In March 2019, I read Share Your Work! and started writing online under my real name. Since then I have published 591 blog posts, (this being the 592nd) with topics ranging from running, religion, medicine, study, poetry analysis, gaming, and happiness. Writing every week has been one of the most important things I do: It acts as windscreen wipers for my ideas, gives me a creative output and has led to me meeting some amazing people.

However, writing under my own name has caused issues over the years. The first began in MD2, when I found out that a colleague had reported one of my posts to the clinical school. In a long email, which cc’d the clinical dean and clinical coordinator, I was told by a staff member to take it down. The post was a de-identified story of a patient who had given me permission to tell their beautiful story. To avoid any confrontations, I complied, yet a few months later I found out that the clinical school was still continuing to monitor my posts. For what exactly I don’t know – but from that day on I developed a paranoia of being censored.

In MD4, I realised that more of my colleagues were aware of my blog than I had anticipated. While WordPress tells me I get around 2000 readers a month I figured they were mostly strangers as I don’t talk about my writing often. But one day in a hospital lift, a friend casually mentioned they found my blog and liked what I wrote. There were about ten other people in the lift including doctors I knew. It was a kind and encouraging comment – except the night before I had written a heavy piece on regret and mental illness. Part of me wished I had bared my soul slightly less.

More recently, I have read reports of fellow bloggers in medicine getting in trouble for their writing, the most notable being Slate Star Codex (now rebranded as Astral Codex Ten) written by psychiatrist “Scott Alexander” who was threatened to be doxxed by the New York Times. In a follow-up article, he tells his story:

Maybe I should explain more of my history here: back in the early 2010s I blogged under my real name. When I interviewed for my dream job in psychiatry, the interviewer had Googled my name, found my blog, and asked me some really pointed questions about whether having a blog meant I was irresponsible and unprofessional. There wasn’t even anything controversial on the blog – this was back in the early 2010s, before they invented controversy. They were just old-school pre-social-media-era people who thought having a blog was fundamentally incompatible with the dignity of being a psychiatrist. I didn’t get that job, nor several others I thought I was a shoo-in for. I actually failed my entire first year of ACGME match and was pretty close to having to give up on a medical career. At the time I felt like that would mean my life was over.

So I took a bunch of steps to be in a better position for the next year’s round of interviews, and one of the most important was deleting that blog, scrubbing it off the Web as best I could, and restarting my whole online presence under a pseudonym. I was never able to completely erase myself from the Internet, but I made some strategic decisions – like leaving up a bunch of older stuff that mentioned my real name so that casual searchers would find that instead of my real blog. The next year, I tried the job interview circuit again and got hired.

But I still had this really strong sense that my career hung on this thread of staying anonymous. Sure, my security was terrible, and a few trolls and malefactors found my real name online and used it to taunt me. But my attendings and my future employers couldn’t just Google my name and find it immediately. Also, my patients couldn’t Google my name and find me immediately, which I was increasingly realizing the psychiatric community considered important. Therapists are supposed to be blank slates, available for patients to project their conflicts and fantasies upon. Their distant father, their abusive boyfriend, their whatever. They must not know you as a person. One of my more dedicated professors told me about how he used to have a picture of his children on a shelf in his office. One of his patients asked him whether those were his children. He described suddenly realizing that he had let his desire to show off overcome his duty as a psychiatrist, mumbling a noncommital response lest his patient learn whether he had children or not, taking the picture home with him that night, and never displaying any personal items in his office ever again. That guy was kind of an extreme case, but this is something all psychiatrists think about, and better psychiatrist-bloggers than I have quit once their side gig reached a point where their patients might hear about it. There was even a very nice and nuanced article about the phenomenon in – of all places – The New York Times.

I realised that the situation Scott described himself in ten years ago, is exactly the situation I am in now. Psychiatry is a specialty that fascinates me, one I am seriously considering applying for in a few years, and the issues he faced I can see myself facing as well. In the full article he describes examples of creators in different fields, from police officers to transgender writers to Chinese tech enthusiasts facing similar problems. Is this a systemic problem, a question into how social media can interfere with work? Probably – but that is a topic for another time.

TLDR?

This post ended up being longer than anticipated. To summarise, there are a few reasons why anonymity is important to me. The first is professional: I want to avoid having future work employers, colleagues or patients finding this too easily and potentially damaging a professional or therapeutic relationship.

The second is personal: I tend to tell stories from my childhood and life and have decided I am no longer comfortable sharing this publicly. Obviously there are content creators that share similar, if not deeper, stories than I do, but very few use their real names and are in medicine with ethical landmines of patient confidentiality and medical professionalism. The memoir This Is Going To Hurt, perhaps the best known book on this topic, had to overcome enormous legal negotiations in order to be published.

The third is mental: Since my experiences above I have felt trapped in what I can or cannot share on this site. In 2019 and 2020 I would tell organic stories that fascinated me, but recently I imagine my posts being read by a colleague or employer and heavily filter my thoughts. For every post I put out there are about three drafts that get canned as I’m not sure if they are “professional enough”. I feel like a bird that used to fly freely that now finds itself caged. It would not be hyperbolic to describe this as suffocating.

This last point is my biggest counter to the argument: “Well who cares? We are all dead and forgotten in a few centuries anyway. Stop overreacting and write what you want – you are not that important.” I am aware that our time is finite and that is exactly the point: I want the limited time I have to be spent writing freely without these professional consequences or mental barriers that come from using my real name.

So what happens now? Truth is: I’m not sure. From today, this will be the last post on this site for some time while I figure out what to do. One option is to disable search engine indexing on this site to not appear so easily on Google. Another is to purchase a new domain name and redirect traffic to that site where I will write under a pseudonym. A similar consideration is to move my posts into Substack under a different name. The most drastic option is to take this site down completely or to make the posts private, though this is one I am considering the least.

One thing is certain: I will continue to write. Though I am very average, the art brings me immense joy and meaning and opened doors I never thought possible. However, for this to be sustainable I require a level of anonymity that this site currently does not provide.

For the people I have flown this topic by: thank you for your support. You know who you are. For the few readers who have spent any time read my musings, I am humbled and hope they were worth your time. I don’t take it for granted, and I promise I will make it up to you when I decide on a path ahead. If there are any updates I will put them here.

My name is Eric Tian, and I love you all very much. Take care.