So You Want An Online Diagnosis?

Last week Doctor D sternly rebuked those who wanted him to answer illegal (diagnose-me-over-the-internet) questions.

Several commenters replied it was D's own fault for naming his blog "Ask An MD." I mean seriously, what answers could an MD possibly have worth reading if he can't discuss your bowel problems?

Oh, so THIS is what you wanted?

So "Ask An MD" is running a special this week only:

Doctor D will answer every single diagnosis or treatment question you ask in the comments of this post!

(Very important small-print disclaimer: None of Doctor D's answers will be correct or sensible in any way )

What good are bullshit diagnoses, you may ask?

The Weight of Perfection

One of the greatest stresses in a doctor's life is having to be correct all the time. Of course, we aren't always correct, but people always expect us to be correct. This leads to a lot of stress in a docs life.

The avalanche of questions started early:

When Young D was a Pre-medical student in college people started asking him questions that were totally beyond his abilities. "Hey D, I get this weird feeling in my stomach, but sometimes it isn't there. What is that?"

Ah, to be young and free of the heavy responsibilities of doctoring!

D would just smile, shrug, and say, "Probably either metastatic cancer or gas."

Young D became legendary for his smart-ass diagnoses, and a good time was had by all.

But then Medical School began and the game of diagnosis became one of life and death. A wrong guess could hurt someone—badly. People kept throwing unanswerable questions at him, but the weight of his profession had crushed D's carefree attitude. He began giving evasive responses and advising people see their own doctor.

D has been practicing medicine for a while now. It is heavy stuff to talk to people every day about the ways that their own bodies can cause misery or kill them.

Doctor D actually doesn't like talking about suffering and death. He would rather open your mind and make you smile. So D started this blog answering people's questions about the odd quirks of the medical profession. For D this blog is a lighthearted way to process the hard and nasty stuff he has to see every day at work.

But work found Doctor D in his secret online hide out. He should have expected it—answering questions about doctors brought patients, and patients have questions about diseases they want to ask doctors.

Unfortunately, I can't answer diagnosis or treatment questions, no matter how desperate you are. I have to admit: I don't even want to try. I miss sleep at night over the guesses I make in my real job. Trying to do the same thing on-line would lead poor Doctor D to have a nervous breakdown.

But Doctor D won't abandon you poor folks so desperate for answers. He can't diagnose you but he can offer you the next best thing: Utter Nonsense!

"Nonsense Therapy is all-natural and involves no harsh chemicals!"

Therapeutic Misinformation

Do you doubt the healing power of ridiculous bullshit?

Doctor D learned this lesson as a young doctor. He had been working for months with a patient who was miserable from one of those frustrating mystery illnesses. She was in the office crying and listing her symptoms. Finally Doctor D shrugged and grinned, "All I have left to offer you is racehorse therapy. We take a rifle and put you out of your misery!"

At first Doctor D was petrified. He had let one of his pre-med smartass comments loose on a real person with real suffering! Then the patient smiled—the first smile he’d seen from her in months. Then she laughed, and D laughed with her. They had a good hearty laugh and the patient hugged him as she left the office.

Things were different after that. We talked and laughed a lot. We never found a diagnosis for her, but we ridiculed the disease mercilessly. It made us both feel better.

Nonsensical bullshit from a doctor can have a wonderful therapeutic effect!

Ask any middle-schooler and they will confirm it: The human body is funny! The human body is silly! The human body is gross! The human body is ridiculous! The human body is a low-down Judas that will eventually screw you over then kill you!

The only sensible thing to do is to mock our bodies on a regular basis.

So send Doctor D your symptoms and he shall mock them fiercely! He shall diagnose you with improbable and silly things! He shall loose his inner child to laugh at your bodily functions! He shall suggest ridiculous and painful treatments!

Not a single one of you shall get any useful medical information from Doctor D’s snarky replies... but you still know you want to send D your symptoms!

Therapeutic Misinformation:

Just like Chiropractics!

It feels so good,
you won’t even care that it’s total bullshit!

All questions will be personally answered by the doctor. So send in those aches, tingles, throbs, swellings, and vaginal discharges!

Now, Doctor D is a busy man, and he doesn’t check his email 8 times a day like more dedicated medbloggers. (Grumpy you're embarrassing the rest of us with your annoying dedication!)

Be patient, and the doctor will be in to misinform you and mock your symptoms shortly!

Doctor D Strikes Back!

It's time we make something very, very clear:

This is not a personal medical advice blog!

A lot of people just stumble across the "Ask An MD" name and start firing off questions before they read another word. I realize you regular D Readers are not the offenders but I have to rant at somebody, so Dr. D is going to nip this in the bud right now:

I will NEVER answer diagnosis or treatment questions online!

"Luke, I am NOT your doctor!"

This isn't that I don't love you guys. It just can't happen. I challenge you to find any MD giving personal medical advice to strangers online. Nope it isn't there!

Doctor D put this info on the "Email Dr. D" page but still a majority the letters to Doctor D basically ask: "Here are my symptoms. What should I do?"

Doctor D used to write polite replies explaining that the blog is here to answer general questions about doctors and the medical system, but I really cannot diagnose you... etc.

..but as the popularity and google rank of this blog has grown Doctor D's inbox has become congested with please-treat-me-over-the-Internet emails. Abandoning all bedside manners, Dr D has begun sending snarky rebukes to the worst offenders: "Did you read the f*cking disclaimer!?!"

But that pesky medical compassion keeps D feeling sorry for all these people sending hopeless requests for help to some random medical blog!

Could These Emails Be The Symptom Of A Real Problem?

This deluge of unanswerable questions got Doctor D thinking. These people begging for answers reveal some real issues with the medical system:

1. Sick people are desperate for answers.
2. It is way too hard to get a doctor to talk to you. It costs too much money to get in, and even then the doc is in and out in like 5 minutes!
3. Doctors are terrible at addressing what is really bothering patients.

"Houston, we have a problem."

Unfortunately, turning to some anonymous doc on a blog is not the solution to these problems.

Do you really want to risk getting an answer from an anonymous doc who can't examine you—some dude who may sleep under a bridge and just plays doctor online to meet chicks? Trust me: you don't want to do that!

And Doctor D won't risk his medical license making random guesses over email for people he's never laid eyes on. Giving you a harmful misdiagnosis over the internet would make Dr. D feel terrible, and it could be the blood in the water that sparks a feeding frenzy of lawyers and disciplinary boards.

Perhaps someday doctors will be more accessible, better communicators, and be able to treat you over the Internet, but this just isn't a reality right now.

Now you have to deal with regular screwed-up doctors working in a bizarre healthcare system. Yes, it sucks, but you really don't have many other options.

This is why Doctor D runs this blog: To help you navigate the tricky world of real doctors.

If He Can't Be My Doctor, What Use Is Doctor D?

Well, if you would even consider writing some anonymous blog for help then your doctor-patient relationship is probably on life support.

It may not be your fault (doctors suck at relationships—just ask Lady D), but you will be the one who gets hurt.

Instead of desperately emailing random bloggers on the internet for answers which will likely be wrong, why don't you learn to work on with the doctors you have in your life?

Doctor D volunteers his time as a relationship counselor for your doctor-patient relationships. D isn't going be your doctor (although, he blogs anonymously so, who knows, he might actually be your doctor?), but he just might teach you how to make your own doctor useful!

So respect D's boundaries! ...And send me some questions I can work with!

What do you think?

Currently there is no way to get answers direct from a doctor online. Getting diagnosed by a doctor miles away who can't examine you is a recipe for mistakes, BUT it would be convenient.

Would you be willing to take a risk with an online doctor? Would you forgo the ability to sue if the advice harmed you? Should the standards of doctor-patient relationships change to adopt to the wired world?

By the way, if you ever sent Dr. D a forbidden e-mail now is your chance to grovel and beg for his forgiveness!

The Best of D (Friday Links)

This blog has grown so much recently that Doctor D's big doctor ego deemed we should link to all the fun and informative older posts buried in the archives. So if you will direct your attention to the right side of the screen you will notice AskAnMD's new feature:

Doctor D's Best Answers

Of course, if you've been visiting Doctor D's virtual clinic as long as WarmSocks you've already read it all, but if you are new here you can go check it out for loads of doctor-patient enjoyment.

Yes I realize that it is sort of cheating to count a "best of" page as this week's Friday Links, but D is suffering from an acute case of laziness today. Sorry. I will be back on my game next week.

Are Modern Patients to Blame? (Friday Link)

Doctor D has made his triumphal return from his vacation and is back to working himself to death and blogging.

Today is Friday which means D delivers some exciting links for your weekend reading. Doctor D has an interesting radio piece for you:

National Public Radio did a piece about how educated patients who read about medical care on the internet are costing too much. Doctor D is so relieved! He had been told all along it was doctors who are bankrupting the country. Turns out it's you patients, who all have "medical student syndrome" and think you have every disease you read about. You even made that nice overworked doctor in Virginia cry!

It actually is an interesting use of 8 minutes:

So medical pages like this one are ruining the healthcare system! Too much information and you start demanding tests and treatments you don't need.

Doctor D's theory is that doctor blogs might actually be helpful with this problem. Instead of just giving info on diseases and treatments, medblogs actually give the perspective of healthcare providers. Hopefully patients who read heathcare provider blogs learn not just about diseases and treatments but the mindset of physicians, which includes understanding why over-testing and over-treating is not a wise choice.

Doctor Blogs could save the healthcare system billions! Hopefully the AskAnMD will get a generous government grant to underwrite Doctor D's important work!

So what do you think? Does being an educated, web-savvy patient make you cost the system more? Do you think reading Medblogs make your healthcare cost more or less?

Health Info Online (That Isn't BS)

A question from a reader:

I’d like to know where I can go for trustworthy information on a diagnosis when I haven’t got an appointment in the near future.

Fortunately we live in the Information Age and you are sitting in front of a computer right now with an ocean of information at your fingertips. The “trustworthy” part is what poses a problem.

There is some crazy “medical” information on the web. Some suggestions are obvious quackery, such as saying that goji juice cures every illness known to man. Some erroneous advice may not be as obvious. There is a lot of money in healthcare, and you don't need any scientific evidence to get access to the big dollars—just ask a chiropractor! There are also a lot of well-meaning people who want to share advice that may or may not really work, like your grandma who was sure that a teaspoon of castor oil would cure anything.

You can start with asking your doctor. A specialist may have a specific site they recommend for your condition. For general information Doctor D typically sends his patients in the direction of familydoctor.org and UpToDate for Patients.

Tips for sorting through the medical information on the Internet:

• Print out what you find and take it to your doctor who can often tell you if it is reputable. Doctor D has researched some very interesting topics because his patients brought them in.

• If it sounds too good to be true it probably is. The more conditions a treatment supposedly fixes the more likely it actually works for nothing at all. This is particularly true of nutritional supplements and “natural” medicines, whose claims are almost totally unregulated.

• Remember that every individual is different. Patient forums can be an excellent way to connect with others in the same situation as you, but the experience of someone else with your condition cannot always be applied directly to you.

• Remember the placebo effect is powerful. Unproven treatments often appear to “work” due to the placebo effect combined with the body's natural ability to heal itself. If a treatment has never been tested against a placebo it is hard to say if it really works or not.

• Consider the source of your information. Who is it and what is their motivation for giving you this info? Big pharmaceutical companies often create “educational sites” whose purpose is to interest you in their drug. Any very nicely-designed site that reminds you to "Ask your doctor about ___" probably stands to make money off what your doctor might prescribe.
  

• Keep in mind that big news/entertainment names are selling drama which often isn't the same as trustworthy medical information. Don't trust everything you hear from Oprah!

• Never take advice from anonymous sources! I mean, what sort of doctor would blog without using his real name? (Just joking. But this is one reason Doctor D doesn't give treatment or diagnosis advice on this blog!)