physicians becoming unhinged

I’ve been involved in social networking for many years, even before it became fashionable. In particular, I was interested in social networking for physicians-there are many potentials for good when doctors communicate amongst themselves, and all of us learn from one another. But most physician social networks come up short-they try to do too much, or else try to be another MySpace or Facebook clone.

A few years ago, Sermo came out with a big bang and a lot of promise. It was a site that was all about conversations among physicians. It wasn’t filled with the usual “talking heads,” but physicians from all walks, who could provide unfettered clinical advice to one another. Drug companies and the AMA signed up early on, since being able to observe (but not join in ) conversations among doctors is a gold mine to them. One thing the AMA learned was that most of us detest the AMA, and eventually there was a major falling out between Sermo and the AMA, reportedly after physicians on Sermo finally woke up and realized the AMA owns the ICD-9 codes that determine physician payment for procedures.

Anyway, I became disenchanted with Sermo soon after that. Not because of the AMA thing, but because I was finding so many of my colleagues on Sermo were conservative. Extremely conservative. And very angry. They were the forerunners of today’s Tea Party crowd, and in retrospect, it was like having multiple conversations/debates with Rand Paul and his ilk. I was labeled a “communist” for having the audacity to even mention the term “universal health care.” I was compared with Noam Chomsky in ways that did a disservice to Chomsky and me simultaneously. The only respectful conversation with a conservative on Sermo, I think, was with a female psychiatrist who trolled all the ob/gyn posts in order to promote her pro-life agenda and rail against godless abortionists like myself. At least she never resorted to personal attacks (nor did I) and it was all civil. That was the best of it in terms of dealing with conservatives on Sermo. There were some progressives, and some of them occasionally chimed in. But it was usually me against several conservatives and I was often dying for some reinforcements who never came.

So I stopped participating in Sermo. At one point, I was #4 among all gynecologists on the site in terms of participation (note-at the time, there were only a few hundred ob/gyns on Sermo, another reason I wasn’t that thrilled with the site-it is still mostly made up of family physicians and internists who talk about things that bore surgical types like me to death). Over time, I went on perhaps 2-3 times a year just to convince myself it was still a waste of time. While it was good that this wasn’t the usual physician site where experts lectured others from Mt. Olympus, it would have been nice to have some folks with significant credibility, since many responses seem to have been authored by the same frequent flyers on the site, none of whom necessarily had any specific expertise in the topic at hand, nor did they provide true evidence-based advice. Anecdotes ruled the day, and while clinical experience and anecdote can be helpful, they’re not definitive.

Recently they updated the site, which was good in terms of Web design. I went back a few days ago to check it out and liked what I saw in terms of UX and functionality. But if anything, it’s even more rabidly conservative now in terms of the physicians who participate. There’s a big post on Atlas Shrugged by Ayn Rand. “Obamacare” is routinely derided, with fear tactics about how physicians will be put out of business (?physician “death panels” perhaps?), how Medicare is being gutted, etc. Even better-a pathologist suggested there would be “armed rebellion” against the government because of its policies, and all this was a consequence of Obama being Kenyan. Great-a pathologist birther. Usually my colleagues in path are very smart and focus on factual evidence. But I guess on Sermo the kooky pathology types come out with conspiracy theories. A ludicrous article by the conservative Heritage Foundation is used by physicians on Sermo to support their hysteria about the evils of health care reform. That’s what it’s come to on Sermo-using a conservative think tank to support your position on a major health care issue. These folks, based on their posts, hate health care reform, hate the government, think our President is a communist, etc. Do they have issues with government intruding on the rights of women to have an abortion? Apparently not. But if the government is even incorrectly perceived as interfering with a physician’s reimbursement, then they want “armed rebellion.”

In other words, many of the physicians on Sermo represent the worst stereotypes people have of doctors. These are angry, irrational types who seem to just be miserable about everything and believe whatever Faux News tells them.

Now, I’ve known since med school that most doctors are conservative. Hell, my best friend from med school supports Bush to this day, and I still am good friends with him. It’s okay for people to have different opinions. If everyone agreed, life would be terribly boring. But there’s a difference between having a different opinion and calling someone names. Physicians are also supposed to know the difference between objectivity and opinion. There are many good resources on health care reform that are unbiased and nonpartisan. And I have issues with the current health care reform legislation, mostly because it seems to me to be confusing, woefully suboptimal and didn’t go far enough to ensure health care for all and also protect a woman’s right to choose abortion. I wanted a single payor system, in all honesty. That puts me at odds with the great majority of physicians on Sermo, and that’s okay. But the great majority on Sermo seem to be enchanted with the Tea Party philosophy of ranting without constructive solutions. And this is disturbing to me.

Certainly the majority of posts on Sermo relate to clinical matters and the discussion can be helpful, and at least not snarky. But too often, even on clinical threads, the conversation degenerates into editorializing and even all out warfare.

In daily life, I interact with many physicians, most, if not all, of whom are not like what I see on Sermo. But I think Sermo, like any other Web-based social network, is prone to snarkiness because of the semi-anonymous nature of the Web. Most of the physicians do not have any identifying information, so the most quiet, benign physician could rant all he/she wants on Sermo without any repercussions since no one has any idea of his or her identity in most cases.

We need good social networks for physicians. I appreciate the AAGL listserv, where all of us gyn laparoscopy folks communicate on clinical matters. But it’s moderated, and we’re all in the same specialty and most of us know one another so it tends to be a supportive crowd, even with a diversity of opinions on clinical topics. Sermo desperately needs some moderation. Normally, I hate moderated forums-it goes against my “socialist” grain, I guess. In many cases, I like the unbridled free-for-all that is the Web. But too many times on Sermo and some other forums (new music ones in particular), the conversations turn ugly fast. Someone needs to be the grownup. There are too many ranting two-year-olds on Sermo who would benefit from a “perfect nanny.”