
Sick but Not Sick - Hooke
http://www.nybooks.com/articles/2017/02/09/sick-but-not-sick/
======
cesarbs
_That listening is no longer valued in today’s medicine. The patient’s
“history” was once the centerpiece of his medical record, his story written in
narrative form. With current electronic templates, information is fragmented
into chunks designed to meet so-called quality metrics and maximize revenue
from insurers. The patient’s story has been reduced to telegraphed key words
that trigger prefigured algorithms, which generate pop-ups on the computer
screen for further testing or generic therapies._

This finally explains why I find medical care in the US so different than what
I had in my birth country (Brazil).

My US experience so far (multiple times): go to the doctor and have 15-20
minutes tops to talk to them (and most of that time is taken by a nurse and
then waiting), describe symptoms and general observations I've made about them
(I listen a lot to my body). With almost no discussion or explanation, I'm
quickly diagnosed with something that almost always sounds bogus to me and I'm
prescribed some medicine with no explanation of what it does.

Back in Brazil: go to the doctor and have 30-45 minutes booked. No nurse.
Explain symptoms. Doctor asks further questions. I answer and offer general
observations. Doctor writes down everything. Doctor appears to _think_ about
it. Doctor offers a few possible explanations as to what is going on and what
is the course of action from then on. Asks what I think about it. If I'm
prescribed something, I receive a full explanation of what the medicine does,
and if I'm OK with taking it.

Another major difference I've observed is that doctors in the US tend to
attempt to treat things starting from the least concerning ailment. I guess
that's why there are so many stories of cancer patients going to doctor after
doctor who treat them for minor things, only for a cancer diagnostic to be
made when the disease has progressed a lot further. Back in Brazil, the
doctors I went to would usually go a completely different route: "it's
probably <insert minor/treatable problem here>", but let's rule out the
sinister stuff first [like cancer]."

I love 99% of my life in America when compared to Brazil, and have no plans to
go back. But going to the doctor here is definitely a subpar experience
compared to what I had there.

~~~
noshbrinken
I've had the exact same experience with American doctors. What is that? These
people are supposed to be scientific thinkers. They've had years of biology.
But I've never met a doctor who applies the scientific method, or cares to.
They are a fundamentally uncurious bunch.

~~~
abrookewood
I suspect it's economic. The faster they can reach a diagnosis, the more
patients they can see, the more money they make. It certainly pays to shop
around in order to find a doctor that you are comfortable with and then stick
with them for life.

------
timothycrosley
I often feel like a lot of problems diagnosed as "psychosomatic" illnesses are
caused by bad nutrition or even lack of sun. As an example: A lot of people I
know recently got sick after living in Seattle for a few years and it ended up
being that at least a portion of the cause was severe Vitamin D deficiency.
Kind of obvious, but also something that most doctors don't seem to check.
When you look up the symptoms of various vitamin deficiencies they have wide
spread and hard to pinpoint symptoms - including random neuropathy. I feel
like it might be wise to for doctors to suggest to patients they see a
nutritionist or to check their vitamin levels if the only diagnosis is
"psychosomatic". At the very least the person might end up generally healthier
after the experience.

~~~
pmoriarty
From another post of mine on the link between depression and nutrition:

 _" I'd like to encourage anyone feeling depressed to take a good, hard look
at their diet and to consider the possibility that they lack some essential
nutrients.

I'm not saying that a poor diet or lack of nutrients will necessarily be the
only or even the main cause of depression, but these factors could have an
impact (sometimes a profound impact) on the severity or frequency of
depression.

For most of my life I've had a pretty poor diet, and while I knew diet could
affect one's mood, I really didn't realize how profound an effect it could
have until poor health recently forced me to make drastic changes in my diet
and to consider and study the potential effects of diet on mental and physical
health.

What I learned was that many, many nutrient deficiencies could have very
severe consequences on one's mental (not to mention physical) health --
including depression, dementia, and even death. Symptoms of a nutrient
deficiency are not always obvious, and some of them take a long time to
manifest -- so long that they kind of sneak up on you and you could almost
feel like what you're experiencing is "normal" or just the way you are (ie.
depressed, just because you have a negative outlook on life).

Once I improved my diet and started taking supplements for essential nutrients
which my diet still lacked, I felt so much better, and have had much more
energy than I'm used to, don't need as much sleep, and my mood and motivation
have dramatically improved.

I now firmly believe that many people who suffer mental issues, including
depression, may be malnourished or nutritionally deficient in some way. Taking
one's diet seriously, reading up on it, and improving it could really change
your life."_

~~~
magic_beans
I couldn't agree more! I have always been prone to severe depressive episodes,
at a frequency of around once a week. It got really debilitating and was
destroying my quality of life.

I noticed my depression seemed to correlate with my poor digestive health --
chronic constipation and frequent food poisoning. Once I started supplementing
probiotics and eating a small amount of kimchi or kraut every day, my
depressive episode frequency reduced to only once every few months (and my
digestive symptoms disappeared).

There's a strong link between your gut and your brain.

This is anecdotal, but changing my diet changed my life for the better.

------
pmoriarty
_" They are medical disorders like no others," O’Sullivan writes. "They obey
no rules. They can affect any part of the body…. Almost any symptom we can
imagine can become real when we are in distress."_

This description reminds me of Lyme disease, which is known in medicine as
"the great imitator" for its ability to present symptoms of so many other
diseases, and therefore quite often be misdiagnosed as something else.

------
gwbas1c
I went to my doctor a decade ago for sleeping problems. He didn't take me
seriously. It wasn't until a random chance orthodontics evaluation that I
learned I had sleep apnea.

That was exactly what I wanted my doctor to diagnose. If he had asked the
basic questions about sleep apnea, (which I didn't know about,) then I would
have been treated much sooner.

~~~
markc
Seconded on checking for sleep apnea. I'd wake up every night after approx. 4
hours with severe sweating, palpitations, tingling and numbness in hands and
feet, acid taste in mouth, disorientation.

I was tested for everything under the sun. EKG, stress test, echocardiogram,
blood workup, blood sugar monitoring (diabetes?), Holter monitor, xrays, .. on
and on. They showed nothing. Several of the doctors tried to gently broach the
idea of "stress" perhaps being the cause. But as far as I can tell I'm
mentally healthy and a low stress guy.

I went through years of doing my own "research". I suspected everything from
heart valve infection, to kidney disease, to lyme, sleep apnea, to some exotic
virus. 8 years of nightly misery and soaked sheets.

I suggested apnea to the doctors several times but it was waved off because
I'm thin.

I even had an ENT specialist put a camera down my nose looking for something
"structural". Nothing.

And yet, after getting a CPAP my symptoms have all but disappeared. WTF? I
felt my doctors were caring and competent. How did they blow this so badly?

------
TheOneTrueKyle
I have had a pain in my left side for over 4 years now. Its a mix of sharp
from my shoulder to my wrist as well as a dulling pain when things calm down.
I think it is related to budging disk issues, but who knows because doctors
don't do anything. Every doctor has given me some vague explanation and threw
medicine my way. I got a medication that is used to treat epilepsy based on a
vague diagnosis.

Over the past 4 years I have gone insane. I have to essentially be my own
doctor because no one is willing to help me. Like the guy in the article, I
too have freaked out thinking it was cancer and probably spread very far.

I gave up on figuring it out. I absolutely despise doctors with a passion, so
much so that I would gladly accept cancer and death into my life than have to
deal with doctors. However, before death, I demand that med school gives me an
MD since I have to do everything myself anyways.

~~~
nickcoury
If you think it may be along the lines of the article and don't have a
resource, I'd recommend Dr. Sarno's A Divided Mind. I had two bouts of knife-
jabbing back pain (couldn't walk down a hall without holding the wall) twice,
a year apart. While I think the way Dr. Sarno approaches the subject has too
much hand waiving, approaching it through the psychosomatic lens gave me
better results than anything else I tried, and I haven't had a recurrence for
the last few years.

Had another friend with similar back issues who was told it was his disks from
some 'top' doctors and he had similar results as me.

~~~
TheOneTrueKyle
Awesome, I will check it out. Thanks!

------
davidgerard
The other thing is: medicine assumes you are a white male. If you are not,
you're some sort of freak they don't know what to do with. A lot of "it's all
in your head" illnesses are strongly typed female. It's a serious problem.

~~~
9q
Do you have any citation for that? I'm pretty sure doctors are trained to look
after different races and both genders. Looking after women's specific biology
is its own entire field.

~~~
nickcoury
It's a real thing. Freakonomics talked about it in one of their recent
podcasts. Basically, clinical trials often exclude or under sample women for a
number of reasons including the confounding factors of menstrual cycles,
pregnancy complications, etc. This has received increasing attention lately
and is getting better, but a ton of the current scientific wisdom is based on
underrepresentative samples.

[http://freakonomics.com/podcast/bad-medicine-part-2-drug-
tri...](http://freakonomics.com/podcast/bad-medicine-part-2-drug-trials-and-
tribulations/)

~~~
9q
I can understand it for drug trials. If men are more "homogeneous" and don't
create additional parameters with which you have to consider, then for
trialing it would make sense.

Race wouldn't really play a part here I don't think unless a medicine happened
to effect a race differently (e.g. African people often have sickle-cell
anemia, so you do have to consider race sometimes as well).

But the user above actually said something differently, in that people are
treated differently. Like I said, doctors are trained to treat everybody
regardless of race/ gender. Clinical trials based on variables of
participants, and the general treatment of individuals is completely
different.

~~~
davidgerard
I'm talking about how it works in practice. Ask someone in one of the targeted
groups what it's like with getting their problems taken seriously.

