On confidentiality in blogs

I sympathize with Dr. Charles, who agonized about "the tied hands of the physician writer." We have hundreds of stories to tell. But how to disguise the data, so that patients don't recognize themselves? I could start with a straightforward post: a history, a symptom, an anecdote. (I have edited this quite heavily since first posting, because....well, because I was worried about confidentiality, and the tone bothered me. Levity is not respectful sometimes, and this was one of those times.) How much do I have to alter clinical information, before launching it into the blogosphere?

I had a hypothetical somatic delusion all worked out, as an example. (All right, it was silly.) Then I thought, oh gosh...someone, somewhere has that symptom. And we aren't just talking among friends here...someone knows someone who has that symptom. They will read this. They'll start talking. Someone will say, that's what happens to mentally ill people! It will appear here and there...it will turn up in Google searches. How to proceed with medical blogging?

Recent posts about privacy have tended to focus on doctor's liability. I'm thinking about the effect on patients, on people who have embarassing symptoms, who will see our blogs and think, "oh no..." And the jocular tone of my blog..."The psychiatrist is laughing at me! The blogosphere is laughing at me...I've become entertainment..." Oh, horrors. Not everyone, of course, will feel that way. But if someone does....

I won't be able to to attend Bloggercon this year. I hope they can spend some time on this issue. We could use a little help here.