My Conclusion

Friday, I asked the readership of this blog to express their opinion on my posts which dealt with Ian Thorpe, an olympic australian swimmer, who is currently suffering of an unknown respiratory condition. My question specifically was to inquire if I was being "Unethical" in publicly stating my opinion of what I felt was the likely diagnsis. Your views were mixed. for example, Moof said:

1) Ian Thorpe is a public figure.
2) You didn't make an accusation, you made a speculation.
3) Physicians have as much right as anyone else to speculate about whomever they will - even (and especially) when the subject matter is in their field of knowledge.
4) The only problem that I can see isn't one of ethics, but perhaps one of indiscretion (gossip?) ... depending on how you see 1) public figures and 2) the nature of the speculation.

And Graham reiterated similar concerns with:

It's definitely rubbed me the wrong way since you first started posting about it. If you were speculating about something a little more benign, I don't think I'd mind. But you're speculating about something serious and terminal; I'd feel the same way if you were speculating about something like cancer or ALS, I think I'd feel the same way. (Not to mention all the stigma that comes with HIV.) I think as a physician you're automatically able to know more about some people from your training--perhaps something that a non-physician would call strange or different or normal variation, you would know it to be disease.

And then there was an anonymous blogger (a physician) who stated:

I think ethically you have to ask yourelf several questions:
1)In publically speculating, did you bring harm to the patient's character? ( gossip)2) If so, do the needs for society to know outweigh the respect for an individual's privacy?
3) By virtue of your M.D., do your speculations have greater weight, and therefore carry more potential for grater harm?

I thought all the comments were great and quite thoughtful and I appreciate you all taking the time to write them. I did have difficulty though seperating if the problem was the fact that I was speculating about HIV? Or was the problem that I was speculating at all?

Speculation by its very nature is gossip. I get paid to speculate. People pay me for my services to speculate on their medical condition based on what information I have. Most of the diagnosis that physicians make are based on "the most likely" etiology. Isn't that speculation?

So I think what bothered everyone was the fact that I speculated that Ian Thorpe may have HIV. Probably due to the fact that HIV is a disease which still carries great stigma.

It was likely my fault. I had intended to begin trying my hand at speculating on general medical issues in the media, a la CodeBlueBlog (although, I profess, could probably never be as good as he was adn I so enjoyed reading his entries). For example, was Sharon's stroke due to medical error, or more recently, what is the true reason for Milosevic's death. I just so happened to pick up on Ian Thorpe's condition as the first and in this particular case HIV was my leading diagnosis, stigma or not.

Perhaps the best advice came later in the commentary from Echo Mouse and I urge you to read it carefully. I believe some of you may be taking what you read here a little too seriously:

My view is that blogging is personal unless it's part of a business or organization. You don't affiliate your blog with your hospital, private practice or any other agency. So I view your blog as a personal blog, despite the fact that you are a doctor.

Now, when it comes to expertise, everyone has enlightenment on certain things by virtue of their occupation. A blog is a place to express personal viewpoints. Your personal views include your training as a doctor. So while speculation about someone's health might be considered wrong in your capacity as a doctor, you are not at work here, you are blogging here. Based on all of this, I don't see that you have broken the H.Oath or spread gossip. You mused on something of interest to you. On your personal blog. Granted, HIV status can kill a career but you have never claimed to be an expert on HIV nor are you being consulted about this person's health. You're just stating your thoughts. That's okay as far as I'm concerned.

One of the reasons I took a break from blogging was because it was seemingly too political for a while there. People need to stop and think. Your blog is not the NY Times nor do you work for Reuters or the AP. If they stop in to read, they need to remember it's the same as stopping in to have coffee or tea with you. You're entitled to your opinions. Trying to limit that by throwing your profession at you is the sort of thing society does to shut people up, which definitely goes against free speech.

So you see, when you stop in to read here it's just like stopping in to have a cup of coffee. So what will it be regular or decaf?

I won't have the coffee, it gives me a case of the runs.