By Robert Bazell Chief science and health correspondent
NBC News
updated 7/30/2008 12:07:32 PM ET 2008-07-30T16:07:32
COMMENTARY

Anyone paying the slightest attention to the digital world knows of the huge success of social networking sites, with Facebook and MySpace in the starring roles.

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There are now sites for lawyers, marketers, real estate agents, stamp collectors, those undergoing divorce, and just about any category imaginable — including doctors.

The biggest site for physicians, Sermo.com, not only is becoming a huge community — 72,000 so far with a couple thousand more signing on every month — it has the potential to bring profound change to American medicine. 

Its founder Dr. Daniel Palestrant, a 34-year-old surgeon with an MBA, believes it could one day supplant the American Medical Association as the voice of America’s doctors.

Palestrant had thought the site would appeal mostly to younger doctors, but it didn’t turn out that way. The average Sermo user is over 45. As Palestrant sees it, doctors spend much of their early professional lives — from medical school through residency and then fellowships —
surrounded by other doctors. Some retain positions in the academic bastions that trained them, but the vast majority go out “into the community” where they practice either on their own or with a few others, often very few in their specialty.

As the doctors settle into adult lives, their neighbors, spouses and friends quickly bore of all that shop talk doctors love to do.

Many of the doctors use Sermo for venting frustrations. Some of the posts I saw were touching and revealing. (Full disclosure: Sermo decided what I could see; to join the community, one has to prove he or she is licensed to practice in the United States.)

One doctor described “a horrible day” that included having a patient newly diagnosed with lung cancer, and dealing with a family after a patient decided “to be DNR/DNI” (do not resuscitate/ do not intubate). How do others, this doctor asked, deal with such “compassion fatigue?”

The first response: “heavy punching bag in the basement, Scotch (single malt), Cuban cigars and Comedy [Central]'s 'South Park' … also throw in a copy of Maxim.”  The next said “Crying helps –especially with a loving shoulder to do it on.” 

Later on, the some of the responses took a different tone: “It does take awhile to stop emotionally bleeding with your patients,” one doctor wrote. “This is the hardest thing I have learned after many years in practice … that it is possible to care [for patients] and think and practice without having to bleed and cry with them.”

Some doctors look to the online community for help in day-to-day practice: “Has anyone seen an infant with this specific broken bone who was not a victim of abuse?” one doctor posed. In this way, Sermo could easily become a very sensitive early warning system for unusual outbreaks of infectious disease or adverse reactions to medications and devices.

But much of what I saw centered on views about the state of medicine. It is hardly news that many practicing physicians — especially those over 45 — feel betrayed by insurers, the government and the direction their profession is heading.

In a recent survey on Sermo, 99 percent of more than 1,000 polled agreed that the public does not “understand the struggles that physicians face in today’s marketplace.”

  • 88 percent said financial pressures were impacting their ability to care for patients;
  • 90 percent said proposed Medicare cuts would limit their ability to take new Medicare patients;  
  • 71 percent said they had considered taking cash only for their services;
  • 62 percent said they were considering changing careers altogether.

It is hard to know how much such views represent bravado in response to an Internet question as opposed to the realities of career decisions, or how much it represents the views of all doctors who have signed up for Sermo, let alone all practicing physicians.

Palestrant thinks the Sermo community could morph into the voice of American medicine, which emanates mostly these days from professional organizations like the AMA or from the thought leaders who hold positions of power in academia. That’s still a ways off; the company is not even profitable yet. But the best sign of its success, on its own terms, is that at least three other start-up companies are trying to create competing online physician communities.

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