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We all win when We all Share

Doctors may find their lives more meaningful -- and easier -- if they give a little more than they get
Illustrative: Doctors performing an organ transplant. (Flash90)
Illustrative: Doctors performing an organ transplant. (Flash90)

I wrote this following blog post before coming across this web post. The author of this web post describes to a great extent what I have written about below. I would humbly suggest that you read both, to get a full sense of the possibilities of sharing data in the medical world.

The following link discusses the capabilities of a well-known service called WAZE, as well as some of its future plans. WAZE is a tremendous success story based on what is a simple but brilliant concept: creating a better experience for all, by sharing information by all. In the specific case of WAZE, the information relates to traffic movement. but the WAZE concept can be applied to other areas like medicine.

Let me immediately note that sharing information within the medical realm is far more sensitive a topic than sharing traffic information. Nevertheless, with the appropriate system, it should be possible to remove any possible identifying information from the scanned documents, digital notes, imaging studies [like x-rays, CT’s, MRIs, etc.], blood results and so on, before presenting this information in a public forum for all to see and comment on.

A physician who is dealing with a difficult case could submit frequent updates as to the status and tests of the patient, and then wait for the opinions of other physicians who have logged in to review the same case. In truth, there is no reason that the comments should be limited to other physicians. A nurse or physician assistant or a patient who has experienced the same set of symptoms could all contribute to the discussion. Perhaps mostly for protecting against any medical legal claims, the identity of those that contribute comments could be kept anonymous.

What would stop someone from making a random comment that is totally inappropriate for this case? The answer is, nothing. The point of this tool is to allow an experienced physician to treat a patient while taking advantage of the opinions and input of others. If anyone else comes up with a possible idea that could be helpful, the primary physician would still have to evaluate this idea on his/her own.

So imagine a patient who has a difficult to treat cancer and the primary physician presents the case on the public forum. Then, let us say, that one of the suggestions is to use high-dose vitamin C. The physician who is caring for the patient might find this option interesting, but then would investigate it and then decide if it is appropriate. In some ways, such a tool could be thought of in the same way as simply submitting a set of search terms to Google. The physician would be expected to review any possible helpful suggestions and to see if there is any evidence in the medical literature that validates the suggestion.

If the physician is at a world-class center for a given problem, it may be said that such a forum is unnecessary. Any problematic case could be discussed with other  world-class physicians and researchers, and thusly find the best option for the patient. But what of the doctor who is caring for a patient in a relatively small town and finds him or herself at a loss to diagnose the patient.

The local physician could just refer the patient to the closest hospital. But even in the United States, the closest hospital might be geographically far from the patient’s home, and would likely be lacking in top level expertise in the medical area of concern. It is not so simple for patients to simply “hop on a plane” and travel to a major center, especially when they do not yet even have a clear diagnosis.

So, when you consider all of the options within the reality of many healthcare systems, it is tremendously helpful to have a forum on which you can share medical information and in return, get back potentially critical input.

Physicians these days are very sensitive to the issue of remuneration for their time and advice. I personally cannot imagine an effective business model by which contributors to such a forum could extract a significant payment. The only possibility I can see is one in which there is an option  for the consultant physician to send a private message to the local physician, offering his name and services for a stated price. This information would then be passed on to the patient, and the patient could continue the conversation directly with the remote consultant, using any form of communication tool, even a simple telephone.

Is there any reason for physicians to freely share their knowledge via such a forum? My answer unfortunately, sounds naïve. There is supposed to be a part of medicine that is not about remuneration. When a doctor sees someone clutch their chest and collapse in the middle of the street, I would hope that this physician would initiate care of the patient before checking the patient’s wallet for some proof of insurance. In a non-emergency situation, I still expect a physician to have the simple desire to learn and teach. On such  a forum, a physician could simply help a person in need. In return, the physician might learn something from the whole exchange. Even the top expert in an area of medicine can learn something new.

There definitely is an option to have a system whereby physicians declare themselves openly and thus could potentially charge for their input into the forum. But then this would truly cross over the line into personalized remote medical care, and there would be a potential medicolegal risk to deal with. No system is perfect.

Perhaps one group of physicians, who would enjoy partaking in such forums, is retired physicians. In this way, these doctors could still contribute to the welfare of the general public, and keep their clinical minds sharp. There is nothing magical about retirement. A physician’s knowledge does not vanish just because he or she has passed a certain age. We actually do need a way to involve retired physicians in healthcare, for their sakes and ours.

To maximize access to such a forum, the forum should be easily accessible via any mobile device and the desktop. You could extend the idea to other areas such as law and agriculture. Imagine one farmer asking for help with a crop, and receiving a response from a university researcher working on the same crop but from half way across the world.

In the recent movie “Lucy”, about a human being who is able to tap into 100% of her brain’s function, the ultimate purpose seen in life is to pass on what you know and what you have learned. So when I say, “thanks for listening”, I definitely hope to receive your comments in return so that I may listen and learn as well.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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