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> 1. Like any other industry, 90% of medical “experts” are totally incompetent. Yeah, I've come to the same conclusion. When I was a kid it took 2 years to dia

• throwaway205826 5y ago
  Yep, if you really want someone to think hard about your condition, a hospital is the wrong place to go. And a lot of doctors will become defensive when they realize you’ve put more thought into it than they have.
• data_spy 5y ago
  Not sure if true, but whenever I've had a foreign born doctor, they tended to be better in my experience.
  • davidhyde 5y ago
    The quality of the group of doctors who emigrate from one country is not representative of the quality of all the doctors from said country. For example, it could be extremely difficult to emigrate and may require exceptional talent over peers to do so. It all depends.
• tyingq 5y ago
  Same for me. Slightly bulging neck. Itchy calves. Dry skin. Lethargy. Took years before anyone ran the relatively simple TSH test.
  • qwerty456127 5y ago
    If I were you, asking for this test would be the first thing I would say at the doctor's, explaining why I want it would be the second. Obviously most people wouldn't know they need it but IMHO this has to change. Everyone should be taught basic physiology and diagnostics at school. Every device comes with a basic manual - so every body should. I actually wonder why isn't this already the case in the USA where many people can't afford a doctor. Living some years without insurance taught me I really need to have some basic medical knowledge myself and it actually is easily available nowadays.
• quickthrower2 5y ago
  With doctors, you are your own doctor and the doctors you see are subcontractors. First appointment is a job interview. That’s the best way to think of it IMO. I guess I’m privileged to have the money to do this. Google helps you know what it could be, but you need to do a fair bit of research and critical thinking. Unfortunately if you are sick this is the last thing you want to do!
  • ryandrake 5y ago
    I'm all for taking charge of your own health priorities, but don't go too far to the other side of the spectrum. Witness all the "shade tree epidemiologists" that came out of the woodwork last year. One or two Facebook conspiracy videos, and they were suddenly health care experts, confidently spouting off COVID-19 facts they picked up from the YouTube channels of Crystal Energy Lady or Vitality Supplement Guy. Doing research means actually researching. Not doing a few Google searches and watching YouTube videos that already validate what you feel in your heart.
    • quickthrower2 5y ago
      Good point. Reader beware! There are sites that seem to give good evidenced based and well researched answers. Even then when you go to the doctor and say “I read about x can I get that tested” it might be “sure you can get a test but the information cannot guide treatment so it’s not worth it” so in that case maybe the doctor knows the details better than you could ever hope by searching the internet. But the internet is a good way (and not including avoiding YouTube!!) if building up an initial mental model, then you can suggest things to doctor and see how they respond. I feel that if you go in blind you are at more risk of a lazy doctor doing the 3 things lazy doctors live to reach for as a snap judgement: antidepressants, antibiotics and a psychologist referral.
    • Arete314159 5y ago
      Ok, but doing a little research on pubmed in March of 2020 allowed me to see all the research that had already been done on SARS, that showed spread within apartment complexes and indicated these sorts of diseases were almost certainly airborne rather than spread by droplets. And a lot of "outsider" aerosol experts were saying that all year. Still it took the CDC months and months to admit it. When the experts start acting like experts, I'll be happy to hang up my shadetree epi role for good. But for now the WHO and CDC have been very political in their pronouncements and not as science-based as I would like.
• lupinglade 5y ago
  Same conclusion here as well.
• bhickey 5y ago
  A few years back my father had a valve replacement due to childhood rheumatic fever. At ten days post op he woke up with an unstable heart rhythm and went to the hospital. They gave him drugs to get the rhythm under control, which failed. After two days, I get a call from my sister, a neurologist, telling me to get to the hospital immediately. When I arrived, he was short of breath and in a bad way. At the hospital my sister took one look at his EKG and remarked that he was at risk of going into tamponade at any moment. She asked if anyone had bothered to do an echocardiogram when he was admitted -- they hadn't. She just about chewed out his nurse and they ran the echo. Lo and behold, he had pericardial effusion: a half litre of fluid was compressing his heart. They rushed him into the catheter lab, drained the fluid and his symptoms resolved immediately. On Monday I was having coffee with a coworker and mentioned that my father had a valve replaced and he'd been in the hospital over the weekend. My coworkers immediately remarked, "Oh, he had a pericardial effusion." The medical staff had become so fixated on his erratic rhythm that they had forgotten the context of his case: if someone shows up with symptoms of a post op complication, don't start by trying to diagnose an unrelated malady. My coworker? His mother had a valve replacement and had a pericardial effusion. That's a lot of words to say: checklists save lives.
  • nyokodo 5y ago
    > if someone shows up with symptoms of a post op complication, don't start by trying to diagnose an unrelated malady. Did they know he had the operation? Medical record sharing in many places, especially the United States, is atrocious even where it exists which is far from everywhere and causes a lot of problems.
    • bhickey 5y ago
      > Did they know he had the operation? Yes and besides the big line of sutures down his sternum should've been a giveaway.
• Arete314159 5y ago
  It took me 15 years before I learned I had a b-12 deficiency. The test is simple and cheap, the treatment is simple and cheap, and the symptoms have been known for decades.
  • 7thaccount 5y ago
    Vitamins?
• IG_Semmelweiss 5y ago
  Veterinarians are no different. Was abroad in a tropical climate to wait out COVID. Took our dog. 10 days before traveling back home, I see a engorged tick walking on the living room floor of our Airbnb. I was terrified because we have small children. But having grown up in a tropical country with a dog that would be full of ticks sometimes, I didn't think about our dog much. On the 6 hour plane home, our dog is basically mute. He's very good traveling, but never that good. We finally get home. He's not eating. He's sitting curled up by the door. I thought he missed the huge patio of our tropical house and the outdoors. Finally, when his favorite visitor came and he didn't even flinch, I knew something was really wrong. Unfortunately, I had waited too long to take action: The day before the vet appt, my partner called me freaking out saying our puppy's eyes were rolling back and he was barely moving. I rushed him to a VEG clinic, where they ran all kinds of diagnosis. I told the doctors where we had been, what I had seen, our dog's behaviour in the prior days etc. At this point i start requesting all the diagnostic results because a close person to me is a vet in said tropical country, and she could literally diagnose our dog.... over WHATSAPP. Her assessment was immediate and direct: My dog has babesia, and had gone into shock because the parasite had eaten all his white blood cells and platelets. Doctors in the US were not quite on board yet. They first asked a million questions on what my dog had eaten. They were convinced that something was wrong with his stomach because he wasn't eating and also I believe there was tissue inflammation / sensitivity (which was also explained by other factors related to tick disease). They did run a tick panel and came back negative. They were not convinced by the babesia hypothesis. It detected no antibodies for it. (IIRC, My contact had told me that was common in situations where the virus had obliterated the immune system and the body had not had enough time to manufacture antibodies which could be detected by the test.) Then starts the cachopony of errors. My dog breed is known to have heart murmurs. His murmur was present prior to the trip, and i had test results from the vet in the tropical country which showed the murmur had magically gone from a 1 to a 5 in about 1 week, so they started saying he had a heart problem. (nevermind that the heart behaves erratically when blood is poisoned by foreign invader). Next day, they start saying it could be heart disease coupled with genetic issue. They want to do genetic tests. I say no. At this point i have to discharge our dog because the clinic will close for the weekend. I take the dog to my vet. There they say its some kind of cancer (!!). They insist i do a biopsy... By now my dog is stable but I still needed an Echo to be able to complete the diagnosis puzzle and avoid hospitalization at a major nearby hospital.. Took him to another VEG that was open, for diagnostics. This was covid, so i was sitting outside in the bitter cold with a sick dog. After a 5 hour wait they give me my results and sent me on my way, no directions on what to give our dog to keep him stable. Next day, our dog deteriorated rapidly, and I was forced to do what I had been trying to avoid: get him admitted at the animal hospital. Signed off on a minimum admission of $2.5k. But hey, at least they didn't redo all tests (they wanted to). Finally the resident infectious disease expert onsite requested a full tick panel (the IDEXX24 standard panel does not screen for babesia). Babesia is confirmed almost 5 days later. Final bill $4500. VEG did reimburse me almost $1000 because the managing director agreed it was borderline malpractice to discharge my dog from the 2nd location without a proper plan. I should be clear, although the doctors at the 1st VEG location were waaay off making up diagnoses as fast as they could think them, at least they did not hand me the dog and tell me... "good luck" , which is what the 2nd location did. And the experience with them from a financial standpoint was not adversarial. Both locations were forthcoming with costs. Very much unlike the hospital, which made me feel bad for.... trying to get any sort budget, before admission. TL-DR: To a hammer, everything looks like a nail. A clinic does well with broken bones, foreign objects in the belly, and the like. They don't do well with infectious diseases, even those that are quite common elsewhere, particularly for those that they never see at home.
• ishiz 5y ago
  Richard Feynman in What Do You Care What Other People Think? says something similar happened with his first wife Arlene who contracted tuberculosis. If we trust his account, then it went something like this: Arlene presented with bumps on her neck and the doctors couldn't figure it out. In his free time Feynman read medical textbooks in the Princeton library, and the first thing in the book is tuberculosis, which it describes as being "very easy to diagnose." Feynman assumes if its so easy and the doctors can't figure it out then it has to be something much rarer, something like Hodgkin's lymphoma. He asks the doctor about Hodgkin's, and the doctor admits it is a possibility. > When she went to the county hospital, the doctor wrote the following diagnosis: “Hodgkin’s disease?” So I realized that the doctor didn’t know any more than I did about this problem. After several months the doctors order a biopsy of her neck and pretty easily confirm it was tuberculosis. Feynman concludes that he made a huge mistake assuming they ruled out the easiest diagnosis.
  • qwerty456127 5y ago
    Feynman's behavior seems rather irrational in this case. If he believed the doctor was smart and competent he shouldn't have interfered. If he doesn't he shouldn't have made the assumption about what the doctor "obviously considered". As a result the doctor probably concluded he should never listen to the patients' ideas and rather always put the easiest diagnosis which also is a quite common kind of a doctor to meet and is not much better than a totally incompetent one who doesn't even know the most common diagnoses but at least would listen to you as long as you sound reasonable, make the tests and try prescribing the medications you suggest as long as they are in line with the literature.
    • recursive 5y ago
      Competence isn't yes/no.