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Scott Shreeve, MD

Hey there!

I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Change Agents: Knowledge Prosititution*

Prostitution (prŏstĭ-tūshən) n.
  1. The act or practice of engaging in questionable work for hire.
  2. The act or an instance of offering or devoting one’s talent to an unworthy use or cause.

I couldn’t help the title – with all the Paris Hilton stuff in the news – you just have to wonder what people will really do for a buck. Therefore, it is with some surprise that I continue to learn about the questionable underbelly enabled by the Health 2.0 movement. Having already profiled Practice Fusion’s business model (and the subsequent industry satire)I can’t help but wonder about what Sermo is doing.

First off, I want to congratulate Daniel Palestrant, MD for bailing out of his surgical residency to pursue the dream of aggregating physician conversation. I like what Sermo is trying to do: challenge or corroborate each others opinions, accelerating the emergence of trends and new insights on medications, devices and treatments“. By enabling real-time conversations irrespective of geography and time constraints, Sermo functions as a powerful “collective physician intelligence”. Indeed, the “physician lounge” conversations have often been the best, most sanguine teaching moments of my career. Not only do you learn the scuttlebutt, but over time you can pick up the trends that give you an overall vibe for healthcare delivery at the hospital. I believe there is a very large and important role for a physician community like Sermo to play.

Obviously the Vulture Capitalist think so too. Now flush with more than $12M dollars, what is Sermo going to DO to go from an interesting sidelight to an ongoing business concern? Just as with other community aggregations sites (MySpace, Facebook, and YouTube), it probably doesn’t have to do much. Mere aggregation is seen as such a value add that people are literally willing to pay billions for it. The fact that Sermo has been successful aggregating nearly 15,000 physicians is enough to make most medical-industrial complex marketing and advertising schlicksters drool.

But I challenge the direction that Sermo is going. Reading further, “On Sermo, there is no cost to physicians to participate. In fact, Sermo also enables physicians to be financially rewarded for their astute observations and clinical insights. The source of the rewards is financial institutions who access a stream of fresh and actionable information on emerging trends and market-changing events in healthcare. A cash reserve is set-aside to compensate physicians for observations that are deemed highly relevant and valuable.”

I am uncomfortable paying physicians for their opinions in this way. A paid opinion is always an asterisk or a disclaimer. Or more perversely, this is knowledge prostitution. Put a quarter in (or give them an ipod) and watch what the doctor says. It just seems so distasteful. Is there any value in these paid opinions? To me, knowing that these physicians are paid is just another filter that I must put up when and if I read their stuff. Knowing now that the AMA and certainly others to follow are going to be trying to lurk in on my posts is even more unsettling.

But hey, maybe my conspiracy theory gene was just being translated. I love the free market, capitalism, and the roiling darwinism of innovation. So with that in mind, I wanted to try out the service for myself. I signed up last year out of curiosity and have only returned occasionally. As part of my evaluation of Health 2.0 companies, I have been posing a therapy question related to an elective procedure that I need to have done. I posed the question to my physician brethren (and sisters!) and was amazed with the response time:

First 3 responses received in 8 minutes.

Thirteen responses received within two hours

I had to wait two weeks before finally seeing the results: Fourty-three respondents. That is kind cool (my orthopedic question probably was probably a little esoteric for most physicians) but the quality of the responses was a little disappointing. I was hopeful to engage someone on some pedantic discussions regarding Four-Corner procedure, versus proximal row carpectomy versus various fusion alternatives, and instead I got this:

Final Sermo results from my SLAC Therapy question

So while these physicians took the time to answer, the quality of the information was not useful to me. Would my results have been better as part of some paid campaign? Furthermore, while my example was just a random question thrown out there, I remain distinctly uncomfortable with the concept of my knowledge, my experience, and my profession being for sale in this manner. I find the corrollaries with the oldest profession in the world to be a cautionary warning against the “Physician for Hire” mentality:

Prostitutes are often victimized by the person for whom they work, and by their customers. Other health issues related to prostitution are early pregnancy for juveniles, rape, tuberculosis, post-traumatic stress disorder, assault, and other acts of violence—including murder. There are also negative consequences besides those related to health issues. In places where it is common, prostitution lowers the value of property. It also degrades the status of women. Published research studies concerning prostitution as a public health issue in urban communities have come primarily from developing countries.

So, Sermo, I will give you the benefit of the doubt and wait a little longer for the market and your physician users to pass judgment. I love the collective intelligence, I love the aggregation, and I love the fact that you have been so successful in introducing core elements of the Web 2.0Architecture of Participation” to health care. However, I just throw up the cautionary comparison for pause.

As for this SLACer, I should just consider paying someone for their opinion.

* The ideas and concepts in this blog are not paid for by anyone (much to my wife’s chagrin)

One comment on “Change Agents: Knowledge Prosititution*

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