Sunday, January 02, 2011

Why Shrinks Don't Blog

Moviedoc writes:
The fact is, though you claim your blog is for psychiatrists, my impression is that few of us participate in any blog. What stops them? Snobbery? Hubris? Ignorance? Apathy? Fear?

I'm going to go out on a limb here and make a guess as to the top reasons why shrinks don't blog. But before I start my countdown, let me say that when I started Shrink Rap, 4 years and 7 months ago, I thought I wanted a blog for psychiatrists--- and suddenly lots of people came along for the ride-- other mental health professionals, other non-mental health professionals, and plenty of patients, as well as some random interested parties. We've Loved having Everyone. The funny thing is, we've learned a ton from our patient readers, and I wouldn't change a thing. A blog by psychiatrists for anyone who wants to listen to us.

So why don't all Shrinks have Blogs???

10. Many shrinks are busy struggling to earn a living and keep up with their family obligations. As the ABPN implements expensive and time-consuming re-certification requirements, this promises to make shrinks more busy. And as more and more agencies expect their psychiatrists to see 20-50 patients a day, shrinks may be even busier. Educational debts in the realm of $200K or higher are not helping.

9. Some shrinks like to spend their free time thinking about something other than work. The three of us don't seem to be in that category of peoples.

8. Psychiatrists have traditionally been taught that part of their work entails some secrecy about their personal lives and that the details of their lives should not be shared with patients. This creates some hesitation about blogs and Facebook and social networking.

7. Psychiatrist may fear being stalked by dangerous patients.

6. During Medical Board investigations, information about the psychiatrist that is easily located on the internet may be used as evidence that a psychiatrist is impaired or inappropriate. Has this happened? I've no idea.

5. Medical blogging is still seen by some as being on the fringe and not as valid a form of communication as peer-reviewed journals.

4. Remember Flea [link to Nov 2010 interview on Science Roll]? The perception is that people who blog set themselves up for bad things. Flea was a pediatrician who blogged about his malpractice case--he ended up settling the case and having his story appear on the front page of the Boston Globe.

3. Psychiatrists worry that patients won't like that they blog.

2. Blogging doesn't pay. While Roy has monetized our blog with Google Ads, we're talking about something along the lines of $100-$200/year.

1. Psychiatry is a profession that centers around intimacy, privacy, and confidentiality and a blog is a very public thing where boundaries might be breached (this from my non-shrink husband).

If you're a shrink and you don't want your own blog, you're always welcome here at Shrink Rap as one of our many anons. We're happy to have you.


moviedoc said...

Excellent suggestions, Dinah. Certainly most are good arguments for remaining anonymous. Another might be that many of us might want to keep how we work mysterious. But psychiatrists have published books, articles in the popular press, and otherwise revealed themselves for years in spite of the same risks and without the anonymity. I could try to guess why I didn't jump in until just this year. Probably just didn't know what I was missing. I believe it is very good for our profession for patients to be able to interact with us as just the humans we are. Thanks to the 3 of you for pioneering. And when you present in HI tell 'em to open their eyes and weigh in.

Anonymous said...

The blog was not monetized via the ads. The book will make some money and bring more readers to the blog, as well. Without the blog, would there have been a book?

tracy said...

When i mentioned to "Best Psychiatrist Ever" that he should blog or at least have a web page, he replied "Being in the phone book is enough!".

Anonymous said...

Nothing special about psychiatrists that preclude them from blogging. Do others in professions and vocations do this? How many priests blog? How many tax attourneys blog? How many urologists blog? What is a blog? An exhibitionist's diary? A reader's forum moderated by the writer? A place for people with like interests to respond to prompts? An educational resource for the professionals and the enthusiasts? All of that? The Secret Life of Urologists would be a pretty compelling blog with the right people writing, maybe.

Anonymous said...

anon #2: great points. Anyway, most docs I know do not have time to blog. They would rather go to their kid's concert or ball game, and if their kids are grown, they just want to read a good book and relax or go out and see some friends.
Anyway, blogging is on the wane.

Sarebear said...

This has nothing to do with anything, but my psychiatrist officially sucks. What do you do about a psychiatrist who apparently doesn't want to know about non-emergency yet distressing symptoms?

Anonymous said...

That psychiatrist sucks, no doubt. I'm sorry for you, sarebear.

Sarebear said...

Thanks, anon. She's on probation with me until I find out at appt on 20th how she feels about this. Since not taking medical messages seems to be the standard for the office personnel (how do you run a psychiatrist office that way???) though I am not optimistic about liking her answer(s). The office personnel has even referred me to leaving a msg to her via EMAIL before, and I'm not comfortable w/the privacy level of that for anything more than general stuff (I mean, I don't think HIPAA can be satisfied with that, either!)

Sorry for the comment thread hijack.

Dinah said...

I read your post and I'm lost as to why you are upset. You called the office to talk about a side effect you'd been having, had changed the medications, and now felt better. The secretary told you to leave a message on the doctor's cell phone voice mail, and you've been told you can send her an email. Why is there a problem? Leave a message on her voicemail. And you're worried about privacy issues with her voicemail, but you'll write about your side effects on a blog? I know you're troubled by the idea that the cell phone is "for emergencies" so it would probably be nice to leave a non-emergent message during business hours and not during the middle of the night, but the reason people have cell phones is so that others can communicate with them. The fact that a secretary doesn't want to be responsible for relaying a detailed and complex medical issue when there are other options available which would be more accurate (email with the names of the medicines and the doses per your report), leaves me wondering why you'd be upset with the psychiatrist.

Anonymous said...

Mostly, it's because psychiatrists don't have anything interesting to say. It's not psychology, it's psychopharm. Behavioral economics has more interesting insights about humans than psychiatry. Hope your "prestige" as a "real medical specialt" was worth the corner you backed yourself in to.

Sunny CA said...

I read your blog posting, and if I understand correctly, it strikes me that you are the one who is failing to communicate, not the psychiatrist. First you should have discussed the med issue at the last appointment, since you knew you were having a problem. Would it help you to talk about meds at the beginning of the appointment so you do not get side-tracked by the counseling part of the session? If you feel uncomfortable leaving a "voice message" on an "emergency cell phone", perhaps you ought to clarify with the doctort how you should handle this situation in the future. As far as the past and present though, you could write a snail-mail letter and it would be there tomorrow if you mail by 5pm. You could send an email. You could send a fax. You could drop off a note with the receptionist. You are failing to communicate. There is nothing wrong right now with the doctor's communication style. My endocrinologist has too small an office staff and they are rude and do not handle requests. As a result, if I would call in a prescription-renewal request, I would often end up off of thyroid replacement for days while I waited and I would call, call, call again trying to get it s renewal. I discovered that a fax gets to my doctor almost immediately and I get action. Faxes can be sent free online. Quit waiting around feeling afraid to communicate. The problem is with you right now, not the doctor.

Sarebear said...

I'll post it in the comments under my post, it got long.

Sarebear said...

To bring this embarrassing episode of mine to an end, I figure some might be interested in what I figured out my problem was that had me so upset about this that I thought others might be upset too, and then I was confused when others weren't, which made me take a long, hard look at myself to try and figure out if there was something else going on (although there didn't necessarily need to be, I'm strong enough in myself to not have others' opinions tell me who I am, but I can take feedback and look at myself when needed).

Whew. Anyway. What I figured out was, I was getting stuck in my OCD. My OCD, apparently, had me having "rules" for how doctors, psychiatrists, and their offices "should" behave, act, etcetera, and if/when they didn't act this way, it felt like my world was falling apart, and I didn't know how to cope with that. As soon as I identified this, it was like I hit reverse on the video of things falling apart; it all zoomed back together, and all was right with my world again, because I recognize that they can run their office any way they want, and I'm actually LUCKY to have someone who'll respond via email (many might feel that patients might take too much advantage of it, which I won't.)

Anyway, I'm sorry for the little or not so little side trip, here, but it's not like I could plan for what my skewed OCD perspective was going to do to me. Sorry about dragging you all along with me on this learning experience.

moviedoc said...

Not that I'm defending or making excuses for Sarebear, but if my patients call and talk to my office manager when I'm not available, I call the patient back. I can understand her discomfort with email, and I've said before cell phones are not reliable. This whole communication business has become much more complicated and difficult to navigate for docs and patients.

Dinah said...

It sounds like you had blog psychotherapy complete with an insight which helped you feel better!
Kind of neat that you could step back and see things from a different perspective. Perhaps you could bottle and sell that. There are days I would like to buy some of that for me.

Tag said...

I think that I agree with number 9
on your top 10.

Therapist and the theraputic field is pritty loaded . Dealing with difficult people on a daily baisis isnt easy.
Most docs& therapist just want to relax on their off time and not think about work .

The above is an expressive art therapy student . I did think about opening a semi profesional blog but it is something I have to think about some more before I take the step into the blog world

tracy said...

Wow, Sarebear...You worked things out really well. i wish i had your kind of perspective! Hopefully, i can learn a little from you.

Anonymous said...

Sarebear rocks!

Alison Cummins said...

You’re explaining why shrinks don’t blog, but you haven’t presented any evidence that they don’t. In a brief look around the blogosphere, they certainly seem to. I have to go now, but most of the following have psychiatry blogrolls: I could follow them up for you if you wanted and compile a longer list?

This is the only urology blog I know, and it’s dead:

Anonymous said...

This is the tip of the iceberg as far as urology blogs go.

Sarebear said...

Thanks, guys!

It is neat, Dinah, thank you.

Aside from not having the personality of Lucy in Peanuts, you made me think of being her and having a stand like she did, didn't she, where she gave advice for 10¢, except this would be: Bottled Psychotherapy, 10¢, Flavors Lemonade and Strawberry! Okay, so I have a strange imagination, hee!

Having gone an extra week without therapy due to my psychologist having been on vacation the week of Christmas to New Year's, this episode happened in the couple days just before I was due to see him again, so right at the end of the the 2-week long break, and I was sorely feeling the need for some kind of insight and/or therapy! It felt like a hot drink of cocoa on a cold winter night, to have SOMETHING relieve some type of anxiety, out of all the various anxieties I've been going through lately; to have something break through all the distorted thinking that I've not had the sounding board of therapy to help me see through some of my distortions.

I, of course, have made use of some at-home writing, to help me during this long break, and it has, but having that other person is MUCH better.

As you said, though, being able to step back and see things from a different perspective (which often that other person helps me do, but it's great when I can do it myself, as turned out here, which is great for my efficacy, a big issue for me) is a big help towards gaining that insight, and, as you said that you wished you could get that more often, it's something that often doesn't come easily (would that it did!). It's like crepuscular rays, those slanting rays of sunshine you see breaking through the clouds after a storm, that illuminate a spectacular scene over the Great Salt Lake out here so gorgeously (or anywhere, really).

moviedoc said...

Thanks for the list Alison, but I'm still disappointed. Two of them are by the same doc and only about half are US psychiatrists. A lot of the material isn't really about psychiatry. With 40,000 psychiatrists in the APA, well, 39,999 since I quit, you'd think you'd see a few more comments. BTW: another reason they don't or that some of us do it anonymously. It smacks of marketing. Woa. This is creepy. My "word verification" word is "angste!"

Anonymous said...

If there are 39,000 psychiatrists in America, and only a small fraction blog, shouldn't we be grateful as opposed to concerned that they are not all blogging? Do we need 39,000 psychiatric blogs and what benefit could we possibly derive? If folks are interested in following psychiatric blogs, there are some good ones to choose from. At what point is there not much left to be said that has not already been said? Case in point: Shrink Rap post on a Wired article and another blogger posts that he has posted on the same article.
Another thing to keep in mind is that a psychiatrist can maintain a blog and not draw much attention or any comments because the blog is boring, fails to connect with people, and so what is the point? Those ones are better off keeping a journal. The Shrink Rappers do a good job of keeping it engaging. They are smart and funny and warm, at least on the blog.
Some shrinks want to, and can blog well. Some should stick to their day jobs.
Do you think everyone should blog? Some patients blog. Should ALL patients blog? Of course not.
Why is anyone so concerned about the number of blogging shrinks? Should they add a course on the art of blogging to the med school requirements?
This reminds me of the Ann Landers or Dear Abby column on the proper way to hang the toilet paper roll. The controversy went on for ages.

The Shrink said...

I think mental health blogging is more prevalent than we'd imagine. Looking at the top 20 health blogs in the UK now, I see 11 are mental health blogs (with psychologist, mental health nurses, a mental health social worker, a student mental health nurse, mental health patients and psychiatrist blogs). Frontier Psychiatrist and (miraculously) myself are in there as blogging Consultant Psychiatrists.

In the top 20, how many other disciplines are present? There's one general surgeon, that's it. Of the only 3 doctors' blogs in the top 20, 2 are psychiatrists.

Psychiatry and blogging; we're not doing too badly at all, to my reckoning!

Anonymous said...

"Psychiatry is a profession that centers around intimacy, privacy, and confidentiality."
It means nature of psychiatry interventions, the identification of the team involved, and the consequences of the intervention should be kept out of the reach of the patient, his family and public.

Oracle at D said...

Thanks for this post! It makes me ask the reverse question: Why does anyone, including a psychiatrist, blog? I suggest: To write. And, to have that writing read. What to say, how to say it, how self-revealing to be, how much time to put in, these are all technical questions that answer themselves based on the level of interest you take in the activity for its own sake. I love to write. Why? Who knows. My hubby is a punster and wordsmith. The most amusing and amazing language drips from his lips regularly. But, he hates writing. This is fortunate. Otherwise I would have to kill him. As it is, I steal his stuff regularly. Actually, that's not accurate. He says I can use whatever I want. I have colleagues frequently press me to write professionally. The idea is intolerably confining. Instead of spouting off and playing with language, I would have to be an expert and justify my statements with research. No, I write to merely express myself. Also, blogging allows me to bypass those nit-picky editors of magazines that say,"We like your stuff, but cannot use it at this time." I figure, if it's any good, people will read it. If not, that's OK. The structure of posting once a week keeps me writing, which can only improve my skills. Dinah, thanks for blogging. That's the other thing. Blogging fosters dialogue. Your posts raise questions and generate discussion. Yay internet!