5 ms·

A meticulous analysis led to a diagnosis of diabetes insipidus

29 points by dougb5 7y ago

pressurefree 7y ago
it's pronounced 'diabeetus'
msie 7y ago
Democracy dies in paywalls.
stevenwoo 7y ago
The misdiagnoses sounded pretty frustrating but the unnecessary gall bladder removal is appalling and galling. TLDR - a bump on the head caused pituitary gland malfunction that no doctor recognized for years.
- killjoywashere 7y ago
  Ok, so, first, there are some diagnoses that are known hard to diagnose. Celiac disease, mycosis fungoides, diabetes insipidus, among many. Half of medicine is rare diseases. The typical physician may see a case once in their career, maybe less. I can say, as a pathologist, the doctor who lives at the far end of many of these workups, I have seen some truly rare diagnoses, stuff that's not in any textbook. And I know good doctors who have missed common diagnoses, myself included. I submit that this attorney in the story was fortunate that this neurologist saw him outside his regular clinic, was a neurologist, and had the luxury of reviewing the chart, probably at night or over a weekend, without ten patients in the waiting room, three stacked up in the clinic rooms, a nurse he doesn't quite trust, a front desk clerk who showed up late, and a note from radiology in his inbox that landed 5 minutes before clinic started notifying everyone that the CT suite is unavailable for urgent scans because the technicians' contract wasn't renewed in time so they're simply not coming to work. In medicine, days off are so wonderful because they're the only real chance to catch up work.
caconym_ 7y ago
I haven't read the article and I'm not going to, but this title sings. Holy crap.
techsin101 7y ago
This is what infuriates me about medical Susan. if something is wrong with you and it's not something in top percentile, you feel nobody's got your back. Every specialist works in an isolation. Imagine you have an app and something is broken and is hard to pinpoint. You involve the cto who involves everyone else: backend, devops, data, frontend... Specialists from entire spectrum. There is no such counterpart for human body. You ping pong from doctor to doctor untill you die or end up in er where right doctors are finally on call. Doctors would spend less than a minute if they could. I wish there was a new sort of health company that would do yearly full diagnosis. Go through all markers in blood etc for example signs of cancer, Alzheimer, prediabetes show up in blood years before.., misbalance of biomes, fluid pressure, pinched nerves.. right now that's not the case.
- lostlogin 7y ago
  It sounds like you’re asking for a multidisciplinary meeting, which is a thing and is regularly used in healthcare for complex cases. I used to help with the image side of a fortnightly breast MDM. It had physicians, an oncologist, pathologist, surgeons, nurse, radiologist and probably a few more disciplines too. There are numerous meetings for other body parts and systems around town. This many vary country to country, I’m in New Zealand.
  - mjevans 7y ago
    What they're really asking for is (attempted) automated diagnosis, where routine tests are done and fed to a computer and a list of things that might be wrong can then be evaluated by humans. If something looks possible more precise tests could then be done to confirm the diagnosis.
    - nradov 7y ago
      Except that wouldn't have helped in this case because the proper tests hadn't actually been done. Clinical decision support systems have been developed to assist physicians with semi-automated diagnosis and they can work, to an extent. But the hard part is gathering an accurate medical history and then reducing it to discrete concept codes that software can understand. Computers can't effectively interview a patient or ask the right questions for rare or complex conditions.
deleted 7y ago
[deleted]
H_Pylori 7y ago
>His primary care doctor at the time, Lopez said, was dismissive, telling him he was “anxious” and “working too hard.” It was an explanation he would hear from other doctors. I've had the same experience myself. It's actually a common experience among those who have a rare or difficult illness to diagnose. People can go years, or even decades, having their symptoms blamed on stress, anxiety or depression, until some doctor finally gives the right diagnosis. In my case I'm still in the phase of awaiting a diagnosis and believe me it's not a place where you want to be in.
ThePowerOfFuet 7y ago
http://archive.is/HwfAS http://archive.is/HwfAS

29 points by dougb5 7y ago

pressurefree 7y ago

it's pronounced 'diabeetus'

msie 7y ago

Democracy dies in paywalls.

stevenwoo 7y ago

The misdiagnoses sounded pretty frustrating but the unnecessary gall bladder removal is appalling and galling. TLDR - a bump on the head caused pituitary gland malfunction that no doctor recognized for years.

killjoywashere 7y ago
Ok, so, first, there are some diagnoses that are known hard to diagnose. Celiac disease, mycosis fungoides, diabetes insipidus, among many. Half of medicine is rare diseases. The typical physician may see a case once in their career, maybe less. I can say, as a pathologist, the doctor who lives at the far end of many of these workups, I have seen some truly rare diagnoses, stuff that's not in any textbook. And I know good doctors who have missed common diagnoses, myself included. I submit that this attorney in the story was fortunate that this neurologist saw him outside his regular clinic, was a neurologist, and had the luxury of reviewing the chart, probably at night or over a weekend, without ten patients in the waiting room, three stacked up in the clinic rooms, a nurse he doesn't quite trust, a front desk clerk who showed up late, and a note from radiology in his inbox that landed 5 minutes before clinic started notifying everyone that the CT suite is unavailable for urgent scans because the technicians' contract wasn't renewed in time so they're simply not coming to work. In medicine, days off are so wonderful because they're the only real chance to catch up work.

caconym_ 7y ago

I haven't read the article and I'm not going to, but this title sings. Holy crap.

techsin101 7y ago

This is what infuriates me about medical Susan. if something is wrong with you and it's not something in top percentile, you feel nobody's got your back. Every specialist works in an isolation. Imagine you have an app and something is broken and is hard to pinpoint. You involve the cto who involves everyone else: backend, devops, data, frontend... Specialists from entire spectrum. There is no such counterpart for human body. You ping pong from doctor to doctor untill you die or end up in er where right doctors are finally on call. Doctors would spend less than a minute if they could. I wish there was a new sort of health company that would do yearly full diagnosis. Go through all markers in blood etc for example signs of cancer, Alzheimer, prediabetes show up in blood years before.., misbalance of biomes, fluid pressure, pinched nerves.. right now that's not the case.

lostlogin 7y ago
It sounds like you’re asking for a multidisciplinary meeting, which is a thing and is regularly used in healthcare for complex cases. I used to help with the image side of a fortnightly breast MDM. It had physicians, an oncologist, pathologist, surgeons, nurse, radiologist and probably a few more disciplines too. There are numerous meetings for other body parts and systems around town. This many vary country to country, I’m in New Zealand.
- mjevans 7y ago
  What they're really asking for is (attempted) automated diagnosis, where routine tests are done and fed to a computer and a list of things that might be wrong can then be evaluated by humans. If something looks possible more precise tests could then be done to confirm the diagnosis.
  - nradov 7y ago
    Except that wouldn't have helped in this case because the proper tests hadn't actually been done. Clinical decision support systems have been developed to assist physicians with semi-automated diagnosis and they can work, to an extent. But the hard part is gathering an accurate medical history and then reducing it to discrete concept codes that software can understand. Computers can't effectively interview a patient or ask the right questions for rare or complex conditions.

deleted 7y ago

[deleted]

H_Pylori 7y ago

>His primary care doctor at the time, Lopez said, was dismissive, telling him he was “anxious” and “working too hard.” It was an explanation he would hear from other doctors. I've had the same experience myself. It's actually a common experience among those who have a rare or difficult illness to diagnose. People can go years, or even decades, having their symptoms blamed on stress, anxiety or depression, until some doctor finally gives the right diagnosis. In my case I'm still in the phase of awaiting a diagnosis and believe me it's not a place where you want to be in.

ThePowerOfFuet 7y ago

http://archive.is/HwfAS http://archive.is/HwfAS