Medical student's apparent celiac disease responded to giardiasis treatment

You need to prove your knowledge to doctors contextually, and even then it's much easier if they are not actively giving you a consultation. Doctors don't respond well to randomly dropping theories on them. If you respond to something by dropping an inappropriate paper for the illness or ask about rare issues when common ones would fit they'll stop listening.

Most of the people a doctor gets either almost can't read or think they have all the diagnosis from "the internet". It's rare to have someone capable, who isn't going to jump to conclusions and just complicate everything, so I get why they discard most of what people tell them.

I actually had a discussion about this with a very experienced gastroenterologist.

They said that doctors love data. Don't come at them with theories or papers. Give them a food diary + symptoms, it helps a LOT more than "I think I have X".

The flip side of this is that doctors aren't infallible, and will often struggle with rare diseases that they don't deal with on a daily basis, or in some cases were never even taught about in medical school (such as recent discoveries).

It's true that doctors have to deal with a constant flurry of "I did my own research and think this bruise I got yesterday might be liver cancer", but sometimes people with legitimately debilitating illneses slip through the cracks and have to aggressively advocate for themselves to get any real testing done, particularly if they have a very "let's wait a few months and see what happens" type doctor who never seems to make any progress on their own.

> but sometimes people with legitimately debilitating illneses slip through the cracks and have to aggressively advocate for themselves to get any real testing done

Sometimes they do, but by definition it's likely not you. It's important to think here that everyone thinks "they are the informed one" or that they are the one that "might have the rare one". Same reason why most people have bought a lottery ticket in their lives or why everyone is of above average intelligence.

I like being active in my medical treatments by doing my own research but I censor a lot of what I say to a doctor, it's usually more to make sure I understand what's going on and that I can double check things.

It is too bad most people don't like all the dull gray truth in your comment. Everybody thinks they are the exception, for good and bad.

On top of that, there are medical schools, not just one. A doctor might be following a [compulsory] guideline from his association / state / institution / college.

A technique I have a lot of success with is asking why <some observation> doesn't change their opinion. It leaves the doctor in a position of expertise and authority, so they're usually happy to spend the time teaching you. Normally I learn a lot about some gap in my medical knowledge, and sometimes the additional reflection changes the doctor's opinion and gives me better outcomes.

Why is it too much to ask for doctors to take sufficient interest in their patients to clock just how sophisticated they are, and react accordingly.

Depends on if their mind is made up. Yeah, I failed the food challenge test because you used the wrong thing! No, you can't use pork in place of ham--the trigger was something that gets added in the process of making it ham.

Kind of. Even when their mind is made up, they're likely to try to answer (since the framing places them on a pedestal). Both you and the doctor will notice anything obviously wrong with the answer. I've met a few young doctors who would dig in their heels (different from explaining why they're right; if they're actually right and teach me why then I think that was an incredibly valuable opportunity), but you ought to, in most parts of the world, be able to fire them and find somebody actually willing to talk to you. Almost all of the time I meet doctors who handle the framework I set out exceptionally.

Your pork/ham comment is interesting. For other toxins/allergens/..., I see doctors very explicitly examining every possible extra ingredient/factor before even deigning to consider that the bulk solid might matter (e.g., most chocolate allergies are actually to soy lecithin or one of the other mixins). I'm surprised anyone would rule out a ham problem just because they tested one kind of pork.

Doctors don't love data: they love a veneer of data on top of a seductive narrative, typically at a conference in Bermuda, after a couple of wine glasses.

> Doctors don't respond well to randomly dropping theories on them.

Because they are liabilities. If he follows along with your theory and you get worse, he doesn't get to claim he was following accepted medical practice.

Plenty of smart guys turn into the doctor's worst enemies after things start going wrong. Wanna know what arguments they use in court against doctors who show patients this sort of respect?

> I couldn't possibly have known

> He is a doctor and I'm just a patient

> My judgement was impaired due to my sickness

If patients want to start dropping theories on doctors, they should be ready to share in the responsibility for the outcome. Courts have demonstrated that the vast majority of people are not ready to accept that responsibility.

> Most of the people a doctor gets either almost can't read or think they have all the diagnosis from "the internet".

Well said. Many of my patients are illiterate. Imagine how hard it is to obtain informed consent. Combine that with internet diagnosis and it's a shit show. I have people asking me about the benefits of some YouTube charlatan's special himalayan salts on a daily basis. And that's when they're not already using those things and dismissing medicine as a corporate conspiracy to keep them sick and perpeptually consuming drugs.

I have no problem with people who googled things, understood those things and who want my professional opinion on the matter. It only becomes a problem for me once they start trying to determine what the treatment is going to be. It's my name, signature and license on the prescription. The only options available to the patient are the ones I'm willing to write on that paper.

> A doctor might be following a [compulsory] guideline from his association / state / institution / college.

I have no doubt they are, compulsory or not. When things go wrong, the first thing the judge asks is whether the doctor followed established medical practice, whatever that may be.

So take them a food diary and a bottle of wine??

This is about the most charitable thing I've ever read on this site about physicians.

As a physician with a degree in nutrition, I find most HN threads about medicine, nutrition, or the health system very frustrating, and in spite of it being the only area in which I'm formally qualified to opine, it's also where I've earned most of my downvotes (which prior to 500 internet points kind of mattered). I eventually learned to just bite my tongue here.

Curiously, I think my "hacker spirit" is what drove me to medicine. In undergrad, I was spending 5+ hours per day reading medical literature (mostly nutrition, endocrinology, exercise science) and had decided that doctors were mostly idiots, and eventually decided to change majors from ME to pre-med.

In medical school, I was a real handful to many of the lecturers, which I kind of regret now. Ends up it is really easy to publicly humiliate someone when they mis-state or misunderstand a minor detail that you've studied in depth, even if they have far greater expertise in the field.

In medical school, residency, and practice (EM), I've learned a lot about why things are the way they are. In my field, many patients are entirely obsessed about some problem and completely lose track of reality when discussing it. It becomes part of their identity. They don't know how to read or evaluate medical literature, and they lack the background knowledge to the extent that even beginning a discussion is onerous.

It's like your uncle who is far to one side or the other of the political spectrum and is well read but only in support of his biases -- yes, you might learn something this time, but do you really want to get into long discussion to find out? He already "knows" all the answers to many unstudied questions, and knows why the studies are wrong for the others. There are so many of these patient encounters that it is entirely infeasible to engage with even a small proportion of them and still get your job done, so you learn to nod, smile, and move on to determining whether or not a life-threatening emergency exists or not. You definitely don't have time -- at least in my field -- to really listen and consider all of these. Unfortunately it's not always easy to differentiate symptoms that are possibly psychological, exaggerated, self-limiting, or impractical / impossible to diagnose in my clinical context, from those that present opportunities for me to make a difference even if not a true emergency.

I still think that many doctors are idiots that lack critical thinking skills and self-reflection, and unfortunately almost nobody outside of academics reads primarily literature that isn't forced on them (MOC). I've tried to show many friends and colleagues how to set up RSS feeds for pubmed queries for their topics of interest -- zero people have seemed impressed. In contrast, I think much of HN leans heavily on representativeness heuristic and doesn't consider likelihood ratios when evaluating their test results.

Anyway, thanks for the considerate comment.

It's obvious he thought the problem was upstairs. If you're a medical mystery they're going to consider psych and some of them will consider it too much.