COMMENTARY

August/September 2003: Community

Priscilla Scherer

Disclosures

September 12, 2003

Introduction

Just about every morning as I'm exercising in Central Park, I pass a woman who looks to be about my age, with a pace that looks to be about the same as mine, radio strapped to her arm and attached to earphones, as is mine. We've taken to smiling and nodding as we pass each other. When one or the other of us has been away for a few days and returns, it is clear from the angles of our nods and smiles that we have missed each other and are relieved that things are back to normal. My fantasy is that if I suddenly got a cramp in my soleus muscle, she would stop and know exactly how to help. And I would do the same. I realize that neither of us has as much experience with muscle cramps and tendonitis as Greta Waitz, but still, this anonymous colleague and I would know what to do for each other. We are part of a particular community of people who walk in the park at a particular time of day.

Same during the blackout last month: Neighbors shared strategies to prepare against the possibility that water pressure would fail (fill up your bathtub) and alternatives to cooking with electricity-powered gas ovens (use a match!). As members of the 2003 blackout community, we shared cars, cell phones, Band-Aids, batteries, and beer and thawing foods from our freezers to create magnificent impromptu building and block parties.

Less dramatically but perhaps more significantly, in academic institutions around the country and the world, generalists and specialists help each other out during informal "consultations" about difficult or puzzling cases, bringing invariably unique individual experiences to the discussion, kernels that help each other out; each is an expert, albeit perhaps not renowned outside their own small sphere.

Indeed, when we ask physician authors/experts to write about the various conferences, we liken the coverage to the conversations that take place in the hallways and elevators in medical centers across the country after each of the big meetings. "How was the AAN/ANA/AES/IHS (fill in the blank)? What's in the pipeline for Alzheimer's?" someone will ask. And the answer is both the style and the substance of our guidelines for authors writing for the tens of thousands who are in community hospitals or rural areas with no other neurologist with whom to hash things out.

There are other examples of the unique community of Medscape. Where else can a general neurologist in New Delhi run a difficult case by one of the world's experts in movement disorders, with thousands of other physicians listening in on the conversation?

But perhaps the most remarkable example of the Medscape community is that found in our Discussion Boards.* It is impossible to know where all the discussants are situated geographically. Locating a participant on the basis of his or her surname may be erroneous -- everyone could be writing from somewhere in the Midwest of the United States, I know. Still, some do identify themselves as South American, Middle Eastern, Indian, European, etc., and it is kind of thrilling to imagine all of these neurologists and other physicians coming together from the 4 corners of the world to work out their diagnostic problems in our virtual doctors' lounge.

It's all there: Is there a lab in Brazil that will test CSF for CJD? Yes, in Rio. Can a rheumatologist communicate with a neurologist (yes, and transatlantically, to boot) and, as a bonus, sort out symptoms that may or may not relate to a syrinx? How to diagnose a Middle Eastern child with the sudden onset of torticollis? No political exchanges yet, but can they be far behind? Maybe they can. Thus far, these discussions have transcended politics, borders, economics, and egos. They're in the realm of patient-focused medical practice, and everyone involved seems to anxiously await the outcomes of the cases brought forward.

So, stop by when you have a chance. Eavesdrop. Add your two cents. It may be more valuable -- and valued -- than you think.

* Medscape Neurology & Neurosurgery Discussion Boards are restricted to physician members. All others will find discussion groups pertaining to them when they log in and click the "Discussions" tab. Those listed include the Medscape Member Discussion Boards and those for medical students, nurses, pharmacists, and physician assistants.

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