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.
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