Between a rock and a hard place: inside professional P2P healthcare communities

mecThis post describing how a family doctor sought prescription advice from fellow members of the Sermo community demonstrates everything that is good, as well as things that are less good, about the velvet rope professional peer-to-peer healthcare communities. 

On the one hand, yes, the doctor’s query produced a surge of responses from the community. On the other, it took several days for consensus to be reached. Such reports from the trenches offer signposts to the future, but also raise difficult questions.

The fact that her original enquiry provoked ‘a lively discussion[…] in the days that followed’ certainly challenges the promise of Sermo’s ‘know more, know earlier’ strapline.

At some point in the intermediate future, status update platforms such as Twitter (existing inside or outside of professional P2P sites, although the latter does at least validate the status of the poster as a healthcare professional) which have attracted a sufficient number of professional members and specialists on a global basis will have the capacity to provide real-time Dx and Rx advice.

However, how can the advice be filtered for accuracy and relevance, with the most appropriate content appearing first, and inaccurate or dubious advice being channeled into another data stream?

In addition, how can debate be curtailed in order to expedite the production of a result without making participants feel that their contribution has been overlooked or that their voice stifled, which would indubitably diminsh their willingness to participate in the future?

Both of these questions presuppose an acceptance of the validity of the concepts underlying evidence-based medicine and a desire to see its benefits transposed into evidence-based practice. They also assume that the participants in this exchange of ideas are amenable to steering their interactions between the Scylla of EBM guidelines and Charybdis of social networking’s indisputable utility in facilitating interaction between healthcare professionals.

How can the competition between evidence and eminence in this description of a possible future for professional P2P healthcare communities be managed?

Thanks to @PediatricInc for the link

3 thoughts on “Between a rock and a hard place: inside professional P2P healthcare communities

  1. Providing unstructured P2P communities such as the Sermo one would seem to perpetuate the tendency of physicians to seek answers using an eminence based (ask a colleague) approach – which is currently the most popular mode (see Injecting evidence into discussions such as this would probably be best accomplished by an add on of some sort – perhaps participation by a librarian, health informaticist, or EBM-adept clinician in the discussion, or building in easy ways to link to evidence based answers at sites such as FPIN ( or TRIP Answers (

    Had that been available, the Sermo participants might have fairly quickly been able to find evidence summaries relevant to the question (such as this one – and focused their expertise and ensuing discussion on applications of this evidence to the particular situation at hand.

  2. A great post and it raises some interesting issues.

    Clinical uncertainty is everywhere. Unfortunately, a lot of evidence is not produce to answer clinical questions. A recent analysis that I carried out on 358 dermatology questions from general practitioners found only 20% could be answered using secondary reviews. In fact, of those 358 only 3 could be answered using a single systematic review!

    Expecting clinicians to search for answers is itself problematic. Giving doctors a list of 10-20 search results is unsatisfactory, especially if they’re busy. If a doctor had a clinical question that actually would quite like an answer, not the 10-20 search results (some of which might contain a partial answer to their question).

    I thank Lorne for highlighting TRIP Answers. These are genuine Q&As that have been answered – quickly – with the best available evidence. However, (leading on from the point of research evidence not being focussed on answering questions) there is a ‘coldness’ to many of the answers, they appear dis-connected from the clinical space.

    Therefore, I like the notion of having some mechanism of injecting evidence into a debate and allowing clinicians to ‘negotiate’ that as part of their decision making process. I’m involved in a small scale Q&A system that has an attached forum – once every 5-10 Q&As posted results in a big stream of discussion. These discussions take the abstract evidence and embed it in the real world.

    Finally, I also think more work should be carried out around clinical uncertainties in an effort to improve procurement of both primary and secondary research. As such I recommend DUETs (, although a slight COI as I was on the initial committee that helped get DUETs off the ground

  3. Thanks to you both, Lorne and Jon, for your thoughtful contributions. We need to keep chipping away at this – and we will.

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