Why should I trust you?

On call one night as a medical student, I was presenting a case to my intern. As I recounted the patient’s ER course, the intern stopped me and said, “Pal — trust no one.”

That sounded a little harsh to me, but the intern was nice enough to explain further.

“Look, you’re going to be taking calls from doctors and nurses the rest of your career. They are going to give you information about a patient, but it’s you who will be responsible for everything that goes right and wrong. Do you want to hang yourself on someone else’s evaluation?”

As any internist knows, there is a perpetual tension between ER and internal medicine docs. ER docs need to save lives and move meat. The snapshot the ER doc gets is sometimes inconsistent with the bigger picture the internist sees, leading to some conflict. It’s inevitable, really, that how the patient looks in the ER will differ from how they are up on the floor several hours later. And this is what my intern was conveying to me.

Patients will often complain about the parade of students, interns, residents, and attendings who seem to ask the same set of questions, but this was my intern’s point: things change, stories change, clinical facts change, and you better make sure the facts you report are the facts you verified.

(As an aside, it’s a not infrequent occurrence that a patient’s story will change significantly with the length of the white coat. The indigestion the student hears about becomes the crushing sub-sternal chest pain the attending rushes to the cath lab.)

I also remind patients that they don’t know which one of us might be called to their bedside in the middle of the night, so it’s best tolerate us all.

Anyway, this is my long-winded way of getting to the issue of trust. There are ER doctors who I’ve worked with for years and I know pretty well. I know their quirks, and I know that what they tell me is how it is (at that particular moment).

If I get an ER call from someone I don’t know, I will listen politely, but I’m probably going to see that patient first and re-check everything myself.

So “trust no one” isn’t precisely the dictum, but it’s a start. Clearly level of trust is influenced by many different factors.

At January’s ScienceOnline09 conference, Terra Sig’s Abel Pharmboy and I will be hosting a session on blogging and anonymity. It’s a topic particularly important to us as bloggers of medical science. A number of months ago, I “unmasked” myself and never really explained to anyone why. Pseudonyms are a big part of blog culture, and I preferred to keep mine while no longer guarding my real identity (for various reasons).

I would argue that in the blogosphere, there are three levels of identity: real name identity, pseudonymity, and anonymity. Real name identity is still not the “real person”. People write and behave differently online. Pseudonymity (my particular choice) involves using a pseudonym, but having one’s true name generally known or available. Anonymity is just that—the attempt to keep your real life identity completely secret. Each of these levels has different implications on both how the writer behaves and how the reader perceives.

Abel has brought the issue of trust forward—both the reader’s trust of the blogger, and the blogger’s trust in the reader. At our session (which we’d love to have you at, but will probably blog about, or better yet, maybe we’ll live blog it and take questions) I’m sure we’ll address lots of these issues, but we’d like to hear from denizens of the blogosphere. Abel’s question was, “do you trust me?” My question to you is, “Do you consider blogger identity when reading, and if so how? And do you find there to be a difference in the three levels of identity?”

Or of course, ignore my question, and say whatever you wish.