Sick but Not Sick | Hacker News Reader

Sick but Not Sick

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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.

Doctors are human though, and different practices have different processes. Some are absolutely the way you describe. Maybe most, I don't know (my experience is limited there).

Personally when I moved to the US, I had one experience like what you describe, at MGH (best hospital in the world! blah blah blah).

I said screw that, went to a local practice (though still a big one, not an independent) instead. My experience over 3 different doctors (my main one and some specialists) closely match your second one. Been happy since then.

The one exception has been GI doctors. Since everyone in the US has digestion related issues because of the crap they eat, GIs are overloaded and ends up following a near assembly line process with patients. That sucks.

Weird... I don't know anyone with digestion disorders. Well, I know a couple of people who came from India with treatable H.pylori, but that's about it for the last 20 years including friends, family, and co-workers. Maybe it's a different part of the country.

I've definitely had bad doctors and you have to treat them like any professional (Lawyer, Architect, Engineer) who may have very limited time, but certainly they aren't all bad.

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.

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.

Wow, that's the complete opposite of my own experiences with American healthcare. Doctors here always seem to want to do the "yeah it's probably just a headache but let's get an MRI just in case it's cancer" thing. Maybe it's because my insurance covers it, and I tell them that up front so they won't try to save me money by limiting the tests they order?

For an annual fee somewhere between $500 and $1500 you can sign up for concierge primary care via a network like MDVip.com. I signed up my mother last year when she encountered some health issues and didn't feel like her primary care doctor had time to work with her and formulate an appropriate treatment plan. No fault of his - I found out later that he has a panel of almost 3,000 patients. Her new MD has less than 500 patients and will spend an hour per visit with her, is reachable via cell phone nearly 24/7, and will often check in pro-actively to see how she is doing. The difference is night and day, much more comparable to the experience you describe in Brazil. And for less than $1000/year I consider it an absolute bargain.

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.

> 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.

But vitamin deficiency is a relatively simple test, and often done in northern climates. Both my wife and I got one done as a standard blood screen by our doctor; my wife was much more deficient^ than I was, and was told to take a fairly-high vitamin D supplement for awhile. (I was just told to go outside more often.)

^one of the few times I get to say that

> and often done in northern climates.

In the US you often have to ask for it because the Vitamin D test is expensive and not done as a matter of course.

Weird, maybe the symptoms made it more obvious to our doctor that we had a D deficiency.

This was my experience: I felt sick after living in Seattle for about 2 years. Went to a few clinics / then primary care and was told essentially that it was in my head: couldn't find any medical causes said it may be anxiety. I actually started to believe them even though I've never had any sort of tendency to question my own health and have always been a markedly relaxed person even in stressful situations. I dropped it, but eventually, I got a UTI (unrelated) and went to zoomcare for that. They asked about my medical history and based on it they recommended the screening. It turned out my levels were extremely low even though I was already taking 1400 IU of Vitamin D a day on my own as a preventive measure after moving here. A dose of antibiotics and 50000 IU a week + 4000 IU a day for a few months and both problems are now resolved.

Anecdotally, I live in Seattle and my GP has always done a Vitamin D test as part of my standard physical exactly because it's such a common problem up here.

Most of the people on HN probably have Vitamin D deficiency - even living in the mostly sunny bay area if you don't get 30min of daily sun exposure in a t-shirt and shorts you're probably lower than the recommended ng/ml especially if you have darker skin.

This is one of the reasons cow's milk is Vitamin D enriched. Most people don't otherwise receive enough sun exposure to synthesize it.

I think that started as a way to prevent rickets in children. For adults the amount of vitamin D you get from enriched milk is not concentrated enough to supplement for inadequate sunlight (even if you drank a glass a day which most adults don't).

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."

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.

What all do you take?

> I often feel like a lot of problems diagnosed as "psychosomatic" illnesses are caused by bad nutrition or even lack of sun.

Or lack of physical activity, or being overweight. Actually, a lot of people are likely overweight, but malnourished because they eat so many empty calories.

"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.

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.

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?

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.

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.

Awesome, I will check it out. Thanks!

I would recommend reading John Sarno's books, which might help.

edit I see the comment below me also recommended Sarno's books :)

It took ten years to get a doctor to take me serious about some crippling pain I experience.

Still undergoing diagnosis, but MS, fibromyalgia and lyme disease are on the list of likely possibilities.

But, now they can try various treatments for nerve damage, and my pain isn't making me feel utterly insane.

I may be in a wheelchair before I get diagnosed, but simply the knowledge that there is a group of people out there who can understand me takes a heck of a lot off my shoulders.

I would absolutely keep trying.

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.

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.

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...

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.

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.

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