Israel admits that the professional level of physicians who came from other countries (mostly the former Soviet Union and its satelites) is inferior. Israel should have invested in re-educating these physicians and bringing them up to the desired standard. Israel admits to have 2 classes of physicians- Western and non-Western. This is the perpetuation of the conditions which had prevailed in Palestine and the early years of the state- doctors who graduated from German or German speaking universities and those who were educated elsewhere. Never ends." - Michael N

"I am a GP in Canada..but the problem is that I am not Jewish!!! Can I still come? Or is it reserved for the one and only chosen ones?" - C'est moi, Canada
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High demand for U of T health leadership course proves it: MDs make bad bosses

The enthusiastic response to a new course in Advanced Health Leadership geared towards physicians and healthcare executives offered at the University of Toronto reinforces an important lesson that many in the healthcare community have been slow to learn: doctors tend to make poor managers.

According to Brian Golden, a U of T professor of organizational behaviour, who recently , the February session of the course received more than five times the number of applications than they had spots available for.

The problem is, as another one of the instructors in the Advanced Health Leadership course, Joseph D'Cruz, , doctors simply don't get any leadership training.

"Things like teamwork and empathy are not part of the natural toolkit of the physician, particularly empathy towards co-workers. We call this emotional intelligence."

Mr D'Cruz says doctors score "quite low" in this area. "But the good news is that emotional intelligence is something that can be learned."

Doctors have immense potential as managers, he adds. "To be a good manager you need good native intelligence, and doctors have that in spades. They have the intellectual capability to be good managers — but they lack the emotional."

The first step, as with most things, is to acknowledge you have a problem. But doctors are often reluctant to admit it. "They think if they're smart as physicians, they must be smart as managers. That is a myth." says Mr D'Cruz. "Sometimes it's quite an epiphany when they're confronted with their ineptitude."
Are you as bad a boss as the Toronto doctor who reportedly expected an office employee to walk the six hours from her home in Scarborough to his office in Parkdale during the August 2003 blackout in Ontario, when public transit was out of service? Take NRM's quiz to find out:
What kind of boss are you?

1. A nurse at your clinic asks to take the next three days off work for personal reasons. You respond:

a) "Gosh, I hope it's nothing too serious. Let's try to find someone to cover for you."

b) "All leave requires one month's notice. That's the policy — or have you forgotten already?"

c) "Hm… I'll let you know tomorrow," you mumble as you hurry to your next appointment.

2. Your receptionist has overbooked your day — yet again. Patients are upset and, frankly, so are you.

a) "The only thing you're any good at is computer solitaire!" you yell in front of a shocked, full waiting room.

b) You ask to speak to the receptionist privately at the end of the day to sort out how the two of you can figure out a solution.

c) You say nothing and just try to clear through the backlog as fast as you can.

3. A young physician whom you supervise is being presented with an award for his work with underprivileged patients at a banquet on a Saturday night, but you've got hockey tickets. What do you do?

a) Pass the tickets along to a friend. Workplace solidarity takes precedence - after all, there are plenty more hockey games.

b) Make a brief appearance wearing your team's jersey beneath your suit and sneak out of the banquet hall after Dr Goody-goody has finished speaking.

c) You skip the banquet and ride the kid extra hard at the next M & M.

4. A departing staffer asks for a reference letter. You accept -- what else can you do? -- and then:


a) Dig out the forgettable, cliché-ridden letter you wrote for the last person who left, change the name and feel you fulfilled your obligation.

b) Mutter a quick prayer that he forgets he's asked you for a letter, and go on with your life.

c) Do what you promised: write a thorough and well thought-out letter.
For the answers, and scroll down.

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Gay rights advocate physician's death leaves legacy of forward-thinking leadership

An outspoken advocate of gay rights and an early promoter of specialized AIDS care, Canadian family physician Gary Gibson (pictured left) died early this month of a stroke in his home on Salt Spring Island, BC.

Dr Gibson, who came out when he was 40 in the early 1980s, served as a senior member of many disparate organizations, including the AIDS Committee of Cambridge, Kitchener, Waterloo and Area; the College of Family Physicians of Canada; the University of Western Ontario; the Ontario Medical Association; the College of Physicians and Surgeons of Ontario; and the University of British Columbia. He also made a brief foray into Ontario politics with the NDP.

The Kitchener Record ran a on Saturday:

When he was about to do one of the bravest things he ever did, Cambridge family physician Gary Gibson was scared for his professional life.

He told his close friend Paul Ottmann he was afraid he'd lose his practice, maybe be run out of town. He saved enough money to live on for a year.

Then, at the age of 40, in the early 1980s, he came out to the world as gay.
As it turned out, his fears were assuaged; not long thereafter, he went on to a number of professional and personal successes, co-founding the AIDS Committee of Cambridge, Kitchener, Waterloo and Area with his partner at the time and helping to establish one of Canada's first group practices.

The Gulf Islands Driftwood also (PDF) of Dr Gibson's January 3 death.

Memorial services will be held January 20 on Salt Spring Island, BC and February 16 in Cambridge, Ontario.

Photo: The Gulf Islands Driftwood


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