NOTE: My statements are not necessarily my opinions. I often post point-counterpoint essays in which I strongly take one side of an issue and later counter that with antithetical views. This intellectual exercise helps me see the merit in opposing opinions and augments my creativity.

Medscape CME problems
Have time to waste or hair you want to pull out? Earn CME credits at Medscape!

frustrated woman

After spending more time than I should have acquiring CME credits on Medscape, I learned something other than medicine: that even large, well-funded sites in the 21st century can be amazingly inept and painfully slow, as in s___l__________o________________w. After submitting a form or clicking a link, it sometimes took a minute or more for the next page to begin loading, instead of the usual second or less.

That's not the worst part, though. Clicking links would usually take me to the correct page, but sometimes I'd be directed to another one. I'd click the browser's BACK button, return to the page I just left, click the same link again, and finally get to where I wanted to go (incidentally, in every case, my browser had the clicked link still highlighted, proving I clicked the correct one). As a programmer, I wondered how their programmers produced links with random results, and why anyone with an ounce of common sense would do that.

Sometimes I'd access a page and find that the article content was blank, although the rest of the page (header, footer, etc.) was present. The browser's status bar indicated that the page finished loading, but I'd give it plenty of time, just to be sure. Still no article content, so I'd hit the BACK button, return to the page I just left, click the same link again, and finally have the article load normally.

Medscape blank page
A Medscape page without content
that should have content

After reading the CME information and clicking the link to take the test required for credit, I'd sometimes receive an error message indicating the test was not available. What was it doing—resting? Playing hard to get?

Medscape CME test is not available error message

I never needed to wake up Medscape's programmers to solve that problem. I'd just click the BACK button, return to the prior page, click the same link again, and the test would load normally, sooner or later. Usually later.

Now for the pinnacle of exasperation. On countless occasions after submitting a form or clicking a link, the next page content (other than the header and footer, etc.) would be a single word: null.

Medscape null

As a programmer, I know what null means: the absence of a known value for data that is undefined but usually should be defined. For example, if I asked a Medscape programmer for his IQ and he did not respond, the database entry for his nonresponse would be null. Database nulls are not identical to zero, which is a definite number and data type. Nulls might as well be represented as ???

After visiting hundreds of thousands of web pages, I've never before seen null as the sole page content, even on low-budget sites programmed by amateurs. There's a reason for this: although programmers sometimes have difficulty conceptualizing what null represents, even amateur programmers know enough to not print that word as the sole page content. Null means that something isn't set in the database, which is better handled with specific routines to (for example) figuratively fill in the missing blank or notify the user in words that make sense to the average user that something is missing. However, when null appears in a database, and especially when it is output to the user as the sole page content, it means the programmer screwed up, not the user.

Most of my programming time is spent compensating for inadvertent errors by users who are human and hence prone to making inevitable mistakes, or intentional malicious acts committed by people who are sociopathic monsters hell-bent on #&$@!*% things up. Good programmers anticipate how things could go wrong and take steps to make sure they don't. In contrast, Medscape programmers found ways to give users many problems even when they do everything correctly.

After seeing null, I did the only logical thing: clicked the BACK button, returned to the page I just left, and clicked the same link or submitted the same form again. The next page content would sometimes normally appear, but frequently it would not: I'd see null again, forcing me to click the BACK button once more and repeat this cycle (sometimes dozens of times!) until the next page content appeared as it should. In every case, that next page content eventually appeared normally without me changing any submitted form data or clicking other links, thus proving I did my job in correctly using that site. Hence, there was no valid reason for the Medscape circus of nulls.

Couple this maddening waste of time with Medscape's often-glacial page loading speed, and I realized that they have no qualms about wasting user time. The latter is evident in the way Medscape makes users click an inordinate number of buttons and links that lead from a CME topic to the CME certificate even when everything goes swimmingly. They either haven't given any thought as to how to streamline that process, or they don't care, or they delight in making physicians fritter away their time clicking links, busy as hamsters on a wheel with nothing better to do.

Aside from their poor navigational structure that evinces their apathy regarding user's time, my Medscape CME experience was replete with so many bizarre errors you might think my computer is infected with a virus. Not according to Norton AntiVirus. The errors are not typical virus behavior, and they only appear on Medscape, surfacing at random times with no obvious rhyme or reason why they appear or not, or why they eventually go away (e.g., replacing null with normal page content) if they do appear.

The null problem seemed more frequent when their servers were slow and obviously overloaded, so I suspect that Medscape's programmers may not be as dumb as they seem; much of the blame might go to the Medscape brass who can't spot obvious infrastructure problems, or won't invest in the resources necessary to fix them.

The typographical errors I spotted in Medscape's CME topics is an ominous indication that insufficient effort was put into their development and editing. Anyone can make a typo, of course, but before a CME activity appears, it should have been checked by so many bright people that at least one of them would have been sufficiently awake to spot the mistakes. If they are that sloppy with glossing over glaring errors, are they verifying the core info? I'm skeptical.

Speaking of sloppy … some Medscape CME content indicated to me that their experts need more expertise. I discussed the problems in one CME course in another posting.

Like other CME providers, Medscape often does an abysmal job of using the available space or time to optimally convey information. They also omit answers to questions that inevitably arise in the minds of thinking physicians reading Medscape's second-rate presentations that seem hastily prepared so the docs who developed them can rush to their next mediocre CME topic, or perhaps to the golf course.

Related topics

The secret pact of silence in medicine

Sham CME (Continuing Medical Education)

The views expressed on this page may or may not reflect my current opinions, nor do they necessarily represent my past ones. After reading a slice of what I wrote in my various websites and books, you may conclude that I am a liberal Democrat or a conservative Republican. Wrong; there is a better alternative. Just as the primary benefit from debate classes results when students present and defend opinions contrary to their own, I use a similar strategy as a creative writing tool to expand my brainpower—and yours. Mystified? Stay tuned for an explanation. PS: The wheels in your head are already turning a bit faster, aren't they?

“The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”
F. Scott Fitzgerald

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