This guide helps you navigate tips and best practices for using online medical communities for everything from tumor boards to ecurbsides. When doctors share and comment on cases in a secure, online environment, they pool their collective knowledge and offer unprecedented access to information unbounded by restrictions of time or geography.

1. Online Medical CommunitiesHow Online Collaboration is Changing the Way We Practice Medicine
A Physician’s Guide to
Presented by
By Kelli Cleary, Content and Programming Manager, Physician Engagement and Social Media, Best Doctors, Inc. | kcleary@bestdoctors.com
and Eric Glazer, Vice President, Physician Engagement and Social Media, Best Doctors, Inc. | eglazer@bestdoctors.com
BEST DOCTORS and the STAR-IN-CROSS logo are registered trademarks of Best Doctors, Inc. Used with permission.

2. Physician Contributors
Garry Choy, MD
Radiologist, Division of Emergency
Radiology and Teleradiology
Mass General Hospital - Boston, MA
@GarryChoy
Miguel Perales, MD
Deputy Chief, Adult Bone Marrow
Transplant Service
Director, Adult Bone Marrow
Transplantation Fellowship Program
Memorial Sloan-Kettering Cancer
Center - New York, NY
@DrMiguelPerales
2

3. A Game-Changer in
Collaborative Medicine
Imagine your next patient is a challenging case. They’re not improving, and you’re not sure why.
You could email a few colleagues for their opinion, but opinions will be siloed and disjointed and
attaching images with email can be bulky and unsafe.
Or, you could build your network and collaborate with them in near real time with an online
medical community:
• Your case is uploaded and stored securely
• The case is studied by physicians across complementary specialties
• You receive diagnostic and/or treatment recommendations collaboratively
• Collaborators provide biographical and academic/professional appointment information, so
you can vet their expertise
• The case becomes a teaching tool in the advancement of the field of medicine

4. “When doctors share and comment on cases in a secure,
online environment, they pool their collective knowledge
and offer unprecedented access to information
unbounded by restrictions of time or geography.”
– Faculty member, Johns Hopkins University School of Medicine

5. 8 Benefits of Effective
Medical Communities
1. Build a convenient, virtual extension of your peer network
2. Showcase members’ biographical information, including
academic and professional appointments, published articles,
research projects, etc.
3. Share files and diagnostic images easier and more securely
than with email
4. Gather medical experts together, free of scheduling and
time constraints
5. Augment the professional community you already have

6. 6. Improve patient outcomes by considering differential
diagnosis and treatment recommendations from various
experts
7. Build an open-source library of medical information
8. Gain discourse from a community of experts on your most
challenging cases
“Medical communities help advance the wisdom of the crowd, so when you share
your opinion, it strengthens the collective knowledge of the community.”
– Faculty member, MD Anderson Cancer Center
8 Benefits of Effective
Medical Communities

7. High-Yield Clinical Collaboration
Participation in tumor boards, grand rounds and clinical curbsides is
more productive with online communities because they:
- Keep discussion focused and on-task with streamlined
commenting
- Connect physicians in relevant and complementary specialties so
the discussion remains appropriate for the case
- Vet collaborators and allow you to build connections with a
network of highly-qualified physicians
- Organize asynchronous case feedback into an orderly comment
stream
- Hone your collaboration network for future case collaborations,
so that you are spending less time finding the right peer

8. Mainstream Online
Community Platforms
Twitter
– Pros: Ask questions and make connections with the entire world in 140 characters
or fewer
– Cons: 140 characters limits in-depth case discussion, and Twitter is a public forum
LinkedIn
– Pros: Network with peers and professionals
– Cons: Not designed for image or case information sharing, even in private
messaging
Sermo
– Pros: A physicians-only network
– Cons: That network is often anonymous and random, meaning you’ve no way to vet
the information you receive; Physicians are often solicited for polling by site
sponsors; The majority of the dialogue is non-clinical

9. 7 Key Elements of a
Successful Online Community
The online medical community you
create or choose should enable
networking and peer collaboration,
and include the following:
- Data security: Your patient’s data is
safe, so you can focus on their
outcomes
- Medical image viewer: Diagnostic
images are sharp and clear
- Mandatory profiles: Advice comes
from peers you can trust, not
anonymous users
- Thoughtful workflows: An efficient
workflow means you get the
answers you need quickly
- Sub-group creation to allow for
special interest committees such as
tumor boards
- Learning tools such as pertinent
PubMed articles and a library of
great cases
- Freedom from commercial
interests, bias or advertisements

10. Connect, Network, Share Ideas
“I see it as a great tool for networking. You can put a question out there to a group of people
from around the world, and it creates this web of networking that can help facilitate patient
care.” – Ryan Madanick, MD, University of North Carolina Chapel Hill
“By networking (online)…doctors are sharing ideas and gaining medical insights with others
across the globe.” – Ronan Kavanagh, MD, MRCP, Western Rheumatology, Galway, IE
“Online communities connect doctors, which is especially powerful when working on
difficult cases. When we communicate with each other around these cases, collaboration
can produce better clinical outcomes, and an online platform can make that really easy.”
– Dr. John Aloizos, AM, MB BS, FRACGP, FAICD, Garden City Medical Services Pty Ltd; Inala
Primary Care Ltd, Brisbane, AU

11. THE CASE:
Mr. K was in his early seventies and had a history of hypertension and obesity (BMI 34). A few weeks after suffering
pericarditis, he developed a persistent cough and a chest radiograph (CXR) showed left lower lobe (LLL) pneumonia,
which was treated with flouroquinolone.
The cough persisted despite further treatment with predisone and albuterol, and despite an initial improvement in LLL
opacity. He was admitted to hospital a month later with right lower lobe (RLL) consolidation, suggestive of aspiration,
and a diffusely patulous esophagus.
Treatment and testing continued, including barium swallow, esophageal manometry and endoscopy. By the time the
case was referred for online collaboration, Mr. K had visited the ER on three occasions, had been admitted to the
hospital twice with pneumonia and was presenting with imaging consistent with ongoing aspiration.
His cough persisted and was largely unresponsive to benzonatate and pherergan with codeine. His diagnosis was diffuse
esophageal spasm and he was continuing to take metoclopramide and bethanecol.
Case Study #1: 70-75 year old male with history of hypertension and obesity
Real Patient, Real Results
When a treating physician faced a patient with recurrent pneumonia causing
repeat hospitalization, he presented his case to an online medical community for
their opinions.

12. DIAGNOSIS & TREATMENT RECOMMENDATIONS:
Consulting physicians challenged the diagnosis of diffuse esophageal spasm and suggested the problem was reflux
disease leading to aspiration and aspiration pneumonia. They considered the drugs metoclopramide and bethanechol
were probably doing more harm than good and recommended they should be discontinued.
They noted that Mr. K was already on maximum dose of PPI and was not a good candidate for anti-reflux surgery. His
recommendation was that Mr. K should be strongly encouraged to undertake a serious weightloss program as his weight
was exacerbating the reflux problem. Mr. K’s cough, laryngeal edmema and recurrent pneumonia were very likely the
result of chronic aspiration from uncontrolled acid reflux.
OUTCOMES:
Mr. K discontinued the drugs that were exacerbating his gastroesophegeal reflux and undertook the recommended
weight-loss program. He lost 20 pounds and has not had any recurrence of the pneumonia or hospitalization since.
Case Study #1: 70-75 year old male with history of hypertension and obesity
The treating physician consulted trusted gastroenterologists and pulmonologists
in the community, who helped make an astute differential diagnosis.
Real Patient, Real Results

13. Real Patient, Real Results
THE CASE: 70-75 year old woman with CAD, Type II DM,
hypertension, hyperlipidemia and osteoporosis who has had
5 episodes of itching followed by near-syncope or syncope in
the last 5 years. Most recently, she developed acute onset
itching of her hands and feet, followed by flushing of her
face and ears, then diarrhea. Rising from the toilet, she
fainted.
Immediately following this, she was evaluated in an ER
setting. Her exam showed a BP of 80/40, but was otherwise
unremarkable. Lab testing and EKG were negative for any
acute process. She was hydrated and given IV Benadryl there
and her itching resolved.
Case Study #2: 70-75 year old woman with episodes
of itching, flushing, fainting and diarrhea
A physician in Maryland sought help
treating a 70-75 year old woman with
unexplained syncope episodes.

14. TREATMENT RECOMMENDATIONS:
A bone marrow biopsy and aspiration are recommended for this patient to look for evidence of mastocytosis or monoclonal
mast cell activation syndrome. The bone marrow biopsy should be stained for CD117, tryptase and CD25, and the aspirate
should be reviewed carefully for spindle shaped hypogranular mast cells. Aspirate should be sent for c-kit D816V mutation.
In addition, in order to confirm mast cell degranulation as the cause of the events, a tryptase level within 4 hours of a future
episode should be obtained and compared to the baseline tryptase level. An increase of tryptase during the acute event
confirms the mast cell etiology of the attacks.
OUTCOMES:
The treating physician was appreciative of the recommendations, which were “concise, informative and full of details which
were easy to follow through on.” She is recommending a bone marrow biopsy to the patient, to be discussed at their next
appointment.
Community members identified the patient’s symptoms as highly suggestive of a
systemic vasoactive mediator release, such as seen in anaphylaxis or mastocytosis.
Real Patient, Real Results
Case Study #2: 70-75 year old woman with episodes
of itching, flushing, fainting and diarrhea

15. 5 Tips for Success in an
Online Medical Community
 Move your special interest committees, like tumor boards, within the platform
to increase participation and negate scheduling conflicts
 Support your opinions with literature references, and ask your peers to do the
same
 Teach medical students and residents with the cases posted to your online
community
 Invite peers with whom you usually email to join your community: case
collaboration with them will be easier, and the community will benefit
 Provide the level of detail in your own profile you’d like to see in others’
“The best physicians know what they don’t know - remember that the
community is there to support learning.”
– Faculty member, Stanford University School of Medicine

16. For more information, contact Eric Glazer, Vice President, Physician Engagement
P: 617.226.3623 / E: eglazer@bestdoctors.com
Medting™ is the leading physician connectivity software, enabling clinicians to seamlessly
share data and knowledge securely on the cloud. Medting, powered by Best Doctors,
provides clinicians a private, branded forum to easily exchange insights, diagnostic images
and other files. The platform is widely used by life sciences organizations, hospital systems,
medical associations and medical schools around the globe.
Founded in 1989 by Harvard Medical School professors, Best Doctors delivers answers and
improved outcomes for patients and their treating physicians by channeling top medical
expertise to consult on difficult clinical cases. Our products and services include Medting,
ExpertConsult, InterConsultation and Find a Best Doctor. Often our services are seamlessly
integrated into the benefit programs and health care offerings of larger employers and health
insurance companies.
Clinical Collaboration, Simplified