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Two examples about the stupidity of the doctors


HayInNeedleStack

4,329 views

Both examples were originally posted on another forum, where I discuss a topic of my initiated.

Celiac.com Sponsor (A13):
1. Are doctors able to perform a proper differential diagnosis? 

An example about the incompetence of human brain would be medicine. Did you know that the average time that goes for diagnosing Sjogren's Syndrome (an autoimmune disease most often prevalent in middle aged women) is 7 years!? Those poor women suffer years with dry eyes, mouth, and tiredness, but because the symptoms are vague the patient often doesn't notice them, because she thinks they are normal (she has got used to them) and only goes to doctor when more severe symptoms begin. OK, this erroring is not that bad, because it can be really hard noticing a gradual change in sth that you see every day (in this case yourself).

What's really frustrating though, is when you go to your GP, mention her your "dry eyes", "dry mouth" and "constant fatigue", and then the GP says you have depression. Her mind is biased toward picking one symptom (fatigue) which's some causes she can remember, and chooses the most common of them. Probably she'll do the basic blood test to exclude the other causes she can recall, and of course they all come back negative, because she didn't add "ANA" to the list. Or she did add it, and ANA comes back negative, and the doctor concludes the patient doesn't have Sjogren's Syndrome. Wrong! Statistically only 2/3 of Sjogren's patients have positive ANA. What she should do is refer the patient to rheumatologist, who would perform the tear measure test.

Now, I am not a doctor, neither a med student, but when adding those three symptoms in the symptom list of Open Original Shared Link, it gives you all possible causes, tests performed for confirming a hypothesised cause, and everything else I need to know. This would be an example of stupid computer database performing better than a doctor. I truelly can speak from my heart here, because I've experienced it over and over again. Doctors should admit the errors of their mind, and take an advantage from the existence of such web programs: start using them as your aid to perform a proper differential diagnosis! People suffer due to their constant errors. 

2. Another example of the stupidity of doctors

I just asked a web question from an endocrinologist. The purpose of this was to get an advice on my still undiagnosed disease. The question included all my symptom list and all the laboratory blood tests I have performed on myself within the last 12 months, which by now has piled itself up into a 3 page long Word document.

Now, the tests show that I have 7/8 times high androgen hormone levels (testosterone, estradiol and SHBG), and 2/2 times elevated renin-angiotensin hormones (renin and aldosterone), which regulate the blood pressure by affecting blood potassium density. However, I did mention in my question that my blood pressure has always been okay, also (as I naturally had predicted) my potassium levels.

Now, the doctor gave me an answer that was very academic and scientifically true in overall, which is a good thing. She said that 7/8 time elevated androgen levels definitely show a pattern, and for some reason something undeterminable (from simply seeing my test results) causes them to be elevated. However, they can't cause my symptoms. Which basing on the scientific research done in past is also true.

She also noted that 2/2 consequently tested elevated renin-aldosterone is not enough to say it wouldn't be a random spike, caused by the combination of pre-existing genetic feature of mine + this feature reacting to environmental changes. If I waited, there is a handgraspable chance those two hormones would subside. Especially because my blood pressure and potassium are and have always been normal.

Nor is there scientifically any relation between those two hormone groups (angiotensins and androgens). One being elevated can't cause the other jumping over the borderline.

All correct. Statistically she would make a good doctor.

But not in my case. What she didn't consider was the probability of {me having strong and long symptom list, lasting already for seven year} AND {me having two groups of elevated hormones} being/not-being related to each other. The probability of them not-being related would be near to zero. Thus, whatever science says about my test results, one would have to conclude that "I am statistically a rare case". Science is made by observing a large group of people, and conclusions usually made out of correlations, not from individual cases. Thus I say it is much more probable that I have a rare or cleverly-hidden disease, rather than "I am a healthy person who has nothing to worry about", which was the statement the doctor concluded her answer with.

I will not let myself be affected by her judgement, and continue my search for the real answer. 

.......

Hope these two posts give you courage to keep going. Always second guess what people tell you. 

2 Comments


Recommended Comments

Cary

I feel your pain.

I was undiagnosed Celiac for decades because even when a doctor finally said hey, you kind of sound like you could have Celiac, because I have constipation, we didn't test for that.  I really needed my doctor to know that even a Celiac can have constipation.  In my case my colon is too long and therefore has extra twists and it doesn't work right. 

I was always afraid to give my whole list of complaints to a doctor because they say that if you have more than 3 complaints, you are just looking for attention.  Actually it tends to mean you have something complex like an autoimmune disease.  One that causes absorptive problems causes malnutrition.  When you have malnutrition, you have lots of strange symptoms including the skin (so why aren't most dermatologists involved in getting lab tests and making an actual diagnosis?!) or doing a skin biopsy?  A correctly obtained skin biopsy could have diagnoses my DH and therefore my Celiac disease back in 1990.  Didn't happen, even though I specifically suggested a biopsy, although I didn't know what we were looking for. 

It is the rare doc who takes an interest.  It's not like I tried to go to the ER, like many people do for involved and chronic problems. 

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HayInNeedleStack
Quote

I was always afraid to give my whole list of complaints to a doctor because they say that if you have more than 3 complaints, you are just looking for attention. 

I've done that mistake too, but for other reasons. First because I've noticed that some specialists really aren't interested in symptoms that don't fall into the category of diseases they are used to dealing with (hence "specialists"). Second because I hadn't noticed the symptoms or thought they weren't important.
All wrong. It's like in doctor House - you have a list of symptoms, and only certain diseases can cause them. The more symptoms you have, the more accurate the diagnosis will be. Now my strategy for specialists is:

1. first introduce the symptoms related to his/her speciality, in order to catch her attention and justify my visit to her, so that later I won't hear "why are you wasting my time?"
2. then hand over the full symptom list (written on paper), briefly pointing them out
3. any ideas? what tests?
4. if she says some tests not neccesary that I really think are, I insist on performing them
5. if she still denies, I offer paying for myself
6. if still denies, I find other methods

I hate it when doctors are like "I know it all, don't argue!", although my internet research proves their logic wrong.

Quote

In my case my colon is too long and therefore has extra twists and it doesn't work right. 

Actually this is something I've been pondering over myself lately, because I was born with constipation, back then doctors thought it was curious. Later in life I develop severe problems beginning with digestion. And I have noticed I have peculiar body shape (narrow ribcage and a bit widened hips), pictures prove I've had the shape from the birth. The probability of having this body shape is sth like 1/100 or even rarer. I notice my little brother also has this shape, bad hearing, also red-green colorblindness (coincidently also 1% of males) and greater than average flexibility, all just like me. But not the other (adult) brother, who has exhibited none of my symptoms; nor two teenage sisters. Everything has to be connected. 

My new theory: my mother has two X chromosomes, one of them mutated. The mutated one causes all the symptoms, and the daltonism happens to reside in the same chromosome. Me and my little brother got the mutated one, the other brother got the healthy one. Sisters and mother aren't affected, because two X chromosomes cancel each other out (simiar to Daltonism, see its genetics).

Now, what does this X chromosome do? It gives me this peculiar body shape, and because my intestines are located in the abdomen, its ratio with the other organs is also out of normal, meaning I have congenital long bowel, causing the constipation. When 14 years old, I hit the growth spurt, and the internal growth inbalance continued in even further levels. Theories: longening of bowel causes its twisting, twisting allows bacteria to inhabit those areas, namely what we call SIBO; SIBO causes leaky gut, leaky gut all my other symptoms.

I'm first visiting cardiologist to settle some of my other ideas, then I'm going to propose this idea to the senior GI who wasn't very unfriendly towards me, and offered even doing some radiology. Perhaps they could do one of those 3D CT scans of my bowel, showing any twists.

The theory only holds if my little brother also starts having the systemic symptoms; but I'm gonna assume he will, and rather try to solve it before he does.

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