The Case for Hypochondria | Hacker News Reader

The Case for Hypochondria

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The rate of misdiagnosis in the medical field is genuinely frightening. Its not uncommon for chronically ill people to need 20 to hundreds of appointments to get a diagnosis for the disease they clearly have. Worse I think is all the "hysteria" and "hypochondria" misdiagnoses along the way that extend how long it takes to get the diagnosis and causes denial of treatment by other clinicians.

This stuff has a very long history and I can't tell they exist or not what I can say is that doctors miss the real condition all the time. For chronic illness the actual appointment to diagnosis rate is less than 5%, that is an enormous waste of everyones time and money and its made worse by the fact it comes along with a bad diagnosis that dismisses the patient. This is a much bigger problem than investigating someone who thinks they are ill and actually isn't.

That is medical misinformation. It is totally irrational for most people to be frightened of misdiagnosis. The diagnostic criteria for the most common chronic diseases such as diabetes, heart failure, obesity, arthritis, hearing loss, and depression are reliable and straightforward. Misdiagnosis is only a serious concern for more rare conditions or atypical presentations.

Occasional misdiagnoses do occur but let's not contribute to hypochondria by exaggerating the problem.

The medical field has identified around 10,000 "rare diseases" that are estimated to affect fewer than 200,000 Americans each. On net, 10% of the population is estimated to be afflicted by a rare disease, with rampant underdiagnosis. It's less "misdiagnosis" in that the picture is being identified clearly as something other than what it is, but that few doctors have the entire picture, recognize it as one unified syndrome, and recall the title of that syndrome. The mind also loses most information that goes unused, so a disorder that a doctor only encounters once per every thousand years of practice would need a great deal of luck to be recognized, especially by someone who isn't just out of med school. Even something seen only every hundred years or every ten years of practice is usually missed. There are lots of zebras out there that we're calling horses.

https://www.ncbi.nlm.nih.gov/books/NBK56184/

> To have a rare disease is often to have a condition that goes undiagnosed for years while concerned physicians who have never seen the condition before may offer one diagnosis and then search for another when new or advancing symptoms belie the original diagnosis. Once accurately diagnosed, patients with rare conditions may be treated by physicians who have little evidence or guidance to help them—physicians who may experience the frustration imagined by the patient quoted above. Particularly when a condition is extremely rare, patients and families frequently have to travel long distances to consult with the few experts who have experience in treating and studying their rare diseases; patients and their families may even relocate to make access easier. Although the features of specific rare diseases can differ in myriad ways, the effects on life and functioning are often similar and are emotionally and financially devastating for the affected individuals and their families. Patients and family members may feel isolated and alone as they face the challenges of finding helpful information, learning a new medical language, and generally charting their way in a daunting new world.

> As described in Chapter 1, some rare conditions are extremely rare, found in only a few or a few dozen people. Others occur in hundreds, thousands, or as many as 200,000 people in the United States. Many are genetic in origin or have a genetic component. Others arise from exposure to infections or toxins, from faulty immune responses, or occasionally from adverse responses to therapeutic interventions for other conditions. For many rare conditions, the causes are frustratingly elusive.

> Although people may think of a rare disease as something that happens to someone else, rare diseases can afflict anyone, at any age. They can be acute or chronic. Many are debilitating and present an ongoing risk of death. Some are inevitably fatal given current medical options. Approved therapies are available to treat several hundred of these conditions, but most currently have no therapy that cures or modifies the disease itself.

One of the things that various AI expert systems would be great at compared to human doctors, is recognizing the possibility of rare diseases based on abundant data (or full body scans, for that matter) and proactively testing hypotheses. But... well... the only people with access to that data, the insurance companies, are strongly incentivized not to.

Not in that list, really prevalent (approximately 10% of women!), and frequently mis- or not-diagnosed: Endometriosis.

The question we should be asking isn't how easy is it to diagnose the X most common conditions. The question should be given someone goes to a doctor, what's the probability that their condition will be misdiagnosed. And further, what is the lifetime probability that someone will be misdiagnosed? Those numbers, I would wager, are significantly higher than the probability that anyone will be misdiagnosed with diabeetes, heart failure, obesity, arthritis, or hearing loss.

Note, however, I've left off depression. This one actually does get missed somewhat frequently by primary physicians, in part because they don't think to screen for it, or they don't screen for it at an initial visit. Primary specialists tend to look for physical conditions first before moving on to mental health conditions. Continuing with the article's theme about women being misdiagnosed frequently, here's an abstract that notes depression in female patients being misdiagnosed at a rate of 30-50%: https://www.sciencedirect.com/science/article/abs/pii/S02779....

So lets keep in mind that reliability of diagnosis of individual conditions, however common they may be, may have relatively little to do with the overall lifetime probability that someone will be misdiagnosed at some point in their life.

Edit: Some even more shocking mental health misdiagnosis statistics from https://justpoint.com/knowledge-base/everything-you-need-to-...

    > Misdiagnosis rates for major depressive disorders were at 65.9%, 
    > Misdiagnosis for Bipolar disorders was at 92.7 percent, 
    Panic disorder was at 85.8%, generalized anxiety disorder was 71.0 percent, and 
    > Social anxiety disorder was 97.8%.

Given that 1 out of 2 people will develop a diagnosable mental health issue in their lifetime according to https://hms.harvard.edu/news/half-worlds-population-will-exp... this suggests a fairly high rate of overall misdiagnosis.

Depression screening is a standard HEDIS clinical quality measure. Some providers might still skip it and some patients slip through the cracks, but overall most patients who are receiving regular ongoing care do get occasionally screened for depression.

Of course patients who never go in for an appointment don't get screened. There's certainly a gap with people who lack access to care or don't seek it out.

This comment is so out of touch with the reality of the current medical system that I think you're in for a very rude awakening in the future. I can go on for days about all the stories I have to counteract this point. Even doctors themselves are feeling the diagnostic failure issues. My child's pediatrician went into the ER and said "I think my appendix is about to burst". They thought she was just being dramatic and they wanted to discharge her with Zofran and tell her to come back if it got worse. After hours of arguing with the ER doctors and nurses, she convinced them to do imaging. Boom, appendix about to burst. She had an operation 2 hours later.

I'm actually pretty in touch with the reality of the current medical system. There are plenty of stories about diagnostic failures but what does the data show? The vast majority of patients are diagnosed correctly, or misdiagnosed in a way that doesn't significantly impact outcomes.

I think a lot of technologists have unrealistic expectations about healthcare. The reality is that most of it is still more art than science, and outcomes vary based on the skills of individuals in ways that usually impossible to accurately quantify. Anything involving biology is kind of squishy and uncertain. We should try to improve the state of clinical practice but we should also be thankful for how much it has already improved just within our lifetimes.

What data? Are you proposing that there is a reliable way to adjudicate ongoing misdiagnoses for rare or even common illnesses?

It seems like the only ones likely to have any investigation are those that end up being lethal in the short term.

I’ve had issues like this even for non chronic things. Repeated visits for an obvious or easy to determine diagnosis. Unwillingness to order certain blood tests or whatever. Sometimes it is because of health insurance rules, which is itself a problem since it forces me to deal with the big inconvenience and expense of several visits, but other times it is because of the doctor’s arbitrary unwillingness.

One example that frustrated me recently was an issue that could be one of three things, each of which could be confirmed via a DNA test. The hospital’s genetics department was unwilling to just go ahead with the three different tests (they aren’t tested as part of a general DNA screen so it is three specific tests instead) even though it’s the fastest and least invasive way to diagnose. Instead they want an invasive surgical confirmation first, which is far more expensive and time consuming. They shared no good reason when I challenged this - just vague patronizing language that reiterated their unwillingness.

In general I’m frustrated that patients can’t just order the exact tests they want. Why do I need a doctor’s consent for various blood draws? I should be able to pick from a menu and pay for whatever I want.

Clinical reference labs allow patients to order many tests themselves through services like LabCorp onDemand or Questhealth. You can even order your own full genome sequence through specialized services such as Nebula Genomics. Those services might not be reimbursed by your health plan but they are available if you want them.

This is why you do medical tourism to a country like Thailand. Deregulated medical systems mean that you can meet doctors who are empowered to give you any drug you want for like, 1 USD.

If you get travelers sickness (half caused by gut bacteria), you can quickly get low level antibiotics which purges this and gets you back on your feet in a day or two. Not in America though, because the risk of “superbugs” means that everyone should struggle and be in serious avoidable pain.

Imagine how livid I was when I got peptic ulcers and my idiot doctor tried to tell me it was “stress”. I reported his ass to my states medical board and linked the other examples of doctors through history who understood the bacterial cause of ulcers and were sanctioned by their own medical boards for using the right treatment before it was accepted.

Don’t just accept their bullshit. Fight them every step of the way when you know you’re right.

The stupid thing is that the worry about antibiotic overprescription is only applied to humans in the US. Whereas cows are given them with basically no oversight, making the resistance situation worse for humans.

https://education.nationalgeographic.org/resource/antibiotic...

(EU regulation restricts this somewhat, I think)

MRSA isn't bullshit. Your argument makes no sense.

Front line antibiotics don’t cause serious risk of the development of MRSA. I’m talking amoxicillin man!

> In general I’m frustrated that patients can’t just order the exact tests they want.

See jasonhealth.com (for Quest) or ownyourlabs.com (for Labcorp). The main issue is that you can't bill insurance without a provider's order, but a lot of tests are cheaper when not billed through insurance.

I did this recently and it was so easy I felt like I was cheating somehow.

For me to get an appointment with and talk to my doctor to try to convince them to prescribe the test cost, not including the actual draw and test results themselves, would have cost several times more than paying for the test myself.

It's similar to how getting my prescription with insurance costs three times more than getting it from Cost Plus Drugs.

Recently I learned of "fail first" or "step therapy" policies by insurance carriers.

This means that you've gotta try ineffective therapies that are cheaper until you can go for the real thing.

Policies and procedures also tie the hands of diagnostics. Dr. House and Doc Martin could never exist in real life because a gauntlet must be run.

Call your ISP for tech support when you know the diagnosis. They'll read you the script, and you'd better follow the script or you won't get a resolution. Restart your devices, destroy some data, bypass your firewall and AV, reset all your preferences to default.

Why should your PCP be any different?

So often doctors go over your problems without care. Sometimes you describes 4 hard and 1 secondary symptoms you endured for a few months (to avoid being a trigger-happy hypocondriac). They'll only hear the harmless one and talk about it as if that was your main reason behind the visit. Pretty odd.

Drunk man searching for keys under street light

Expertise doesn't equal immunity from the streetlight effect.

Maybe. There's also statistical fatigue. After hearing 100s of people complain about similar stuff you jump to conclusion. Or it may be disdain too.

This resonates with me so much .. I used to think I was helping doctors by giving them as much detail as possible. It'd list all my symptoms, even minor ones, thinking that it's giving them the complete set of information to work from, that the more data I gave them about what's going on, the better their diagnosis would be, the better they'd be able to help me.

In reality every time I did this they universally started to look at me odd, as if I was making things up, or overly anxious, or a hypochondriac, etc. When you list minor symptoms they interpret it as "this guy is complaining about nothing issues" and they start to write you off.

It's infuriating when you give them all the symptoms, both major and minor, and they respond afterwards by just latching onto the minor issues and waving them away and telling me not to worry about it.

There's just such a barrier to communication in such circumstances.

I have a friend with Ehlers–Danlos syndrome, a rare connective-tissue disorder. She spent years in pain while the doctors told her there was nothing wrong, and that it was just in her head.

It was only seven years ago that they updated diagnostic criteria to include her form of EDS, and it took her a few more years after that to get diagnosed. Now the doctors take her very seriously.

Considering how common some version of this story is, and based on my own experiences as a patient, I'm convinced that most doctors lack a functional understanding of conditional probability. They seem to think that if the prevalence of a disease in the general population (or a specific patient's age/sex/racial demographic) is low, then the probability of someone presenting with signs and symptoms of the disease having it is also low, even if there's no better explanation.

Could there be a hundred people claiming fantastical symptoms for every one person who's genuine?

the reality is that very close to 100% of people have ambiguous, transient pain and a large number of them come to the doctor asking for something to be done (and also mix in people who are fishing for pain meds, really are hypochondriacs, or really are experiencing something psychogenic)

in a practical sense, it's extremely difficult to narrow that down to a specific actionable cause, and the system is simply not set up to deal with this stuff

>They seem to think that if the prevalence of a disease in the general population (or a specific patient's age/sex/racial demographic) is low, then the probability of someone presenting with signs and symptoms of the disease having it is also low

Because it is also actually low. Signs and symptoms aren't exclusive to specific diseases.

I've also noticed that they give you a very short time to explain your problem and symptoms and it's not unusual for them to be misinterpreted and/or misunderstood. Sometimes assumptions are made and the doctor gets an incorrect picture in their head. It's a bit like when someone gets interviewed for a newspaper story and when the story is published it has obvious errors.

I often read up on stuff to learn the differential diagnoses, and the unique symptom combinations that could indicate a specific diagnosis.

Then I go tell a physician, and they throw it all out the window.

The pharmacist has a sign posted reading, "Your Google Search Won't Outweigh My Degrees and Qualifications." Don't try to be well-informed on biomedicine, because the knowledge will be counterproductive.

Kinda funny but I have the opposite experience. I go see my doc and tell them what I researched and often they tell me they are impressed, sometimes they tell me they think my conclusion is probably wrong and tell me why they disagree. However I am usually searching PubMed or the library at my Uni and not searching Google or YouTube.

Diagnoses are driven by treatments and not by patient health.

I approached my PCP with a genuine complaint in the category of intermittent "medical emergency". The PCP diagnosed an organ and prescribed a targeted medication without even asking me clarifying questions, much less screening or imaging (except to rule out cancer as a cause, because that would've been more profitable.)

Later I returned to the PCP with questions. How did you diagnose this organ pathology without imaging? Even if you imaged it now, you have no baseline image to compare. Did you rule out other causes? Did you even evaluate my experiences, or review the history of incidents that would definitely be germane to the case? I collected a lot of evidence that the diagnosis was wrong, but I eventually hit a brick wall when trying to secure a referral and visit with a specialist.

Nope, it was "take two of these and call me in the morning". Due to the prescription's targeted nature, the next time I reported taking it, the corresponding diagnosis was duly entered in the chart! Post hoc ergo propter hoc???

I've often been glad not to be held to the standards of doctors. How many guesses does it take to figure out why a copy onto the clipboard didn't work? Or why a shift+middle-drag panned instead of rotating?

Most of my troubleshooting doesn't involve million-dollar equipment and hours of travel. If I was forced to troubleshoot the way doctors have to do--with real human pain and weeks between a visit and a lab test and another visit and two fights with insurance in between, and trying to get by with the $400 test instead of the $4000 test and an xray instead of an exploratory surgery.

Tech people do complicated troubleshooting all the time. Sometimes we test an idea in 15 minutes to rule something out. Sometimes we just comment out 20 lines of code and recompile. Sometimes we have to schedule a system failover and make sure we've got a really good plan to justify the cost and inconvenience. But mostly it's 3 or 4 or 10 guesses to narrow things down and we don't sweat it.

I mean, if a mouse isn't moving, reboot. If it still doesn't move, swap in a different mouse. If it still isn't working check the driver...

If a doctor tried that approach with your hip...

I'm in this fun loop right now where I have an undiagnosed small mass. Everyone agrees the best way to diagnose it would be with an MRI, but no one knows which kind of specialist to have order the MRI or what kind of MRI to order...because we don't know what kind of mass it is. We know it's near a few things, like my lungs and my spine, but it's apparently not connected to them ("apparently" in reference to the cardiac MRI that picked it up incidentally). Everyone who has seen it (original MRI reader, cardiologist) is defaulting to "PCP should order," but PCP doesn't know what to order.

Meanwhile I'm sitting here saying it's asymptomatic, very small, "nonaggressive," "well-circumscribed," and incidentally discovered. Can't we just ignore it? We'd never have known about it but for this unrelated test.

But no. Everyone agrees we oughtn't do that. They just don't know what we ought to do instead.

The system is hard enough to navigate when you're brighter than average and generally well. I have no idea how they expect people to do it when they're ill and have no idea how to read medical research.

ETA: I'm only in this situation subsequent to my sister's idiopathic sudden cardiac death. Medical examiner's report recommended any siblings or offspring be screened for heritable cardiac channelopathies. She had been called a hypochondriac from the time she was 12 until she died suddenly at 29 and surprised the heck out of everybody.

I'm sorry for your loss. May her memory be a blessing.

Thank you. It really has been.

Please just go get a scan somewhere honest (not the US). You might want scans at regular intervals to see if it’s stable, growing, etc, discuss with multiple doctors

In your case nobody in the US system wants the liability of saying you can keep it under observation for a while, and insurance doesn’t want to pay for any more scans.

In Japan I got a shoulder MRI for $300 with an appointment available the next day. For $75 more I sat down with the radiologist who showed me the scan and talked me through it.

You can probably get them cheaper in Mexico, just as fast, with similar quality if you do a little searching

US healthcare is literally a scam. At Swedish Cherry Hill a doctor sent me down to the emergency room for a scan which cost me $8000. I got numerous bills from different parties, plus I was trapped in that room for eight hours under vague threats of legal consequences if I left, while they ran up the tab.

I'd happily (well, not happily--my last MRI sucked. But willingly) get one here in the U.S. if anyone could tell me what test to get.

You can't just walk in and ask for "an MRI." MRIs come in categories. A lung MRI is different from a spine MRI is different from a cardiac MRI. But since this random little mass isn't apparently attached to anything, nobody seems to know what type of MRI I should have this time. (They all seem to agree it does not need to be another cardiac one, thankfully. Eighty minutes in that tube being stopped 100 times and told to hold my breath was excruciating.)

Go to a doctor in an honest medical system and they will tell you which MRI to get

Doctors here are hamstrung by liability and insurance

I appreciate the thought, but "Look at a globe, figure out which healthcare systems are honest, and then figure out which doctor will know what to do based on a vague description of "it looks like there's something in my thorax" isn't actually helpful advice.

The point is that which type of MRI to get depends on what the mass is, but what the mass is can apparently only be diagnosed by MRI. That circle doesn't go away because someone doesn't have to deal with my insurance company.

Whatever you're doing isn't working. You can get as many MRIs as you need inexpensively in better medical systems that can be reached with a short plane flight

It's a skill issue

I want to receive as few MRIs as possible, which you might have gathered from my comments.

That is very much the point.

Edited to add: Why are you pitching having to leave my life for up to months as though it's a good thing and not an extreme lifestyle cost that makes it vastly worse as a solution than trying to get a straight answer from someone locally? Uprooting my life for some indeterminate amount of time is not a solution.

I don't know how you've so thoroughly misassessed everything I care about in this situation, but these is the least helpful advice I think I've ever received from anybody.

I think panic attacks can trigger life long hypochondria, especially really traumatic ones.

I also think for a lot of folks (myself included) it's anxiety over healthcare. I get freaked out that something is wrong, but I get more freaked out that the healthcare system won't be able to fix it in time/appropriately/cost effectively way. In the US, a lot of folks have WebMD syndrome because it's cheaper than going to their doctor.

Panic attacks are a health problem. If hypochondria arises out of panic attacks then hypochondria is a health problem as well (that the US healthcare system can also ignore).

> WebMD syndrome

That is absolutely a thing.

I had untreated sleep apnea for years, which presented in two ways: snoring, and something that looked an awful lot like panic attacks. Every doctor I saw kept insisting that everything was fine, everything was healthy, every test came back clean, brain MRIs and epilepsy screening, chest x-rays, and more cardiologist exams than I care to remember. Sleep apnea is super common, but no one thought to look for it because I was thin. At one point, some idiot doctor threw the phrase "Could be MS.." at me. That lingered in the back of my mind for years.

I've worked in hospitals, I know my way around the system, I'm pretty intelligent, and I usually have my shit together. But that whole experience left some scars, and I'm a lot less mentally robust against illness than I used to be.

My son was born _very_ premature, which gave me an intensive crash course on interacting with the medical system. I know two (mildly contradictory) things to be true about that experience: - My son would not be alive and healthy without the incredible care and expertise of his doctors and nurses, along with decades of scientific advancements on the treatment of prematurity. - Around the margins, his health outcomes would have been worse if my wife and I had simply trusted that same expertise without ever questioning decisions and pushing back on recommendations.

It’s so hard to have a nuanced conversation about the blind spots of our medical system. People want to force you into one of two buckets: you believe in medicine, or you believe in mysticism.

But there _are_ blind spots, because doctors are human and fallible, they aren’t generally experts in every subject that is useful for medical diagnosis (usually including statistics and often including genetics), and it isn’t just doctors themselves that are involved but a whole medical bureaucracy whose incentives don’t always align with optimal patient outcomes.

What I observe is people who build a whole identity around illness and disability, I wonder sometimes if my town (or maybe myself) attracts this sort of person. This kind of person probably has a real disease to some extent but sure as hell they are depressed by the DSM definition and have given up on life. Contrast that to other people, like a blind student who climbed a 12,000 foot mountain with the search and rescue club and was in the group that reached the summit fastest.

I have noticed that sometime in the last decade the message of "it's okay to have a disability" has kind of morphed into, "it's okay to not be a functioning member of society because of your disability".

Maybe it's just because I'm getting older, but I do see less resilience in college students today versus the start of my career.

It seems like a much broader issue than disability. A general approach to difficulty switched from attempting to overcome, to acknowledging and accepting. That being said, this sounds suspiciously similar to what every older generation would say about every younger generation. I wonder if there's any data to back this up.

We have lots of data showing that the kids really are different than their parents in a way never before seen in history

You know it’s bad when public health officials are like: “hmm, the kids aren’t having sex, drinking, doing drugs (except vaping), or commuting vandelism/violence - but their mental health has cratered and they just sit at home playing fortnight or watching cat videos.

Seriously, public health officials think that the kids are literally too good, too prude, and too tuned out. Maybe they’re right…

>You know it’s bad when public health officials are like: “hmm, the kids aren’t having sex, drinking, doing drugs (except vaping), or commuting vandelism/violence - but their mental health has cratered and they just sit at home playing fortnight or watching cat videos.

Well most of those things are expensive. Bedrotting to cat videos is free. Smoking has always been an issue.

I'd also point to a lack of third spaces for everyone from kids to elderly folks. Parents wait in a line of cars to drop their kids off at school, then pick them up in the same line of cars to drive them home.

Maybe replacing malls and diners with social media and fortnite isn't the best thing we could be doing.

Asia is full of third places and has even worse issues than we do with these social problems. They are not the solution

What exactly is "wrong" with not being a "functioning member of society" because of a disability?

I don't think it's a problem when it's real, but for a long time, people with a variety of disabilities have been fighting to find ways they can contribute to society, not using it as an excuse not to have to.

I don't have data on it, but there does feel like there's been a cultural shift to seeking exemption from the expectation that one contributes to society to the extent that one is able.

I think what the strivers have noticed is that there's an inherent dignity that accompanies contributing what you can. People have compassion for people who are making efforts despite their challenges.

But if there's a cultural shift away from expecting an attempt to contribute, people who would otherwise want to get the message that it's not worth it to provide them the support they would need. People would rather just subsidize their lives entirely than take on the more complicated task of helping them work, even when the work does end up net-positive after the help.

Let me shoot back with another cultural phenomenon: there's been article upon article over the past couple of years especially about how young people just plain have it rougher than their parents did starting out. Suppose this is true. Isn't it then individually rational to pursue some strategy other than working as hard as possible?

No. And no, to the extent that I can't even figure out how you're thinking it might be?

"It's harder now, so I shouldn't try" is a complete non sequitur.

If it's harder now, we have to work harder, not less hard.

The only way I can come up with to try to bring rationality into your framing requires adding some other premise, like, "and I don't want the things previous generations had," but that's a giant change to the way you framed it.

Sense of meaning, dignity, etc.

So you're saying you think the lives of people who are not "functioning members of society" are not meaningful? I guess I need to ask you to define your terms then, because I disagree based on what I'd define "meaningful" and "functioning member of society" to mean in this context.

I think this has a few big social components to it.

- If you find yourself surrounded by a community that’s unsupportive, making disability a part of your identity could be an attempt to extract what you need from a community that’s unwilling to give it

- If you develop unrealistic standards or expectations, you might reason that “I can’t do $hard_thing is $self_diagnosis” and not “actually, everyone struggles to do $hard_thing”

> I wonder sometimes if my town (or maybe myself) attracts this sort of person

No. They're everywhere now. It's not just you.

Over time it has grown to feel like people without some kind of serious health issue are the odd ones out.

Right now, ~50% of the US is actively taking at least one prescription drug.

Roughly 73% are overweight or obese, a bit more than 50% have a "chronic condition" although that is often something controllable like hypertension or high cholesterol.

The doctors thought I was a hypochondriac. But the truth was they could not yet see what was wrong with me.

Medical malpractice and / or mysoginy is another common problem unfortunately; afflctions like endometriosis take years to be taken seriously and diagnosed, instead of brushed away.

Yes! Women are constantly ignored on conditions like this. It’s infuriating when you realize all the recurring regular gynecology visits are basically performative.

Once you are diagnosed with a psychiatric issue, everything else you complain to the doctor about is hypochondria. As a male with a serious mood disorder, I feel your pain.

I think a lot of hypochondria & WebMD hysteria is a poor grasp of probabilities.

You can also blame this on WebMD type sites not really calling out probabilities and even in many cases, doctors poorly communicating probabilities.

A lot of people for example might google "my eye hurts" and leap to "possible nerve issue that can lead to blindness!!" when really the probability cascade is something like (I AM MAKING THESE UP) - 40% sinuses, 40% stye, 10% some sort of abrasion, 5% some sort of infection, and sub-1% probabilities of a bunch of stuff that's actually serious.

Different people experience different maladies at different frequencies as well. The first time you experience something can be scary, even if its a routine non-threatening issue with easy treatment.

Probabilities are not physical laws of the universe. A disease having a 0.01% chance in no way is an actual measure of you having or not. If everyone with cancer wrote it off based on probability many more people would go undiagnosed

I guess I should go further and suggest actually exposing conditional probabilities & flow charts, which is essentially how a lot of GPs triage diagnosis.

If you have these additional symptoms, it rules out X, and conditional probabilities are now Z..

If you tried a warm compress/ibuprofen then it rules out Y and your now looking at these probabilities.

Etc.

Right now you google stuff and get a WebMD page with a list of stuff varying from "its nothing" to "its cancer" without a lot of color ..

I agree with this. I do google symptoms myself on occasion, but I always try to make sure that what I see online reflects what's actually going on with me to the extent possible, and I don't freak out when one of the possibilities ends up being, for instance, "cancer," because it's relatively unlikely that I have cancer, and a lot of things end up being symptoms of various cancers.

Here's a great example: I had some weird calluses show up on the very sides of my thumb pads and on the ventral aspect of the first phalangeal joint of each of my index fingers. The areas in which these calluses showed up was exactly mirrored on each hand. I googled a little bit and found a whole lot of nothing, but I did find a reference to calluses and esophageal cancer. I clearly do not have esophageal cancer. I have none of the symptoms so it's just a wildly improbable diagnosis.

What I did was show them to a friend of mine who's a family med doctor. I have an agreement with all my doctor friends that I will not ask them personal medical questions beyond "hey, is this weird and should I go see someone about it?" My friend said those were extremely weird places to have calluses given that they weren't the result of some activity I'd recently taken up using my hands (and they weren't).

Eventually, I ended up in a dermatologist's office where they diagnosed hyperkeratotic hand eczema. Given I have asthma, allergies, and I've had eczema issues in the past, that's a reasonable diagnosis.

And when I went to a doctor, I didn't say "I googled this and these things came up." I said "I have these weird calluses. I don't know why they're there because I haven't started any new activities recently so I'm a little concerned about them."

Hypochondria snuck up on me (it's called "Somatic Symptom Disorder" now and it's not something that gets openly diagnosed, in my experience.)

I had definitely flawed perceptions of physicians and health care in general. I viewed a doctor as someone who'd help you heal if you came in with a complaint. Someone who dispensed good advice and recommendations to be your best, like "here's a good diet. get some rest. take 3 days off work to heal. let me list some exercises you can do." And I was primed to trust physicians and eager to follow good orders like that.

After decades of pursuing health and wellness and attempting to partner with my PCP and specialists I've realized that they do none of that. A PCP's primary purpose, for me, seems to be screening and testing until they find disorders that match up with the medications in their formulary and the treatments on the insurance company's list.

I've had multiple encounters where the doc/nurse reassures me that I'm really healthy and there's no issue to treat and I'm making mountains out of molehills. It became frustrating to me because I felt so bad! And perhaps I did have burgeoning issues that were simply untreatable. Physicians are so often frustrated by patients who've abused and neglected their health, then we show up on their doorstep as a hopeless, lost cause wanting to be rescued.

By analogy, I learned that I shouldn't bug my landlady about maintenance unless something is truly broken and inoperable. The fix often causes more problems -- "the cure is worse than the disease", right?

I'm trying to reorient my relationship to HCPs. I need to relate health complaints to my ability to work or function in daily life, rather than minor annoyances or concerns about future problems. It doesn't pay to complain needlessly, and the medications are just a penalty for seeking help.

Hypochondria may be reinforced by physicians' tendency to find treatments and prescribe stuff. You get rewarded with attention and tasks to do, even if they don't heal you. "Oh doc I feel really bad!" Well let's run some tests and go fishing! Daddy needs a new Ferrari! (My dentist literally drove one. My current dentist adorns his office walls with his own photography of exotic travel destinations instead.)

is there an inverse for hypochondria? and if so, how would it manifest?

https://m.youtube.com/watch?v=Ni0YfrSK570

quite funny and probably true

Or The Black Knight https://www.youtube.com/watch?v=ZmInkxbvlCs

My parents were both medical doctors. They were extremely concerned about hypochondria, to the point where it was essentially forbidden to think about one’s own body or health. To me that’s just as unhealthy as hypochondria, and in a sense its inverse.

never diagnose family members, i had a friend who had a mild attack of polio as a kid, and his medic dad just ignored all the first symptoms because he couldn't accept them.

Is such a prohibition really that unhealthy? If the only result of a consideration of one's own health is anxiety inducing and lacks a path to a diagnosis and treatment, is it worth doing? Of course, _some_ self-awareness is crucial. But, it's a balance between concern and obsession. The former is sensible and the latter borders on the pathological. If something is identifiably wrong, there is something to be done; and that's reassuring, at least. If nothing is identifiably wrong, but only suspected, reasonably or otherwise, there's nothing to be done apart from testing the next hypothesis; that's a very anxious time for the sufferer. At some point, one must decide to stop worrying about what's not known and can't be addressed.

As I see it now that whole line of reasoning is unhealthy. The normal / healthy state of affairs is that your body’s constantly telling your brain “I feel good!”. If you can’t feel that it’s a sign of dissociation.

I'm a little ambivalent on this. Sometimes the body says "I don't feel good!". My body says that quite a bit. Mostly (just math) it's something transient. A sore throat is probably not cancer; a bruise is probably not that either. If there's something to be done, then do it. But, don't perseverate about what it could be. You'll drive yourself mad.

Telling someone not to worry about something, particularly from a position of authority, when the chances are (again, math) that it's not serious seems a charity. "You're fine, and come back in a week/month if it persists. But, stop worrying." is a fair approach. Nobody wants someone else to worry unnecessarily. It's pointless.

Yeah, the kind of people who refuse to see a doctor no matter what; they will often shit on people that are sick / disabled and attribute it to a lack of willpower. Think (grand) parent that humblebrags about their 20 mile snowstorm uphill trek to school.

But there's a variant of that too that will beg you not to call an ambulance for them (either if they're conscious or via a bracelet or something); in the US especially, medical costs are a deterrent for seeking help. It's a thing in my more socialist country (Netherlands) too, where there's a €385 a year deductible for many health care expenses; a lot of people cannot afford that, and they can barely or not at all afford the €144 a month for the base insurance (average rate, although people get a rated government subsidy if their income is below a certain threshold)

Here's a few interesting encounters.

Once I went for a dip in the spa and when I finished, decided to stretch out on the bare ground for a bit to relax (chaise lounges were removed during pandemic)

A neighbor lady immediately began shouting at me and started to call 911. I had to prove I wasn't dead!

Another time I sort of freaked out at a bus stop and laid face down on the sidewalk. Drew a huge crowd and while I refused to move, the ambulance rolled up. There was nothing physically wrong with me but I was transported anyway, just to peel me off the public right of way.

I visited a little pharmacy-based clinic for blood-pressure monitoring and they took two cuff measurements. The charge nurse said it's alarmingly high and she's required to call 911. So I found myself fending off a cadre of EMTs who insisted I needed to go; they put me on the phone with the ER doc who read me the entire risk profile before the ambulance could be dismissed. I calmly informed them that their presence was extremely distressing to me and the sooner they went away, the sooner my diastolic would readjust.

I've walked into Urgent Care and ER 3 times with cardiovascular concerns and each time the outcome was like, "yeah, keep an eye on that for us."

They can bill the patient for hijinks too. Perhaps the general public has hypochondria and enjoys transforming minor annoyances into state-sponsored crises.

If you're conscious and stable, an EMT visit will culminate with the $64,000 Question: "Do You Want to Go to the Hospital?" Well you're the pros; is it necessary or not? Call my insurance or something.

"if farmers would only come by the hospital anytime before it's almost too late, we'd be able to help them with mild treatments" — the doctor in my family

Theoretically it would be called 'hyperchondria' (akin to hypoglycemia and hyperglycaemia) which would be very confusing, and doesn't appear to be used, apart from an Urban Dictionary entry.

> The persistent conviction that one is never or is likely to never become ill, often involving blatant disregard for emergent symptoms, and persisting despite reassurance and medical evidence to the contrary.

https://www.urbandictionary.com/define.php?term=hyperchondri...

That definition sort of just sounds like how most people treat their health lol

I'm not sure what it's called, but I think my father has it! A bit over a decade ago, he had severe abdomen pain but refused to go to the doctor because he had similar symptoms a few times over the past several years and it was never successfully diagnosed before it went away after a day or two. This time though, he got to the point where he was severely jaundiced, and my mother forced him to go to the hospital. It turned out that this time, his gall bladder was filled with stones to the point where it was about to start overflowing into his liver, so they removed it and he's been fine ever since.

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