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You really don’t know how many hypochondriacs we get. And general anxiety disorder with a focus on healthcare. And totally reasonable people who start attaching

You really don’t know how many hypochondriacs we get. And general anxiety disorder with a focus on healthcare. And totally reasonable people who start attaching every last twinge and twitch to their (real) core symptom, and want an answer that encompasses all of them. And these people seek care. A lot. Literally orders of magnitude more than ordinary people do. You have your one story of (x). I can tell you about a score-plus of nuts I see in a regular week. Many of them are frequent fliers: I will get to see the same ones pretty soon with wildly different symptoms that in no way relate to their current symptoms. They certainly don’t relate to the crap they brought me a month ago. I’ll take your wager for “more than half.” Dunning-Kruger is not your friend.

hestipod 7y ago
I do. I worked in healthcare and the overwhelming majority of patients are legit. Same with any category where people are cynical and project that cynicism onto the majority. When I became a patient I became a victim of this categorization. I've been labeled immediately as drug seeking or mental or whatever and things have gone ignored or dismissed until I pushed long enough and hard enough for testing etc. I've told the story over and over irl about working in inner city hospitals and seeing people consistently dismissed and joked about for hours until testing prove them legit and then watching people scramble mostly to CYA not out of any empathy. Was a major contributor to my burnout in the field. Calling worried patients with scary symptoms "nuts" and their issues "crap" really sums up the sort of thing I am talking about and is what makes patients afraid their provider isn't going to do their best to help them. Empathy is required for good healthcare. I recently got another confirmed and terribly depressing diagnosis of an incurable issue, but the provider I was working with was so kind, caring, and informative it reduced the mental impact as much as is possible. A dismissive provider, who was ultimately wrong, a few weeks before had me in an even worse head space than normal until I got to someone good. When I reached out to the wrong one to notify them they didn't seem care at all and dug in harder despite the proof/labs etc. "A few bad apples" isn't because of the few bad apples. It's because the farmer decides all the apples are rotten, and throws them all out with the few rotten ones, while telling others constantly about those rotten ones as if they are the norm.
- avgDev 7y ago
  I had a super serious reaction to an antibiotic. I have been to mayo clinic and somewhere around 60 physicians with different specializations by now. At least 70% of physicians have left me angry, they were simply wrong. Some would not take all symptoms because it is too much to handle at one time. My experience with western medicine has been pathetic. Also, when I was younger I had a sports hernia. It is almost like a inguinal hernia except there is no bulge. I struggled for 12 months. 4-5 months in I had a hunch it was a sports hernia from my research. I have seen total of about 6 surgeons and 4-5 doctors for the issue. All told me it is a strain, gave me NSAIDs, suggested I see a therapist. I found a great doctor in California. He performed the surgery and took images. I had completely ripped 3 different muscles in my inguinal area. By the way, the doctors I have seen were BIG name Chicago doctors from Northshore, RUSH.....it was one of the worst experiences of my life and I often feel hatred towards doctors. The shittiest thing is, that initially it was one side but they gave me a go ahead to go back and lift at work, so I ripped the other side. I was too young, broke and dumb to sue at that time, because now I would take them to the cleaners. I would not be surprised if software engineers do more research than them.
einpoklum 7y ago
You are required - ethically, perhaps even legally - to sort out the hypochondriacs/nuts from the bona-fide-condition cases using sound diagnostics. Now, for the person who complains about a couple of days or sore throat or a headache, you might dismiss them with something mild and symptomatic - but the person who tells you "I've had excruciating pain in my wrists for a year and I can't type", with the medical history to prove it, is definitely someone you should put through a battery of tests.
DanBC 7y ago
Let's try to remember that people with medically unexplained pain will be experiencing real, actual pain. They're not inventing the pain. We can put them through fMRI and see the same bits of the brain light up. The public have 3 incorrect beliefs about pain treatment. 1) Opioids work 2) The only acceptable outcome for pain treatment is elimination of all pain 3) Pain is either real (with a physical cause) or not real (psychologic, or made up). It seems plenty of doctors believe (3) too. Patients reject treatments that don't fit these beliefs. As you know opioids are a good choice for some types of pain, but they're a poor choice for others. The patient will end up with an opioid addiction, and all the side effects from the opioid meds, and they'll still be in pain because they've got a tolerance to the meds. So pain treatment now will try to eliminate pain if possible, but some people that's just not possible, and so HCPs will look at function. How well can the person live their life, even if they're in pain? This leads to a multi-disciplinary approach to pain management, including physiotherapy but also importantly including a psychological treatment. If this was a standard approach for all pain, obviously being tailored for different types of pain, patients would be less likely to reject it. Your "nuts" (a fucking horrible way to describe patients and incompatible with a professional registration in England) would be less likely to reject psychological treatments for pain if they knew that it was also being offered to cancer patients.

hestipod 7y ago

I do. I worked in healthcare and the overwhelming majority of patients are legit. Same with any category where people are cynical and project that cynicism onto the majority. When I became a patient I became a victim of this categorization. I've been labeled immediately as drug seeking or mental or whatever and things have gone ignored or dismissed until I pushed long enough and hard enough for testing etc. I've told the story over and over irl about working in inner city hospitals and seeing people consistently dismissed and joked about for hours until testing prove them legit and then watching people scramble mostly to CYA not out of any empathy. Was a major contributor to my burnout in the field. Calling worried patients with scary symptoms "nuts" and their issues "crap" really sums up the sort of thing I am talking about and is what makes patients afraid their provider isn't going to do their best to help them. Empathy is required for good healthcare. I recently got another confirmed and terribly depressing diagnosis of an incurable issue, but the provider I was working with was so kind, caring, and informative it reduced the mental impact as much as is possible. A dismissive provider, who was ultimately wrong, a few weeks before had me in an even worse head space than normal until I got to someone good. When I reached out to the wrong one to notify them they didn't seem care at all and dug in harder despite the proof/labs etc. "A few bad apples" isn't because of the few bad apples. It's because the farmer decides all the apples are rotten, and throws them all out with the few rotten ones, while telling others constantly about those rotten ones as if they are the norm.

avgDev 7y ago
I had a super serious reaction to an antibiotic. I have been to mayo clinic and somewhere around 60 physicians with different specializations by now. At least 70% of physicians have left me angry, they were simply wrong. Some would not take all symptoms because it is too much to handle at one time. My experience with western medicine has been pathetic. Also, when I was younger I had a sports hernia. It is almost like a inguinal hernia except there is no bulge. I struggled for 12 months. 4-5 months in I had a hunch it was a sports hernia from my research. I have seen total of about 6 surgeons and 4-5 doctors for the issue. All told me it is a strain, gave me NSAIDs, suggested I see a therapist. I found a great doctor in California. He performed the surgery and took images. I had completely ripped 3 different muscles in my inguinal area. By the way, the doctors I have seen were BIG name Chicago doctors from Northshore, RUSH.....it was one of the worst experiences of my life and I often feel hatred towards doctors. The shittiest thing is, that initially it was one side but they gave me a go ahead to go back and lift at work, so I ripped the other side. I was too young, broke and dumb to sue at that time, because now I would take them to the cleaners. I would not be surprised if software engineers do more research than them.

einpoklum 7y ago

You are required - ethically, perhaps even legally - to sort out the hypochondriacs/nuts from the bona-fide-condition cases using sound diagnostics. Now, for the person who complains about a couple of days or sore throat or a headache, you might dismiss them with something mild and symptomatic - but the person who tells you "I've had excruciating pain in my wrists for a year and I can't type", with the medical history to prove it, is definitely someone you should put through a battery of tests.

DanBC 7y ago

Let's try to remember that people with medically unexplained pain will be experiencing real, actual pain. They're not inventing the pain. We can put them through fMRI and see the same bits of the brain light up. The public have 3 incorrect beliefs about pain treatment. 1) Opioids work 2) The only acceptable outcome for pain treatment is elimination of all pain 3) Pain is either real (with a physical cause) or not real (psychologic, or made up). It seems plenty of doctors believe (3) too. Patients reject treatments that don't fit these beliefs. As you know opioids are a good choice for some types of pain, but they're a poor choice for others. The patient will end up with an opioid addiction, and all the side effects from the opioid meds, and they'll still be in pain because they've got a tolerance to the meds. So pain treatment now will try to eliminate pain if possible, but some people that's just not possible, and so HCPs will look at function. How well can the person live their life, even if they're in pain? This leads to a multi-disciplinary approach to pain management, including physiotherapy but also importantly including a psychological treatment. If this was a standard approach for all pain, obviously being tailored for different types of pain, patients would be less likely to reject it. Your "nuts" (a fucking horrible way to describe patients and incompatible with a professional registration in England) would be less likely to reject psychological treatments for pain if they knew that it was also being offered to cancer patients.