I have been following a series of blog posts centered around the story of a birth told by a midwife in the UK. I do not want to go into much detail here because you can read the whole story on Dr Crippen's blog and a follow up comment on A Midwife's Muse. But the crux of the matter is the midwife relates the tale of a homebirth she 'managed' with details of some questionable decision-making and actions. Dr Crippen was so incensed that he reported the midwife to the UK Midwifery Council.
Reporting clinical stories on the Internet
I don't want to get into a discussion about the wrongs and rights of the midwife's management. But I have found the whole story - the publishing of the story, the reply to it from various observers and ongoing online discussion - to be utterly fascinating from a professional and educational point of view. It is a very good example of how the Internet can turn bad on a number of accounts.
Privacy and confidentiality
A major issue is the confidentiality or privacy of the client/patient. I have noticed a number of midwives publishing birth stories on the Internet, and some do not make it at all clear whether they have the woman's permission or not. And it certainly isn't clear if 'Sharon' and her husband had given their permission for this story to be published.
Health professionals have a number of legal and professional obligations and standards with regard to sharing client information, so it is vital that we adhere to them. The Internet is a very big, wide world in some respects, but in other respects it is a very small world and people can be identified a lot easier than one would think. Even if the woman in this story is happy to be identified, I wonder how she now feels about the ensuing publicity. What effect is it having on her state of mind at a time when she has enough to worry about having just had a new baby?
Professional online behavior
The other issue is how we behave online as health professionals. Setting aside the stupidity of publishing a story of clinical actions and assessment that ends up getting reported for professional misconduct, the original post is very unprofessional in the way it is attacks colleagues. Even if the midwife had a basis for her complaints, there are far better ways of dealing with inter-professional conflict and difference of opinions than ranting on a web site.
Reflecting on clinical events on the Internet
I'll be honest, this whole incident has caused me to think further about my stance on reflecting on my clinical practice in an online context. I have advocated that midwives are open and honest in their reflections of their clinical practice in an online environment, because it creates an opportunity for debate and shared learning. I probably still take this position but at the same time, this particular story really emphasizes the importance of being extremely careful about what you say on the Internet. Don't get me wrong, I am not advocating that one covers up one's clinical mistakes, but I certainly feel health professionals have to be careful about what they divulge online.
Being a role model
I have talked about how I feel about being an online role model to students. I feel this is applicable to all health professionals who engage in online communication. We must remember that there are many eyes on us, including students. Do we really want students see us act in a very unprofessional and negative way as demonstrated in this story?
Ultimately, I think the sad thing about this whole story is that it has brought midwifery and home birth into disrepute. So please, everyone, think twice about what you publish on the Internet and how you respond to comments. Think about the profession you are representing and the effects of your online behavior on people like students and health consumers.
How do you feel about the issues that have been highlighted by this story?
Image: 'Autorretrato violento' julianrod