One of the signs of the growing popularity of crowdsourcing is its steady expansion into gated professional communities dominated by experts. Take, for example, medical diagnostics, an area that has for centuries been a fiefdom of medical professionals. Now, a bunch of platforms (CrowdMed being, perhaps, the most prominent) has emerged to provide patients with online medical diagnosis, especially diagnosis of rare conditions that have been missed by doctors.
Hardly surprisingly, the visitors aren’t particularly welcome. Back in September, I wrote about Dr. Joshua Liao, a resident physician in the Department of Medicine at Brigham and Women’s Hospital and a clinical fellow in medicine at Harvard Medical School, who used the pages of the Boston Globe to express his grudge against crowdsourcing.
Dr. Liao was approached by son of his patient, asking the doctor about CrowdMed as a potential help in establishing diagnosis for the patient’s mother. Dr. Liao’s response was no. He explained that a solid diagnosis requires not only patient’s medical history, which supposedly can be provided to a crowd, but, more importantly, direct medical examination of the patient, which can be not. For this reason, in his opinion, services like CrowdMed “produce more questions than answers, and more confusion than direction.”
I see Dr. Liao’s point, because I do understand the value of in-person medical examination. What troubles me with his argument is at least a dozen of “patient success stories” posted to the CrowdMed website, the testimonies by the people who were apparently helped by the crowd after their own doctors failed to do so. How are we to treat these “success stories”? As a fluke? As fake news, a popular accusation these days? Or as examples that in some cases, in spite of what Dr. Liao says, crowdsourcing can really deliver something that a single expert, however accomplished and experienced, can’t?
(And, mind you, I’m not even touching upon a sensitive issue of diagnostic mistakes committed by doctors themselves – a whopping 12 million a year of them – that account for 210,000 to 440,000 U.S. deaths annually).
As you can imagine, Dr. Liao isn’t the only doctor who hates crowdsourcing. Just a few days ago, I came across a piece written by Dr. Jeff Russ, a pediatrician. Dr. Russ’s criticism of crowdsourcing (which he attributes to the rise of medical “populism”) is arguably more grounded and sophisticated than Dr. Liao’s. And yet, when Dr. Russ insists that “crowdsourcing [relies] on the hope that sufficient quantity will outweigh…quality”, I can’t stop from asking myself whether Dr. Russ understands what crowdsourcing really is.
Crowdsourcing is not about quantity; it’s not even about quality. It’s about diversity. Crowdsourcing works not because crowds can generate numerous responses of varying quality, but because crowds can come up with unexpected, often completely unorthodox, solutions. And it’s the lack of diversity – diversity of opinions, sources of information and experiences – that forces professionals, in the medical field and elsewhere, to commit mistakes.
So I have a simple advice for Dr. Liao, Dr. Russ and his colleagues: don’t reject crowdsourcing; embrace it. Accept crowdsourcing as one of the many diagnostic tools in your repertoire. Obviously, there is no need to run a crowdsourcing campaign in case of a simple cold. However, when dealing with a complicated, potentially life-threatening, case (as the one described by Dr. Russ in his piece), use crowdsourcing as means of last resort, after all other diagnostic approaches have been exhausted. You may come up with nothing – well, no harm is done then. You may come up with a bunch of trivial ideas that you already tried and rejected – well, you know now that at least you haven’t missed something obvious. Or you may come across a suggestion that you never thought about – because it’s so unexpected and unusual. It might not work in the end, true, but it will push your thoughts in the direction you didn’t envision before.
Worse a try, if a patient’s life is in danger (if you ask me, a patient).