Online Physician Forums: A Virtual Professional Community

AUGUST 01, 2007
The Beginning
When I started Docsboard.com I was a regular contributor to various non-medical forums, mostly technology related. I was impressed by the camaraderie and willingness to freely share information and provide hard-to-find, otherwise esoteric information on these forums.

In my first year out of residency, I was struggling with evaluation and management coding like most new attending physicians, so I set up Docsboard.com with the idea that if I were to share my electronic lab book and computer and handheld knowledge, I would in return learn from experienced physicians about the business side of medicine— stuff we never get taught in medical school or residency.

Discussion forums, message boards, and Web forums in the present incarnation are relatively new to the Internet. They mostly derive from bulletin board systems (BBS) and Usenet newsgroups, which are older than the Internet as we know it today. Participation in online forums or BBS wasn’t a mainstream Internet activity up to until a few years ago. BBS were online communities with discussion and file download areas. Some also served as email gateways. BBS were the predecessors of the Usenet newsgroups that were popular in the early 1990s. Newsgroups could be found on just about any topic and were arranged in hierarchies with the original Big 7 covering computers and the Usenet itself, science, games, social activites, miscellanoues topics, religion, and politics. Participation in the discussions, as well as access to the software, was almost always free to the user. In the late 1990s, Internet spammers discovered and virtually took over newsgroups, making them increasingly unpopular.

Discussion forums provide a useful resource today with discussions archived in a searchable format. I have often found answers to technical questions on various forums that tech support couldn’t answer; in fact, a large percentage of search result hits from search engines point to discussions on forums in part because there are literally thousands of discussion forums on every subject imaginable, and they are designed to be easily archived and searched.

Benefits
Physicians are getting busier and have ever more demands placed on their time. I predict that discussion forums will prove increasingly popular as a vehicle for informal communication among physicians who are pressed for time. Medical organizations will also take advantage of these forums to promote communication among members.
Online forums provide a semianonymous medium that encourages the free exchange of ideas between physicians from different disciplines and parts of the country. There are no other interactive formats I am aware of through which we can discuss issues that affect our profession, such as the medical liability crisis and managed care. Forums, unlike blogs, allow anyone to start a new thread or discussion. Blogs require regular updates by the blogger, while forums can run with minimal input from the administrator.

Physician Only Vs. Public Access

Such forums as those found at Docsboard.com differ from other medical forums that are aimed at the public, where patients seek advice on disease conditions, in that they are open to only authenticated physicians. Sites that give real-time advice to patients have to deal with liability issues; in fact some state medical boards are in the process of formulating new telemedicine regulations to cover these physician–patient interactions.

Impact on Medicine
Forums provide a medium for rapid dissemination of information to member physicians. As professional organizations discover forums, they will have at their disposal a rapid means of disseminating information to a large number of physicians and receiving almost instantaneous feedback from members. Many physicians who are looking to invest in EMR products have come across www.docsboard.com during their due diligence and have been able to discuss the subject with other physicians before investing large fortunes.

Hans van der Slikke, MD, PhD, Medical Director of OBGYN.net—which hosts several online forums—believes that such forums have absolutely had an impact on medicine, but adds that “in order to really have an impact, [they] should be linked to evidence-based literature. The way it is now, it’s like colleagues meeting each other at a conference, and now and then it gives some new ideas, some new ways to think about certain problems. And in this sense, it adds some quality.” He also feels that forums can give physicians an international perspective, which leads to mutual understanding.

Underexposed and Underutilized?
Dr. van der Slikke feels the reason that online physician forums are underexposed, and therefore underutilized, is because “it’s quite expensive (advertising!) to expose them, and a lot of activity is needed to keep them running.” Further, physicians in general are among the last to adopt new technology. Interestingly, many new members of www.docsboard.com are not only new to forums, but to the Internet as well. However, physicians are discovering that online forums are an excellent resource for finding information on handheld devices, EMRs, and other useful information. Yet still these forums remain underutilized.“I think if there was more funding to have some other attractive extras like the Cochrane database available for [physician forums], this would attract a lot more of our colleagues,” explains Dr. van der Slikke.

It is critical to have the necessary funding available for the forum to be properly managed and updated and to provide compensation for those who are providing expert opinions, states Ross Dworkin, Online Forum Facilitator for Blue Grotto Technologies, which provides the technology for a number of medical expert and opinion leader support forums. "Physicians aren’t going to use a forum unless they are confident that when they ask a question, it will be addressed by a respected member of the medical community. An organization willing to spend the necessary $50,000 - $125,000 (which includes the technology, management, technical support, and associated honorariums) per year to properly operate a responsive, respected forum needs to feel confident that physicians are going to use it.” This isn’t always easy to predict, since some physicians may have tried some of the earlier versions of forums and found them to be difficult to navigate, frustrating to use, and worst of all—not responsive on a timely basis. Currently, in addition to society and journal sites, Internet-savvy physicians rely on search engines to scour the Internet for information. Therefore, many of the forums in operation today are more nichelike, and are geared toward loweruse, higher-value opportunities, such as supporting speakers, key opinion leaders, investigators, and consultants. Naturally, these types of forums usually are designed to comply with appropriate OIG guidelines.

Discussion Types
The bulk of Docsboard.com discussions are in the clinical areas and are only accessible to registered physicians. We have dedicated areas for discussing difficult or interesting cases, with the ability to post X-rays and CAT scans with the cases. The clinical forums are divided into different specialties, but this does not stop a psychiatrist from asking general medical or cardiology questions in the appropriate forum.

Privacy, Ethical, and Liability Issues
Patient privacy issues are always a concern for such forums. We advise our members to avoid providing identifying details about the patient cases they discuss. While no member would purposefully post a patient’s name, discussion of rare conditions or about a staff member could make identification fairly easy. We have a group of six volunteer moderator physicians who have the ability to edit a post if they feel it is likely to violate privacy. One option for running a forum is for a moderator to “first review the question and make sure it’s in adherence with forum guidelines; the problem with that is, once you show a propensity or a capability or a capacity to edit or modify content, you do take on certain liability and certain obligation,”adds Dworkin.

Read about the future of online physician forums and access interviews with Dr. van der Slikke and Mr. Dworkin at www.mdnetguide.com.


Online Physician Forums

AAO-HNS Discussion Forums
These forums of the American Academy of Otolaryngology—Head and Neck Surgery require members to log in and non-members to join in order to reply to and post messages. Discussion focuses on Medicare coverage of phone calls, inter-professional relations, donation of materials to missions, equipment wanted and for sale, and other topics.

DocsBoard.com
Designed for practicing physicians and residents in training, this non-commercial, physician discussion forum helps doctors—including those from other countries—exchange ideas and discuss issues of concern to the profession “in a friendly atmosphere.”The forum aims “to become one of the premier sites for information about Electronic Medical Records, Handheld device use in medicine, and Practice Management.”

Doctor to Doctor
Sponsored and maintained by Neurosurgery International, the Doctor to Doctor Online Discussion community facilitates “international cooperation and collaboration in neurosurgical education and patient care.” Registration is required to view the case discussions, for which all identifying clinical information has been removed or coded for confidentiality to protect patient privacy. Russian and Chinese versions are also available.

Electronic Medical Records Discussion Forum

These forums of the “most frequently referred to source for unbiased information on electronic medical records” are continually updated—with the last post contributed just minutes before this writing—and include discussions beyond EMRs, including medical voice recognition, billings, general IT, hardware, non-EMR software, clinical medicine, and more.

MomMD Forums
This “most active online community for women physicians, medical students, and premedical students”allows registered users to join any of 21 forums, including “General Discussion,” “Debates, Issues & Talk,” “Introductions & Connections,” “Physicians,”“MomMD Physician Job Board,” “Job Share Network,”“Residents,” and “Family & Parenting.” The site proclaims“You don’t need to be a Mom to love MomMD!”

MDLinks
Discuss the United States Medical Licensing Examination (USMLE), medical books, residency and fellowships, the Medical College Admission Test, United Kingdom medical exams, nursing, classifieds, and more at the MDLinks Forum. USMLE seems to be the most popular topic of discussion with nearly 50 subtopics and more than 100 postings.

OBGYN.net: Forums
Here, medical professionals can choose to discuss general Ob/Gyn topics, Ob/Gyn ultrasound, recollections and comments about their early years in medical ultrasound, residency and internship, the latest technology, Ob/Gyn nursing, and general Ob/Gyn topics (for which a Spanish-language forum is also available). The forums are heavily used, and posts are made virtually continuously.

TumorBoard.com
TumorBoard.Com was conceived and developed by a pathologist from Florida who wanted to “provide an online pathology image forum whereby pathologists from all over the world could come together and discuss their cases without fear of liability, consultant fees, or ego issues.” Though not a traditional discussion forum, the board enables visitors to upload images to seek opinions from members, after which the images are placed in a library for viewing by other visitors. Board-certified pathologists who register with the pathology e-community can also provide their input.





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