
The perils of being your own doctor - Hooke
https://www.theguardian.com/news/2016/aug/04/perils-being-your-own-doctor-als
======
tominous
This could just as easily be about the perils of knowing how to look up
symptoms on the web.

If you're reading Hacker News you're probably used to reading fast,
integrating new knowledge into a mental model and applying it all to solve the
problem at hand. You often have to be an "instant expert" in everything. So
the temptation is to be an instant expert in your own (self-diagnosed)
condition.

Here's my advice after spending way too much time with doctors over the last
year (since my wife was diagnosed with cancer).

1\. Knowledge: A doctor will have far more general medical knowledge and
experience than you. Your GP or specialist should be the bedrock of any
diagnosis or treatment. However, it is absolutely possible to read the
literature and get a more current or targeted understanding of _some_ of the
nuances of your particular disease. Don't be afraid to discuss them with your
doctor, even seek second and third opinions, but don't just rely on your own
judgement instead of theirs.

2\. Motivation: Doctors are conservative: they need to avoid liability and
maintain good relationships with their peers. As a patient you will have a
different risk/benefit calculation. In some cases you will need to push your
doctor to perform that specialised test instead of just offering reassurance,
or to try that experimental treatment instead of the "reasonable futility" of
standard care.

3\. Symptoms: You know best your own symptoms, but you may not have the
objectivity or experience to understand them and compare them to other people.
You should document them as much as possible, maybe even graph them or make
charts, to make this information accessible to your doctor. I've found that a
simple timeline containing symptoms, measurements and interventions can be
incredibly useful in tracking a condition.

~~~
Shinkei
Wow. I am a physician and this is perfect.

1\. You just need to read about the Dunning-Kruger effect. Enough said.
[https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect](https://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect)

2\. Each physician has their own motivations for this one... some liability,
some internal moral code, but some just understand that science is about being
objective. That being said, prevailing wisdom is that medicine is as much an
art as it is a science.

3\. Yes, but be careful. Try to establish a relationship with your provider
before pulling out the graphs and spreadsheets.

~~~
icantdrive55
Let's not forget good insurance, and large amounts of money.

I hate to be that guy, but I have been to too many unneeded office visits over
my years, or have been told flat out Dr. Whatever charges $350/hr. Hour? It's
always just a short visit. As, I've gotten older, I don't want to spend to
much time with them. The shorter the office visit the better.

Yea, and I know, your physician lives are so terrible. You had to pay $400,000
for school. You had to get through that residency in which you where hazed, by
other Doctors. You have to listen to people whine, and complain--in many cases
because they are sick, and in pain. (Get ready for the "I don't treat pain"
Doctor", and the FDA is on their side. I don't feel like debating this one
either. Too tired.)

Yea, you guessed right, I'm no fan of the American Doctor. I don't like the
system? Or, I just don't like American Doctors, with that ego. An ego that
seems undeserved after getting into med school, in so, so many cases.

On another note, I'm shocked at how seemingly little advances medicine has
made in the last 30 years. Advances that help the patients. Not theoretical
advances that look nice on paper.

I smile, and kiss their ass, but there's no love, nor even much respect
anymore.

Signed,

Alotofpatients

(I'm not comming back to this post. I will add this, I used to think older
doctors were better. I think I was really wrong. In my life, I have met one
doctor who appeared to get better with age. He had some unusual medical issues
throughout his life that appeared to make him care?)

~~~
cmdrfred
I take home about 32k a year. I also have asthma. I will have it until I die.
With the insurance my company offers my medicine is 150 dollars a month on top
of the $175 a month fee. To get the prescription I need to pay another $75
dollars every 6 months to the doctor (At the end, They dident even bother with
the pretense of busting out the stethoscope anymore I'd come in sit down and
they would write the script) I buy the same medicine from India for $30
without a prescription online. It's a scam pure and simple. The choice for me
was either drop the insurance and buy a house or rent and pay for insurance
that covers little and costs a lot.

~~~
no1youknowz
I too have asthma.

When I was in the US, I needed a certain type of inhaler. It cost $150. I kid
you not, I was furious! I had to pay knowing full well, the same inhaler cost
£5 in the UK. Talk about a serious markup!

Now back in the UK. Before I go back. I will visit my doctor about 5 times and
stock up on them. Bring as many as I can in the UK so that I never run out
again!

~~~
cmdrfred
People claim that they "Spend so much on R and D that they need to be able to
charge these prices". My drug albuterol was in use 100 years ago.

------
mahyarm
There are also the perils of not being your own doctor:
[http://journals.lww.com/neurologynow/Fulltext/2016/12040/Hav...](http://journals.lww.com/neurologynow/Fulltext/2016/12040/Having_His_Say__Spasmodic_dysphonia_rendered.17.aspx)

------
asdfologist
TLDR: a doctor thought he had ALS though he actually had a harmless (and
poorly understood) condition called benign fasciculation disorder. His
extensive medical knowledge made him very paranoid & depressed about actually
having ALS, and it took many medical tests to finally convince himself that
he's perfectly fine.

~~~
lostlogin
>His extensive medical knowledge made him very paranoid & depressed< I'm going
to say that it was the sleep deprivation brought on by having a small child in
the house, the effects of which care be pretty terrible.

------
xlayn
I do always corroborate what my doctor say.

    
    
      -with another doctor
      -as a conclusion from information on the internet.
    

For example I had a kidney stone, I were recommended to get surgery
immediately, I was going to get Shock Wave Lithotripsy... after long weeks of
checking the conclusion was that due to offerings in my country I had to wait
to have the kidney stone lower in order to have it extracted via
Ureteroscopic.

I got this knowledge after at least 10 different appointments.

Luckily for me I found a document by an USA Kidney organization depicting
procedures and satisfaction outcome.

Edit: Here is the study:
[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991578/](http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991578/)

------
kqr
Hoo-ee. I'm not a doctor but I had a bout of serious hypochondria (in my case,
heart related) and I recognise all of this. After many, many tests and doctor
visits they managed to convince me I'm in good health. But that didn't stop my
worries, and my odd behaviour/obsessions that followed.

They referred me to a therapist, which eventually helped a lot.

That said, I still sometimes feel it, but these days I can forget entirely
about it after a minute or two.

~~~
Sander_Marechal
Yes, I have the exact same thing! Four years ago I started out with panic
attacks brought on by stress and sleep deprivation. I was convinced I was
having a heart attack and would drop dead on the spot.

It took some time to fix the root causes, but even after that I didn't quite
recover. Anxiety about possible panic attacks were stressing me out, causing
me to lie awake in bed. Talk about a vicious circle.

Therapy and the book "Hope and help for your nerves" by Claire Weekes helped a
lot. Occasionally it will pop back up but not nearly as bad as it once was.

~~~
stuxnet79
Similar experience but my first panic attack was around 8 years ago. Have
recovered somewhat as of ~2 years ago, but this is due to extensive CBT and
medication. I don't think I will ever completely eliminate the attacks - it's
just a matter of managing them at this point and minimizing the negative
effects they have on my life.

"Hope and help for your nerves" by Claire Weekes is a classic.

That being said I believe mental health is still not diagnosed and treated
well enough by modern health care systems. Took me more than 4 years of
bouncing around from doctor to doctor before I found one who could help me.

------
bllguo
It's funny, I can see how being a doctor amplifies paranoia, since you now
know of all kinds of horrible afflictions that could strike. I can also see
how it reduces worrying since you are a trained medical professional.

~~~
tgokh
The former is extremely common in medical students:

[https://en.wikipedia.org/wiki/Medical_students%27_disease](https://en.wikipedia.org/wiki/Medical_students%27_disease)

------
damla
I'm a highly interested person in medical subjects, and for some reason, I
easily memorize and relate information regarding human body. For example, if
my mother in law complains about her anemia, and her tinnitus 2 years apart,
when I read somewhere that some type of anemia can cause tinnitus 4 years
later, I remember her instantly. This phenomenon of me helped a lot of family
members in different situations, so I don't want to give up searching on
medical issues completely. I developed some rules in years:

1 - Make a quick search if something too common regarding symptoms, or
something seems urgent to see a doctor.

2 - Don't diagnose, if you suspect something specific, I don't tell it to
doctor, nor anyone.

3 - After search if this seems something really small, try some safe home
therapies, otherwise, go to doctor

4 - Following the diagnosis, check it through the internet.

5 - Always check the medications, to understand the doctor's approach,
aggressive or safer, or if medication is just placebo or pain-killers.

6 - Take the madications as prescribed, but combining the information on
internet and impression on doctor, consult a second doctor if you feel
necessary.

7 - If you see the doctor - just in case - not for serious complain, and the
medication seems just for the symptoms not the reason don't use the treatment
and see if something gets worse or better without them.

8- If something serious in hand, always search the internet for further
treatment, whether lifestyle changes, and to see what might we expect. Resist
reading forums, even though you may find really useful information in them,
most of the time people who cannot heal, or had serious side affects on
medications write. So this affects brain statistics on in a wrong way.

9 - If you have a specific disease, foundation-like sites on the specific
disease do provide useful, organized, advanced, and most updated information.

~~~
TeMPOraL
> _or if medication is just placebo or pain-killers_

Doesn't checking that basically immediately defeat the therapy itself? I.e.
placebos work as long as you don't know they're just placebos.

~~~
donutz
> Doesn't checking that basically immediately defeat the therapy itself? I.e.
> placebos work as long as you don't know they're just placebos.

Not necessarily:
[http://www.scientificamerican.com/podcast/episode/placebos-w...](http://www.scientificamerican.com/podcast/episode/placebos-
work-even-when-you-know-10-12-23/)

------
nixy
I was half expecting this to be about Dr. Leonid Rogozov, the Soviet doctor
who performed an appendectomy on himself[1] while stationed in Antarctica in
the early 60's.

    
    
      [1] http://rarehistoricalphotos.com/leonid-rogozov-appendix-1961/

------
junto
I think this kind of thing should be called "paternal shock fatigue syndrome".

Our western culture has a thing about getting babies and toddlers to sleep in
their own beds and rooms from a young age. There are a wealth of self help
books out there that new parents treat like a Bible for getting your babies to
sleep. "Every child can sleep", "no cry sleep solution", "solve your child's
sleep problems"; the list goes on and on. It's an entire micro industry inside
the parenting industry.

After having two children, I've come to the conclusion that it's unnatural to
get babies and toddlers to sleep apart from their parents. They don't like
being alone. Getting out of bed and wandering down the cold hallway in the
middle of the night to try and comfort a crying child, over and over again,
should be telling you that something is wrong. Instead you think, "well John
and Maggie's baby stay sleeps through, so ours should be able to as well.
Let's try and keep them in their bed".

Before you know it, months sleepless nights has you physically and mentally
exhausted. You're still trying to get up every morning to go to work and put
in a full days work. When your child has a nap in the day, your wife gets the
chance to catch up on a bit of sleep too. You accidentally nod off for three
minutes at your desk after lunch, completely and utterly shattered. You come
home, your wife still looks exhausted too, especially if she's breastfeeding,
so you try and help out, changing diapers and helping to feed the baby.
Finally it's bed time for your baby. You stay up until 11 since it's the only
opportunity you and your wife have to doesn't some time together alone. The
cycle repeats.

Finally you start to get ill, and often. Colds and minor ailments. If you're
unlucky you develop worse. In my case I developed Ulcerative Colitis. A
debilitating gastric psychosomatic illness. The first sign was a slight
bleeding when going to the toilet. Within months I was bleeding so badly, I
thought I had bowel cancer. I finally dragged myself to go to the doctor,
petrified of what I might have. An unpleasant experience of a camera being
shoved up my ass confirmed that I had UC.

"What's the cause, and how do we fix it?" I asked the doctor? "Nobody knows
the cause and here's a bunch of medication that will calm everything down" was
the answer. Come back in 4 weeks.

The symptoms did reduce and I'm still dependent on the daily medication, even
now years later.

I've tried to change my diet, reduce my stress, but nothing send to improve
it. It seems I'm a lifer. But I start to think about the "why" question.

The timeline was interesting. It started about a year after my first child was
born. Her sleeping was a nightmare. We insisted on trying to get her to sleep
in her own bed, in a room right next to ours. I was utterly shattered and run
down at this point. I'd had one cold after another. My sinuses were completely
blocked and my GP was convinced I had a bacterial infection in the sinuses
that needed antibiotics. Two weeks after I'd finished the antibiotics, I had
my first bleed. You can read into that what you will.

I believe that my psychosomatic illness was primarily caused by stress and
exhaustion. As a result it was not able to correctly recover from the course
of antibiotics, and the gut got itself out of balance.

That was my experience. I'm sure if we looked we'd find many examples of
parents, especially fathers, who have developed various psychosomatic
illnesses and other ailments after becoming fathers.

My advice to anyone becoming a parent is quite simple. Let the child sleep
next to you, ideally in a co-sleeping bed. Getting up in the middle of the
night and walking anywhere is fatal. Try to make sure that your wife doesn't
have to work (or the father if the wife is working full time). At night decamp
into a different bedroom. It makes absolutely no sense for both parents to be
awake in the middle of the night dealing with the child. One of you needs to
maintain a normal sleep routine if you're working a normal work routine.
Otherwise i can almost guarantee that you're going to get ill.

If like to clarify that I think this can happen to mother or father. But I
think it is often the father's in our western culture that are trying to be
the modern father and work a full days work.

In conclusion, this applies to anyone having a lack of sleep over a long
period of time. We forget how important good sleep hygiene is. For the people
here working extremely long hours on their startups and burning the candle at
both ends, this also applies. Just look at Margaret Thatcher and what years of
4 hours of sleep a night did to her.

~~~
roel_v
Not to dismiss your experience, but saying that your colitis was caused by
your children not sleeping in your bed is a stretch at best.

Also, if you think that you have to stay up until 1am to get some time with
your spouse alone to keep the relationship up, imagine what toll it takes (on
a relationship) to have children in your bed all night every night for years
on end (if you have 2 or three children one or two years apart and your
children (or just one at a time) sleep with you until they're, say, 4, that's
7 years easily. And my 5 year old would sleep in our bed every night if we'd
let her).

Look, I have no interest in rehashing this (for (mostly US/UK, it seems) new
parents) hot topic here, and yes our children sleep with us every now and then
when they're sick or just scared at night; but let's not start claiming that
not sleeping in the same bed as your children will give you all sorts of
chronic illnesses without evidence, however basic. There are millions of
people developing chronic illnesses every year, a lot of them are bound to
develop it while having small children.

~~~
junto
I think you misunderstood what I wrote. I wasn't implying that my children
were the direct cause of my UC, but I am convinced that it played a part in it
due to poor sleep hygiene and being run down.

Such diseases are complex and have potentially multiple factors that bring it
in to play. Sleep deprivation is just one of the potential factors.

~~~
roel_v
No I think I understood, but probably my first sentence was stating your
position overly causal and less nuanced than you actually mean.

Essentially your last paragraph boils down to 'it's better for ones health to
co-sleep because it reduces stress which is a contributing factor to my
disease and others', which is probably true in the most generic sense, but not
in a sense that is actionable or can be directly reduced to co-sleeping in
general. By that I mean, the same can be said of having a co-worker who chews
his food very loudly throughout the day, or living next to a railroad, or any
other of millions of things that can cause stress.

I mean, you are saying that co-sleeping is 'better' (even for small values of
it) for your health because of stress-related reasons, right? (my whole point
hinges on that assumption) Well, my point was that there is no data to even
suggest that, or that it's a _net_ negative after taking everything else into
consideration. It's just an anecdote, one that is easily explained by the law
of large numbers, nothing to draw a normative conclusion from.

Not trying to pick a fight, and I realize that you're not posting a peer
reviewed article.

~~~
nommm-nommm
Not only that but he implied that the doctor's symptoms were caused by
children sleeping their own bed!

If any parent has unexplained symptoms it must be caused by their children
sleeping alone!!

------
smnplk
I just diagnosed myself with diabetes/pre-diabetes. I'm going to invest into
that sugar monitor thingy to check myself.

~~~
mindcrime
One nice thing about diabetes (if such a thing can be said) is exactly that
the blood sugar monitors are available OTC and are fairly cheap. Test strips
are kinda pricey, but if you just need one batch for a few initial tests, it's
not too big a deal.

So yeah, if you're worried, you can test yourself and get a reasonably idea of
whether you have an issue or not. That doesn't mean you shouldn't still go to
a doctor, especially if the readings _are_ high. But if you test yourself 10
times and never get a reading over 100 (just to make up an example) it's
pretty safe to assume you're not diabetic (note: this is not medical advice).
It's a little bit harder to confirm diabetes though, as even a non-diabetic
person can see brief spikes in their blood glucose - in particular after
eating a meal with a high glycemic load. Generally speaking, it's probably
best to test yourself when you've been fasting for a while, perhaps when you
first awaken in the morning.

OTOH, if you get any reading over, say, 200 or so, it's very, very, very
likely that you're diabetic. A non-diabetic person will almost never see a
reading that high, even after chugging a bottle of Coke or something.

The other good thing about diabetes, IF it's type two, is that it is often
treatable without insulin injections and may even be treated with nothing but
diet changes and exercise (eg, weight loss).

Source: am diabetic.

~~~
ars
> and are fairly cheap

There's an even cheaper way, if you are willing.

Taste a drop of your urine. If it's sweet then worry.

In the past this was part of the job description of every Dr. Tasting your own
urine, OK, I guess. But someone else's? Yich.

------
known
I usually verify the types of treatment
[http://effectivehealthcare.ahrq.gov/index.cfm](http://effectivehealthcare.ahrq.gov/index.cfm)

------
wineisfine
The strange thing is, many doctors dont take good care of themselves. They
smoke, they drink, etc.

~~~
kirrent
You mean they're people? In any case, doctors are healthier than the general
population on average across a lot of measures.
[http://www.theatlantic.com/health/archive/2012/08/is-your-
do...](http://www.theatlantic.com/health/archive/2012/08/is-your-doctor-
healthier-than-you/260706/)

~~~
philjohn
Always amused me when my father regailed us with tales of seeing his
cardiologist, who told him in no uncertain terms that smoking is the one thing
he shouldn't slip back into, it's awful for cardiovascular health.

After the appointment he spots said cardiologist in the car park smoking.

As you said, they're just people too.

------
pokemongoaway
This seems like marketing for pharmaceuticals when the fact is that we have
more people being doctored by those with traditional medical credentials than
ever before in history. Anyone with experience in this area knows that medical
processes are designed to avoid litigation more than they are to adhere to the
Hippocratic Oath. Is it really to the point that we're even discouraging
people from even thinking and researching about their own health? Not only
outsourcing their health, but even outsourcing how to think about their
health! This naturally skews the analysis of "health" from one's experience of
it to its adherence to the parameters to a Merck Manual, for example.

