Recently online news publication, Search HealthIT, published a letter to the editor from a patient with concerns about the “anonymous nature” of SERMO, in response to an article about how physicians seek out and share medical opinions and diagnoses online.
At SERMO, we welcome this kind of discussion with all stakeholders in healthcare: “conversation” isn’t just what we do, it’s our name. The question, “how can we make sure physicians have meaningful conversations that improve patient care while protecting the patient”, is something we discuss daily with our physician advisors, strategic partners, patient advocates, and internally to improve the capabilities by which information is shared on SERMO.
Hundreds of patient cases and related clinical discussions are posted on SERMO every week ranging from acute life-threatening cases to researching rare disease. Members post a wide variety of things including tricky mental health situations, questions about how to advise a patient about new therapies and even how to manage the questions and expectations raised by patients’ families.
Patient privacy is deeply respected by all
When it comes to respecting patients’ privacy, all images and patient cases posted on SERMO are required to be scrubbed of any and all information that could cause a patient to be identified. Our physicians are incredibly diligent about protecting privacy, so much so that even if a patient gives approval for images of their face to be posted on SERMO, other physicians participating in these discussions will request non-essential features be distorted or obscured.
Crowd-sourcing isn’t a crutch for bad doctors; it’s a channel for better outcomes
The concern that physicians accessing a tool like SERMO will “lead to the same effect on clinician’s knowledge and memory as Google has evidently had on the abilities of users to retain information, meaning that it reduces the clinician’s ability to draw on clinical knowledge and make judgements independently and increases reliance on an instant hit of information” is ill-founded. While this concerned patient is thinking about the Google effect, we would challenge her to think in terms of the public good Wikipedia has be proven to be. The wisdom of the masses – shared knowledge among many peers – has been proven to extend the reach and improve the quality of information shared, so much so that nearly 50 percent of US physicians who use the internet for professional purposes use Wikipedia for information.
Consulting reference materials and collaborating with peers on patient cases are not new behaviors in the medical world. Peer-to-peer collaboration is so common, in fact, that it has a name: curbsiding. In the past, curbsiding occurred in hallways, in a doctors’ lounge, or, more recently, through mass email groups among specialists – a widely used and far less secure method of collaboration. Without this collaboration, doctors are limited by false barriers and data siloes that are not designed with patients’ best interests in mind.
SERMO harnesses what has worked for decades for physicians and expands a physician’s reach exponentially though a global social network of physicians. Instead of having to catch a colleague on the way to lunch, they can now upload a patient’s case right from their bedside, including images, scans, and x-rays to solicit insights from a community of hundreds of thousands of other physicians. While drafting the case discussion, the treating physician tags the relevant specialties they’d like to hear from, and upon publishing the post, SERMO “pages” these doctors via email to come consult on the case, acting as a more secure version of the “mass email groups”. Diagnoses are confirmed or ruled out, second opinions are given, tests and next-steps are offered and patient lives are improved (or even saved) faster than ever before.
False assumption #1: anonymity promotes unprofessional interactions
Firstly, all SERMO members are verified as physicians before they’re allowed to join and a member’s ability to see another doctor’s specialty gives credence to suggestions received. Doctors are trained to explore new ideas and challenge each other in a tone and style that outsiders might not understand. Anonymity can add more spirit to this dynamic, but conversations are moderated by administrators if members feel anything is getting to be a distraction from the conversation at hand. In the increasingly digital world, our SERMO physicians understand that it’s important and easier than ever to fact-check advice they receive before implementing a plan of action. SERMO is not meant to replace all physicians’ resources – we enrich doctors’ options to consider and increase their productivity.
False assumption #2: anonymity limits the reliability of the feedback
Anonymity may also be more concerning to a doctor seeking advice if they only expect a few physicians to weigh in on the case. On SERMO, however, the average patient case has 22 comments from a variety of specialties they’ve targeted and those who simply find the cases interesting. The threads evolve as a typical differential discussion would among peers – sometimes disagreeing on the best path to take – but usually coming together with a recommended plan of action. Anonymity provides a doctor the safety and support of peers to be able to say, “I don’t know,” and “I could use your help.” It’s not all academic and sanitized discussion, especially when patients’ lives and careers are on the line. Doctors are passionate and dedicated. If anything, anonymity empowers doctors and flattens clinical discussions; participants cannot hide behind credentials or rank. The marketplace of opinions on SERMO lives at the crossroads of data-driven and experience-driven, moderated by administrators who understand when to step in to protect the mission of the platform.
Crowdsourcing in action: how SERMO helped save a life
A good example of this is the case of a 14 year old boy who coughed up a “branch-like” mass. A strange sight that most doctors will never see in their lifetime, the practicing physician posted the case on SERMO. Doctors suggested a whole host of tests and potential diagnoses, discussing the pros and cons of each together. A few hours after posting, a Cardiologist who knew exactly what the diagnosis was commented, “…he needs to see cardiology urgently for plastic bronchitis following Fontan surgeries…please give them a call and ask whoever is on call for the weekend when they can see him (or have him admitted)”.
Another doctor agreed with the severity of the situation based on their own relevant experience, “[I had] a little 3 year old patient of mine who died from this recently. Mother had shown her doctors a cast she had coughed up while in the hospital for respiratory symptoms post Fontan, but sent her home without recognizing the diagnosis. She died a few days later.”
The treating physician was able to verify the situation, expedite referral without waiting for results to come back from the lab, and in two days the boy was treated and his life was saved.
Had the physician disregarded the SERMO community because feedback is anonymous, or worse, had he waited for the lab results to come back showing what the “branch-like” mass was before acting…or had he even stayed in-house, calling for a consult in a hospital he may have worked in (as the 3 year old girl’s physician did), the outcome would have likely been tragic. Expanding the breadth of knowledge surrounding a specific case, breaking down the barriers that limit a doctor’s ability to take care of their patients to the best of their abilities, understanding that there might be some colorful and frank conversation along the path to helping each other, in our opinion, far outweigh the risks that technology can “reduce [a] clinician’s ability to draw on clinical knowledge” (ie, make them a bad doctor). Faster, more efficient clinical collaboration with built-in respect for patients’ privacy makes good doctors better.
We feel certain the 14 year old boy’s parents would agree with us.
If you’re a physician, please join us inside SERMO.