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Several of us feel that we need to call a code on this site and assess viability. It's edging on unsustainable.

UPDATE: This is an evolving process; please check the discussion in the chat room below for up to date discussion: You're invited to join the chat "The State of Health", where we are currently discussing next steps

To summarize:

In order to restore viability, we have proposed a related site, Medical Sciences, to foster a community of experts - and we anticipate long-term benefits to Health.SE.

MedicalSciences.SE targets a more professional/academic-level scope that can better foster an engaging learning community for medical field related professionals, students, and laypersons with expertise.

Action is necessary. A viable site requires a critical mass of "experts" to be actively engaged. Up/downvoting is critical here - maybe more so than any other site, since wrong Health answers can cause physical harm. This site has not been able to maintain this critical mass, thus it has been slowly dying.

We've decided that either a new site, or a radical transformation of this site, is preferable to death.

(Note: I will use the term "experts" or "professionals" to refer to healthcare and medical-related professionals, students, and academics. This includes mental health, pharm, PT, biomed, RD, etc.)

There are too few hi-rep users/experts active at any one time to keep up with the Review queues, monitor new posts for problems, answer, and achieve critical mass to up/downvote enough to meet Beta criteria. I understand why (see below). But right now just a few of us are active, and it's overwhelming.

This has been a complaint for quite some time, I've gone through old metas, and we've tried to stimulate several conversations recently, but we are at an all-time low. I found a ton of great meta discussions from 2015 that we should be having now. But few are even paying attention to meta at this point, yet we need to do something.

So I'm going to ping everyone with hi rep or who I saw invested in shaping HealthSE over the years. You need to participate in determining the fate of this site!

It's obvious why users drift away. We all know the problems plaguing HealthSE.

  • At least 25% of questions asked are off-topic
  • High number of personal advice requests
  • Poor quality questions and/or answers that need lots of monitoring (or are beyond fixing)
  • Lack of academic effort of many (most) participants
  • There are not enough professionals (experts) sustaining the site

And then we get fatigued by the sheer volume of the above. This is not solvable without major changes.

I believe one primary problem is there is nothing fostering a community of professionals.

A community of people with expertise is VITAL to the growth and maintenance of an SE site. I think that is why we're almost dead.

Let's look at an example of a major success: Math. There are 3 sites that are well defined:

I think part of its huge success is that MathOverflow EXISTS just for professionals, fostering an active community of them.

Then, many pop over and participate on MathSE. THAT is how you keep professionals involved. THAT is how you infuse lifeblood into MathSE. Other Overflow sites work the same way.

Math parallels Medicine. Questions professionals would discuss are often too complex for non-experts, and non-expert questions aren't as engaging for professionals. Medical advice questions are the equivalent of Math homework questions: off-topic and shut down quickly. If Math were all 1 site, PhDs' discussions on like Fermi's paradox etc would be lost among "how do I tangent" type questions. Those are valid questions, but not professional caliber, so it doesn't foster a community.

When "Health" was in Area51, I fought hard for 2 separate sites, one for professionals and one for non-experts, and lost. They said it was elitist, which is ridiculous since everyone is a layperson in most fields but their own.

I think it's become crystal clear that WE NEED to foster a community of healthcare/medical-related professionals and students or this site WILL NOT survive. Plain and simple.

And either way we need a name change. It's pretty clear we need to use Medical rather than Health, since repeatedly we've heard people say that just the name Health causes confusion in scope.

My and Narusan's recommendation is that we ADD a MedicalOverflow site, and either

  1. Leave HealthSE going, but update its scope and FAQ etc.
  2. Pause HealthSE until we decide how best to proceed
  3. End HealthSE (after copying over the best questions that fit the new scope, if possible)

One great things is that there IS NOT another Medical professional site like this. StudentDoctorNetwork has a forum with the closest thing to a Medical Q/A I've seen, and that's far from ideal. In school I wished we had this! It could become a very valuable site for the medical community - especially med and pre-med students!

Which brings me to my questions:

  1. What are your thoughts on this? Say everything you're thinking!
  2. Would any of you awesome predecessors consider coming back to participate in this restructuring?
  3. Do you think we can gather new participation from our colleagues, students, etc?

You're invited to join the chat "The State of Health", where we are currently discussing a reshape of the site

Ping-a-thon: everyone who has above a certain rep OR I recognize from Meta posts. Sorry if anyone was mistakenly omitted; please ping them.

@anongoodnurse @aduckinthewinter @arkiaamu @AtlLED @ButterflyAndBones @CareyGregory @CCR @Centaurus @Chris @CountIblis @DoctorWhom @Don_S @Dr.Duncan @Fomite @FranckDernoncourt @GrahamChiu @Jan @Jjosaur @JohnP @KateGregory @kenorb @LangLangC @Lucky @MarkDWorthenPsyD @michaelpri @Mike-DHSc @Narusan-in-coma @NateBargettini @PillsNPillows @Pobrecita @Prince @RockPaperLizard @rumtscho @S.Victor @Shlublu @StrongBad @Sue @Susan @threetimes @YviDe

  • I want to emphasize these are not my thoughts alone, a number of us have been discussing. We don't want it to die. But it needs a major change. Also, part of why I'm presenting this NOW is that my participation will be spotty for the upcoming months, and Narusan's in a "coma," so our currently active hi rep users are effectively almost halved. I'm worried the other few hi-rep users will burn out quickly. – DoctorWhom Sep 14 '17 at 10:19
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    Thank you for having the time and posting this. Pinging doesn't work in posts though, so no-one will see a notification. You could ask michealpri and the moderation team, maybe they have an idea how to reach the other users. Alternatively, we could just post a link to this question between an answer of every user you wanted to ping. That's slight abuse of the system though and I'd ask the mods beforehand. – Narusan Sep 14 '17 at 12:36
  • @michaelpri Is there a way to do this ping-a-thon to pull in as many people as possible to this discussion? – DoctorWhom Sep 14 '17 at 18:38
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    I endorse this proposal 100%. Half the problem can be solved by a simple name change. People googling around get a hit with the name "Health" and so of course they ask about their toenail here. Why would they bother reading the help section when nothing requires them to? So simply changing the name to make it more obviously a professional site will solve a huge part of the problem. – Carey Gregory Sep 17 '17 at 3:00
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    @CareyGregory We went a bi further than just changing the name, feel free to have a look and complain about everything we changed. – Narusan Sep 17 '17 at 9:29
  • @Narusan-in-coma Yeah, I understood that it's far more than the name, and I'm good with those ideas too. I just think a well-chosen name will eliminate most of the requests for medical advice. – Carey Gregory Sep 17 '17 at 14:29
  • @CareyGregory This is what I hope as well. – Narusan Sep 17 '17 at 14:46
  • Thank you for the ping. Unfortunately, I've had too much deleted content on this website (~10 answers, dozens of comments, and several questions): it killed my motivation to contribute in any way except asking questions, so I'll stay mostly passive. – Franck Dernoncourt Sep 18 '17 at 0:21
  • @FranckDernoncourt That's a pity to hear. Maybe you can give the site a shot after the reshape. – Narusan Sep 18 '17 at 19:51
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    @FranckDernoncourt I agree with Narusan! I think you asked a lot of good questions, I hope you return eventually when we're done with the reformation! – DoctorWhom Sep 18 '17 at 23:37
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I was directed to this question by a user and asked for input. I would not have volunteered this opinion otherwise.

I believe this site is already dead in the water. At best, it was treading water in the beginning, but it has drowned under the burdensome but necessary expectations of such a site. It is a terrible fit for the SE model, and has been from the beginning. But as Skeptics not only survived but thrived with the same expectations, the same is not true (and never has been) of Health.SE.

I only visit the site when a rep change shows up and I'm curious as to what I wrote (I've written enough answers that I sometimes forget what I said.)

When I do, and I see the front page, I'm reminded of why I never come here anymore. The worst are questions about penis size, masturbation, 'can I be pregnant?', what do I have/why is this happening (asking personal medical questions) etc., ad nauseum. (The front page today doesn't actually look too bad, which is why I answered two questions.)

What can be done to save it is a different answer. But the fact that I have remained the highest rep user while not being here at all for (? well over a year) should say something important (I love medicine, I love helping people, I'm active on a number of sites, I thought this would be a great adventure. It's not for lack of passion - or that I was asked to step down as a mod - that I'm gone.)

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    Thanks so much for commenting. Do you not think a professional site is viable, then? From the start I thought SE was a perfect site for the kind of thing I was hoping it would be - discussion of guidelines, asking questions across specialties, med students especially. Nothing like that exists, much to my frustration during school That's in theory. In practice, that would depend on participants. I suppose one thing is how to keep it pro and keep out penis and diagnose-me questions even there, but with an active enough community those can get shut down quickly. – DoctorWhom Sep 14 '17 at 16:55
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    @DoctorWhom - My son who just finished med school had plenty of online sites he could turn to. I'm not sure what they were, some were for med students only (I know that), but it was clear there was camaraderie there. I would enjoy mentoring med students through problems/issues/etc. God knows, we need all the help we can get in a profession that looks down on asking for help. And I did like being a source for my son. Shutting down a question isn't enough. – anongoodnurse Sep 14 '17 at 17:20
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    I'm still a resident. Of course we ask colleagues questions or hit literature, but even seasoned practitioners have questions sometimes, or want to discuss changes. I love mentoring and teaching and would love to know those sites, could you share them with me (via chat or however)?. I never found much during/before med school but maybe I wasn't looking in the right place. SE is an amazing site and would be ideal for this purpose. I was involved in other SE sites before Health existed and I dreamed about its potential. It could happen, in theory. The question is would it. – DoctorWhom Sep 14 '17 at 18:37
  • First of all, thank you for taking the time and answering. I felt bad about pinging you directly, but this answer of yours shows that (from my perspective), the hassle was worth it. I hope that you were not too annoyed by that. // I have started a beta proposal but I'll terminate it soon. The question is whether you are in principle willing to give a site for medical experts only a shot. Your answers are highly valued (and, although you were inactive since I've came here, you have gained 2000 rep, while I've gained 1400 in total, I believe) as is your contribution. This is why we ask the – Narusan Sep 14 '17 at 19:01
  • [cont'd] senior members of they want to give it a shot. Without a strong Community from the start, it will be over quick and there's no point starting it in the first place. – Narusan Sep 14 '17 at 19:02
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    @Narusan-in-coma - No, please don't misunderstand. I didn't mind the ping, or posting an answer. I stated my reluctance only because as an inactive user, I don't feel my input has any value in shaping the site. There were several doctors here when I was here. I don't know how many are left. I would welcome a site for medical people; the problem is how to keep abusers of the site - people insistent on asking 100 questions about a toenail problem they have - from ruining it. SE is open to all comers. – anongoodnurse Sep 14 '17 at 20:29
  • @DoctorWhom - I will ask my son, but I doubt he'll give me an answer. I think it's because I homeschooled him, and he's taken all the teaching he can stand from me, lol, until he's in need, i.e. he doesn't want me to join those sites. :) – anongoodnurse Sep 14 '17 at 20:32
  • @anongoodnurse Invitiation to the chat room, if you have an awful lot of time to waste on us. Basically, you are the type of user we want to win back, so it would be great to have you as a "dummy". You've been on the other side of the argument. I've only been comatose for like 2 days now – Narusan Sep 14 '17 at 20:37
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Regarding Expertise

I've been following the progress of this site from a distance, but I've gotten a strong sense of angst about whether this subject is even something that should be represented on the Stack Exchange network. It's not hard to see why; these could be questions of life and death. And yet, I'm optimistic that such a site could thrive. My (possibly misguided) hope comes from seeing amateurs build truly useful sites such as Philosophy.

In the private beta (long before I was hired) we discussed whether the site was about or doing philosophy. At the time, we were basically a bunch of programmers who had dabbled in philosophy. (Programmers tend to think they can learn anything and philosophy seemed trivially easy at the time.) A few years later, the quality of the site (as evaluated by users) was pretty good. Some users are working philosophers (if you can call it work), others are students of philosophy and still others are dabblers like me. So it's absolutely possible to build a site for all levels of expertise in a topic starting with rank amateurs.

Regarding MedicalOverflow, I don't think it's necessary to attract experts. In fact, the history of MathOverflow suggests that experts saw the value of the format first and literally begged to have a site. Separately, Stack Overflow users with an interest in mathematics requested a site on Area 51. These two sites existed in totally separate spaces until MathOverflow joined the Stack Exchange network. While MathOverflow aims for research level questions, the general math site has plenty of experts and doesn't need MathOverflow to attract them.

That isn't to say there's no advantages to having a site for research math separate from broader mathematical questions. But you don't get there by fiat. Our experience creating communities with the hope that certain people will show up shows that hope is invariably dashed. For better or worse, the MedicalOverflow concept is only going to work if the experts are already clamoring for their own site. Meanwhile, having another site will not solve the problems on this site; Mathematics has had to deal with their own problems as if MathOverflow did not exist.

Categorizing Questions

Let's assume for a moment that Health is a topic that can be reasonably handled on Stack Exchange. What would such a site look like? My wife is a nurse and when I talk to her about work, it seems like there are three categories of activities:

  1. Technical—Things like changing dressings, calculating dosages, IV starts and blood draws, monitoring vital signs, and so on.

  2. Education—Since patients have health issues even after leaving the hospital, it's necessary to teach them (and often other family members) how to care for themselves.

  3. Communication—Separate from instructing patients, healthcare professionals need to to exchange information in all sorts of ways. That includes taking patient medical histories, giving and receiving report at shift change, calling in specialists, charting everything, and that sort of thing.

I don't have as much understanding of what doctors do every day, but I gather they also diagnose and plan treatments. I expect these are the sort of questions lay people are most likely to ask and professionals the most reluctant to answer. They are also the least helpful questions for future readers since everyone's medical history is going to be different. So let's put this type of question aside for the moment.

Clearly, this site could work very well for education-type questions. General questions, such managing diabetes or what it means to "take with food" or how to organize medications to avoid error, avoid the problems with diagnosis because they assume a diagnosis already exists. This type of information is common across the internet (often with "consult your doctor" warnings) so there's no reason these questions couldn't be answered here too. What's more, non-experts might answer just as well as experts. I'd rather hear from a diabetic than a brain surgeon about managing diabetes.

In my non-expert opinion, technical and communication questions could be rephrased as education questions:

  • "Why can't I draw blood from this patient?" => "What are good techniques to draw blood under these conditions?"
  • "Which specialist should I contact about my headaches?" => "Which specialists treat chronic headaches?"

You don't even need the question itself to be rephrased. Answers can just sort of assume the question is more general than it represents itself as. It's not as if someone would consult Stack Exchange while they drawing blood. More likely, the questions would be asked later when thinking about the events of the day.

Finally, I suspect there's a way to rephrase requests for a diagnosis into more general education questions. Most of these questions should probably be closed and eventually deleted, but I think there is room for people to describe symptoms and get educated on what might be causing them.

A Path Forward

I've rambled on long enough without really knowing what I'm talking about. In addition, this is the sort of conversation that works a lot better when everybody is looking at the same specific questions. So I'm starting a self-evaluation using a random sample of 5 recent questions. I think that will be a good place to start understanding what isn't working and what can be done about it.

It's easy to look at the front page of the site and assume that's what's random users see too. But if you look at traffic statistics, you see that most visitors arrive via search:

Traffic Sources

As a result, it's probably more representative to look at questions that have a lot of views and anonymous feedback. These are the questions people are actually using.

Once we have more information about the site's current condition, I think we can start evaluating solutions. Maybe shutting it all down is the only thing to be done. But I suspect there are actions ordinary users can take (editing, voting to close, answering with references, etc.) to improve the quality of this site.

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    But I suspect there are actions ordinary users can take (editing, voting to close, answering with references, etc.) to improve the quality of this site. Yes, there are. But if there are only 3 to 4 regularly active users, they can't manage the site themselves. This is the core problem: We need more experts, more active users. Currently, the site is not attractive for me, DoctorWhom, anongoodnurse or others, because we are not the target audience. This is what we want to change. And by altering the scope and target audience, we get more professionals and will ultimately be able to answer – Narusan Sep 16 '17 at 13:11
  • [cont'd] the Education aspect you described above. We receive almost entirely nothing but diagnose and plan treatments questions. This is a huge problem for the site. But one could assume that Health is focused on one's health, which is not the case here. This is why I think a change of the site name is vital. We have moved away from the idea of nuking towards reshaping. – Narusan Sep 16 '17 at 13:13
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    I have to agree with @Narusan-in-coma. If the same problem exists now as when the site first launched, it is highly unlikely to get any better. I was very much in favor of aggressive moderation: edit the question to suit the site (don't throw the baby out with the bath water), close the irreparable ones, ask for references (and explain why we need them), etc. Back then, I just thought people had to get used to how Health.SE was different from other stacks. But there were lots of unhappy users highly reluctant to change their thinking. The atmosphere here was not good, to say the least. (cont.) – anongoodnurse Sep 18 '17 at 21:38
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    My son is a nurse, and I'm very proud of what he does, but medicine is a lot more about science(s) than nursing. Anatomy, Physiology, Biochemistry, Pharmacology, Radiology, etc., etc. We don't only diagnose and plan treatments, some of us do research and the rest of us have to know how to interpret that research (I can't tell you how often lay people misunderstood what they read and posted here as a source.) I didn't even mind answering "what's my diagnosis?" questions when they were general enough to help others. (We all get sore throats. Why a doc does x and not y is important.) (cont.) – anongoodnurse Sep 18 '17 at 21:46
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    Being an armchair philosopher is so much different than being an armchair physician, and there are as many of those as there are armchair quarterbacks. There are simply not enough expert users that remain happy with the site to stay and do the work. When we do get passionate professional users, they try hard, burn out and then drift away. If the site changes so that it's geared to "armchair physicians", it will thrive (and cause harm.) Otherwise... I admire your enthusiasm and hope, but I don't think any analysis will help, because the problem is so complex. – anongoodnurse Sep 18 '17 at 21:52
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    @Narusan-in-coma: The short answer is that I'm kibitzing here and don't really know the background of this site. The longer answer is that active participants on the site are the folks who will be applying any scope change, so we're basically here to advise based on our experience with other sites. In my experience, Stack Exchange sites tend to work best when a wide range of people are encouraged to participate. It seems unlikely that attracting experts will be enough. There's got to be ways for eager amateurs to pitch in or burnout will be inevitable no matter what the scope of the site. – Jon Ericson Sep 18 '17 at 22:18
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    @JonEricson - Eager amateurs are welcome here, and have given good answers (see, e.g. michaelapri's or HDE's answers.) But you need the experts, and enough of them. I've found answers here with 6 upvotes, which were completely incorrect. Only an expert would know that. When someone misinterprets the literature used in a citation, only an expert is going to spot that. If you misinterpret Emmanuel Kant, no one is going to be potentially physically harmed. If there are only two, three, or five experts at a time, they will burn out. – anongoodnurse Sep 19 '17 at 14:50
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    @JonEricson I've posted an answer to this question explaining what I think is wrong with the site, and why many experts do burn out. health.meta.stackexchange.com/a/773/8212 – Narusan Sep 19 '17 at 15:57
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    @JonEricson +1 to anongoodnurse - as another "expert" participant the burnout on this site is very real. It happens in every field, but there's something unique about health - and I think it has to do with the "everyone has a health, not everyone has a math" issue. The number of basic-level questions is between 1 and 2 orders of magnitude more than the number of expert-level questions. Experts almost inevitably tire of just answering without being stimulated with new knowledge. We aren't doing what it takes to stimulate and foster a culture of participation. – DoctorWhom Sep 20 '17 at 5:43
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    @JonEricson Like I said, I'm in this FIELD because I love helping people understand these concepts. Giving advice and explanations is rewarding, but incomplete. Medicine is a field where our training is infused with journal clubs, case studies, grand rounds, M&M, observing experts then being quizzed to death, and asking each other challenging questions. Many of these engaging interactions COULD and SHOULD happen on SE. It is PERFECT for it. But it HAS NOT happened here. I fought to have Medical for professionals, Health for laypersons; if we had, I think things would've been different. – DoctorWhom Sep 20 '17 at 5:50
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    The one you highlighted about knees was answered by a PT (doctorate) an MD (doctorate) and a layperson (it-happened-to-me-once); the PT answer was a beautiful labor of love that took a lot of time, and that's not sustainable long term in this environment. Many of us have invested in detailed answers too, and it is a recipe for burnout here. We have seen it so many times. This is a different site than others. The wide range of people that you mention above has not worked here. We have StackOverflow and others that are basically ONLY experts; we tried a wide-open format, but it's not working. – DoctorWhom Sep 20 '17 at 6:12
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    @JonEricson Sorry for the ultra-pinging, but here's an example of a seemingly good question AT ITS ROOT but which can't be answered adequately. It couldn't be answered at all until I dramatically overhauled it; even then, just a part-answer. health.stackexchange.com/questions/13694/… It took effort to rewrite her question just to give that sliver answer. It may help her! And some others. But this is the kind of thing we have to do with a HUGE number of questions in order to answer them. – DoctorWhom Sep 20 '17 at 6:28
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    Also we've created a new How To Ask page, but it hasn't been updated yet. I hope it helps, but it will not be nearly enough as most people don't even look at what we DO have there. We need more experts, and they won't stick around unless we make more than just minor adjustments. We don't have enough experts now; without dramatic change, those we DO have will drop off. The site will straight up die then, or become overrun with guesses, grandma's remedies, pseudoscience...aka quackery. And then it will NEED to be manually killed - or rebooted. That's why now, while defibrillation has a chance. – DoctorWhom Sep 20 '17 at 6:37
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    @DoctorWhom - You got m&ms while you got pimped? (j/k) I don't know which country you're from (it sounds like the US) but I was glad to finish the pimping stage. Unfortunately, most of the "learning opportunities" stop when you finish residency. I was shocked by the abrupt cessation. Even in teaching hospitals. The heavy workload makes it difficult even to discuss papers with colleagues. So, yes, I agree with you; this was a place where an exchange of ideas could happen, but failed to. – anongoodnurse Sep 20 '17 at 14:20
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    @anongoodnurse Yes yes yes yes yes. I hope to have it not stop abruptly after next year. I really want someplace like what you're describing to exist, and I love the SE format!!!! And no, I never did receive M&Ms when being pimped but that gives me an idea for when I'm on service again in Nov... ;) Yes USA. You? – DoctorWhom Sep 21 '17 at 1:39
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Stackexchange describes itself as: "Expert communities. Each of our 170 communities is built by people passionate about a focused topic."

Definition of expert

1 obsolete :experienced 2 :having, involving, or displaying special skill or knowledge derived from training or experience

When "Health" was in Area51, I fought hard for 2 separate sites, one for professionals and one for non-experts, and lost. They said it was elitist, which is ridiculous since everyone is a layperson in most fields but their own.

Elitist is indeed a strange concept to bring up there.

I found Health.SE just recently. It is overall sometimes interesting, fun, helpful and educating. But the impression is that volume is low and sometimes the quality is indeed lacking. Hey. It's in beta.

The math sites quoted I have not analysed. It seems strange to me that you find so much cross pollination between them. If that is the case then it might be indeed a good idea to start another site with a narrower focus.

While I agree that the site needs more of the experts SE claims for itself I do not agree about terming them "professionals". Not the least because of your own statement about ridiculousness. If that is needed to attract actually more them I hold that to be not entirely desirable.

  1. How should that be enforced here? Entrance exam? Paper of proof submitted?
  2. That might be deterring or encouraging to certain types of potential new users (me being unsure which is which and which is better or worse now)
  3. Might give undue credibility (see 1) and
  4. Which types of of professionals are included? Surgeons vs nutritionists, vs homeopathic faith healer and shamans? All could be called professional, somehow. And everyone of them is entitled to their own stupidity. While a surgeon may have his educated opinion on "drinking 1l of coke a day is fine for you" a professional shaman may have excellent advice on "eating right" (of course, not mentioning the spirit world and backing it up with proper references)

I see your points and I am unsure of how the problems I see might be tackled.

It's especially interesting to watch a more or less scientific consensus arise in this kind of community. Trained experts of real medicine, researcher of chemistry, medicine, biology and other sciences, historians, dyed in the wool alternative medicine practitioners and highly interested lay persons coming together, discussing on (a) topic without the real life credentials visible, just based on pure reason and argument. Well, that's my ideal anyway.

A comparatively low level participation of experts, a similarly low level of interesting questions and answers are the reasons given above. These are structural problems.

Diagnosis requests and quack advice being the main problems on the content side. Diagnosis just has be forced out. It's unethical, dangerous on many levels and simply unsound. I don't trust Dr. Google and I wonder how anyone could. Quack on the other hand I thought was priced into the design of SE in general. Principle being that good content rises, bad falls out of site. That needs a critical mass to work and "why users drift away" then presents a hen and egg problem.

One design problem of SE is of course that destructive, malicious, hating or crusading people might downvote good content and without reasons or explanations given this is a systematic weakness.

Currently I feel the site mainly lacks visibility, no one I told about it has ever heard of it, lest seen it. Then of course they all might be not that intersted in such a site from the start. Why? What is the motivation to be active here? There is no money in for the user, the gamification of rep and badges might not be enough.

After all these random ramblings I think it a good idea to promote this site more, especially to "professionals": colleagues and even more especially students with the following benefits in sight: fostering skills on the interpersonal, the intersectional level, gaining and sharing experience, helping others. That should go into the refinement. Another site might be a good idea, but that also further splits up the forces. Ending Health now would be sad.

BTW: looks like I can follow Area51 and login there but can not login to the proposed site? Hanging in login loop there.

  • A few thoughts: a) 2 years before, just after this site has reached public beta, there were times where Meta posts had 10 or even up to 18 upvotes (Meta is for me a good way of measuring users who really care about the site). Most of them left. // My motivation to be active here is to learn something, which is why I left. Apart from you, DoctorWhom and a very few others, it's just not possible to learn something from each other. // Health.SE is doomed, in my opinion, because the name alone attracts Dr. Google. // Regarding who is professional: We wouldn't be requesting credentials but instead – Narusan Sep 14 '17 at 14:49
  • [cont'd] answerers will expect that the asker has a certain amount of background knowledge of the topic and there's no need to clarify how the nervous system works before answering why X is the case. My initial suggestion was to nuke Health altogether: It started wrong (personal medical diagnosis used to be tolerated a bit) and we'd have multitudes of old questions to close. Furthermore, if we can't get enough users to participate in the new proposal, we won't get enough users to participate on Health.SE either. Regarding the login to the proposed site: A site doesn't exist while it's in – Narusan Sep 14 '17 at 14:51
  • [cont'd] definition phase. – Narusan Sep 14 '17 at 14:51
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    Just musing about the names: just 'Health' indeed seems to have some connotations that are somehow selfhelp, Aunt Betsy, green and alternative… But the pun 'MedicalOverflow' might have problems on its own, you know, a bit unhygienic. – LаngLаngС Sep 14 '17 at 15:30
  • That title should be "Work-In-Progress". I'm open for recommendations. // Feel free to provide example questions, obviously we are not experts in all fields (if we can claim being an expert in any at all) and it would definitely help to have a broader list of example questions in the beginning. – Narusan Sep 14 '17 at 15:32
  • @LangLangC thank you! Good points. Name aside, I had no other term for a more academic discussion. It could be defined better if we thought about it more. – DoctorWhom Sep 14 '17 at 17:02
  • @LangLangC as it is, not a lot of experts will stay in this current environment. I've seen quite a few come and go. The sheer number of poor questions is exhausting to keep up with. MANY users don't take the site seriously like other sites, because they approach health differently than other topics. Everyone has a health and could say SOMETHING about it, not everyone has a math. People don't read the rules and there aren't enough to police it. – DoctorWhom Sep 14 '17 at 17:07
  • I previously brought up the site a few times at conferences. The largest group I hit was about 50 MD's, and exactly 2 were even interested in loading the site, after which 0 were interested in participating. I don't think it's a publicity issue. – Atl LED Nov 10 '17 at 17:27
  • @AtlLED Which site exactly, Health or MedSci? Did any of your contacts give reasons? "Lack of personal time" is hardly addressable (&all I ever heard), until we get much more attractive on both sites. But "they do this YX bad, for the following principle violation" would be sth to consider immediately? – LаngLаngС Nov 10 '17 at 20:48
  • I'm not 100% on that last question, but: Health.SE; most felt there was no need; the few who were interested in principle were completely uninterested once they saw the low quality of the first page of questions. – Atl LED Nov 10 '17 at 21:31
5

I think this community has had problems from the get go. I think what is lacking are questions that are interesting to experts. When I look at the questions that were asked in the first days, I see very few that I am compelled to read. While most are good questions and require experts to answer, the answers are of little interest to other experts. I would like to see more questions that address problems that experts would encounter (e.g., a grand rounds type case study) or questions that an expert might have to answer (e.g., bedside manner when dealing with uninformed sex/pregnancy questions).

As an expert, and I use that term loosely as I am a mere PhD, I want to learn something when I read questions. I think the homework type medical advice questions are fine since seeing how an expert explains the answer is informative, but we are lacking questions from experts about problems experts face. I, and I believe a lot of SE veterans who have given up on the site, would be willing to sift through a lot of bad questions, if there were at least some good questions.

I would suggest a push to get high rep users to ask expert level questions coupled with using bounties, and generous up votes, to get the experts who check in to become excited again.

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    I have asked a few questions. They easily suffocate in the garbage of other posts. This is why me and @DoctorWhom hope that changing the site name and scope will both deter bad questions and attract more experts because, as you say, expert questions could make this site feasible again . – Narusan Sep 19 '17 at 21:58
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    +2 @StrongBad for "I would like to see more questions that address problems that experts would encounter (e.g., a grand rounds type case study) or questions that an expert might have to answer (e.g., bedside manner when dealing with uninformed sex/pregnancy questions)." and "suggest a push to get high rep users to ask expert level questions coupled with using bounties, and generous up votes, to get the experts who check in to become excited again." – DoctorWhom Sep 20 '17 at 1:31
4

How-StackExchange-WorksTM

Every successful StackExchange site has a solid base of users who are revisiting the site on a daily basis.

Puzzling, PCG, they're in for the fun. SFF because they can talk about books/movies they really enjoyed with other people who really enjoyed them. SO because the site's just so helpful to programmers, on so many different occasions.

Health is a one-time hit only. You've just visited your doctor and have a question about something she told you? You visit Health.SE. But that's not the case every second day. This is why we have a low rate of accepted answers: Most users never return. They sign up to ask a question and don't even log in to upvote the answer, but just read it as an anonymous user.

Because of this, we will never be able to change the behaviour of a majority of the users. This is why Health.SE was doomed from the beginning.

The fault is not in our stars, but in ourselves.

Health.SE is failing. This is because of the target audience of the site (or the audience the site targets without willing to do so): inexperienced, "newbies", to medicine.

But we are different. The people who answer are not newbies to medicine (well, a few might have outstanding Google skills). We chose that audience, so we are to blame. This is why the fault is in us.

Yet, we can create a site targeted for us. For us, those who have fun talking about their job and explaining procedures to others, those who wish to broaden their horizon to other aspects of medicine, and those who want to learn about their subject of interest.

I am because I can't do all that on Health.SE. I don't have fun here. The mess is just way too huge. But I could, in principle, on a site targeted for me.

We would need roughly 200 "professionals" joining and subscribing to get this new site running. This might be unrealistic, this might be idealistic. Maybe what I'm outlining here might be romanticised, based on lose assumptions.

But I will give it a shot, if I can see just the dimmest light at the end of the tunnel. Because I like helping people, I like learning, and I like talking to you.

  • Recently I kept thinking that this "one-time hit" thing might actually be one of the biggest road blocks here. How can we keep Eintagsfliegen alive, i.e. stay around; and learn how to do stuff here? First-timers have a hard time everywhere on SE. But here they mostly day in the waiting room. (That is not the chat, but before they get to the operating table…) ¿Some way to remind them to at least return and check on the answers? AFAIK "newbies to medicine" are still welcome, very indeed, and will be, if they are willing to learn? (Stay at least long enough to accept sth?) – LаngLаngС Oct 17 '17 at 13:09
  • @LangLangC As long as the target audience of Health.SE is the way it is now, there is no way of keeping Eintagsfliegen: They don’t have any incentive in staying here, and I can not think of a way to create one for them. Obviously they are welcome if they ask good questions (and we should upvote questions stronger in order to encourage askers to ask again), but a large user group doesn’t have follow up questions and - unless they return to the waiting room, which hopefully isn’t soon after their first visit - they won’t bother coming back. This is why I think medical sciences is the way to go. – Narusan Oct 17 '17 at 13:52
3

Speaking as a personal contributor (as opposed to a moderator), I have been on the site since the initial days. I agree that the scope has lent itself to some of the worst dregs of misinformed questions out there on the internet. At its worst, the front page appears like a yahoo questions page.

I do like the idea of making it more about the practice, rather then the topic. A doctor is not really going to want to come on to an answer site such as this to see "If I rub garlic under my fingernails will my hair grow again?" and similar.

However, I would vote against completely scrubbing and starting over. That is a long haul, and would require the whole Area 51 proposal, approval, beta phase again and you will not get as many of the original starters to go through it again. See the quote from the Fitness SE during their scope debate about a year after they launched as Fitness & Nutrition

While its the whole point of Area51 to only launch sites that have sufficient experts. The problem I've always had with Nutrition is that we lacked the required experts to answer these questions authoritatively.

So a Nutrition site that would be cast off from Fitness, which in all honesty is not what's happening, would need to go back to Area51 and get sufficient followers to get back into beta again.

Physical Fitness did a fairly rename and major overhaul of their scope a year or two into their initial beta (It launched as Fitness & Nutrition, and nutrition was dropped as it attracted many of the similar types of questions we are getting), and was successful. While it has not made it out of beta yet, it still remains a viable, active community with a solid core of contributors after 6 years. (And nutrition alone has failed at least once in Area 51).

I would also want to ensure that it is not only doctors in the traditional sense that are included. PA's, NP's, nurses, EMT/Paramedics, etc. should be encouraged to stay in, and I would also include laypeople that can ask intelligent questions about things they have questions about (Selfishly, as an example this question that I posed).

I would also revisit the necessity to have studies or other evidence to back things up. Obviously in many cases it would be necessary to discuss and provide article backup for cutting edge/theory medicine, but there are many things that medical professionals just "know", and having to provide a reference for commonly known medical facts I believe becomes onerous and turns off potential contributors.

  • Obviously, laymen and else are included. The idea was to assume a certain amount of background knowledge and understanding of medicine, making "Will garlic make my hair grow" off-topic because someone doesn't understand how hair growth works at all. Everybody here is an expert (if at all) in only a small field. But we have a broader basic knowledge and common sense. This is why answers wouldn't have to be backed up ferociously, as most claims could be attributed to common knowledge. Can pull of a total reshape? What will happen to questions that used to be on-topic and are off-topic now? – Narusan Sep 14 '17 at 20:10
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    "At its worst, the front page appears like a yahoo questions page." No. At it's worst, it looks like a porn advice site. – anongoodnurse Sep 14 '17 at 20:11
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    @Narusan-in-coma - I am not sure. While I am a mod on fitness, I became one after the removal. When people bring them up as "proof" we promptly close them and point them at the help and meta discussions. And I don't think it's a total reshape, it's a culling. Rebrand, vigorously pursue and close now off topic questions that get put in, and see how it goes. At worst, it fails and we try again in area 51 with a different scope. – JohnP Sep 14 '17 at 20:13
  • @anongoodnurse - Good point. I was being a little more delicate. :p – JohnP Sep 14 '17 at 20:13
  • @JohnP I've tried so much on Meta here that I'm sceptical we could get input of more than two to three users for a reshape. I'm willing to give it a try if you as a moderator assist us, because we will probably need Community Managers or Moderators to change scope, close-reasons etc. – Narusan Sep 14 '17 at 20:18
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    @Narusan-in-coma - I would be willing to help as a moderator, but we also need to reengage high rep former users as well. I would have to ask a lot of help from CM's, as I'm not sure of the procedures for rebranding a site. I'll ping a couple of CM's and get their input. – JohnP Sep 14 '17 at 20:21
3

Ok, I feel obligated to point out that when a pt is flatlining it's time to start punching out some CPR, not reaching for the paddles. And like @anongoodnurse and others, I've thought this site died a long time ago.

There are plenty of question answer sites for MD's, the trick is that they are all subscription based and require for the user to actually spend money and be approved for registration (and actively discourage users broadcasting about them in public forums). Which is probably why MD's like them, it really holds out the public so high level conversations can be had. It's also why I doubt the current model will ever work as is.

Quite frankly MD's have always enjoyed having more resources than PhD's from most other fields, which could easily explain why the paid market responded to having Q/A forums for MD's but not Math PhD's as an example. They're integrated into the medical systems we're already using in hospitals so it's not even a personal expense (at least at the last two institutions I worked for).

I've long felt my participation in this site was for the public good, and that there was little I could ever get when asking questions (which I tried). And if that's going to be the motivation for medical professionals (which I understand is well beyond the category of MD's), then the quality of the questions would have to be particularly high (and we all know they're not).

I'm quite curious to see if some passionate users can make a Frankenstein's Monster of the remains of this site, but I can't really find the motivation within myself to be a major part of that effort.

  • I have the feeling that we've already tried to run Frankenstein's Monster the past few months, and I'm at a point where I'll either give up or punch out some CPR. I think that we drastically need to change the target audience of the site from newbies to professionals. – Narusan Nov 10 '17 at 16:44
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    I don't know what your background is but I can say that there's really no/little market desire for an SE site for MD's in the US. – Atl LED Nov 10 '17 at 16:49
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    Some users (@DoctorWhom) who are from the U.S. have stated their desire claiming that there is nothing like SE for MD's in the U.S. I'm not from there, so I can't tell. If you say a site targeted at MD's is not relevant for you and won't be helpful, I can perfectly understand that. I fear that helping none-professionals is out of question though sadly, because the amount of time needed is too high and the quality of questions way too low. – Narusan Nov 10 '17 at 16:53
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    @Narusan-sedated Others may find something different. I've always practiced at tier 1 research institutions, which have had subscriptions to Q/A forums specifically for MDs. A private practitioner in rural Montana might have the different experience and I would be curious to know that. I would actually participate in a public form of experts and think it's a good idea, but I don't think that there's demand for it. I have literally tried to pitch this to other Physicians IRL and failed. – Atl LED Nov 10 '17 at 16:58
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    Admittedly that was with the front page of questions that looked similar to the way they do today. @anongoodnurse maybe able to speak to this as well. – Atl LED Nov 10 '17 at 17:00
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    This is why I think we need a change of site name, scope and target audience. – Narusan Nov 10 '17 at 17:01
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    @Narusan-sedated I understand that, and hope that it will work. I wanted to highlight however that there is a difference from being willing to participate and feeling as though there is a need for such a site. Many of the professionals I know felt as though there was a need for an SE model site in their field. I still appreciate SE biology for example. – Atl LED Nov 10 '17 at 17:07
  • @AtlLED I would be super interested in learning what MD Q/A sites exist, as I have not run into ANY of them except a couple that were more pre-med applicant oriented (e.g. SDN). I eagerly searched for some sort of professional/student QA website during pre-med/med school and found none. Some of my colleagues at the time were really interested as well. If sharing names here is frowned upon, please send a chat - I AM really interested. I realize that by design in our profession we ask each other questions, and those who stick with academic institutions have even more opportunities. – DoctorWhom Nov 11 '17 at 15:01
  • I genuinely love the model of SE and wish we had a critical mass for highly academic discussions on the site! Sadly I think it failed because we didn't separate professional/academic questions from non-professional (basically, patients') questions from the start. I fought in Area 51 for the dual Health and Medicine sites, I saw the need to differentiate as keeping academic level questions separate maintains a stimulating community for professionals, but the leaders didn't. – DoctorWhom Nov 11 '17 at 15:27
  • Some specifically vocal leaders were not professionals themselves, and to be blunt, they seemed offended by an inaccurate perception of elitism. They argued basically that all questions are equally valid and separation was a sort of unfair segregation. They wouldn't consider that the needs of the audiences were different. Now here we are, with scores of low quality questions for each academic level question, drowning them out and driving academics away. Again to be blunt. – DoctorWhom Nov 11 '17 at 15:30
  • I started on biology SE during med school before Health existed, and was active but disappointed that medical questions were largely off topic. I had a number of excellent questions that were well suited to the SE format, and knew other students who did as well. And the medical field, because of its direct impact on human life, might be the most important field of all to have robust forums for refining knowledge, engaging fresh eyes' perspectives, stimulating deeper inquiry and generating innovations. Also, not everyone remains connected to academics. – DoctorWhom Nov 11 '17 at 15:39
  • @DoctorWhom have you tried SERMO? – Atl LED Nov 11 '17 at 15:40
  • @AtlLED no, I just looked at it and had no idea it existed. Exciting! Will definitely check it out tonight (if last night's white cloud comes back). – DoctorWhom Nov 11 '17 at 15:45
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    @Narusan-sedated Yes and TBH, I'm starting to think that we really will have to go down the asystole side of the ACLS algorithm and push epinephrine - a massive cull of ALL low quality questions, strict and harsh modding, shutting down wrong questions and answers rapidly (e.g. lowering the # of votes required to close to maybe just 2), giving more privileges to high rep users, putting in hard stops for asking questions, etc. Worth a try. Because if a health QA site isn't adequately reviewed by experts able to discern correct from incorrect, honestly, it risks causing HARM just by existing. – DoctorWhom Nov 11 '17 at 15:57
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    @AtlLED thank you for the suggestions, I'll look into them. Almost all of my bio posts are medical related. But a good number of my questions and a few answers got shot down because they were too medical. I'm a relatively recent MD/MPH grad, a few years into a dual residency. I can see both sides to this whole thing. I certainly feel what drives other pros away from Health. By seeing what else is out there for professional QA type sites, it'll help me understand what's worthwhile to try. It's kind of sad, though, SE has the potential to foster a beautiful academic community. – DoctorWhom Nov 11 '17 at 16:09

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