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Delusions of Anonymity

Posted by Dr No on 08 December 2009

mask3.jpgThere has of late been some sharp discourse over the health of the UK medical blogosphere. JD kicked off with Where are they?, featuring a man with a worried back peering anxiously downhill. Many lively comments followed. A few days later the irrepressible RP popped up with Club Culture – which provoked JD to accuse her of doing a “hatchet job” on him, which she denied (and DN is with RP on this one). Meanwhile over on the NHS Exposed blog, JL was re-activating the long running fear of official interference in blogging activity.

All of which had the effect of returning Dr No to a question which has pricked him ever since he started to blog: whether to blog anonymously, as Dr No, or whether to, err, be himself - the “err” arising because Dr No already writes as himself, and only adds Dr No at the time of posting.

There is, of course, one very sound reason for blogging anonymously: protection. Protection, not just for the blogger against scurrilous and vexatious officials, but also for his sources, and his patients, should they enter into the content of posts.

But just how substantial is this firewall of anonymity? Certainly, it is a barrier, but is it, for all its apparent opacity, a wall of paper vulnerable to the first finger poke of official enquiry; and that when the heat is on, the paper will burn, and all be revealed?

Most likely yes – it seems the courts would have no difficulty ordering disclosure. Even while the screen remains intact, might not its diaphanous nature betray the writer, as an unseen shaft of backlight reveals the give-away clue? Dr Grumble has said that he has been outed; how many other anonymous bloggers have, unknowingly, given away their identities?

Nor is it the case that those who do blog in their real name have been lost, let alone wiped – if anything, they have carried on while others, often anonymous, have faltered. Rita Pal – the undisputed grand dame of medical blogging – remains as lively and erudite as ever. Liz Miller, Helen Bright and Julie McAnulty continue to speak strongly, and show no signs of wavering.

That said, lack of real substance in the barrier of anonymity is but one concern. Could there be darker sides to anonymous blogging?

The vitality of the revealed bloggers suggests there might be. It is one thing to hide behind a screen, quite another to reveal oneself to the world. Could it be that with the authenticity of identity comes a vigour that is denied to those of us who hide our selves; that we who hide can play a game of easy come, easy go; and that that easiness, over time, weakens our resolve, while the real ones have a named self to hold on to?

And if – as seems the case – much medical blogging is motivated not by malice, but by a genuine desire to expose what is wrong, in the hope that something right may happen, could it be that remaining anonymous, with its inescapable overlays of “something to hide” and “not willing to stand up and be counted” has the effect of greatly weakening the influence of what we have to say? Does anonymity amount to a shot in our own foot – and so go some way to explain the expressed sense of futility so evident in the recent debate – as well as the relative ineffectualness in the wider world that gives rise to that futility?

Dr No is not about to reveal all – for now, at least. But he will continue to pricked, and so to wonder whether she should once and for all dispense with his delusions of anonymity.


It was a great surprise to me when one day I received an email from a reader I have never met telling me that I was putting too much information on the blog and that these were my extension numbers: XXXX and XXXX. She was right. That reader I knew as Potentilla. Her real name was Christian Jago and she had an important influence on the development of my blog. She kept my secret. Sadly she is now dead.

By then people who knew me or Mrs Grumble had already worked out who I was. One worked it out from the very first post because of a description of our dog. It is very difficult to keep your identity completely secret. I didn't realise that to begin with. Even the mention here of a distinctive dog might give something away.

I am now much more careful about what I blog about. I might criticise the government but not local managers. The government is not going to act against humble Grumble. Local managers might. Potentilla who knew a lot about these sorts of things pointed that out to me and I haven't forgotten her advice. I feel safer being careful than relying on anonymity. But a bit of anonymity is still useful for the reasons you have stated though I have now given up mentioning any patients. Even if they are made up patients somebody might claim they are not and that is not a risk worth taking.

I started off blogging when I was campaigning as a health independent in the Scottish Elections, so from the start my identity was known. It is a good discipline;it does make you check stuff and means you don't resort to ad hominem when you're arguing with someone, but I wouldn't recommend anyone who works in the NHS revealing their identity. I'm not a medic and I'm in a completely different position, but the NHS has a particularly spiteful attitude to whistleblowers, so I think you should keep your persona as it is, Dr No.

I strongly suspect those of us who think ourselves anonymous are nothing like as anonymous as we think we are. Fido gave the game away for Dr G; JD has Frodo (and Sam) in his sidebar... and people have managed to work out details about Dr No from the smallest clues. Dr No hasn't had the "Good Morning Dr ????, your extension number is XXXX" email yet, but it can only be a matter of time. And of course we only know about the people who tell us they know: how many others know, but don't say? Maybe even our local managers already know, but are keeping quiet, biding their time until they blow us out of the water...

"I am now much more careful about what I blog about" and "I have now given up mentioning any patients. Even if they are made up patients somebody might claim they are not and that is not a risk worth taking" - and that with the veil of anonymity in place. This is JL's predictions being borne out in practice.

Maybe remaining anonymous actually contributes to our perceived, even actual, vulnerability. As long as we remain hidden, so can our "disposal" by the authorities remain hidden. Those who live in the shadows shall die in the shadows...

Julie - I suppose anonymous campaigning would have about it an air of The Manchurian Candidate - and so be doomed from the start! I still think the presence of a real identity on your blog gives it a groundedness that Dr No lacks. But he is also inclined to follow your advice for now. Revealing identity is a one way street, and so best not to go down that street until absolutely certain it is the right route to take.

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