I literally used to get laughed out of the clinic, told I was a healthy young male and just needed to exercise more. After a decade of this, I was finally diagnosed with gout, something doctors had just been lying about testing for. No one could believe someone could have gout in their 20s (It's been developing since my late teens and I've generally had arthritis my entire life, since I was a child).
It took a physician's assistant, who happened to see me one day when both of my doctors were on their third extended vacation of the quarter, to hear my plight, take my suggestion of gout seriously, and do the leg work, also revealing to me that "full test panels" don't include uric acid by default and that my doctors had been lying to me about their thoroughness.
The assistant was also massively more knowledgeable about the disease, its history, the history of treatment, etc., and disease in general, than either of the two doctors running the clinic. Really opened my eyes.
This is why, although I know there will be problems with it, we should get AI and blood tests more accessible for individuals. Accessing the healthcare system for "I know I'm not 100% but ... I don't have anything specific wrong like a broken bone" is basically a crapshoot - and a totally stupid one.
I have seen young men get diagnosed with gout, but they were Islanders (Samoans and Maori in my case), who I believe are at a higher risk so doctors are more aware of it
Funny enough I also got diagnosed with gout once in my 20s. I have always had somewhat bad toes/bunions (probably partially genetic, and partially wearing only tight soccer shoes as a kid) and I went to a wedding wearing some new leather shoes that I hadn't broken in yet. The next day I woke up with a fever and horrific pain in the sides of my toes. Went to doctor and they did some tests and were also seemingly surprised at the results indicating gout. They asked me to come back in a week to double check, and by then my symptoms were gone and the tests no longer indicated gout.
I wonder if the medical textbooks only mention gout as a historical curiosity and not as a modern day disease. I have an older relative with gout, have met someone in their 30s with gout, and yesterday heard a story about an acquaintance with gout, so it's not that rare anymore.
Doctors are trained to be arrogant, dismissive of unknown unknowns, and with a terrible understanding of statistics.
Add to that:
- They have a lot of patients and not enough sleep.
- They need to pay back a huge student loan.
- They hold terrible responsibilities and risk being sued.
- They don't have much time for themselves, let alone update their knowledge.
- Most patients are overreacting idiots, so it's a winning strategy to ignore what they tell you most of the time.
- They are not trained nor selected for empathy or open-mindedness.
And you get so many medical errors.
Basically, you have to double-check everything they do, and endure their cynical rebuttal when you make suggestions, ask questions or try things they didn't request.
I had to face many such errors myself, two almost lethal.
When you can, shop for one that is both good and is open to discussion. But even then, there is a limit. At some point, your doctor WILL fail you, so you have to take responsibility, usually when you're weak and at a low point in your life.
And if you are wrong, people will tell you you should have listened to your doctor, but if the doctor is wrong, well, shit happens.
One of my practitioners is a friend of 15 years, I literally lived with him, he is considered top in his specialty. I'm surrounded by people working at the hospital.
He saved my life once.
Even that is not enough. I still have to double check stuff every time.
> At some point, your doctor WILL fail you, so you have to take responsibility, usually when you're weak and at a low point in your life.
The two times I've been hospitalized in my adult life, I've been incredibly thankful for my parents stepping in to act as my patient advocates, including pushing back on doctors when necessary. (The first hospitalization was guilliane-barre and the other a rare hemotological condition, so i wasn't in a great place in either scenario to advocate for myself).
A pediatrician in my family has said that patients get significantly better outcomes when they have a patient advocate, because even if they are directly related to you (i.e. parents or sibling), they are going to be far better at being objective on the situation than you, the person being affected by it, is
It makes more sense when you realize most of the time it’s not <disease>. Doctors see thousands of patients per year and 99% of them have common conditions with straightforward diagnosis.
Add on top vague symptoms that can’t actually be measured and are subjective and you end up with challenging diagnoses.
I do agree that patients should educate themselves and advocate for themselves. Doctors aren’t perfect and they don’t know everything.
But it helps to have some perspective of what doctors deal with on a day to day basis.
"Basically, you have to double-check everything they do, and endure their cynical rebuttal when you make suggestions, ask questions or try things they didn't request."
I had frequent headaches and the student health service referred me to a well-known and very respected hospital for tests as an outpatient. The doctor to whom I was referred was a well-known neurologist with papers to his name—probably the most eminent neurologist in the country at the time (even now, some decades after his death, his name appears on Wiki as someone of eminence).
He then sent me for a series of tests at the hospital and they extended over a number of days although not consecutive (which was inconvenient). Those tests were rather exhaustive and included amongst others neurological tests, brain x-rays, electroencephalographs and testing my eyes including injecting fluorescein into my veins to improve the contrast of the photos they took of my eyes/retina—afterwards I was pissing out that brilliant florescent yellow dye for the better part of a day.
Keep in mind that those tests involved other doctors and clinicians who would have examined the neurologists report, so decisions weren't taken in isolation.
After all that and multiple visits to the hospital he said that they could find nothing wrong with me and suggested that I be admitted for at least three days for further tests! I declined as I was about to have uni exams and never did return to be admitted.
Several months later I visited a local GP practitioner because I'd had a bad dose of the flu and after he'd dealt with that I mentioned my ordeal at the hospital.
He was palpably furious and mumbled quietly under his breath which was just audible enough for me to hear "fucking idiots". Within a split second he went on to say "presumably during all this testing no one actually suggested that you might have migraine?" to which I replied "no". That made him even more annoyed.
He then prescribed a common Parke Davis formulation called Ergodryl, which, back then, was a common go-to drug for migraine, it's a formulation of egotamine tartrate, caffeine and diphenhydramine (a well-known antihistamine).
Problem solved, that drug completely killed my headaches. I've never forgotten that incident and although I've experienced similar inept performances I've never experienced one on that scale again. Ever since I've never fully trusted a medical diagnosis unless confirmed by second options and backed up with tests. It pays to be not only cautions but also to do one's own independent investigations.
From my experience, not all doctors are mediocre to the extent that I'd wished I'd seen another, some I've visited are quite exceptional and have an innate ability to cut to the core of a problem immediately, or at least start investigations on the right footing. Unfortunately, from my experience, they seem few and far between in numbers.
I was once introduced to a state director of health (the State's top medical officer) through a common interest outside of medicine and I got to know him relatively well. Some time later I mentioned that incident and he said to me without hesitation that he would not trust 90% of his profession to make a competent diagnosis, and he went on to say that if I were ever to be stricken by some dangerous life-threatening disease that I was to give him a call and he'd provide me with a short list of the competent ones who he'd trust—one's that he would go to if he became sick. Fortunately, to date I've never had need to take up his offer.
Frankly, for the lay person this has to be a significant worry. How on earth does one know who is competent and who is not, especially if it's at short notice?
American doctors are also reluctant to do rabies shot. Yeah they are expensive, the risk is low and there are ways to rule it out, but I'd rather not die. Other countries can get them anywhere for cheap. Here...thousands of dollars in the ER. One reason could be its just not administered enough. The other is, for profit American medical system because no one wants to die.
"Other countries can get them anywhere for cheap."
Those of us outside the US understand the US health care system is more profit orientated than many other countries but we cannot understand the huge price differentials, they're often huge in comparison with many others. Surely figures that high are nothing other than price-gouging. (Even if demand is low and the stuff has to be imported the additional costs can't be that costly. Surely not?)
So why doesn't consumer and or monopoly law kick in to stop it (as it does in many other places)?
Certain things are way under-diagnosed, especially anything relating to a chronic condition that does not have an easy biomarker. Doctors get cynical about their patients.
Chronic Lyme Disease is a popular choice for hypochondriacs (or maybe they're actually right, who knows?) so it gets raised eyebrows when people think they have it.
The majority of doctors I've interacted with, with a low-single-digit number of notable exceptions, seemed to estimate their own intelligence at about 1 or 2 stddev higher than it actually was. Combine this with (I imagine) a large number of legitimately stupid and/or hypochondriac patients, and you have a recipe for really shitty diagnostics.
soulofmischief|10 months ago
It took a physician's assistant, who happened to see me one day when both of my doctors were on their third extended vacation of the quarter, to hear my plight, take my suggestion of gout seriously, and do the leg work, also revealing to me that "full test panels" don't include uric acid by default and that my doctors had been lying to me about their thoroughness.
The assistant was also massively more knowledgeable about the disease, its history, the history of treatment, etc., and disease in general, than either of the two doctors running the clinic. Really opened my eyes.
AdamN|9 months ago
anitil|10 months ago
The5thElephant|10 months ago
Our bodies are such strange mechanisms.
jerlam|9 months ago
BiteCode_dev|10 months ago
Add to that:
And you get so many medical errors.Basically, you have to double-check everything they do, and endure their cynical rebuttal when you make suggestions, ask questions or try things they didn't request.
I had to face many such errors myself, two almost lethal.
When you can, shop for one that is both good and is open to discussion. But even then, there is a limit. At some point, your doctor WILL fail you, so you have to take responsibility, usually when you're weak and at a low point in your life.
And if you are wrong, people will tell you you should have listened to your doctor, but if the doctor is wrong, well, shit happens.
One of my practitioners is a friend of 15 years, I literally lived with him, he is considered top in his specialty. I'm surrounded by people working at the hospital.
He saved my life once.
Even that is not enough. I still have to double check stuff every time.
VoidWhisperer|9 months ago
The two times I've been hospitalized in my adult life, I've been incredibly thankful for my parents stepping in to act as my patient advocates, including pushing back on doctors when necessary. (The first hospitalization was guilliane-barre and the other a rare hemotological condition, so i wasn't in a great place in either scenario to advocate for myself).
A pediatrician in my family has said that patients get significantly better outcomes when they have a patient advocate, because even if they are directly related to you (i.e. parents or sibling), they are going to be far better at being objective on the situation than you, the person being affected by it, is
dev1ycan|9 months ago
Says the programmer who is giving an opinion on a field that is not his...
newyankee|10 months ago
refurb|9 months ago
Add on top vague symptoms that can’t actually be measured and are subjective and you end up with challenging diagnoses.
I do agree that patients should educate themselves and advocate for themselves. Doctors aren’t perfect and they don’t know everything.
But it helps to have some perspective of what doctors deal with on a day to day basis.
caycep|10 months ago
hilbert42|9 months ago
I had frequent headaches and the student health service referred me to a well-known and very respected hospital for tests as an outpatient. The doctor to whom I was referred was a well-known neurologist with papers to his name—probably the most eminent neurologist in the country at the time (even now, some decades after his death, his name appears on Wiki as someone of eminence).
He then sent me for a series of tests at the hospital and they extended over a number of days although not consecutive (which was inconvenient). Those tests were rather exhaustive and included amongst others neurological tests, brain x-rays, electroencephalographs and testing my eyes including injecting fluorescein into my veins to improve the contrast of the photos they took of my eyes/retina—afterwards I was pissing out that brilliant florescent yellow dye for the better part of a day.
Keep in mind that those tests involved other doctors and clinicians who would have examined the neurologists report, so decisions weren't taken in isolation.
After all that and multiple visits to the hospital he said that they could find nothing wrong with me and suggested that I be admitted for at least three days for further tests! I declined as I was about to have uni exams and never did return to be admitted.
Several months later I visited a local GP practitioner because I'd had a bad dose of the flu and after he'd dealt with that I mentioned my ordeal at the hospital.
He was palpably furious and mumbled quietly under his breath which was just audible enough for me to hear "fucking idiots". Within a split second he went on to say "presumably during all this testing no one actually suggested that you might have migraine?" to which I replied "no". That made him even more annoyed.
He then prescribed a common Parke Davis formulation called Ergodryl, which, back then, was a common go-to drug for migraine, it's a formulation of egotamine tartrate, caffeine and diphenhydramine (a well-known antihistamine).
Problem solved, that drug completely killed my headaches. I've never forgotten that incident and although I've experienced similar inept performances I've never experienced one on that scale again. Ever since I've never fully trusted a medical diagnosis unless confirmed by second options and backed up with tests. It pays to be not only cautions but also to do one's own independent investigations.
From my experience, not all doctors are mediocre to the extent that I'd wished I'd seen another, some I've visited are quite exceptional and have an innate ability to cut to the core of a problem immediately, or at least start investigations on the right footing. Unfortunately, from my experience, they seem few and far between in numbers.
I was once introduced to a state director of health (the State's top medical officer) through a common interest outside of medicine and I got to know him relatively well. Some time later I mentioned that incident and he said to me without hesitation that he would not trust 90% of his profession to make a competent diagnosis, and he went on to say that if I were ever to be stricken by some dangerous life-threatening disease that I was to give him a call and he'd provide me with a short list of the competent ones who he'd trust—one's that he would go to if he became sick. Fortunately, to date I've never had need to take up his offer.
Frankly, for the lay person this has to be a significant worry. How on earth does one know who is competent and who is not, especially if it's at short notice?
fma|10 months ago
hilbert42|9 months ago
Those of us outside the US understand the US health care system is more profit orientated than many other countries but we cannot understand the huge price differentials, they're often huge in comparison with many others. Surely figures that high are nothing other than price-gouging. (Even if demand is low and the stuff has to be imported the additional costs can't be that costly. Surely not?)
So why doesn't consumer and or monopoly law kick in to stop it (as it does in many other places)?
pjc50|9 months ago
A particularly nasty one is endometriosis.
treis|9 months ago
wyager|10 months ago
dessimus|10 months ago