In May 2007 Robert Lindeman, a pediatrician from the Boston area, found himself uncomfortably in the public eye when the Boston Globe exposed his pseudonymous life as a blogger in a sensational front page story. The reason? Dr. Lindeman, who clearly loves writing, had been live-blogging under the name “Flea” about his experiences as a medical malpractice defendant. The plaintiff’s attorney found out, he was exposed on the witness stand, and the case immediately settled. His site came down and he disappaeared from the blogosphere.

Since Dr. Lindeman had been commenting as Flea on my blog since before the trial (see the comments: Practice Tip: One Way to Cross-Examine The Attractive Doctor), and I covered the trial as best I could from the start and continued thereafter through the media fallout, I decided to follow-up with an interview request when I saw a short interview with him yesterday.

Dr. Lindeman graciously accepted my invitation and answered questions via email. These are, by far, the most extensive public comments he has made since the trial. The questions were designed to be open-ended and there were no edits, although I have added some links. All of my questions were answered, and he took me up on the offer to ask himself three more:
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1. Are these questions being answered by Flea, or by Dr. Robert Lindeman? And what, if anything, is the difference?

These questions are being answered by Dr. Robert Lindeman. I often speak of Flea in the third person, just as Flea spoke of himself in the third person. But under the hood, Flea and Dr. Lindeman are the same guy. Flea uses more bad words in public than Dr. Lindeman does. Flea displayed visual imagery of scantily clad women and you won’t find this at my legitimate web site. There, however, I have unburdened myself of sharply-defined points of view designed to provoke thought. For example, the article I wrote for natickpediatrics.com on ear infections was far more inflammatory (pardon the pun) than the piece I wrote at Flea. I was surprised to see this when I looked at the pieces side by side.

2. When you were creating the posts about trial preparation, you must have known you were playing with fire. What were you thinking?

What is this, Saturday Night Live? Naturally, I was not thinking clearly. A better question might be “Why were you not thinking?” Here’s why not:

I was under a tremendous amount of stress. This patient’s catastrophic death struck me and everyone else involved in his care as a complete and utter surprise. I had been trying to help this boy, and he suddenly and unexpectedly died. Never, until the moment the process server showed up in my new office, did it occur to me that what I had and had not done could be construed as malpractice. When I opened the envelope and read these things about my being “negligent, careless, and without skill”, I picked up the phone and called my personal lawyer. I thought I was being accused of manslaughter. I had suffered the loss of a patient and now I was being accused of having killed him, or so I thought.

My lawyer calmly explained that I was being sued for malpractice, not manslaughter and advised me to call my malpractice carrier. I put the envelope in my top drawer and went in to see my first patient of the day. My new practice had been open for two months.

Over the next five years I managed to forget I was being sued for long enough to get through the day and take care of patients the best I could. As the trial date approached I felt increasingly isolated and anxious. I felt as though this story, and the story of malpractice litigation in general, is one that ordinary folks have never heard and doctors are reluctant to tell. I believed that the anonymity would shield me. I know what you’re saying to yourself now. Like I said, I was under a tremendous amount of stress. I’ve been told that stressed-out people do dumb things from time to time.

3. What went through your mind when you saw the front page of the Boston Globe with your name and photograph above the fold?

Honestly, my first thought was “Look! I stuffed Fred Thompson!” (the announcement of his presidential bid was below the fold). Seriously, I knew ahead of time that the article was coming out because my lawyer had called me the day before. I had no idea I’d be put on page one above the fold. With my picture. My next thought was, “holy-moly now I have to tell my parents! To this point they knew neither that I had been sued nor that I was a blogger. Things unfolded fairly quickly after that. Two of my sisters, who also knew nothing about any of this, began calling me frantically. I spent most of the day explaining.

4. What were the reactions to the Globe story from your friends, neighbors and patients?

The range of reactions can be categorized in three groups. The smallest group was the fugitive group. Within hours of getting the paper, several families called to ask to have their children’s records transferred. One father showed up in person to demand his daughter’s chart. One mother kept a well-visit, made no mention of the case during the visit, then called up a few days later angrily demanding the charts for her three children. Several more would depart over the coming weeks. Some parents called to talk about it. I suspect a few are still making up their minds as to whether they want to stay. Some of my colleagues have stopped talking to me. Some refuse to make eye contact.

The next largest group was the supporters. Almost immediately, I began getting calls and emails from colleagues and families telling me they supported me and appreciated what I was doing. My rabbi showed up at our home the evening the article appeared. My fellow-congregants at shul were particularly supportive, even one who had until recently written for the Globe. Another fellow-congregant is well-known as a fierce personal injury lawyer. He never said anything to me about the case, but the very next shabbos he made a point of sitting with me at Kiddush and schmoozing me. He didn’t need to say anything. I understood what the gesture meant.

My mother-in-law cancelled her subscription to the Globe.

The largest group is everybody else, most of whom don’t know what the hell to say or to think about any of this. The next day, several of my wife’s acquaintances crossed the street to avoid her or looked away as she walked by. I suspect they didn’t know how to react. As for patients, the majority said nothing. Half of this group doesn’t read English-language newspapers. Some friends, all highly educated people, sincerely didn’t understand what happened and asked me to explain it. The rest have simply said nothing.

5. You must have read many of the press/blog stories and commentary that followed your exposure. What was fair and what was not about the coverage?

Immediately afterward I didn’t read anything, even your blog. After several weeks the temptation became too great. I read some perfectly horrendous things said about me, but honestly, I wouldn’t characterize any of it as unfair. Nasty? Brutal? Sure. But not unfair. What’s unfair in the blogosphere? I’m sure there’s stuff I haven’t read, but I’d rather not look. One group that has been paying attention has been plaintiff’s lawyers. Former fellow-bloggers periodically send me their “hit reports” demonstrating that readers with domain addresses at law firms have been searching their blogs for my name or the word “Flea”. I dunno, Eric, is it “fair” to say that the sharks are still in the water?

6. What regrets do you have about the incident?

You’re kidding, right? Where do I start? I regret that this boy died. Boys aren’t supposed to die, particularly when physicians are trying to help them. I regret the effect that all of this had on the boy’s mother. I regret that her pain was drawn out and exacerbated by a plaintiff’s lawyer whom I suspect cares very little for her and for her boy. I regret the effect this had on my wife, who suffered mightily from beginning to end.

I regret the enormous waste of time and energy on the part of everyone involved in this case. I’m particularly sorry for the jurors, who really appeared to be trying to make sense out of what must have seemed to them one great confusing dog-and-pony show.

I regret that five-hundred years of the rule of law and trial by jury have left us with this enormity that you call malpractice litigation. Is this really the best we can do?

I regret the loss of several families with whom I had bonded. With only one exception, each departure stung.

I regret that I may have chilled some of the dialogue in the medical blogosphere. If I didn’t chill it, I suspect I turned down the temperature a few degrees.

7. What are the three most important things you would tell a new blogger, medical or otherwise?

That’s really two questions. My advice to new bloggers is 1) go on, 2) have fun, 3) knock yourselves out. The blogosphere is the true marketplace of ideas. Long may she reign. To medical bloggers my advice is the following: 1) Every time you post, recite the following to yourself as though it were a mantra: “I am cutting rope with which to hang myself. I am cutting rope with which to hang myself (etc.)” 2) Any time you write anything, anywhere, recite the following to yourself as though it were a mantra: “I am cutting rope with which to hang myself. I am cutting rope with which to hang myself (etc.)” 3) Don’t blog anonymously.

8. How, if at all, do you think the incident will affect you five or ten years from now?

Let’s start with tomorrow. Tomorrow I expect to wake up and the job I’ve done every day for the past 8 years. Multiply that times five and ten years and I suspect you have my answer. I guess most folks will forget about this incident … except for our colleagues the plaintiff’s lawyers. I already know that pdf copies of Flea, incomplete though they may be, have been downloaded and distributed to at least one plaintiff’s attorney firm that I know of in Boston. I suspect they’ll need sources of prior inconsistent statements if anyone should come to them with an inquiry. I don’t know if I’ll ever write for public consumption again.

9. You had an award-winning blog because you had something to say and you wrote well. What are your thoughts on returning to the blogosphere?

Thanks for the compliment. Almost every day I see something or read something that makes me absolutely want to howl. I almost immediately compose a blog post in my head. And there it remains. Why? Because if I ever blog again my wife will kill me. Then she’ll divorce me. And I’m obviously not the smartest physician in the world, but I ain’t that dumb.

10. A hypothetical question: You’ve been called for jury duty and the case involves a question of medical malpractice. What will you tell the attorneys during the jury selection process about your ability to sit impartially ?

I will tell them that Roger Clemens will admit to using performance-enhancing drugs before I will able to sit impartially on a malpractice jury.

11. If this happened to someone else, and you were going to ask questions like I am doing now, what three questions would you like to see asked? And how would you answer them?

Neat question, Eric, thanks.
[The next three questions are Dr. Lindeman’s own]

12. Do you think the public knows enough about malpractice litigation?

No. Someone who has been through it ought to tell the story.

13. What advice, if any, can you give to colleagues about lowering your risk of being sued?

Whereas I suppose it’s possible in theory to lower one’s risk of being sued, in practice it cannot be prevented. If you are a physician and you make diagnoses for a living, the odds are very good that you will fail to diagnose a disease some day. If the patient dies or suffers harm, the patient and/or his family will probably consult with a plaintiff’s attorney. In some instances, the attorney will take a shot at. In practice there is no number of tests, no number of x-rays, CTs or MRIs that will prevent you from being sued. If the patient dies, call immediately to express your grief.

14. If you could turn back the clock to junior year in college, knowing everything that will happen, would you change your mind about careers? Law perhaps?

No. Even now, every day when I wake up, after expressing gratitude to the Almighty for my having opened my eyes, and for the blessings of my wife and children, I thank God I’m a physician. What’s wrong with me?

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Addendum: On 1/16/08, Canadian Medicine published more of the interview with Dr. Lindeman. A small part of that interview had been the subject of it’s initial story. (Hat tip to Bob Coffield)

Blog Commentary at:

• The Flea Exposed, He Returns to Tell His Story (Simple Justice);
• “Every time you post, recite the following to yourself as though it were a mantra: ‘I am cutting rope with which to hang myself….'” (Althouse)

It’s been six months since I’ve mentioned the experience of “Flea,” the pediatrician who was not only an award winning blogger, but also decided to live blog his own medical malpractice trial under his pseudonym. He got busted on the witness stand by opposing counsel and the trial settled the next day. Two weeks later, it was on the front page of The Boston Globe (See: Doctor “Flea” Settles Malpractice Suit After Blog Exposed In Court.)

Flea has now given, it seems, his first interview on the subject. It comes in the National Review of Medicine (“Check my blog and call me in the morning“), a Canadian publication.

What does he have to say? From the article:

“No wonder when doctors write, they write namby-pamby noncommittal crap,” says Dr Lindeman, “it might get you in trouble someday.” His advice? “Don’t blog anonymously. For physicians, writing is dangerous. There is something really messed up about that.”

And, he adds, don’t write about your malpractice trial.

For those who want yet more on the saga of Flea, the pediatrician who was live-blogging his own medical malpractice trial under his pseudonym until he was outed on the witness stand by plaintiff’s counsel, the American Medical Association’s American Medical News has an article, Internet won’t protect your secret identity. It includes an interview I did with them last month.