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Comment by thenerdhead | Hacker News Reader

I went to a cardiologist in 2021 and told them I am concerned that I have lingering health issues due to a covid infection months earlier prior to vaccines being available to the public. Heart pain, unexpected palpitations, racing heart rate, etc. Was previously training for a marathon.

That cardiologist told me that covid has no effect on the cardiovascular system and the heart cannot feel pain and discharged me to a PCP after running a handful of tests to rule out anything (Echo, EKG, labs, etc)

Now here we are in 2023, I have had long covid for almost 3 years and cardiologists are now admitting they are wrong. This article is pretty telling on the dismissive behavior and the truth catching up to them.

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>>cardiologists are now admitting they are wrong.

Not a surprise - almost everything initially said about covid was wrong; maybe next time people saying things should be so absolutely definitive about things they clear don't know enough about (yet). I would rather doctors hedged their advice/proclamations a bit, then to be definitive when they shouldn't be.

The ridiculous truth is that we got zealous COVID absolutists as an counteraction to Donald Trump. It was purely a political phenomena.

The "it's just a cold" crowd was also a political reaction and they didn't come out look any better.

For me it wasnt even a cold, i had no symptomps whatsoever

> I would rather doctors hedged their advice/proclamations a bit, then to be definitive when they shouldn't be.

Then we'd be complaining that they're telling us two wholely different opinions.

Medicine, like science, is based on available data. I have no problem with them admitting they were wrong based on new data.

agreed - but not only did they know they didn't have all the information - so they were in effect making a guess based on the limited information they had - but they also took the extra step of discrediting anyone that held a different opinion.

That is not 'science'.

Ok, so lets take this the other way.

The doctor says "Yep, Covid fucked you over"... What changes?

That doctor is not handing you out a candy bag of medicine to see what fixes your issues. Your "was training" is still going to be that "was". Now after some large number of people like you start showing up for the same issue, then some smaller portion of them get direct diagnosis (either post death, or during some other surgery), the doctors won't know what to do as a means of treatment. It's likely it will be years longer till we have effective means of treating long covid symptoms.

I suspect GP would find the subjective difference between "go home, it's all in your head" and "you aren't crazy, but I don't know how to help you" to be meaningful.

A lot changes.

1. I would feel taken seriously.

2. I would still be seeing them to check-up on my health.

3. I would be discussing the budding literature to try promising things (i.e. atorvastatin, AT1RB, etc) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9520195/

4. Other patients who are young and healthy are also validated (i.e. we are seeing more of you)

5. etc

The problem with western medicine today is that if you cannot be treated, they want you out of the system. The system is starting to get much better at adapting to these novel health challenges though. I suppose that will happen when there's 65 million across the world with these issues!

The system is already overloaded by an aging population and a shortage of practitioners. There is no capacity to schedule extra office visits for the sake of making patients feel that they are validated and being taken seriously. That may seem cruel, but that is our reality. It's only going to get worse as the demographic situation continues to deteriorate.

There's absolutely a shortage, but what about recent innovations or acceptance of things like e-visits, 24/7 clinics, and even AI-assistance for clerical work taking more load off of practitioners?

For example, I'm looking at my HCP's app right now and can schedule a call with my doctors as early as next week for an e-visit. For an in-person visit, it's closer to a month. But they have absolutely been taking my extra office visits due to my condition.

Telehealth visits and expanded clinic hours make obtaining certain types of care more convenient for patients. They do nothing to address practitioner productivity and workload. It's still one practitioner working directly with one patient.

AI might eventually reduce charting workload slightly. A few vendors have launched new products in that space but they haven't had much impact yet. In the ideal case they might allow for an average doctor to squeeze in a couple more short encounters per day.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540911/ Suggests both pros and cons depending on if the facility is at capacity already or not.

It would unlock insurance money for treating the root cause.

Long COVID's effects are so random and personalized that many people have to throw the kitchen sink at it until they find a solution that works for them.

What insurance money is being locked? If a patient has severe symptoms then insurers will pay claims that meet medical necessity criteria for symptomatic treatment regardless of whether the patient has been formally diagnosed with "long COVID" or whatever.

To be fair, this is something built into the average humanity. If we have learned something from young, it takes very much to change this belief. It can be anything from what is the best programming language to politics, religion or whatever. For discussions with the opposite belief, it easily goes into - "He has been brainwashed" - land. It's very hard to convince someone that they have been wrong their whole life, especially if there has been loads of studies supporting that case.

> Now here we are in 2023, I have had long covid for almost 3 years and cardiologists are now admitting they are wrong. This article is pretty telling on the dismissive behavior and the truth catching up to them.

I think this is being too demanding of doctors. Their opinion changed because the science changed. Discovery and understanding simply takes time. Practicing doctors aren't scientists, they aren't charged with the responsibility for discovering new disorders and treating them correctly on a per-patient basis. Their job is simply to understand the best available consensus about disorders and treat their patients accordingly. And... it sounds like your doctor did exactly that.

And it surely sucks terribly that the understanding was wrong. But that's not really the fault of your doctor. No one could have treated you better at the time except via dumb luck. It's OK to accuse them of being an asshole about it, but not really about being "wrong" so much.

If being taken seriously is too demanding, then I will continue to do so.

My story I hope shows this exact sentiment mentioned in this article:

> “It’s important to acknowledge that these patients are suffering,” Anagnostopoulos says. “Many of them are young and unaccustomed to being sick or held back in any way from what they want to do. They often feel they haven’t been taken seriously. And what they want to know is that the doctor sitting with them is developing a plan for improvement.”

I think I agree with you there. But being unsympathetic and being wrong are two different states, and it's important to distinguish the two. The doctor did the "right" thing according to the understanding of the time, they were just a jerk about it. And that's being a bad doctor, but it's not delivering "incorrect" treatment.

It's basically a converse take to the "You're not wrong, you're just an asshole" meme.

Cardiologists aren't exactly known for their bedside-manner. Also I did present these reputable journals this article alluded to:

> As the COVID-19 pandemic was getting underway in early 2020, doctors in Wuhan, China, began to report that many patients hospitalized with the disease had cardiac injuries. Heart attacks were frequent, especially in patients with underlying risk factors, and there were numerous cases of myocarditis, which occurs when the heart’s muscle layers become inflamed. Roughly a quarter of patients with severe COVID-19 had elevated blood levels of troponin, a protein marker for cardiac damage.

Still was dismissive of covid having any effect on cardiovascular. But you can only learn so much in 60 minutes over 3 months right?

Again, that's misstating the science. No one could "learn" about cardiovascular effects of covid in 2021 because there was simply no consensus understanding.

"Doctors report many patients [...]" framing is true of all sorts of nonsense, all the time (including about covid! Hydroxychloroquine was being boosted by the same kind of anecdotal evidence). That's... just not how medicine works. How do you know which anecdotes are nonsense and which are correct? You do the science. And they did. But not in time for a lot of people, and yes, that's awful.

This is what they call "patient-led" nowadays. It isn't misstating.

I can understand their skepticism, but these professionals should always be open to new data and should at the very least make a note of it in your records so the retrospective analyses can be done. Do you know if any of your symptoms got recorded?

American doctors are trained to dogmatically accept medical treatments uncritically. The dogma is called the "standard of care" and the entire medical, billing, and legal system will work against you if you deviate from it. They will only change their ways when they are told to do so from higher up.

"Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead"

And yes, what you state is exactly what the doctor should do. Otherwise you're taking all the testing and experience of all the other doctors that have already worked on this issue and tossed it out the window. When an individual patient shows anonymous behavior your document everything you can for future investigation. You don't get to play research laboratory on your patients.

Doctors aren't mechanics. They are the engineers. Nurses are the mechanics.

Engineers run it by QA before pushing it to prod.

Oh, you wish. You frigging wish.

That lasts until someone who is the CTO's buddy gets a hair and decides to get exec override, then pushes to prod, deleting the company financials.

And the medical equivalent of QA is generally a very awe inspiring strain of nurse.

> "Airplane mechanic decides service manual incorrect, custom fix leads to 200 dead"

All airplanes of the identical model have an identical manual.

No two humans respond the same to complex (or often, even simple) health conditions/situations.

Just because we don't have enough docs doesn't mean custom solutions are the enemy.

Now, if we had an unlimited number of doctors this wouldn't be near the problem (why we have a limited number of doctors is a different question). If a huge portion of the US population wasn't old relative to the part of the population that is young, this wouldn't be near the problem. If a massive portion of the US population wasn't... um... massive, well then this wouldn't as much of a problem.

But the country we are left with has too few doctors, too many old people, and too many unhealthy people. We can argue until we're blue on why that is the case, but that does nothing to change that your doctor has about 5 minutes with you and an entire waiting room full of patients today, tomorrow, and the everyday after that to the point they are turning patients away in most places.

Custom solutions aren't the enemy, but in situations where an applicable evidence-based medicine protocol exists it would be malpractice to deviate from that without a damn good reason. Those treatment protocols produce good results for average patients (i.e. most of us).

Nonsense. That is not how American doctors are trained. Have your ever actually talked to a medical school professor, or an attending physician in a teaching hospital?

In recent years the medical profession has been shifting from being mostly an art to mostly a science. Clinicians are supposed to follow evidence-based medicine protocols rather than making things up as they go along because those produce better outcomes on average. They should only deviate from those protocols if the patient has some sort of contraindication, experiences serious side effects, or fails to respond. Unfortunately we still lack clear protocols for many conditions including post-viral syndrome.

http://dx.doi.org/10.1136/bmjebm-2023-112311

Yes, there are several doctors in my family. They are great at treating acute problems and absolutely clueless about managing chronic health conditions unless there is a drug for it.

The majority of chronic health conditions are the result of lifestyle choices. Those are largely outside the scope of medicine, and it is unreasonable to expect solutions from doctors. They have some drugs that can ameliorate symptoms in severe cases but those mostly don't address root causes. Patients might get better results from a personal trainer, dietician, therapist, or social worker.

now that COVID has a few years to run we have new data for scientist to discover it's effect.

back then no one knew anything about COVID. it's not like the doctor was hiding the truth. people are expecting them to be all-knowing is just being unrealistic. did you expect him to just pull out a magical pill from his back pocket to fix everything.

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