I had a nice dinner last night with a group of medical bloggers and journalists (I don't recommend the scallops). One journalist, a veteran of many years, asked me, "is your goal to convince people, or are you preaching to the choir?"
It's a simple question, one that I probably should ask myself daily but don't. Rather than extracting an answer from my behind, I decided to think about it for a while.
The answer, I think, is both and neither. It's hard to judge given that the percentage of readers who comment is low, but the question wasn't "are your readers convinced", but "do you intend to convince them?"
Blogs are an odd beast existing in an in-between world of "not journalism", "not editorial", and other "not" phrases. It's whatever the blogger wants it to be, although it's becoming clearer to me that if I'm going to stay serious about writing, I'd better understand what these other things are that I'm "not". Not being a professional journalist, I can't devote myself to a story in the same way as someone who gets payed to research and write stories. Instead I write about what I already know, or what my narrow expertise allows me to learn quickly. And because I write what I know, I often allow my own passions to come through in the writing, especially my reverence for patient care and my abhorrence of snake oil and other "alternative" flimflam. When I write with a passion about how little I respect CAM and its boosters, am I really going to convince anyone? Or am I just another random guy with a strong opinion?
I like to think the answer is both and neither. I do come at this with a unique perspective as a writer. Most medical journalism is not done by medical professionals (and most medical writing is not done by people who can write). Sometimes I take a strident tone which is probably going to rally the troops, but is less likely to win me any converts. But I also try to tell real stories of real people looking for answers. Sometimes medicine has these answers but fails to communicate them. Sometimes we don't. And this is a group I hope to reach more an more.
People with difficult medical problems for whom there is no simple solution don't stop looking for answers when they leave the doctor's office. People come to me because they want help, and if I don't give it to them, they're going to vote with their feet. As a physician, I must try to help my patients understand their illness, and sometimes that means helping them change their expectations. Lots of doctors, either because they don't want to "take away hope" or because they want to make a buck, will give patients the answers they want to hear, rather than the truth. It's difficult, but possible, to tell patients the truth and help them continue to hope. That's hard, and not particularly profitable--and it's the essence of medicine. Anyone can prescribe an antibiotic for an infection; it's really not that difficult. But telling patients the truth and helping them retain hope is hard work. Part of being a doctor is giving bad news, and those who would rather avoid it shouldn't be doctors.
A recent commenter asked my why I would use the language of morality to talk about the antivaccination movement. After all, can't we have disagreements without impugning each others' moral character?
Given my responsibilities as a doctor, morality and ethics are central to what I do. They're unavoidable. What my journalist colleague taught me (or reminded me) was that it's helpful to have a goal in mind when you write. Sometimes my goals are clear to me, sometimes not, but one of these goals is to communicate to a wide audience that real medicine, practiced ethically, is hard, messy, and and in a very profound sense, real. Offering people hope based on your own ideas rather than the bulk of medical evidence may be easy, but it's not medicine, and it's not moral. If I don't convince everyone about a particular scientific fact, fine, but I want you, dear reader, to understand the reason behind the passion, to help you understand that sometimes the best medicine is not the medicine you want, but the medicine you need.