Answer Me THIS
Posted by WhiteCoat on November 20, 2008
People frequently send me e-mails asking my opinion about things and giving me ideas for posts.
One of the e-mails I recently received was from a place called JustAnswers.com.
The e-mail states that JustAnswers is the “largest Expert answer site that has 20,000 Doctors, OB/GYNs, Psychologists and other Health Experts.” There are experts from other fields that answer questions as well, but I focused on the health questions. Similar system to the poll contemplated on MDOD’s blog not too long ago.
The gist of the JustAnswers.com site is that people ask a question and offer money to experts who will answer the question. The cost for answering the questions that I looked at ran from $9 to $40. The site administrators take 50% to 75% of that money and pass the remaining money to the expert. There is a feedback system where experts get positive or negative scores and those asking the questions can even leave the expert a “tip” for an exceptionally good answer. Of course, the site administrators keep 25% to 50% of the tip money, also.
If you want to view the full conversations regarding previous questions, you have to register and pay $3 for each question.
Sample questions included the following:
“My feet have been swollen for the last two days. I have been ill with a bad cold and have been taking the Z pack and hydrocodene cough medicine. I have been through taking this the last two days I still have a lingering cough and am now couging up clear. I am also taking blood pressure medicine and advair and zyrtec. Cnn the medicine I took for my cough made my feet swell?”
“Recently I have begun to “leak” at night. My general practioner has explained it as an enlarged urethra. I’m 69, female. I do have to urinate 3-5 times each night, and inbetween I leak some sometimes. Apparently, nothing internal has “fallen”. I find nothing online to substantiate her explanation. If there is something to do for this, what is it?”
“I have had Addison’s Disease since 1981 taking Prednisone 10MG 2/day. I have been dignosed with Osteoporosis with an AT Score of -2.7. Since June 2008 I have had 12 Vertebras with compress fractures ranging from 20% to 90% compressed. I have had 2 Balloon Kyphoplasty and 10 Verteboplasties. With this meny fractures in the spine should I be looking into disability. I am very concerned for my future fracturing additional vertebras. Do you have any history of people with this magnatude of fractures with my medical history. What would be your direction go back to work or disability and if disability do I have a leg to stand on?”
This site raised several issues in my mind.
First, it seems like the patients asking the questions all have access to medical care. The issue in each case appears to be that the medical care they are receiving is failing them in some way. Doctors aren’t answering their patients’ questions. Is it because the doctors the patients are seeing are too rushed? Maybe the doctors do explain, but the patients don’t understand. Whatever the reason, patients are paying cold hard cash to get “second opinions” from these experts.
Second, I keep wondering about the liability involved in answering these questions. If you’re a doctor and responding to a specific scenario, you’re practicing medicine. What if you answer a question from a patient in a state in which you are not licensed? Practicing medicine without a license? What if the patient takes an inappropriate action (or doesn’t take a necessary action) based on what the physician has written? I’m sure JustAnswers.com doesn’t supply medical malpractice insurance. Maybe I’m just too big of a fan of Overlawyered.com and I’m reading too far into things.
Finally, I have a question about who is really answering your questions. Many of the answers that were “accepted” were vague and, in some cases were flat out wrong. Unfortunately, the patient can’t determine the validity of an answer and there is no way to “call bullshit” on the expert opinions. So is the “expert” really a high school kid that is misrepresenting his background and then looking up the answers on eMedicine.com? How do you know who you’re dealing with? The terms state that you will not misrepresent yourself, but I don’t see any verification mechanism on the site. The person giving you advice about your leg swelling could be my crazy Aunt Barb or … Deborah Peel for all you know.
Then there’s the silver lining. This is almost an example of what can happen when patients and doctors get together without some other third party getting in the middle. Only problem is that the JustAnswers.com is acting like the insurance companies. They’re taking too big of a piece of the pie for the minimal services they provide.
The concept has promise, though. Instead of the third parties setting a price for a service, the market determines what the service is worth. Patients ask a question and offer cash to answer it. Experts either accept or reject an answer based on that price. If the price isn’t high enough, the question won’t get answered. Offer $50 for the answer to a question and you’ll have experts elbowing each other in the heads to answer the question first. At some point there will probably be a premium placed on one’s credentials – if they can be proven. “Smarter” experts would presumably get paid more money.
Capitalism at its finest.
This is the way all medicine should be practiced.
Now if we can just do something about that darn middleman.
Courtney said
I have a suggestion for a post: What are the top 10 injuries you see in the ER over the holidays compared to the rest of the year?
Depends on the holiday. I can tell lots of stories about the fights at Thanksgiving dinners
ERP said
I guess people just want a second or third opinion about their condition. It almost does not matter whose opinion it is….
Marilyn said
Yes, my doc is too rushed to listen well, remember what we’ve discussed in the past, and do a thorough job. That’s why I have been forced to become my own expert on my own (and no one else’s)thyroid disease and treatment by reading online thyroid textbooks and searching medical journals via ebscohost. As I’ve mentioned in the past, if I had not educated myself (and my doctor), I would still be seriously ill.
marcia said
Judging from my parents’ and other relatives’ discussions about doctor visits, I’m betting some of those patients never even ASK questions.
Just makes me want to beat my head against the wall because they never seem to know what’s going on or how to manage their medical conditions better (unfortunately, they live four states away). Some of them can’t even tell you what medications they’re on, the dosage, or what the med is designed to treat. They may see specialists and sub-specialists for different conditions, but there is no coordination of information.
Meghan said
Meh- I used this site when my dog had a rash (they have dvm, vet techs too). I only got one answer, from a vet tech, and it was all general bla bla bla that I had figured out myself anyway. I was using it as a, “Do I really need to go to the vet for this” kind of thing, but I didn’t find it all that helpful.
Dr. Greenbbs said
uh, yeah….slightly dangerous, I think.
Amy-65C said
This seems to be as vague/generic/commonsensical-but-useless as WebMD, but at least WebMD is free.
All we need now is a site with LiveChat:
“Hi… I just cut my neck and my blood is gushing out. I don’t want to do to the ER. Can you tell me what to do?”
Patient said
Well, here’s a thought, from the patients’ side of things. I have a doctor that I go to when I need it- like I’ve got bronchitis or something. However I have hypothyroidism and it’s managed with medication, but for various reasons, I don’t really think everything is managed as it ought to be. Yet, I don’t go to this woman and tell her about this. I don’t talk it out with her, I don’t explore the options with her, and insist that maybe the standard blood test they give me once a year or whatever really might not be telling us everything. WHY? Because she is a family practice doctor, and I really don’t think she knows much about the subtleties of hypothyroidism. I’m no expert but from what I read online, a lot of people are very affected by using medication with T4 alone or T3 alone or T3+T4 and whatall. It’s dizzying. I think if I talked to her about that and suggested changes, she’d look at me like I had three heads, blow me off, and pat me on the head and say something to pacify me, order the same blood test and that’s the end of it. She’s done this sort of behavior before when I actually did try to talk to her about why I was so tired all the time. Stupid me, when I get in that office I am too timid to do anything other than nod my head and suggest that well really maybe it’s just because I stay up too late and don’t exercise enough, probably I just need to work on getting to bed earlier, nod head. (After all, I’m not the one that went to school for umpteen years for a medical degree, surely it must be nothing) *bang head against wall*
So why don’t I get a new doctor? Because I have to go through insurance. All I have is a list of names that means absolutely nothing to me. I could end up with someone who is absolutely a horror to work with, they might know even less, I might dislike their personality instantly, they might insist I do some nightmarish procedure, who knows what. Not to mention waiting six months for my first appointment! I get to see my present doctor the same day, if I need to, and usually within a week or so at most. At least with this woman, while she may be overly busy and act like she’s not paying attention half the time, she leaves decisions in my hands and if I decide not to do XYZ then that’s the end of it. She doesn’t hassle me, she respects my decision.
So you might be able to understand why people like me would use these answer-sites. Yes it’s dangerous- but if other people are like me, I have to make my own decisions as to what to do about my health. I have to research it myself, and take the evidence to my doctor and push it in front of their nose and say Here, let’s do this, and here’s why. If I don’t, they’ll just take the easy way out.
William said
I just finished the first step in Dr. shopping, randomly scheduling an appointment with a physician off the insurance’s participating providers list. We’ll see if he passes the test with the first visit next week. The problem here is that I don’t know of a way to check any health care provider’s reputation and competency other than word of mouth (and when you’re generally healthy, these things just don’t come up often in conversation). Granted the state (Fla) does have a free license check for standing and disciplinary action, but that has holes in it also. Here’s a goldmine idea (HIPPA lawyers willing and Govt. don’t rise); start a “Rate My Professor” style site for providers and let the market work it out. The closest thing I found was something called “Angie’s List” and they demanded registration and $$ up front to even see what they had to offer…. I don’t have the time to devote to this now so if someone can make it work, go for it. If not I may see what I can do next year.
William sends
Lisa said
I guess people just want a second or third opinion about their condition. It almost does not matter whose opinion it is….
Just as easily you can waste quite a few months trying to find a doctor worth his salt. When is the last time you were interviewed before hire?
I’ve waited months to see a certain doctor and have been rewarded with a blank look when my problems were presented. Do you know how long it takes to see a doctor these days?
Very good point.
Next time you make an appointment with a new doc, try giving a 15 second summary of your medical problems and seeing whether or not the doc is comfortable dealing with them.
Mrs. Dr. WhiteCoat is very good about helping prospective patients get appointments with the right doc if patients have something that is over her head.