Why I No Longer Blog About Medicine

Through the latter half of my student years and into my first few years as a junior doctor, I kept a blog. In the beginning it was quite general, as blogs tended to be in those days, but it gradually became more specific to my job, and in the end I was pretty much blogging about medicine only. It wasn’t an academic blog — the kind where you share interesting case studies and problems and discuss the literature and so forth. It was anecdotal, chronicling the journey travelled from medical school to actual, practical medicine in South Africa. It was a candid description of what it felt like to be a junior doctor in this country. Posts documented everything from my first attempts at various procedures, to my ineptness at certain specialties, to the particular challenges presented by dealing with an impoverished and often poorly educated patient group, plagued by HIV and violence, within a healthcare system that is woefully under-resourced. I had a dedicated readership that engaged often and intelligently.

One day, towards the end of my community service, I just stopped blogging. I posted a link to a recipe site, and then never blogged again. At the time, I couldn’t really explain why. I enjoyed writing, and people seemed to enjoy reading what I wrote. I thought maybe I was just too tired and burnt out from work and studying to spare the extra energy to write posts that were pretty short but took me hours to write and rewrite before I considered them fit for public consumption. I worried it was because I had stopped enjoying and being interested by what I was doing. I couldn’t quite figure out how or why it happened, but the desire to write just vanished. I didn’t even say goodbye to my readers. I just disappeared.

Now, years later and with some perspective, I think I understand better why I stopped.

Firstly, the ethicality of blogging about patients had always been an issue for me. I went to great lengths to keep everything very anonymous. I blogged under a pseudonym, and only ever revealed the country I worked in, but never the province or the town. There were no pictures of patients, and scanning the blog now the only clinical picture I can find is of a fatty lump in a kidney dish: a large lipoma I once removed. There is no way, from my blog, that anyone could identify particular patients or even professionals, and the stories were of such a generic nature that they could have happened anywhere in this country. Nevertheless, there is an argument that just as people should own the rights to pictures taken of their bodies, regardless of how anonymous the pictures are, they too own the rights to their stories, and that nobody should share them without permission. Each post was the story of a patient or professional interaction I’d learned from, but none of these would have existed had it not been for the bodies of the patients that provided the teaching.

Secondly, I needed to start examining why I was actually blogging. In the beginning, my blog documented a wonderful voyage of discovery. From the joys of nurturing a patient with late-stage HIV back to health to seeing a stab heart being operated for the first time, it was all about the new and amazing things I was learning. And I think I documented those well, along with all the fears and frustrations involved in embarking on a medical career. But gradually, as the novelty of seeing perforated hearts being sewn up wore off, the more important questions presented themselves: why, for example, was I seeing young, healthy men presenting by the hundredful, their bodies full of knife wounds and their blood full of alcohol? As the Discovering Medicine stage wore off — as caesarean sections became easy, as stitching wounds became commonplace — a major issue became, for me, the conditions under which our patients lived. As dealing with district level health issues became easier, the blog could no longer be only about me and my experiences, and was moving towards an examination of the community that provided those experiences. And I found I couldn’t articulate my thoughts in a way that wasn’t either voyeuristic or judgemental.

People used to tell me that I should continue blogging so that ‘other people’ could ‘see things the way they are.’ But I couldn’t tell you how they really are. In my role as a South African, public sector doctor, I am a tiny but integral cog in a massive machine that grinds and grinds and grinds away without stop. However, I am very much a spectator when it comes to the actual human inputs and outputs of the machine. A healthcare system is simply a reflection of what is happening within the population it serves, and I am not a member of the population served by the hospitals I work in. I am not a part of the community I was blogging about. Although I deal with and try to help solve some of their problems, I observe my patients from a distance forged by unfair advantage and all the perks that come with that advantage: wealth, education, and a life fairly free of the health problems created by poverty. As such, it would be horribly presumptuous to think I have any real appreciation for the myriad processes which finally bring patients to our doors. So it’s not for me to preach about how destructive alcoholism is, nor bang on about the problems with unplanned pregnancies. It’s not for me to criticise the parenting strategies of people scrabbling to provide enough food for their children, nor to arch my eyebrows at the kinds of people requesting motivation letters for social grants.

Honestly, my blog was never going to benefit any patients. My posts were of the kind that readers wanted: peppered with doctor-humour, funny or gory-cool, sad stories that either had a cheerful moral or were far enough removed from readers’ own lives so as to seem like fiction. I am not proud to say that. I am in fact quite ashamed of of many of the things I wrote. I am truly sorry that I never graduated to posts that challenged my own beliefs, habits and prejudices, instead of aiming for the low-hanging fruit of likes, page hits and flattering comments. What I could have done was examine the role of my own past in the architecture of today’s South Africa. I could have talked about the role my own white and healthy-person and middle-class privilege play in the ongoing saga, but I guess I was too lazy or scared to do that back then.

I wrote about farm workers whose children died of kwashiorkor, lamenting the sadness of it all, but failed to examine the politics and humanity of people who shipped in migrant workers to pluck their fruit but then didn’t pay them a wage decent enough to save their children from starvation. I wrote about examining women who were victims of rape, choosing to remark only at my own surprise at the calmness of these women, my own embarrassment at the colloquial terminology they used, my own difficulty with folding and labelling the evidence boxes. A more meaningful post would have looked more carefully at the role I played in these women’s experiences, and asked myself if I had truly treated them with the compassion and respect I would have wanted for myself or one of my own friends.

In fairness to myself, I think my writing from those days reflects the egocentric nature of many junior doctors who are too overwhelmed by their own tasks to fully appreciate the challenges faced by the people they are treating. I think the posts are probably still of value to young doctors who are at a similar stage in their careers now to what I was then. Knowing that your experiences are not unique can help to make them more bearable.

I now work in an ‘Ivory Tower’, a place very removed from the nitty gritty of community care, where we have every resource at our fingertips. My job now is very specific, and involves performing operations that aim to cure disease. We know our patients have problems that extend beyond the scope of the operations we perform, but we seldom need to engage deeply with them, other than to request a social worker referral on the morning round. I still write about medicine occasionally, but I write about doctors and hospitals, and not about patients. I’m happy to stick with that, because almost a decade in, I do believe I have a little wisdom and understanding in those areas. I suppose I am still doing what I did then: tackling the safe known and comfortable topics. I doubt I’ll ever write about patients again, and if I do, I’ll do it very differently.