Saturday, December 15, 2007

Sermo - Ten Things I’ve Learned from Sermo Doctors

A Sermo loyalist recently said Google, Sermo, and Wikipedia were three websites he consulted most.

Based on six months of contributing to Sermo posts and reading the feedback and blowback, I agree with the reader on Sermo. I also like the other two, and would throw in as a fourth choice.

The learning has come from the heat – criticisms with what I had to say, and the humility – finding what I had to say didn’t make much sense. For me, it’s the heat, not the humility.

My interest is medical innovation, what doctors can do to survive and thrive and improve care and outcomes.

Here are ten things I’ve learned from Sermo.

Doctors prefer,

One, the technological to the ideological. I should have known this. In 2001, 225 internists were asked what the ten most important innovations during the last 20 years.
The top ten choices were:

1) MRI and CT scanning

2) ACE inhibitors and angiotensin antagonists

3) Coronary stents

4) Statins

5) Mammography


7) Proton pump inhibitors

8) SSRIs

9) Cataract extraction and lens implant

10) Hip and knee replacements.

Two, the democratic to the autocratic. Doctors obsess on
what they can do on the ground not on how to react to what flows down from government or health plans.

Three. the clinical to the managerial. In sheer numbers, clinical posts and comments dominate Sermo. Doctors prefer to talk of what they do, not what government agencies, health plan medical directors, or practice managers tell them to do. The lesson for me: don’t wander too far off the clinical reservation.

Four, teaching to preaching. Doctors love to teach each other, to share experiences rather than being preached to. When I get preachy about reform or some other matter from on high, my Sermo ranking plummets.

Five, performing to reforming. Doctors have solid and specific ideas on how to reform the system, but they prefer to talk about how best to perform in the clinical trenches.

Six, the pragmatic to the axiomatic. When outsiders proclaim doctors must do things according to protocol, :doctors respond by saying I will do it the best way that fits my patient’s circumstances.

Seven, patient chronologies to informational technologies. Doctors remain skeptical of IT, diagnostic support systems, or electronic and personal records, as practical or universal substitutes for their personal knowledge of patients.

Eight, pen on paper to finger on keyboard. Many doctors say they think better through the head of a pen than the tap of a key. It’s more human, and patients consider it more personal. Patients detest having a computer between them and their doctor.

Nine, patients rather than health plans. For years, doctors have been tangoing with health plans on who should control care. Doctors prefer dealing directly with paying patients rather than being paid indirectly on not at all through third parties.

Ten, clarity, verity, and parity between market and government driven care to ideological purity. Doctors recognize Medicare and Medicaid have been a God-send to many Americans, but we also know the market brings innovation, choice, and freedom. We’re healers, not conservatives or liberals.


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