6:38pm August 2, 2014

On “self-diagnosing”

writingcyan:

jackaldope:

would you diagnose yourself as HAVING THE FLU? would you TELL PEOPLE YOU HAVE A SORE THROAT without a doctor’s approval? of course not. as everyone knows, symptoms are arcane runes inscribed on the body and can only be interpreted by doctors, and wizards

The problem isn’t the interpretation of symptoms, though; some illnesses manifest in obvious and unique symptoms which leave no doubt of the underlying aetiology. However, 99% of illnesses present with symptoms which allow differential diagnoses, i.e. other, less common illnesses which share the same set of symptoms and which must be excluded from consideration by use of various clinical tests before adequate medical treatment can be initiated.

For influenza, some (un/)common differential diagnoses (based on Influenza-Like Illnesses, ILI) are (from my pocket guide to differential diagnoses):

Cytomegalovirus.

Rhinovirus.

Adenovirus.

Echovira.

Parainfluenza Virus.

Mycoplasma.

Acute Respirator Distress Syndrome.

Meningitis.

HIV.

Mononucleosis.

Histoplasmosis.

Metapneumovirus.

Respiratory Syncytial Virus.

Bronchiolitis.

Pharyngitis.

Pneumonia.

Streptococcus pneumoniae infection.

Chlamydial pneumonia.

Myocarditis.

Epiglottitis

Poliomyelitis.

Malaria.

Lyme’s Disease.

Legionnaire Disease.

Dengue Fever.

Hantavirus.

Q Fever.

Herpes.

Hepatitis C.

Rabies.

Coxsackievirus.

Retropharyngeal absesses.

Drug use of: Influenza vaccine, interferons, monoclonal antibodies, chemotherapy, Levamisole, biphosphates, Caspofungin, opioid withdrawal.

I found a full list here - most of these aren’t relevant to Emergency Medicine, but just have a scroll through that page and consider the number of differential diagnoses available for ILI.

Most of the time, most, when patients present with flu-like symptoms, it is just the flu and it’ll go away on its own. Sometimes, it’s Avian Flu or Swine Flu, but still, most patients improve without assistance and don’t seek medical attention, assuming (sometimes correctly, sometimes not) that they’re just having the flu. This doesn’t mean, however, that their “self-diagnosis” was correct; their “flu” could potentially be any one of the illnesses listed above, which is why all diagnoses must be supported by clinical tests. For this reason, when presented with any given set of symptoms, doctors operate with a list of differential diagnoses and a working diagnosis, which is their personal “best guess” until test results come in—and more often than not, the working diagnosis changes as treatment progresses and more tests are performed. (I’ve had the “you came in with a sore throat, but it’s actually HIV” chat with patients myself. HIV can present as f—ing anything. It’s always a differential diagnosis. Forget about Lupus, Dr. House.)

Unless you have knowledge of relevant differential diagnoses and access to clinical testing, you cannot diagnose an illness correctly—even doctors get it wrong sometimes, if they can’t uncover all the differential diagnoses. Which is why the layman’s “self-diagnosis” is a) not possible, b) appropriation of medical terminology (and as tumblogger, you ought to know appropriation is bad), and c) potentially very dangerous. (Just look at this post. Did you know, OP, that Ebola also presents with flu-like symptoms? Should you really be telling people to “self-diagnose” with common garden-variety influenza when we’re currently experiencing the most severe Ebola outbreak in human history?)

I understand that Americans (and others, but this seems to be mainly a US issue on tumblr) do not have access to adequate healthcare—which is an absolute travesty and something y’all should think hard about when you’re old enough to vote—but a “self-diagnosis” is not a diagnosis, and it’s a potential health risk to yourselves as well as potentially hurtful to people with actual diagnoses, especially when it comes to mental health issues. One thing is “self-diagnosing” with the flu or a sore throat, another completely is to “self-diagnose” with ADHD, PTSD, Asperger’s, Bipolar Affective Disorder, etc., because these are rare conditions and you become, by claiming them, representative of patients with these disorders, except you aren’t representative if you don’t actually have the disorder, which is unbelievably harmful to the people who do and might limit their available treatment options—you might indirectly be responsible for someone’s death by claiming an illness you do not have.

Don’t ever “self-diagnose” with a mental disorder—if you experience mental health symptoms, they might a) require psychiatric treatment, or b) be indicative of hormone imbalance, or pernicious anaemia, or cancer, or something else which requires immediate medical treatment. Remember: in 99% of illnesses, differential diagnoses exist. Always see a doctor (if possible—if not, consider the benefits of democratic socialism, e.g. universal healthcare).

And finally, let me just ask you this: Why self-diagnose? Doctors diagnose patients for the purpose of medical treatment; (almost all) diagnoses come with a treatment plan attached. “Self-diagnoses”, on the other hand, aren’t used for treatment purposes—can’t be, because they weren’t made by a medical professional. If you think you have a certain illness, you can study up on it, you can take steps to see if your symptoms respond to e.g. a gluten-free diet or a pet-free environment or cough syrup, and based on this you can form your own (limited, unsubstantiated) “working diagnosis,” but you cannot “self-diagnose.” I personally suspect that “self-diagnoses” are only good for one thing: scoring cheap point on social media websites. :/

(Addendum: No, you don’t have Ebola. If you’re experiencing flu-like symptoms, please don’t call your doctor and tell her you have Ebola. It’s just the flu, cross my heart. Or HIV.)

(Addendum 2: I’m not a classist or an ableist, but I am a socialist. My #1 reason for disapproving of “self-diagnoses” is because they’re indicative of an oppressive and exploitative capitalist system of government which denies its citizens basic human rights such as free and equal access to healthcare. Don’t send me angry messages about it on tumblr, Americans—rise up, throw off your yoke!)

I’m sorry but no? This really doesn’t cover it?

Like your whole argument is that “go to the doctor and get treated”

So what do you expect people to do when they already tried that?

You have this totally backwards from my experience at least.

Because you see this is how it works usually for me.
1) present with symptom
2) go to doctor, be told I am fine
3) continue to progressively get worse, doctor ignores
4) years later diagnosed with something then, now irreversibly sicker

in fact here is a fun list of my illnesses by onset, self dx time, and doctor dx time

1) erythromelagia: started by age 6, complained of exact diagnostic criteria for 14 years, diagnosed at age 20.
2) hyper mobility: started causing noticeable issues around age 15, diagnosed at age 16, self diagnosed at age 20, informed of diagnosis (they didn’t tell me!) at age 23
3) polycystic ovarian syndrome: started complaining of month long periods and horrible pain starting at age 13, diagnosed only after I passed out and was sent to the ER at age 17
4) gastroparesis: started to get noticeably bad by age 18, again, literally complained “I don’t think my intestines move food”, diagnosed age 23
5) sensory processing disorder: somehow managed to stay undiagnosed until age 22 and I don’t think I can even communicate how obvious my symptoms are
6) I had to drop out of both high school and college and only last year did doctors decide to test me for a having an intellectual disability (I have one, but they won’t tell me which because that is just a symptom of)
8) mitochondrial disease: the overarching diagnosis that is probably the most important one. officially diagnosed at age 23. Unofficially diagnosed by a social worker who was in NO WAY qualified to make that call, who possibly saved me because I would have never known where to look otherwise.

Basically what I am saying is.

I have no self diagnoses currently. But every single (correctly) diagnosed illness I have I spent months or even years fighting doctors JUST TO TEST ME. Because sometimes the doctors WON’T DIAGNOSE YOU. You can’t just say get tested because they won’t do it.

Also how exactly are the people who aren’t officially diagnosed “limiting available treatment options”? If you don’t have a diagnosis your “treatment” options are pretty much limited to over the counter drugs, certain therapy groups, stuff like yoga and acupuncture etc. Like any -limited- treatments usually have very strict rules to actually get them. You usually not only have to convince the provider but also the insurance that you are ~worthy~ of being helped.

So don’t you dare tell me the person who self diagnosed with mito and decided to treat themselves (the whole medicine cocktail is OTC. No DX required) is the one “limiting available treatment options” when I have spent my whole life having doctors deny me aid on the basis I couldn’t possibly be right about how I feel and must have been a liar.

Money is not the only thing limiting treatment. The doctors are. We ask for help and they don’t fucking listen. Doctors might be more qualified but when they are putting out the same “I want to go home” effort level as the average walmart employee they lose to google in accuracy. A brain is no good if you refuse to use it.