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Explore This IssueOctober 2015
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Two of the great traditions of medicine are the curbside and party consults. In the former, participating physicians informally discuss an especially difficult diagnostic problem. During the latter, a patient will approach the doctor to ask about some possible medical problem and what they should do about it.
The advent of the Internet has brought about the idea of crowdsourcing or the process of seeking a problem’s solution from a wide community. This allows expert (and possibly not so expert) opinion from a wide range of experience (or lack thereof) that might not be otherwise available.
“In a lot of respects, crowdsourcing can be looked upon as the online equivalent of someone approaching you for some advice,” says Christopher Collins, MD, program director, Division of Rheumatology, MedStar Washington Hospital Center in the District of Columbia. “Crowdsourcing has been done for years, and we often do basically the same thing in e-mailing or talking amongst colleagues within a single institution. This is a similar concept—just on a much larger platform.
Currently, there are two types of crowdsourcing. One is physician initiated, in which the physician posts relevant (but HIPAA sanitized) case reports or images for comment and suggestions. In most cases, these are restricted to only physicians. Examples of this type include HealthTap, Doximity and Sermo.
The other group is patient centered, in which the consumers themselves provide the information and ask others to suggest other tests or diagnoses that could be considered. The responders may not always be physicians. CrowdMed.com is an example.
“From what I have seen [while] participating in CrowdMed, a significant percentage of the patients may actually have rheumatic diseases,” says Dr. Collins. “As a concept, it has the potential to be useful for these participants. Very few of these cases are straightforward, and that is the challenge of these diagnoses, which attract patients to these kinds of sites. If they were easily diagnosed, they wouldn’t need the help of others to pool their thoughts together and [come up with] alternative possibilities.
CrowdMed allows a person to share their story on the site, where participants called medical detectives can see and comment on it. They may or may not be physicians, although most are. Both patients and responders can post anonymously.
After going through an assessment process, the top three suggestions are passed along to the patient. The detectives can earn small amounts of money, but Dr. Collins says the draw for him is simply the challenge of solving complex medical problems.
There are some concerns with this type of crowdsourcing. One is a problem that seems inherent any time the Internet is used.