An Internet Quiz: ABIM's Website Moves the Goalposts Again

The Internet loves mystery...

and cover-up.

There are very bright minds out there, and nothing gets those juices flowing for the dedicated Internet sleuths than when someone is trying to hide a carefully crafted change that benefits the Big Guy and screws the Little Man.

Lately, I've been watching the myriad of changes to the ABIM website.

It's got a whole new look and feel, full of big flashy graphics, but little on content. They will argue, no doubt, that it's all made to improve the navigation on their website and to introduce the bold new ideas they have concocted to be sure the fine print is missed.

So here's the challenge.

Take a minute and go the the ABIM website. (Warning, you'll need more than just a minute for this contest, but if you've got the time, this might satisfy criteria for some MOC points/CME credit).

Click on the Maintenance of Certification banner.

Look over to the left and find the "Policies" button. Here's what the screen looks like today:

(Click to enlarge)

Scroll down to look at what you've missed below the fold, as shown here: 

(Click to enlarge)

Now, this is where things get fun. It will be like The Price Is Right, where Bob Barker asks the contestant to look behind Door Number 1, Door Number 2, or Door Number 3. Go ahead, and click on one of those drop-down arrows of your choosing. What you don't realize, it that behind every one of those arrows, is the hidden surprise that has changed - your MOC® contract with ABIM in all its (hidden) glory.

So here's the challenge...

... which part(s) has(have) changed in the last six months?

Good luck!

-Wes

Medicine to Social Media: Get Over Yourself

I have noticed an interesting psychodynamic to most medical bloggers, social media enthusiasts, and internet-savvy individuals use social media:

... we all are narcissists.

We love our blogs, our posts, our "wall," our "followers," our "subscribers," our "friends", and our "unique visitors." Just look at people constantly checking their Blackberry's and iPhones at the dinner table. We are, after all, creating a 'community' of sorts all around us that never stops. We know that without others liking our comments or content, we receive no viewer traffic. Without noticeable traffic, we die.

Really, that's as deep as social media gets.

Of course it takes some gonads to say this. It is far easier to say that I give up my time, energy, and insights selfishly so the world can share my brilliant (and not-so-brilliant) exposés. That would sound far "cooler" and more hip in today's "e-mo-tional" electronic world. While I would hope there might be a modicum of usefulness for others when I participate in social media, the reality is that I've found I like to write. I like to find the story behind the story. I like to make friends. And I like to feel I'm adding a physician's voice, however small, to the increasingly overcrowded health care internet din. I realize that like it or not, for our younger generation who have grown up comfortable with this online world, to not have an internet presence is to not exist.

Now before I have the world of social media descend upon me like a hoard of locusts, let me say public sharing of information may not be a bad thing. There are times when we need companions. There is even quite a bit of useful information out there. For patients, the value of this information or of having "friends" in a time of crisis is incredibly important. Some feel it's so important that the enthusiasm for social media has spawned and entirely new internet breed: the socially-empowered "e-patient." And thousands of commercial interests are more than happy to facilitate their empowerment.

But I find it funny that social media "experts" continue to ponder why doctors don't "engage" more in social media. After all, it's the rage, right? Come on guys, get with the program! What are you really like? You need an online presence in today's internet world. So frenetic is the trend that nearly every major (solvent) hospital and hospital system is paying large sums of money for their public relations and marketing departments to employ social media "specialists" to develop Facebook pages, live-tweet the day's events, and engage their patient communities in the daily news at the hospital. Come join the latest web-chats, tweet-a-thons...whatever. Marketing plans. All to keep their patients coming back for more.

But for doctors, they understand that medicine is an intensely private affair. There is no place for narcissism during a patient visit. Medicine is also very ugly at times: bloody stools, discharges, lesions and psychiatric issues come to mind. Not that these ailments can't be found on YouTube. They can. And sometimes these not-so-pretty issues present very real challenges for diagnosis and treatment for doctors. One might think that the instantaneous communication afforded by social media would be the perfect place for "on-line collaboration." Yet in reality, using social media, even doctor-limited online forums, might be the worst place a doctor could ask for advice, especially when uniquely identifiable issues specific to an patient are discussed with others in such a potentially public, legally-discoverable way. For many doctors, the legal, ethical and political climate is simply not conducive to permitting patient-specific discussions on the internet.

Nor should it be.

And this doesn't even begin to address the issue of time. Participating in extra discussions outside of patient care takes time, and for people who create original content rather than link-bait, it takes lots of time. Worse, few of us can type, so even the requirement to enter five passwords at five different sites presents challenges for those already struggling to get their paperwork done before heading home.

So as we move forward in this increasingly connected internet-facilitated medical world, the limitations of social media will continue to present challenges for doctors and the developers who strive to develop niche sites catered to them. No matter how you parse it, doctors don't avoid the internet and social media because they're simply Luddites, they avoid the internet because they enjoy the benefits of anonymity, privacy, efficiency and legal protection that comes with dropping off the grid.

Now excuse me while I check my Sitemeter stats again.

-Wes

Specialist Health Care of the Future?

AsktheMedicalSpecialist.com: Two questions answered for $19.99... within 48 hours... guarenteed or your money back. With some liability disclaimers, I'm sure.

-Wes

PS: I'm still trying to figure out how their cardiologist will handle my symptoms of an acute MI. Maybe he'll just say, "Best of luck?"

HeartSurgeons.com Bidding Update

Well the bidding has ended. It seems $17,350 failed to reach the "Reserve" price to purchase the domain name "HeartSurgeons.com." I wonder what they purchased it for originally?

Still, it was an impressive showing.

-Wes

Heart Surgeons: Now's Your Chance

It seems that the HeartSurgeons.com domain name is up for sale. Either a clever entrepreneur is offering this for your acquisition, or Mid-Atlantic Surgical Associates has fallen on tough times. They seem intrigued that Cardiology.com reportedly went for $550,000, but I've seen this amount proported by two different purchasers over the last three months. Seeing as Cardiology.com has internet dating and music downloads associated with it, I'm not sure it's such a good deal. Gee, could HeartSurgery.com want to go the same way?

Given the declining surgeries heart surgeons are seeing this days, though, it might be a declining asset and go for cheap.

Right now, the bid is $102.50 on e-Bay.

-Wes

Addendum: 16 Aug 2007 @ 1830: Wow, bidding's up to $8,600!

Twenty Questions

I while ago, I had a friend show me this little electronic ball called "20 Questions" that promised to guess what I was thinking with only twenty questions. I thought a bit, decided on an inanimate object for the gizmo to guess, and then answered the questions one by one that the device posed to me. For each question I pushed the buttons corresponding to "Yes,"No," "Sometimes," and "Unknown" in response. I was astonished at the depth of answers the device could conceive based on my answers, but soon realized I could "beat" it by thinking about something fairly obscure or unusual.

Now it seems "20 questions" has come to diagnostic medicine.

iVillage.com has introduced a beta version of its "Symptom Solver" in conjunction with GE Healthcare that helps patients determine possible causes for the symptoms they are experiencing. It seems that medicine can really be reduced to 20 questions!

So I decided to take the system for a test drive.

My case?

I pretended to be a 24 year-old 34-week pregnant woman who has had two hours of chest pain associated with abdominal cramping from a dissection of a coronary artery with an associated heart attack that also induced labor (I had a case like this). This was on the Women's Wellness section of their website after all... Let's see how it does....

First question: My age? 18-29. Check.

Second question: Which symptoms (about 20 were shown)? I clicked on "Abdominal pain or discomfort" and "Chest Pain." Check.

Third question: "Tell us more about your abdominal pain?" I clicked "Abdominal Pain extends to the back and other areas." Check.

Fourth question: "Tell us more about your chest pain?" I clicked "Chest pain extends to arms, shoulders, neck, back or jaw" and "Chest pain for longer than 20 minutes." Check.

With the next screen, I received an "Emergency Notification" in small red letters at the top of the question box suggesting I seek immediate medical attention for my chest pain extending to my arms, shoulders, neck and jaw and chest pain for over 20 minutes. But I ignored this and continued... after all I'm only 24 years old!

Fifth question: "Additional symptoms?" I checked "Chest tightness," "Abdominal tenderness," "Sudden sharp chest pain," and "Heartburn." Check.

The next screen gave be my most likely diagnoses so far in the following order: (1) collapsed lung, (2) gastroesophageal reflux (What's that, I wonder as a non-medical person?), (3) pancreatitis (huh?), (4) cardiac ischemia (sounds interesting...but they expect me to know what this is?, and (5) heart attack (I know what that is, only old people have one of those...). Oh, and this little disclaimer appears:

The Symptom Solver service is designed for educational purposes only. You should not rely on this information as a substitute for personal medical attention, diagnosis or hands-on treatment. If you are concerned about your health, please consult your family’s health provider or go to the emergency room.

So I answer the next question:

Sixth question: "Tell us more about your heartburn?" I click "Frequent heartburn." Check. (Hey, things must be better! That little red warning box went away...)

With the next screen, GE reflux springs to the top of the likely diagnoses! Whew! I'm feeling reassured already! Glad it's not my lung! So I continue...

Seventh question: "Select additional symptoms:" I checked "indigestion." Check.

Eighth question: "Select additional symptoms:" I checked "Cramps" here. Check.

Of course, it wants to know more about the cramps. I noticed now the diagnosis of Irritable Bowel Syndrome is now in the mix of possibilities. (Hello, would anyone think about pregnancy??? But maybe the "Symptom Solver" needs more information...)

Ninth question: "Tell us more about the cramps:" I checked "Abdominal cramps" and "Sudden, severe abdominal cramps." Check.

Tenth question: "Additional symptoms?" This time I didn't see anything that correlated, so I said "None of these. Show me more." (Ugh... Hmmm, I'm feeling this sudden incredible sense I need to have a bowel movement...)

Eleventh question: "Select additional symptoms:" Hmmmm. My eyes don't look yellow, I'm not dehydrated (am I?), my heart is not pounding... I just have to have a bowel movement. So once again I click "None of these. Show me more."

The next screen got closer when it again asked for additional symptoms:

Twelveth question: "Select additional symptoms:" Oh my goodness! Although I feel like I needed to have a "bulky or foul-smelling stool" but I hadn't had this yet, so I again checked "None of these. Show me more." By now, I'm becoming weary...but I persist!

This time some interesting things popped up to select:

Thirteenth question: "Select additonal symptoms:" I checked "Loss of interest in sex" and "bloating." Check. (By the way, I have been at this for an hour now. It seems the website loads its ads too slowly...) Wow, that chest pain sure is burning... The order of diagnoses right now? #1: Gastroesophageal Reflux, #2 Collapsed Lung, #3 Heart Attack, #4 Irritable Bowel Syndrome, #5 Pancreatitis.

Fourteenth question: "Select additional symptoms:" Hey look, there's "Pregnancy!" So I click it!

Sadly. I'm asked again to select an "Additional Symptoms:" So for Question Fifteen, I answer "Pain all over."

Question sixteen appears: "More symptoms!" So I pick "Lump or mass in the pelvis or abdominal area."

Again, adding more symptoms is what is needed it seems: But for question seventeen's questions, I pick "None of these. Show me more." (I'm feel a bit masochistic now...) And now, my top five diagnoses do not include heart disease: #1 Gastroesophageal reflux, #2 Irritable Bowel syndrome, #3 Esophagitis, #4 Ovarian Cancer, #5 Collapsed Lung. And yes, it wants more symptoms for question seventeen.

Question seventeen: More symptoms: I pick "Severe lower abdominal pain or pelvic pain."

And again: It wants more symptoms but I've run out. 10 more answers to the additional symptoms questions with "None of these. Show me more." makes clear that the program will continue to ask symptoms until the person clicks "Skip to Results." At which time I see an explantation of Gastroesophageal reflux disease, Esophagitis, Irritable bowel syndrome, Collapsed Lung, Ovarian Cancer, Misscarriage, Stomach Cancer, an then finally, Heart Attack (#8).

I think I beat the game, but probably sacrificed my fictional heart and baby...

What is clear is that more and more of these tools will soon surface on the internet, especially with similar efforts underway by Steve Case, former co-founder of AOL (RevolutionHealth), or by other corporate efforts like the Continua Health Alliance. It is clear that patients are turning to the internet more frequently to identify a cause of ailments before seeking the advice of a health care professional. While there is great information out there, there is a moral to today's post:

Take these symptom-related questionnaires with a grain of salt... you might just beat them at your expense.

-Wes

From Salad Mixers to Blood Products

The Food and Drug Administration (FDA) launched their direct-to-consumer website today, so I thought I'd check out the Heart Health link on their page. I found the side-bar on the right handy since it disclosed most of the major recalls and approvals granted by the agency recently. But I was struck by the reports found under the Recalls and Safety Info button. Under this button is all of the FDA's Enforcement Reports for a particular year. Some of these reports contain everything from recalls of salad mixers and cantaloupes to blood products potentially contaminated with malaria.

Now admittedly this is great information, but can the public really use this in its present form?

And tell me, what does a salad mixer have to do with the heart?

-Wes