Most of us have turned to professional and personal networks using social media to get ideas, solve problems, and better understand the things that are on our minds; crowdsourcing is part of our world now. Doctors can do the same thing, and three weeks ago medical crowdsourcing saved a 14 year old boy's life.
The boy's doctor used SERMO, the rapidly growing social network of more than 340,000 doctors from around the world, to find an obscure answer. SERMO allows doctors to solve difficult patient case questions-and sometimes save lives as they do-using the network as a source of collective medical knowledge and experience. This disruptive new healthcare phenomenon is available only to licensed and verified physicians.
In the case at hand, a 14 year-old boy came to his primary care physician with a persistent cough. The doctor ran all tests that were indicated by the case but found nothing. During a follow up visit the boy and his mother returned with an "branch-like" mass that the boy had coughed up. He reported feeling better, but his mother wanted the doctor to see it.
Before sending the mass in for lab analysis, the doctor photographed the mass and posted it on SERMO. He also created an accompanying poll with multiple diagnoses listed. His goal to crowdsource insights from specialists and colleagues he would not otherwise be able to access.
Within 30 minutes he got one response, and over the following two days 231 US and UK doctors discussed 16 possible diagnoses based on the branch-like mass the boy expelled.
The answer? Fontan-Associated Plastic Bronchitis, an extremely rare respiratory illness associated with previous heart surgeries. This is an illness that few primary care doctors ever see, but within a few hours, one SERMO cardiologist figured it out.
"While pulmonary may help, he needs to see cardiology urgently for plastic bronchitis following Fontan surgeries...please give them a call and ask whoever is on call for the weekend when they can see him (or have him admitted)," the cardiologist explained.
A pediatrician with pulmonology and respiratory expertise confirmed what the cardiologist said:
"I agree that this is very concerning for plastic bronchitis. We see this very frequently in our hospital especially in patients with congenital heart disease... I agree with [the first to diagnose plastic bronchitis] that he should be seen by cardiology ASAP."
One additional doctor linked to a related post that described the death of a child with the same condition who went undiagnosed:
"[I had] a little 3 year old patient of mine who died from this recently. Mother had shown her doctors a cast she had coughed up while in the hospital for respiratory symptoms post Fontan, but sent her home without recognizing the diagnosis. She died a few days later."
This information spurred the boy's doctor into immediate action-which saved his life. The doctor referred the boy to cardiology without waiting for results to come back from the lab. Two days later, the cardiology team treated the boy successfully.
Medical crowdsourcing hinges on the fact that no one doctor can diagnose everything. Modern medicine is more and more specialized, and doctors who see patients must parse out a primary illness from among 13,000 known medical conditions. Based on personal knowledge and training alone, this is an impossible task.
SERMO recently conducted a poll of doctors from Germany, France, Italy, Spain, the UK, and the US. The majority of respondent doctors-up to 87 percent-indicated that at least 20 percent of patient cases fell in the medical "grey zone." The report indicates that the grey zone is just like the branching mass case; in this area doctors believe they would benefit from input from a broader range of doctors. Very rare conditions like the one in this situation are especially challenging.
SERMO provides a medical crowdsourcing forum for doctors who need the benefit of the broader experience of colleagues to address the "grey zone." In 2014, doctors posted 3,500 challenging patient cases on the social network; these cases were viewed 700,000 times and garnered 50,000 comments. Most doctors receive responses from peers around the country and soon around the world within 1.5 hours on SERMO, and the typical solve time is within 24 hours.
According to the US National Center on Policy Analysis 10 to 20 percent of cases are misdiagnosed annually. 28 percent of those erroneous diagnoses are life-threatening, and as many as 40,000 people die from fatal diagnostic errors in US intensive care units each year.
"Many treatable conditions go mis- or undiagnosed for years not for a lack of science, but simply because doctors traditionally do not have quick access to a network of specialists who can quickly recognize potential red flags of challenging conditions," said Dr. Richard Armstrong, a general surgoen and SERMO member. "Medical crowdsourcing has the power to change that, giving doctors around the world free access to the best collective medical expertise at the tip of their fingertips."
"Medical crowdsourcing fills a huge void in healthcare today and is transforming the way doctors practice everyday medicine," said Dr. Easton Jackson, the treating physician in the boy's case and a SERMO member. "Now, in real-time, doctors can access hundreds of years of combined medical education at the push of a button to get faster-sometimes life-saving-diagnoses."
Anonymity is at the core of successful SERMO use because it allows doctors to safely weigh in and act quickly on tough cases. Because it is a verified a doctor-only environment, this kind of anonymity is possible, and it is this anonymity that distinguishes SERMO from other social networks for doctors.
"Having the ability to access insights from my colleagues safely and securely-in a closed, doctors-only environment that also maintains patient privacy-is critical and certainly played a central role in making the diagnosis in time and saving this young child's life," said Dr. Jackson.
SERMO began in 2005 in the US and expanded to the UK in April of this year. The social network is for fully verified, licensed physicians only. SERMO's mission is to unite physicians in a virtual doctors' 'lounge' which functions as a trusted, private, and safe platform for open discussions. SERMO boasts more than 305,000 verified American physicians-about 40 percent of the entire US community-from 93 specialties. Now there are also 38,000 physician members from the UK, about 16 percent since April 2015.
