Behind doctors' social networking websites

Behind doctors' social networking websites
Publish date: Feb 20, 2009
By: Brandon Glenn
Source: Medical Economics

After examining a woman suffering from severe pelvic pain and heavy bleeding, Danine Rydland, MD, knew she needed a drug that would suppress the patient's menstruation in preparation for her hysterectomy.

But the West Virginia ob/gyn didn't know exactly what to prescribe. At first, she thought birth-control pills were the answer, but she wavered after considering a host of complicating factors: The patient was a smoker over 35, suffered from a history of heart problems, and had pelvic surgery as a child.

Unsure of how to proceed, Rydland requested permission from the patient to post a description of the condition and history on http://www.Sermo.com, a social networking website for physicians. The patient consented, and a lively discussion ensued: In the days that followed, more than two dozen posts addressed Rydland's query.

One physician suggested a drug that suppresses menstruation. A consensus quickly emerged, and Rydland opted to prescribe the drug to her patient—a move she may not have made without the online advice she received.

A self-described Sermo addict, Rydland, 53, spends about two hours on the site each weekday and six hours over the weekend. "I like the community of doctors," she says. "I have made cyber-friends. They understand my problems and share my triumphs."

Judging by the number of similar sites popping up, an increasing number of doctors share Rydland's view.

At first considered little more than a refuge for teenagers discussing indie bands and cheerleaders, social networking sites have exploded beyond the bounds of MySpace and Facebook. From top-dog Sermo to upstarts like http://www.Ozmosis.com and http://www.iMedExchange.com, the number of networking sites dedicated to physicians has proliferated in the past year, offering opportunities to share advice on clinical situations, practice management—even what wine goes best with grilled salmon. And it's not just young doctors getting involved; the average age of Sermo members is 49.

But not all physicians are sold on social networking. Critics cite concerns over doctor-patient privacy, usefulness of shared information, and the looming specter of malpractice implications. What's more, some argue that Sermo, in particular, exploits its members by selling access to investment firms and other outside groups to observe physician interactions. Controversy may be brewing three years into the era of online physician networking, but the trend shows no signs of slowing.

A NEW KIND OF DOCTORS' LOUNGE

Daniel Palestrant, MD, was a surgical resident in the Boston area when the banter inside his hospital's physician lounge sparked his imagination.

He noticed that doctors learned a lot from informally chatting with colleagues, but they had no means of sharing, comparing, or evaluating those insights with members of the wider medical community. In 2006, Palestrant launched Sermo, named after the Latin word for "speech," with the vision of forging a platform for physician communication and collaboration.

Thus far, finances have not been a problem: Legg Mason Capital Management, a blue-chip private equity firm that is one of Sermo's major investors, has already poured some $40 million into the company, says Adam Sharp, MD, Sermo's chief medical officer and one of its first employees.

"The greatest unknown was: Would physicians buy in?" Sharp says.

More than 105,000 Sermo members have answered resoundingly. Enrollment has more than doubled from a year ago, and the site is adding new members at a rate of more than 1,000 a week, according to a spokeswoman.

"There are times many of us feel like we're on an island," says Baltimore ob/gyn Christos Ballas, MD, who opened his Sermo account in 2007, after reading about it in The Wall Street Journal. "[Sermo] makes me more comfortable knowing I'm not alone. I felt like I had immediate company with people in my own shoes."

Similar to MySpace and Facebook, Sermo contains profile pages that allow users to list their professional backgrounds, post blog entries about anything from clinical problems to vacation destinations, and use the site's self-contained e-mail program for personal, out-of-public-view communication between members.

"The unique thing is that you've got people from every specialty," says Elizabeth Pector, MD, a family physician from Naperville, Illinois, and an avid Sermo surfer. "You get an idea of what challenges psychiatrists, pediatricians, and oncologists are facing on a day-to-day basis, some sense of how they think, and what evidence they're taking into account when deciding on a treatment regimen."

Once, Pector posted a picture of her own swollen, aching wrist and asked for feedback on what the problem could be. Numerous diagnoses came in, ranging from arthritis to psoriasis to trauma. But after visiting a hand specialist, Pector learned the ultimate cause of her inflammation: "Two hours a day of clicking on a mouse," she says.

THE LIGHTER SIDE OF DOCTORING

Former Starbucks IT executive Tobin Arthur launched http://www.iMedExchange.com in the summer of 2008, with help from $2.5 million from 100 investors; nearly all of them are physicians, and about 225 other doctors have received small pieces of equity in iMed for serving on its advisory board.

Arthur, the company's CEO, believes doctors are likely to join multiple online communities, just as many people have accounts with MySpace, Facebook, and LinkedIn.

Though Sermo is iMed's top competitor, Arthur says Sermo's success has been a blessing for his company, allowing iMed to learn from its competitor's experience. For example, Sermo proved that social networking sites for doctors can be attractive to investors, and there is a market for the services the sites provide, he says.

But he also sees a key distinction between iMedExchange and Sermo. "We view physicians as human beings first and doctors second," Arthur says. "We're most interested in having physicians connect on issues unrelated to the practice of medicine."

In this way, iMedExchange caters to physicians like Howard Luks, MD. The orthopedic surgeon at Westchester Medical Center in New York is a member of both sites, but he prefers iMedExchange because it offers a break from medicine.

"I'm more interested in the alternative offerings than talking about clinical situations," he says, noting that he works in a large group practice, so he can easily discuss medical issues with colleagues.

Luks takes part in an iMedExchange forum for wine connoisseurs, as well discussions devoted to the financial aspects of retirement. Topics of user groups and forums range from electronic health records to 1970s pop music.

Whether the topic is catheters or Cabernets, Sermo, iMedExchange, and other prominent sites capitalize on their members' desire for reassurance.

"It's nice to know that there are other docs who are thinking the same way as you are or have dealt with the same problem," Luks says.

PHYSICIAN BACKLASH

Patricia J. Roy, DO, recently created her own Sermo account to see what all the fuss was about. So far, she's not impressed.

"It always seems like the tones of the postings are whiny . . . dissatisfied, or very superior-sounding," says Roy, a family practitioner from Muskegon, Michigan. "So I delete all the e-mails they send and will probably unsubscribe soon."

San Diego family physician Jeffrey Pearson, DO, shares Roy's disdain for social networking sites, despite the fact that he once advocated online communication earlier in his career: In the mid-1990s, he participated in an "ask a doctor" forum on http://www.MSN.com. He'd spend a couple hours each night in the forum, answering questions from patients.

"It made me a better doctor because it gave me insight into what was on patients' minds," he says.

But he has no interest in interacting with doctors on networking sites. If he has a clinical question, he seeks answers using more traditional resources.

Others in the medical community express concerns beyond annoying bloggers or inconvenient clinical support.

Most physician sites stress that they are for "doctors only," ostensibly to reassure participants that their conversations are accessible only to professional peers. But the way these "doctors only" sites confirm eligibility varies considerably.

The question has sparked its share of blog-fueled controversy. In 2007, http://www.MedGadget.com, a blog dedicated to emerging medical technologies, published a guide to hacking into Sermo and other doctor networking sites. According to the blog, at the time Sermo required four pieces of information to verify a doctor's identity: name, medical school attended, date of graduation, and Drug Enforcement Agency number. For the first three pieces of information, MedGadget suggested consulting states' online physician directories. For the DEA number, the blog advised finding a copy of a prescription from a doctor or paying a small fee to a site such as http://www.DeaNumber.com, which charges $9 to confirm a doctor's DEA number.

Doctors in the Sermo community were not amused, lambasting MedGadget for publicly undermining the site's security. Sermo, for its part, has bolstered security in the wake of the incident, though Sharp claims the upgrades are not a response to MedGadget's hacking tips.

"It's incredibly important to us that the community not be infiltrated by non-physicians," he says.

Sermo, in particular, faces another unique challenge: winning over doctors concerned about its business model. Unlike most web-based businesses, Sermo doesn't make money from selling ads. Rather, it charges around $100,000 annually to hedge funds, Wall Street firms, and big pharmaceutical companies for the right to observe Sermo discussions and post questions to members.

Why would these companies care what doctors discuss online? Because they can learn what's being said about the usefulness of drugs or medical devices, thereby gaining exclusive insight into the companies that sell those products.

The idea behind Sermo's business model is to "create content that's valuable to outside parties, allow them access to the community, and charge them for it," Sharp says.

Count Jim Meehan, MD, an ophthalmologist from Tulsa, Oklahoma, as one doctor who objects to Sermo's business model—and that's putting it mildly. Meehan started a blog called http://www.SermoSucks.com to air complaints about the company profiting from doctors' interactions.

Addressing Sermo CEO Palestrant, Meehan wrote, "It doesn't take a rocket scientist to figure out that you are selling us out to malpractice lawyers, the insurance industry, big business, the government, and anyone else paying to eavesdrop."

MALPRACTICE CONCERNS?

Not surprisingly, Sermo downplays malpractice issues stemming from giving or following advice on the site. "Providing opinions and information is not malpractice," the company says in the Frequently Asked Questions section of its website. "Legally, the materials available through Sermo are for informational and educational purposes only and are not a substitute for the professional judgment of a health-care professional in diagnosing and treating patients."

But some healthcare attorneys say it's not that simple. A Sermo user who gives bad advice on the site could find himself involved in legal proceedings if his name were to come out during a malpractice trial of the doctor who followed his advice, according to Lee Johnson, JD, an attorney in Mt. Kisco, New York. Any doctor who provides advice without examining a patient or medical record could be at some risk of malpractice claims, she says.

To Johnson, seeking advice on a patient's treatment from Sermo users is tantamount to what's known in the medical profession as "curbside consulting"—obtaining advice from another doctor who hasn't examined the patient or his medical record. Just as with any other form of consultation, the doctor who seeks advice from a social networking site must use her best judgment about whether to act on it, Johnson says.

Doctors should view advice gathered from a networking site as "just an additional resource" in their decision-making process, similar to an "informal chat in the hallway" with a colleague, says Steven Kern, JD, a healthcare attorney with Kern Augustine Conroy & Schoppmann in Bridgewater, New Jersey.

"There's got to be the recognition that this information is not intended as a substitute for an informed medical opinion," Kern says.

Unfortunately, some of the major physicians' professional organizations offer little insight to doctors unsure of potential liability issues associated with the giving and taking of advice from networking sites. When contacted for this article, the American Medical Association, American Academy of Family Physicians, and American College of Physicians offered no specific policies, guidelines, recommendations, or tips for users of doctors' networking sites. (The AAFP does have a Facebook page, however.)

An AMA spokeswoman referred an inquiry about networking sites to the organization's policy on "Use of Health-Related Online Sites," which advises that physicians who provide health-related content on the web should ensure that the information they share is "accurate, timely, reliable, and scientifically sound."

Concerns over privacy and security will likely persist, but the number of physicians enrolling in social networking sites appears certain to grow.

"As newer physicians coming out of residency gain access and become active, [social networking sites] are going to be a much better avenue for us to talk about larger issues that concern us on a daily basis," says New York physician Luks. "We're only seeing the tip of the iceberg in terms of adoption and use of physicians' social networking sites."

Contact the author at bglenn@advanstar.com

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