Making the Virtual Rounds: The Use of Blogs by Health-Care Professionals

Abstract

In the “Health 2.0” era, digital media has altered how health care is conducted and how patients consume medical information. This article explores the reasons why health-care professionals create their own blogs and how they use blogging as a component of their work. We examine interviews with medical bloggers (n = 83) featured on “Grand Rounds,” a weekly medical blog forum or “carnival,” to interpret the ways in which blogging is incorporated into their everyday lives. In performing a qualitative thematic analysis, we develop five themes that help capture what blogs mean to these health-care practitioners. The uses of blogs speak to articulating and reestablishing a professional reputation, connecting with patients informally, writing for therapeutic reasons, negotiating institutional constraints, and promoting community and health-care reform.

Keywords

blogs digital media health care health communication virtual community

Introduction

In modern democratic societies, media technologies are used to document and share meaningful aspects of everyday life (Durham & Kellner, 2006). Over the past 20 years, the use of media to represent lived experience—known also as self-chronicling—has intensified with the proliferation of opportunities offered through Internet access (Gillett, 2007, p. 28). One such opportunity is the ability to create a blog, which closely resembles an online diary in how it provides a virtual space for personal writing (Hookway, 2008; Lawson-Borders & Kirk, 2005; Rettberg, 2014). But what is more, blogs are also interactive; they possess features that allow communication with others and have been used to develop communities based on interest or affinity (Miller & Shepherd, 2004; Wei, 2004). This capacity to share information widely across geographic space through blogs and other online media is becoming a valuable asset for professional development and networking.

In the world of medicine, web-based tools are increasingly being utilized. The terms Health 2.0 and Medicine 2.0 (Hughes, Joshi, & Wareham, 2008) now describe online activities at the intersection of health care and digital media in North America. This landscape is marked by significant changes, not just in technology but also in the relationships between and among medical practitioners and patients. One point of entry into the exploration of Health 2.0 is a weekly online forum called Grand Rounds. Like conventional medical rounds, this community brought together on a weekly basis a group of health-care bloggers who shared what they determined to be the best online content available on a certain topic. The information or links they discovered would be summarized on their own blog and shared with members of the network. Often, there would be a discussion among the members about the weekly Grand Round that is presented. The topics were typically related to providing medical care or commenting on health-care delivery, including how information is accessed and what this means for patients and physicians.

Online health-care forums like Grand Rounds represent an expanding network in which individuals from different professions, specialties, interests, levels of education, and geographical locations share their perspectives on their work through blogging. As will be explained, most empirical research on health information online examines digital media use by patients, rather than medical practitioners. This study will therefore balance a body of literature largely focused on patient use of the Internet and its impact on the doctor–patient dyad. By focusing on medical workers' own explanations, we gain insight into why they keep blogs, and how blogging affects their professional lives. In what follows, we first review the literature on Internet use by patients and doctors. Then, we describe our theoretical approach and methodology. Last, we present an original qualitative thematic analysis of interviews that illuminate the use of blogs by health-care professionals (HCPs).

Literature Review

In recent years, a number of web tools (blogs, forums, podcasts, wikis, etc.) have surfaced to personalize health care, disseminate health information, and promote health education online (Hughes et al., 2008). It is estimated that 35% of the U.S. adult population—or, one in three American adults—have gone on the Internet to seek out health-related information (Fox & Duggan, 2013). Studies of Internet use have found that the loosening of institutional control over medical knowledge may encourage individuals to take a more involved approach to their physical well-being (Hardey, 1999). Having access to e-mail, websites, and online support groups is seen to increase the capacity for patients to make informed decisions about their health (Kalichman, Benotsch, Weinhardt, Austin, & Luke, 2001; Sharf, 1997). In addition, the Internet also provides a space for patients to write and share “illness narratives” (Hardey, 2002, p. 32) and for community development among individuals with similar health problems (Fox, 2001). Clearly, a much broader range of health knowledge and interpersonal support is now at our fingertips thanks to the expansion of the World Wide Web.

While the majority of research on the Internet and health care is about patients, there is a growing interest in web use by HCPs. There are a number of surveys and meta-analyses of existing studies that demonstrate how Internet use among physicians is increasing (e.g., Brown, Ryan, & Harris, 2014; Cooper et al., 2012; Masters, 2008; von Muhlen & Ohno-Machado, 2012). While the exact numbers are unknown, it is estimated that over 250,000 HCPs are using Web 2.0 tools in the United States (Hughes, Joshi, Lemonde, & Wareham, 2009). Research shows that seeking and verifying health information is a main reason why physicians go online (Casebeer, Bennett, Kristofco, Carillo, & Centor, 2002; Hughes et al., 2009). The Internet can indeed be considered to facilitate and extend the basic duties of a physician: to keep up to date with medical research (Chew, Grant, & Tote, 2004) and exchange ideas with peers (Hillian, 2003; Hughes et al., 2009). Blogs, in particular, are said to have transformative potential for health-care delivery; they can used to form support networks for physicians and patients, incite discussion about health and policy, and provide another forum for consultation (Cohen, 2007; Miller & Pope, 2010). Discovering such possibilities has led to forecasts that online social media will play an increasingly central role in medical professions.

Other studies have looked more closely at what HCPs think are the advantages and disadvantages of Internet technologies (e.g., Chew et al., 2004; Morris-Docker, Tod, Harrison, Wolstenholme, & Black, 2004; Norum & Bergli, 2005). On the one hand, some physicians find social media to be beneficial for sharing knowledge, collaborating with peers, and constructing an online persona or brand (e.g., Alpert & Womble, 2016; Kovic, Lulic, & Brumini, 2008; Lewis & Dicker, 2015; Panhani, Watson, & Partridge, 2014). On the other hand, there is also notable concern among clinicians that information about health and medicine online is inaccurate, which can create tensions between doctors and patients (Hart, Henwood, & Wyatt, 2004; Hughes et al., 2008; Levy & Stombeck, 2002). Underlying this worry is the view that the Internet's decentralizing capabilities has contributed to a general skepticism and demystification of medical expertise—known as “deprofessionalization”—that may disrupt the status and autonomy of medical practitioners (Broom, 2005, p. 320; Hardey, 1999, p. 832). This skepticism, in the United States at least, should not be viewed as superficial. Historical polling data suggest that public trust in physicians has declined sharply over the past half century (Blendon, Benson, & Hero, 2014, p. 1570). In light of these opportunities and anxieties, it is worthwhile to further investigate how HCPs feel about digital media and its effects on contemporary health care.

There are few qualitative studies that look specifically at medical blogging. First, there is Hillian (2003) who examined the use of patient weblogs by doctors and concluded that they can “be an effective and efficient tool for exchanging information between patients, providers, or between a patient and his/her provider” (p. 333). More recently, certain scholars have asked HCPs directly about why they keep medical blogs or social media profiles. Walden (2013) interviewed naturopathic physician bloggers and found that blogging allows them to build credibility and increase public knowledge of alternative medicine (p. 245). Also, Panahi, Watson, and Partridge's (2016) respondents appealed to blogs because they provide ample space for writing and the ability of cultivate online discussion (p. 102). These studies provide a starting point for our examination of blog use by HCPs. We continue this line of inquiry by asking the following questions: Why do HCPs keep a blog and how do they position their blogging within the Health 2.0 terrain? Analyzing accounts for blogging will build upon our current understanding of the way medical workers are motivated to use the Internet as a component of their work and personal lives.

Theoretical Approach

With the massive growth of the Internet in the past 20 years, digital technologies are increasingly embedded into our social spaces and interactions (Altheide, 2014; Couldry, 2012; Hine, 2015; Miller & Slater, 2001). These forms of computer-mediated communication are highly participatory and decentralized, thus diverging from how mass media is traditionally produced and consumed (Altheide, 2014; Couldry, 2012). Not only are there more media formats now than ever before, but our use of these tools is also fundamentally reshaping how social life is lived (Altheide, 2014; Cerulo, 1997; Miller & Slater, 2001). Media production is no longer the exclusive domain of profit-driven corporations; it is now something that most people can easily create themselves, which may result in greater democratization. According to Coleman (2005), blogging, specifically, “is a source of nourishment for a kind of democracy in which everyone's accounts counts” (p. 274). Yet, other communications scholars refute such “utopian” views toward new media development (Garnham, 1993, p. 254). Fuchs (2006), for instance, is less optimistic about the democratic and emancipatory potential of blogs. He cautions that “there is no automatism in the effects of blogging” in the sense that it will necessarily produce greater civic mindedness (p. 57). This is because blogs are inescapably interconnected with various cultural, economic, political, and technological structures. While blogs can be considered to be personalized and alternative media, they nonetheless remain influenced and constrained by broader social forces.

Applied to the current research, medical blogs help shape and are shaped by the institutional discourses and regulations of health-care organizations. They are also bound up with the ideologies of “deprofessionalization” (Broom, 2005; Hardey, 1999) and medical skepticism or “mistrust” (Panahi et al., 2016, p. 100) that have come to characterize our eHealth era. We therefore conceptualize medical bloggers and their blogs as socially embedded in the contested Health 2.0 landscape. To understand the reasons why HCPs are interested in keeping a blog, it is necessary to analyze their individual accounts and how these accounts connect to the contexts and expectations of Health 2.0. The motivations and explanations of bloggers are examined as reflections of social actors in a particular role (professionals in the health-care industry) negotiating the benefits and risks of online communication with respect to that role.

Data and Methods

Grand Rounds—The Best of the Medical Blogosphere

Grand Rounds (http://getbetterhealth.com/grand-rounds), founded in September 2004, was a network of health-care bloggers (also called med-bloggers) that shared a weekly summary of notable contributions made to the medical blogosphere. This digital compilation is an example of what is referred to as a blog carnival (Morrison, 2013). Blog carnivals are weekly online discussions among bloggers with similar interests. It is a type of online community of practice in which bloggers join together to share information on a regular basis. With Grand Rounds, the topics of the blog summaries varied from week to week with a chosen blogger, or blogger group, taking responsibility for compiling content from the Internet. The topics included: doctor–patient encounters; a profile of a particular person involved in medicine; experiences in medical education; commentary on a new scientific discovery; and, theorizing and debating various aspects of health-care delivery. The last compilation of Grand Rounds was posted on March 13, 2012 shortly before going on an indefinite hiatus. In total, there were roughly 200 weekly carnivals among members of the Grand Rounds.

The data for this article are gathered from a series of interviews with medical bloggers (n=83) that were conducted by the network itself and posted on Grand Rounds between November 17, 2005 and July 24, 2007. Those who were interviewed tended to be well-known and highly active medical bloggers—such as “Kevin, MD” and “Medpundit”—whose blogs have been profiled in other studies (e.g., Cohen, 2007). Interviews asked bloggers to discuss what was unique about their own blog, the reasons why they started to blog, and the significance of this practice for this work. Hence, the focus is more about motivations for blogging and less about particular medical or health-related topics. In treating these interviews as data, we were able to extract important insights not simply about what HCPs blog about but more specifically why they blog.

While dated, analyzing this sample of interviews is still relevant for a number of reasons. Namely, there is little qualitative research that explores the purposes for which physicians use the Internet (Hughes et al., 2009) and, to our knowledge, there have been no studies that take the Grand Rounds forum as a dataset. Furthermore, scholars have demonstrated that blogging remains popular among HCPs over the past 10 years. For instance, the physicians in Panahi et al.'s (2016) recent study expressed that blogs were their second most preferred online platform after Twitter (p. 102). Also, in their extensive review of 951 health-related blogs found online, Miller and Pope (2010) note that 49.8% of the bloggers worked in health professions (p. 1515). Since blogs continue to be used frequently by HCPs, we believe that the rich data found in the Grand Rounds interviews warrants examination and can be used toward gaining a better understanding of the reasons for medical blogging.

Methods

Since we did not perform these interviews ourselves, we are conducting a “secondary data analysis,” which is the practice of reusing qualitative data that was independently collected by others (Glaser, 1962; Heaton, 2008). While secondary analysis often refers to using data from other scholarly research, it can also be performed on other types of accessible data—like online interviews. In the methodological literature, there are particular recommendations about how and when to use a secondary analysis. Of chief importance is assessing the comparability of past and current research. Explained by Glaser (1962), “If the data are comparable with respect to population, situation, and variables, then the social scientist merely analyses it according to the specific operating problem” (p. 72). We believe that because of an equivalent focus on asking HCPs about the reasons why they blog, the interview data from Ground Rounds can be effectively analyzed to answer our research question. Since these interviews were not borne out of academic research, we treat them comparably to online documentary data. We are more concerned with examining the narrative accounts as provided by the respondents than the questions they were asked.

We take a “constant comparative” approach to data collection and coding (Johnson, 2000). We use this technique because it is particularly well suited to interpreting personal narratives or interviews, as demonstrated by other qualitative studies of physicians' Internet use (e.g., Hughes et al., 2009; Walden, 2013). We began by performing some preliminary online searches and found Grand Rounds to be a hub for medical bloggers. Digging deeper into the forum, we discovered that they conducted interviews with their members. Because of the striking relevance to our research question, we took these interviews as a purposive sample to analyze. Upon archiving and organizing the data, we began coding the interviews using an open and inductive method. Simple keywords (e.g., “privacy,” “patient interaction,” “information-seeking,” etc.) were first used to label the content of bloggers' responses. After reviewing and comparing the frequency of these initial codes, we then developed a final set of more detailed categories that described patterns from across the interviews.

Once the interviews were coded, we were able to perform a qualitative thematic analysis. Simply put, a qualitative thematic analysis is “a method for identifying, analysing and reporting patterns (themes) within data. It minimally organizes and describes your data set in (rich) detail” (Braun & Clarke, 2006, p. 79). This type of analysis places less emphasis on the quantification and generalizability of findings and is more appropriate for the development of thick analytical descriptions. Performing the analysis allowed us to refine and replace our original codes and focus even more narrowly on the reasons for blogging and the “functions” of blogs for physicians (Walden, 2013, p. 241). In so doing, we were able to determine the most prevalent themes in interview content with respect to our research question about how and why HCPs use blogs. We derived five overall themes that help explain how these HCPs account for blogging. By drawing on a number of reflections and opinions, we provide some valuable insight into the intentions of medical bloggers and their relationship to the health-care system.

Analysis

(Re)establishing Reputation

As mentioned earlier, once private and institutionalized medical information is now widely available online and this newfound accessibility may be encouraging a “deprofessionalization” of health professionals. Some patients no longer rely on, or uncritically accept, the advice given to them by doctors and choose to explore second opinions on the web. Because a large number of HCPs are wary about misinformation on websites, they go online to expose contradictions, critique “bad science,” or defend certain therapy and product recommendations. These practices may be answering calls from various medical organizations, such as “ASCO,” who urge physicians to “take advantage of the greatest opportunity to disseminate credible information and influence both our peers and our patients” (Lewis & Dicker, 2015, p. 768). Med-bloggers frequently explain that they started writing blog posts because most people without medical degrees are simply unable to properly interpret and understand health writing. Expressed by Dr. Emily De Voto (The Antidote), “It really does take a certain amount of critical understanding of science to separate the wheat from the chaff, not to mention putting findings in context.” Therefore, HCPs use their blogs to inform readers about what is credible and, in effect, reinforce their authority as medical experts.

A number of bloggers also express a desire to personally assist patients in navigating the potentially overwhelming and confusing information about health care. For example, Graham Walker (Over My Med Body) states: “How many people are probably going to see the Medicare Part D Walkthru? Not many. But I keep doing it, hoping that it maybe helps a few people make sense of it.” These types of blogs can perhaps improve relationships between doctors and patients. As Fard Johnmar (Envision Solutions) states, “because of the information available on the Internet, patients are entering into partnerships with their physicians where they are playing a larger role in the their care.” However, these actions also constitute an attempt at re-professionalization; they reestablish HCPs as the necessary intermediaries of medical and lay knowledge. On this topic, Dr. Jon Mikel Iñarritu (Unbounded Medicine) explains:

The issue is whether the information is right or useful, and whether you know how to apply that information. There's a solution to this problem: have professionals write about their field, and explain it in plain language – not a specialized blog, but one “readable” to anyone. (Dr. Jon Mikel Iñarritu, Unbounded Medicine)

It is in this capacity that medical bloggers can assert their reputation and reaffirm trust in their expertise. In certain respects, these insights are comparable to findings on naturopathic doctors who turned to the Internet to help rebuild individual credibility (Walden, 2013). While much academic research and popular discourse has emphasized the destabilization of the role of doctors, the channels of dialogue that the Internet opens may also counterbalance these effects by providing HCPs with new ways to develop a professional identity. Thus, Health 2.0 technologies create problems of, but also provide solutions to, deprofessionalization.

Interacting Informally With Patients

The ability to engage in new forms of interaction across space and time is perhaps the most obvious opportunity that the Internet affords. While web tools, like blogs, are not replacing face-to-face encounters, they do have the potential to enhance doctor–patient communication (Cohen, 2007). By providing a space to interact casually and share personal writing, online media can improve doctor–patient relationships by “humanizing” the physician (Alpert & Womble, 2016, p. 830). In other words, this practice of entering into trusting and open conversations “increases the human sensibilities of both patient and doctor and heightens the quality of their interaction” (Mechanic, 1998, p. 286). In this context, HCPs can use their blogs to communicate informally with patients, which in turn provides readers with a richer and more intimate understanding of their physician's identity and personality.

How this new doctor–patient relationship is navigated varies by blogger. Some, like Dr. Charles (The Examining Room of Dr. Charles), explain how their patients have reacted to their blogs: “I've learned that my readers – the patients – can be quite amazed and indeed frightened that there is a regular, opinionated, and sometimes judgmental person behind each white coat.” Others express worry over being discovered by patients. In reference to the use of a pseudonym, “MedPundit” says, “[it's] because I don't want a knowledge of my personal beliefs to be an inhibiting factor in my patient relationships.” By contrast, several bloggers openly mention their blog to patients and believe that they have experienced professional gains from online interaction:

Some of my patients are aware of it, and we discuss it during patient visits. Some patients have even found me via the blog and switched to me as their primary care physician. There seems to be a demand for physicians who understand the Internet's role in patient health information today. (Dr. Kevin Pho)

For many, the appeal of blogging is in its function as a platform for communication. In support of the potentialities of Health 2.0, some HCPs view this online technology as an unobtrusive, voluntary way to meaningfully connect with their patients: “Blogging is a way to welcome readers into the conversation, when they want to, on their terms” (Dr. Enoch Choi). Welcoming readers into dialogue allows doctors to better familiarize themselves with their patients and also to talk about their own lives. Moreover, some declare that blogging has directly improved doctor–patient relations: “I'd like to think that even the doctor-patient relationship has gained a Band-Aid as people express their experiences with the healthcare world, even if that healing is in homeopathic doses” (Dr. Charles, The Examining Room of Dr. Charles). The candid and collaborative nature of blogs then is believed to have positive effects on health-care delivery. While many doctors already have strong ties to professional peers, social media use can provide HCPs with closer connections to those they serve. Put concisely by Alpert and Womble (2016), “A physician's online presence also offers patients a glimpse into what it might be like to interact with the doctor in the examination room” (p. 829). It would appear that med-bloggers are interested in using the Internet to present themselves and communicate in honest and informal ways, in effect defying norms of being wholly impersonal.

Blogging as Therapeutic

In popular culture and much social research, clinicians are often portrayed as objective and stoic despite the many emotional aspects of their work (Nettleton, Burrows, & Watt, 2008). To address or alleviate some of these conflicting expectations and emotions, HCPs may turn to blogging. Life writing can indeed improve the mental and physical health of physicians by providing emotional equilibrium, self-healing, and reducing social isolation (Shapiro, Kasman, & Shafer, 2006). These benefits of blogging are referenced in many ways by the HCPs in this sample. For example, Dr. Allen Roberts (GruntDoc) says that he started his blog as a way to “blow off some steam” and Dr. John Crippen (NHS Blog Doctor) describes his blogging experience as “enormously therapeutic.” Similarly, “PaedsRN” uses his blog, in part, to communicate “the kinds of mixed-up feelings” that medical workers have. Others even claim that writing about your feelings is not only personally cathartic, but it can also help raise awareness of mental health issues. As Dr. Deborah Serani explains, “I am open about my own experiences with depression, and I think bringing that personal piece to my blog lets others see that they don't have to be ashamed.” Blogging is therefore considered to be a constructive way to express and promote the expression of a range of emotions.

Many bloggers note that “venting” or “cathartic” posts are written during or following an upsetting event in the workplace, such as an interpersonal conflict or a loss of a patient. Typically, doctors fear that emotional responses to patients will be seen as unprofessional in public medical contexts (Nettleton et al., 2008) and this expectation can become a source of private anxiety:

Often I have to suppress my emotions in the course of my work and I find this one of the more difficult and unhealthy things that I do … Surgeons aren't meant to sit in a treatment room cuddling a tiny baby with tears in their eyes … They're meant to be made of steel. Or at least, that's what we're encouraged to believe. (“Barbados Butterfly”)

Such suppression seems unreasonable given the extremely challenging nature of many health care professions. Blogging is said to provide some much needed solace under times of occupational duress: “I think every healthcare worker feels the enormity of their task and the impossibility of perfection. We need to have an outlet, some cathartic ‘generativity’ that helps us remember why we enlisted in this often heartbreaking field to begin with, or at least allows us to poke fun at ourselves” (Dr. Charles, The Examining Room of Dr. Charles). Hence, for many HCPs, blogs serve a therapeutic function in their lives; they read and write them as a way to find personal and interpersonal comfort amidst various forms of stress and pressure.

Describing and Negotiating Constraints

It is necessary to recognize that health-care blogs are particularly constrained by ethical and institutional obligations. It is common knowledge that doctors are held to a strict responsibility to not divulge intimate or identifying information about patients. In a number of cases, the online personal writing of med-bloggers becomes subject to organizational regulations or screening. These bloggers must negotiate telling their story and telling the “right” story. In this sense, writing is not an unrestricted process; it must align with particular social and institutional expectations. When HCPs talk about why they blog, many describe not just the benefits but also the challenges of using social media.

It is not surprising then that many med-bloggers adopt pseudonyms. “MedPundit” admits, “I didn't want to embarrass my employer with my views.” Anonymity is often a means to maintain candor and ensure protection, especially if writing vitriolic pieces about their job. Regardless of any disclaimers to the contrary, med-bloggers feel that they inevitably represent their employers, and express trepidation at the thought of readers conflating their opinions with that of the company they work for. Ethics are also heavily considered when writing posts about patients. Anonymity does not exempt HCPs from ethical standards of their workplace, resulting in a tension between autonomy and morality:

I exhaustively reviewed ethical standards for what doctors are “allowed” to say, and feel that all medical bloggers should be careful and follow the implied rules. But to let lawsuit fear creep into the realm of reasonable self-expression is to have lost the last vestige of freedom. Doctors are still brave enough to deliver babies, to do their best to find cancer early, to remove ruptured appendixes despite the fact that we all get sued eventually, probably multiple times in our careers. We must certainly be brave enough to have a public voice, whether in the form of letters written to the editor about our deranged healthcare system, or as semi-obscure words describing the hour of a fictionalized patient's death as shared on medical blogs. (Dr. Charles, The Examining Room of Dr. Charles)

Many of these concerns about how personal privacy, attitudes, and conduct will be perceived by patients and employers, resonate with other studies on physicians' views toward online media (e.g., Alpert & Womble, 2016; Panahi et al., 2016).

Sometimes, however, medical organizations are supportive of blogs and recognize their utility. Upon discussing her blog with her clinical director, “Tundra PA's” writing was incorporated into the company's recruitment website because they felt it accurately reflected their work life. In other cases, employers become aware of blogs independently:

The people in charge of my program know about my blog; about 10 months ago they spoke with me about it and asked that I make sure that I am meticulous about privacy issues. The fact that they knew about the blog and that the head of the program had read it was a little disconcerting, even though I've never said one word about the program. Just knowing that you're being watched is enough to make you think twice before you write something that refers to a real patient. (Dr. Sam Blackman, Blog, MD)

This excerpt shows how organizational circumstances affect how HCPs blog and what they can write about. Balancing blogging with professionalism becomes even more complex when one considers how med-bloggers reflect and represent not only an employer but also the broader discourse of contemporary medicine. This is often characterized as burdensome and restricting the possibility to be self-expressive. In this way, private opinions and public service can sharply collide:

With Donorcycle, I wanted to be able to kvetch and laugh at absurdities and such. I didn't think anyone outside of a few TCs would be interested in what I had to say. Then I got some comments from people that were negative. Being sensitive (no, really), I started to think that maybe I had more of a responsibility to keep organ donation in a good light for all the nonmedical people who read the blog. Every time organ donation gets bad press, people say no to donation. And every time they say no, someone dies. (“TC,” Donorcycle)

With multiple bloggers reporting being suspended because of the content of their blog, anonymity and self-censorship become profoundly important. The interviews in our sample demonstrate that these dilemmas profoundly shape how HCPs use the Internet. Negotiating these constraints is a part of the med-blogger's writing process and a reason why they blog the way that they do.

Promoting Community and Reform

By engaging in regular online communication, bloggers can create strong bonds with one another. Many acknowledge that through writing, commenting, and collaborating, they are part of a “virtual community” (for a review of definitions, see Fuchs, 2006). Members of other blogging groups—such as “mommy bloggers”—have described how feelings of support and solidarity can stem from being involved in such a community (Lopez, 2009; Morrison, 2011). It is common for med-bloggers to write about the trends, trajectory, and relative well-being of their online group. Because personal blogs often incite self-disclosure and statements of empathy, the blogosphere can provide compassion and communality not found elsewhere on the Internet.

There is a general sentiment that the development of an influential online community can be an asset in prompting medical reform. However, a major debate surrounds the question of what type of medical blogging is useful. With the various styles, themes, and genres within the group, there are contentions that some kinds of blogging are more beneficial than others. One clear division is between what we call “daily” blogging and “medical issues” blogging. “Daily” bloggers—like “KeaGirl”—use a blog to “chronicle [their] day-to-day events.” They emphasize the value in doctors shedding light on their own interpretations of work experiences. Their position is summarized well by Niels Olsen (The Haversian Canal) in stating: “we, the millions of little reporters, by looking a little closer to home and reporting our observations, can add enormous value to the Internet one little bit at a time.” These writers believe that giving readers access to the context and untold meanings associated with even the most mundane tasks is an important endeavor. Everyday posts are considered a way to demystify health care for patients and promote supportive interaction among practitioners.

On the other hand, the “medical issues” bloggers are concerned primarily with politics, policies, and social change. They typically regard such casual and observational blogging as trivial. These individuals express that med-bloggers should be more concerned with increasing their quantity of readers and developing a collective identity in order to effectively provoke change at an institutional level. Dr. Chris Rangel, for instance, is described as using his blog to “agitate for reform”:

The other thing I'd like to see is for a medical blog to make that quantum transition from entertainment source to advocate…In the end, physicians, healthcare workers, patients, and healthcare access and quality will all be on the losing end of these decisions unless we act now to become a major player in the game.

Hence, for this faction, online dialogue and a supportive virtual community is not enough. Med-bloggers should be using their presence on the Internet toward broader changes off the Internet. With social media becoming a popular conduit for group mobilization and activism, it is likely that even more HCPs will use the Internet for political engagement in the future. Other research has indeed found that HCPs go online to connect with government officials over issues of social policy and public health (Alpert & Womble, 2016, p. 830). By now, it should be clear that many HCPs write blogs for different reasons that range from personal and informal expression to professional and political interaction. While disputes over the essential purpose of medical blogs persist, a number of bloggers believe that blogging can and should be used toward promoting medical reform.

Discussion

Blogs are just one feature of a movement in which Internet technologies have been integrated into many health-care practices. The effects of this Health 2.0 phenomenon include the changing meaning of patienthood, subsequent shifts in the doctor–patient relationship, and a demystification of expert knowledge known as “deprofessionalization.” There have been limited qualitative investigations into how HCPs feel about these changes and why they choose to use online tools. Our work has sought to illustrate some of the motivations for medical blogging by drawing on HCPs' own words. Through a thematic analysis of interviews featured on the Grand Rounds forum, we found that most bloggers describe the benefits and complications that the Internet offers to the health-care industry. Their own uses of blogs speak to articulating and reestablishing a professional reputation, connecting with patients informally, writing for therapeutic reasons, negotiating institutional constraints, and promoting community and health-care reform.

While the Internet may be rife with inaccurate writing about health and medicine, medical bloggers mention that they are interested in correcting misinformation even if only through informal conversations. This practice of verifying and fixing content may also be motivated by an interest in publicly asserting medical expertise. Bloggers have explained how Internet access poses both threats to and opportunities for their professional development. On a more personal level, many express that they write blogs because it is a cathartic experience. Yet, in their reflections, they acknowledge that workplace regulations can often inhibit self-expression, and consequently, the therapeutic aspect of writing. As medical organizations become more attuned to web tools, blogs and other social media kept by physicians are likely to be subject to even greater institutional surveillance and appropriation. This would further constrain possibilities for personalized Internet use such as life writing and interacting informally which, as this study has shown, are some of the very reasons why doctors choose to go online. By moving in this direction, improving public trust in physicians and the quality of the doctor–patient relationship will remain a challenge. But that does not mean that HCPs will not face this challenge head-on. Based on these findings and projections, HCPs will continue to have a complex and ambivalent relationship to digital media, but they will also continue to adjust to the ever-changing Health 2.0 landscape in creative and meaningful ways.

Conclusion

Before concluding, it is necessary to address some of the limitations of this research. As outlined earlier, this study makes use of secondary data, which means that we did not ask our own questions to medical bloggers directly. Doing so would have provided more opportunity to probe participants about certain topics and to follow-up. In addition, our decision to collect data in this manner means that our study lacks external validity. our sample of bloggers, and their responses, cannot be used to represent the medical blogger community at large. With that said, we have tried to mitigate these issues to the best of our ability. We treated the interviews as documentary data—or, narratives—and employed appropriate methods for coding and analysis. Also, since most studies of Internet use by HCPs are survey based, analyzing any form of qualitative data about personal opinions and experience is still a valuable and uncommon endeavor. The excerpts provided in this article are reflections from HCPs on their work, their communities, and their lives that are seldom expressed in other types of popular discourse.

There are several other reasons why this research is timely. First, web-based tools are being used by an increasing number of physicians (Hughes et al., 2009). While calculating rates of use is worthwhile, it is also beneficial to look deeper into the meanings that these tools hold for HCPs. Understanding the intentions for why medical workers go online can help to inform effective medical education and health-care delivery in the future. Second, demonstrating how and why HCPs connect with others online can promote public health. Research has shown that when patients have effective communication with doctors, they tend to take a more proactive approach to managing their well-being, which results in better physical health outcomes (Stewart, 1995). Last, in light of our findings, our study also points out the need to acknowledge HCPs as emotional actors who desire a space for informal self-expression and conversation. With the growth of online technologies continuing to blur the lines between work and personal life, it is necessary to pay attention to how people feel about these developments and the ways they facilitate or complicate everyday practices.

As the era of eHealth moves forward, more forms of digital media will be integrated into the delivery of health care, and it will be important for social scientists to continue this line of inquiry. Future research should be directed toward the uses of and differences between other forms of social media—especially Twitter, given its popularity among physicians (Alpert & Womble, 2016; Panahi et al., 2016). While Twitter can provide greater reach and readership, it is also far more textually limiting than blog platforms. Therefore, HCPs may be drawn to Twitter more for networking and less for personal writing. In addition, it would be fruitful to examine the development of online networks created specifically for medical professionals, such as Sermo (http://www.sermo.com) and Doximity (https://www.doximity.com). By looking into these communities, many of the exploratory themes from this study can be expanded. Why were these websites created and how are they used for interaction, professionalization, and health-care reform? Moreover, because these groups are more private than blogs and exclusive to licensed physicians, are they able to mitigate issues of misinformation and institutional constraints? Finally, studies can also further explore the following: What patients and health-care organizations think about the online presence of physicians; how media platforms can be developed to best address the needs and concerns of HCPs; and whether or to what extent med-bloggers have influenced health-care policy changes across the globe. With their capability to redefine so many aspects of the health-care industry, it remains crucial to understand the ways in which and the reasons why medical professionals and their patients make use of the Internet.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Casey Scheibling is a PhD candidate in Sociology at McMaster University in Hamilton, Ontario, Canada. His dissertation research examines a burgeoning community of North American men who write online parenting blogs—known as “dad bloggers.” He is currently the recipient of a Joseph-Armand Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council of Canada (2016–2019).

James Gillett is an associate professor jointly appointed in the Department of Sociology and the Department of Health, Aging, and Society at McMaster University in Hamilton, Ontario, Canada. His work on health and media has appeared in peer-reviewed journals such as the Journal of Communication Inquiry and Media, Culture & Society.

Gordon Brett is a PhD student in Sociology at the University of Toronto in Toronto, Ontario, Canada. His research interests are in sociological theory, cultural sociology, and the sociology of the body. His current projects involve incorporating embodied cognition into theorizing practice, gender, and social change.

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