Defibrillating Health.SE

Question

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:

• MathSE: General public https://math.stackexchange.com/questions
• MathOverflow: professionals https://mathoverflow.net/questions
• MathEducators: professors https://matheducators.stackexchange.com/

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

Answer 1

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.)

Answer 2

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:

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.

Answer 3

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.

Answer 4

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.

Answer 5

How-StackExchange-Works^TM

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 status-comatose 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.

Answer 6

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.

Answer 7

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.