AskMe screws the pooch

December 5, 2007 6:43 PM

AskMe gets it badly wrong, as the original poster reveals here.

I remember seeing that first post come across the green and thinking "I'm not touching that with a ten-foot pole." The reason is because it is not possible to provide decent health-related advice without doing what docs call a "history and physical," and that's simply not possible in the AskMe framework. Significant information will always be missing.

Others were less cautious, and offered every wrong opinion imaginable. From encouraging the poster to take more or different drugs (SSRIs often worsen problems in schizophrenia), to lobbing a wrong diagnosis at her (social anxiety disorder), to telling the poster that there was nothing wrong with her. No one got it right. Many of the responders got it dangerously wrong.

Who knows how long these wrong opinions delayed the diagnosis, or what other harm they may have done? Who knows how often this has happened in other threads, with well-intentioned, authoritatively stated, wrong advice?

You should all be much, much more careful. We should all be much, much more careful.

posted by ikkyu2 to etiquette/policy at 6:43 PM (254 comments total)

This, on the other hand, is an excellent, humbling point.
posted by absalom at 6:48 PM on December 5, 2007

Y'know, every time I read something by ikkyu2, I respect him more.

Wise words.
posted by dirtynumbangelboy at 6:53 PM on December 5, 2007 [2 favorites]

hypervenom doesn't sound resentful of AskMe's advice, however helpful, unhelpful, harmful or otherwise it may have been, though. I'm not sure what we're doing here in MetaTalk, other than highlighting somebody's posts. Are we trying to set some more exacting standard for possibly medically-related questions and answers? What is to be accomplished by this post, ikkyu2?
posted by cgc373 at 6:53 PM on December 5, 2007 [2 favorites]

Shame on all of you, er us.
posted by iamabot at 6:55 PM on December 5, 2007

I think you should print out what you wrote here and hand it to your therapist and your prescribing physician.

.......


I was relieved to read in the last paragraph that you are seeking help from a therapist and taking some medication.


.....

You have to focus on your therapy and medication.


.............

Those are in the first three or five comments. Seems pretty good to me for asking strangers on the internet.
posted by shothotbot at 6:55 PM on December 5, 2007 [2 favorites]

Noted. Who would have thought that asking a mostly anonymous group of strangers on the internet advice about something that could be a life-or-death matter would be a misguided idea?
posted by dhammond at 6:57 PM on December 5, 2007 [1 favorite]

You'd have to be crazy to get mental healthcare advice from random internet people.
posted by pompomtom at 6:58 PM on December 5, 2007 [23 favorites]

Did they tell him to go to legal aid to get free legal representation, too?
posted by The Straightener at 6:59 PM on December 5, 2007

The reason is because it is not possible to provide decent health-related advice without doing what docs call a "history and physical," and that's simply not possible in the AskMe framework. Significant information will always be missing.

With this in mind, should we ban physical- and mental-health related questions?

I'm not being flip. I know ikkyu2 is a doctor, and I'm asking if the opinion of the medical community would be that we do more harm than good by answering health questions at AskMe.
posted by pineapple at 7:03 PM on December 5, 2007

Ok ok, aside from shame on you, what is your point here? We need a warning sign with sirens whenever posting a question of a medical nature? We need to screen people who answer questions for accuracy or expertise ? Are you looking for a fix to the process or ... ?
posted by iamabot at 7:05 PM on December 5, 2007

Are we trying to set some more exacting standard for possibly medically-related questions and answers?

I think that's a good idea.

What is to be accomplished by this post, ikkyu2?

Interested people who use AskMe can read it and learn from it, in context. What will eventually be accomplished will be determined by the readers of the post, insofar as they change their practices; and by Matt, Jess and cortex, obviously, if they see fit to change anything.

hypervenom doesn't sound resentful of AskMe's advice

I am not convinced that this metric is going to be the best way to think about the possibility of AskMe causing someone serious harm in the future.

Let me make a completely hypothetical example. What if the well-meaning posters in hypervenom's initial post had convinced her that her feelings were "normal" and, therefore, would never get better? Grateful for the advice she received, and with no thought of resentment, what if she then proceeded to take the only course that seemed to make sense to her, given what she was going through and what she felt to be true: committing suicide.

I have heard of mentally people committing suicide on far less reasonable grounds, and in fact it is one of the more common ways for a person to die of/with schizophrenia. And if you look at published studies of interviews with people who have failed suicide, "It's never going to get any better" is one of the top reasons we know about for trying to commit suicide.

Well-intentioned advice, gratefully received, can cause great harm if it is wrong.
posted by ikkyu2 at 7:07 PM on December 5, 2007 [5 favorites]

Yeah no shit. Seeking medical advice from strangers on the internet is a bad idea. What's your point. It sounds like you want these questions banned but I can't really tell anything beyond your "shame on everyone" attitude. Seriously, why did you post this?
posted by puke & cry at 7:09 PM on December 5, 2007 [2 favorites]

I'm asking if the opinion of the medical community would be that we do more harm than good by answering health questions at AskMe.

There is absolutely no doubt in my mind, and there hasn't been since I joined this site, that trying to answer health-related questions in AskMe with concrete advice does more harm than good. I've occasionally suggested that people go see their doctor, but other than that, I've tried my doggonedest not to post anything that could ever be construed as advice applicable to specific cases.

There are exactly two reasons for this. One, even the best informed answerers don't have enough information to render advice safely. Two, even the best informed askers lack the expertise, background, and context to evaluate the advice they're receiving on its merits.
posted by ikkyu2 at 7:11 PM on December 5, 2007 [1 favorite]

Seriously, why did you post this?

Seriously, I just answered that question.
posted by ikkyu2 at 7:11 PM on December 5, 2007

Wow, people are defensive. Thanks for posting this, ikkyu2; it reinforces what you've often said, and hopefully will make at least a few people hesitate before blithely tossing off "helpful" advice based on too little evidence and understanding.
posted by languagehat at 7:15 PM on December 5, 2007 [3 favorites]

Let me make a completely hypothetical example. What if the well-meaning posters in hypervenom's initial post had convinced her that her feelings were "normal" and, therefore, would never get better? Grateful for the advice she received, and with no thought of resentment, what if she then proceeded to take the only course that seemed to make sense to her, given what she was going through and what she felt to be true: committing suicide.

I know you're trying to make a point here, but I think you may be reaching a bit. I know that you don't give medical advice over the internet, but next time why don't you retract the 10foot pool and chime in with " please consult a professional", that response is likely to be more productive than this thread.

I think there are a number of points that are re-iterated every time this type of thread comes up and the most valuable is: asking people on the internet questions is likely to get you an answer whose value is less than or exactly what you paid that person or group of persons for answering the question. When pb and cortex get around to writing the medical advice oracle plug-in we can start vetting the efficacy of it's advice.
posted by iamabot at 7:17 PM on December 5, 2007

"Ok ok, aside from shame on you, what is your point here?"

Shame on you, dipshits?
posted by mr_crash_davis at 7:21 PM on December 5, 2007 [12 favorites]

Often in AskMe people speak about medication usage with an authoritative knowledge they probably don't have, and people seem way too quick to diagnose which is pretty much always inappropriate. This is especially true with issues around mental health. IMHO personal stories and empathy are fine. Suggesting medications, their usage, and making diagnosis is not.

We always say: who would be such an idiot to take such advice from an internet stranger. But why not raise the bar on our own responses and NOT diagnose or talk about medications in a manner that is beyond our scope as consumers.

It's dangerous and well worth discussing here in MeTa.
posted by dog food sugar at 7:22 PM on December 5, 2007 [1 favorite]

Also, the best name for so-and-so's cat wasn't "kitteh", it was "Mister Whiskers".

You've been warned.
posted by mr_crash_davis at 7:22 PM on December 5, 2007 [6 favorites]

My experience is that really smart people tend to have difficulty boxing in exactly where their knowledge is strong or weak, or defining those areas where they have none at all. The problem is that a well educated, smart person can make an argument that has no basis in knowledge or expertise sound very authorative by force of rhetoric. There are a lot of smart people here that don't understand that their general knowledge accumulation doesn't extend into certain fields of expertise with specified knowledge that a layperson doesn't have access to, nor will be able to logically intuit. That doesn't stop them from making an authoritative statement because they figure they're smart, well educated and whatever answer/solution they intuit is probably the right one anyway, or at least is logical considering the information that has been given by the poster.
posted by The Straightener at 7:23 PM on December 5, 2007 [20 favorites]

I think you may be reaching a bit

I don't agree, obviously, or I wouldn't have posted. In the course of my professional career I have prevented at least 3 suicides, maybe 5.

The problem with being very casual and dismissive where severe illness is concerned is that if someone commits suicide or drops dead because of a wrong diagnosis, you can't undo your casual, dismissive mistake.
posted by ikkyu2 at 7:24 PM on December 5, 2007 [1 favorite]

I think we're going to hear a lot about how AskMe does health advice a lot better than the rest of the net, while ikkyu2 contends that "better than awful is still pretty bad and often dangerous." But I don't see a clear way out, aside from maybe yanking "health" as one of the categories for questions, and maybe a guideline adjustment that says something like: "This site is not for medical advice." Such a change will prompt our local lawyer/advocate members to speak up about legal advice being also pretty badly managed hereabouts, and we'll get a bunch of jokes about the white site looking more professional, etc. The open-ended quality of the questions is one of the compelling things about AskMe, and I guess we as a community try to err by supposing the members—askers and answerers—can take the advice as it's meant, and not as professional, gospel, or any other kind of authoritarian truth. Everybody knows to some extent how much to trust the advice of semi-anonymous internet acquaintences.
posted by cgc373 at 7:25 PM on December 5, 2007 [2 favorites]

I really have to agree here. It makes me very very nervous to think of folks coming onto AskMe to ask serious mental health questions. It's dangerous, and to be honest, I really don't think they should be allowed. When it comes to medical questions that don't relate to mental health in particular, like what to do about a hangnail, et cetera, then those don't make me so nervous. Folks asking those types of questions probably have the rationality about them to seek expert advice from their doctor if things get worse, and are probably in a better space to evaluate the merits of various responses.

Folks asking mental health questions are not in that type of rational thinking mode, oftentimes, and speaking as someone who has struggles with depression his whole life, the idea of bad advice / diagnoses being given to those folks is really fucking scary.
posted by lazaruslong at 7:25 PM on December 5, 2007

ikkyu2's advice is even more on point when you stop to realize that the suicide rate among those with schizophrenia is 20 to 50 times higher than in the standard population, and that suicide is the highest cause of mortality in such patience.

Please take his hypothetical - and this thread - with all due seriousness.
posted by absalom at 7:26 PM on December 5, 2007

I agree with ikkyu2. Beyond 'what does it feel like to have [blank] done?' we really shouldn't be giving out medical advice here.
posted by jonmc at 7:26 PM on December 5, 2007

struggled *
posted by lazaruslong at 7:26 PM on December 5, 2007

PATIENCE?

Jesus fuck, ya'll, sorry. I'm clearly done for the knight.
posted by absalom at 7:29 PM on December 5, 2007

Seriously, why did you post this?

On the facts to hand, almost certainly Narcissistic Personality Disorder.

No problems, though. ikkyu2 can cure these by drinking a litre of coconut cream and then standing on his head for an hour per day, followed by a four hour ice-bath.
posted by UbuRoivas at 7:29 PM on December 5, 2007 [8 favorites]

For the record, I never answer any medical questions and especially any psychiatric questions because it's an exercise in futility. I'm just incredibly put off by the finger-wagging of the post here.

"YOU MIGHT HAVE HURT SOMEONE AND YOU SHOULD FEEL BAD FOR IT!"

Sheesh. Follow that up with a "THEY COULD HAVE KILLED THEMSELVES AND IT'D BE YOUR FAULT" and there's way too much condescension in here.
posted by puke & cry at 7:30 PM on December 5, 2007

The problem with being very casual and dismissive where severe illness is concerned is that if someone commits suicide or drops dead because of a wrong diagnosis, you can't undo your casual, dismissive mistake.

Yes, I agree with you here, but AskMe isn't a place to get a medical diagnosis, so what's the next step beyond, and I'm paraphrasing "be careful with your answers".

re you looking for language on the Ask form to highlight that questions that are medical in nature are not answered by people holding medical degrees and are not medical advice? I can agree with some of what you're saying but you're not getting any closer to FIXING what you have a beef with, and at some point in the ask and answer dance the Asker needs to be held responsible for the context and content of their question, so how does the process get fixed?
posted by iamabot at 7:31 PM on December 5, 2007

Would you prefer we wait until someone really does kill themselves, puke and cry? Or are you saying that it couldn't happen?

It's not like I'm proposing anything that's massively counterintuitive. Even you seem to agree with my main point - "yeah no shit" were the words you used - yet it goes on.

I don't mean to be condescending, and I'm not trying to protect the business interests of doctors. I think there's a real potential for harm here.

And finger-wagging is actually one of my key talents. I make a joke at cocktail parties that my two most useful tools as a doctor are [raised index finger wags left and right] and [extend forefinger and shake the whole hand forward and backwards rapidly at the wrist]. I get a good laugh out of it but it's true.
posted by ikkyu2 at 7:34 PM on December 5, 2007 [3 favorites]

puke & cry: "For the record, I never answer any medical questions and especially any psychiatric questions because it's an exercise in futility. I'm just incredibly put off by the finger-wagging of the post here.

"YOU MIGHT HAVE HURT SOMEONE AND YOU SHOULD FEEL BAD FOR IT!"

Sheesh. Follow that up with a "THEY COULD HAVE KILLED THEMSELVES AND IT'D BE YOUR FAULT" and there's way too much condescension in here."



Thankfully, this isn't about you.
posted by lazaruslong at 7:35 PM on December 5, 2007 [2 favorites]

Ikkyu2: Ask MeFi: 32 questions, 4266 answers.

Incredible generousity.
posted by cior at 7:36 PM on December 5, 2007 [3 favorites]

iamabot, I think your questions are really important, and I'm not sure I know the answers to them - I'm not particularly creative that way, I would never have thought of a MetaFilter if left to my own devices. I sure would welcome a creative solution for this though.
posted by ikkyu2 at 7:36 PM on December 5, 2007

I see what you're saying, but by that token we get things "wrong" every day. I've previously asked for advice and opinions about health issues, pet issues, and other sorts of vague things and I've gotten answers all over the map, often contradictory. It's possible to get wrong answers and right answers and up to the question asker to determine which advice sounds best, and of course the more tangible and practical a problem, the more likely you are to get a satisfactory answer.

I think the over-arching theme of ask mefi is that you are soliciting help from thousands of strangers that may have shared your experiences but no one can properly diagnose something like a psychological condition based on a couple paragraphs read on a page. I don't quite see this example as something we should be ashamed of, a person gave out a bunch of psychological symptoms and asked about drugs and everyone responds differently to therapy and psych meds and offered their experiences. As most often happens here with regards to medial/legal/psychological advice, the most correct answer is "go see a professional about that" and the backup answer is a bunch of strangers sharing their experiences and what they think may be the issue.
posted by mathowie at 7:41 PM on December 5, 2007 [9 favorites]

Thanks for posting this, ikkyu2.

I'm pretty surprised at the negative reaction to this post. It seems not only appropriate, but necessary, to consider what's at stake in these types of situations. This wasn't a question about a router, it was a question written in the midst of a psychotic break by someone who was advised about what their specific diagnosis might be, to consider changing their medications, and told to consult a self-help book. What part of AskMefi speaking with (well-intentioned) authority about such serious issues, and getting it wrong, does not deserve discussion?

Mental health questions on AskMe call forth a very high number of anecdotal answers from people whose knowledge is basically confined to their own case. Many people tend to recommend what worked for them and to defend that recommendation against all the equally valid anecdotal recommendations of other answerers. People frequently offer diagnoses with an astounding degree of certainty, who have nothing but the internet to guide them. Even though it should be abundantly clear that it's impossible to diagnose someone in the context of an AskMe question, especially an anonymous one, concrete diagnoses are still offered. Those diagnoses are frequently disproved by the meager information available in the post, but because many answerers have NO TRAINING WHATSOEVER in mental health diagnosis, they miss these obvious contraindications.

I'm not sure what the solution is. I'm hesitant to suggest that there should be no such questions posted to AskMe, but I think it's entirely appropriate to discuss the issue, and it's appropriate to acknowledge that in this case the answers were demonstrably incorrect and that the errors were potentially dangerous. Even if the only conclusion is that we should be more careful with our answers, that's a lot better than not having a discussion about something like this.
posted by OmieWise at 7:42 PM on December 5, 2007 [1 favorite]

Oh, and this:

hypervenom doesn't sound resentful of AskMe's advice, however helpful, unhelpful, harmful or otherwise it may have been, though.

really has no bearing on whether or not its a good idea to offer incorrect diagnoses to someone in the midst of a psychotic break.
posted by OmieWise at 7:44 PM on December 5, 2007

ikkyu2, you'll have to forgive my tone through some of this, half of my day is spent talking to people about fixing technical or operational problems that pop up again and again and there's little focus on the process which can be very frustrating. My apologies.

I still agree with you that it's dangerous, I think there's a certain level of "shame on you" that will maybe get the attention you're looking for on the issue, the thought that comes to mind is building a case to add another sentence to the Ask form or to the FAQ. Dunno how much traction/etc that would get, people tend to hate change and given the recent flag enhancements I think there's a certain amount of resistance to change right now.
posted by iamabot at 7:44 PM on December 5, 2007

Thanks for posting this. We do need to be reminded of our limits. Most of us aren't medical professionals, and even if we were, we just can't assess someone properly in this environment.

But I just want to make one point. Yes, every single person in that AskMe thread failed to diagnose the schizophrenia. While I saw one person rubbish therapists and medication, many other people agreed with her therapist's diagnosis of social anxiety and encouraged the poster to talk with her therapist and told her where to find cheaper versions of the SSRIs she had been prescribed.

What I didn't see in this specific thread was a bunch of people spontaneously diagnosing her with SA. They just supported the completely wrong diagnosis and prescription her medical professionals had given her for months. So while this is a particularly dramatic example of a misdiagnosis, I'd say the medical professionals who actually treated this person were much more at fault than AskMe.

That said, I absolutely agree with you that a hell of a lot of bad medical and psychiatric advice can be offered on the green. We should much, much more cautious from now on. Maybe the default assumption should be that the current medical professionals someone is consulting probably have it right, but that it wouldn't hurt to get another opinion if the person feels that they are not improving.
posted by maudlin at 7:44 PM on December 5, 2007 [2 favorites]

How does the process get fixed?

No one - not even the doctors here - can ethically say: maybe it's such-n-such syndrome or blaa blaa disease. But many people do say such things. They are diagnosing the asker. I click on their profile and they seem completely unrelated to anything medical. Diagnosing the Asker should stop. The Answerer is in no position to make such a statement and should recognize that. The same goes for medications. No one should be prescribing medications. But Answers do this all the time.

Personal experience with a disease or medication and comments about that are different. The Answerer has a responsibility here.
posted by dog food sugar at 7:44 PM on December 5, 2007

trying to answer health-related questions in AskMe with concrete advice does more harm than good

I'm surprised to hear that.

ikkyu2, in your opinion should I as the person running the server do something beyond a big disclaimer telling askers to take any advice/answers in the health category with a huge grain of salt? (probably the legal one too)

Educating people that seeing a professional is most important seems adequate to me, without discounting everyone's input too much.
posted by mathowie at 7:47 PM on December 5, 2007 [1 favorite]

I agree with ikkyu2 that hypervenom was not well served in that thread, but then again, what can you expect from random internet advice, especially in such an area. Everyone imposes their own world view and experiences and these things are so subtly different for everyone. I still think that for the average person who asks such a question, AskMe is a great resource. The average person is average, not schizophrenic. A schizophrenic may not get good answers from a forum lacking in other schizophrenics (who care to speak up) and experienced medical professionals. This is just too difficult and arcane an area for the average person to be of great help. That being said, seven or eight months from a plea to AskMe until a diagnosis does not seem excessive for such a difficult and long term disorder. A few more proddings toward seeking professional help given the depth of the issues would have seemed in order in the thread though. On the other hand, the OP was already on powerful medication indicating that even his or her doctors were struggling here.
posted by caddis at 7:47 PM on December 5, 2007

How about a 'go see the doctor' flag specifically for askme?

(pretty soon we're going to have more flags than the UN, but in this case it's a good idea, I think).

Ther's a pretty serious disjuncture between AskMe and the rest of the site, I think. The blue and the grey are where you can go have a friendly argument about whatever and 99% of the time, there's no real harm done. But AskMe is people asking for real-world advice, so carrying the casual 'this is just online bullshitting' attitude there is not a good idea. Which is precisely why I don't comment there as much.
posted by jonmc at 7:48 PM on December 5, 2007 [1 favorite]

My experience is that really smart people tend to have difficulty boxing in exactly where their knowledge is strong or weak, or defining those areas where they have none at all. The problem is that a well educated, smart person can make an argument that has no basis in knowledge or expertise sound very authorative by force of rhetoric.

I think doctors, in particular, are guilty of this.

But is ikkuyu2 saying that anytime anyone says to you: "I feel like I'm going crazy..." you should tell them: "I'm sorry, being crazy is a medical condition and you need to speak to a qualified psychiatrist."

My mother-in-law is a faith-healer and I find what she does to be extremely unethical because she claims an authority on human health that she has no reason to believe she has: asking advice of other people and listening to (or not listening to) what they say is how human beings operate. The idea that only professionals are allowed to give advice (even on important matters) is really narrow-minded.

Frankly, I find many of the comments that Ikkuyu2 makes, strike me as "arrogant doctor." I think it's part of the training.
posted by geos at 7:52 PM on December 5, 2007

I'm just not sure that "buyer beware" is completely adequate. While the thread in question wasn't egregious in terms of wrong answers, it did end up being about something very serious. And I do see really egregious examples of people offering diagnoses and medical advice, about which they have no knowledge, to people who are asking questions in some desperation. I'm not sure why all of the onus should be on the Asker side if this is going to be addressed.
posted by OmieWise at 7:53 PM on December 5, 2007

Arrogant doctor training or not is beside the point and no reason to dismiss the discussion.
posted by dog food sugar at 7:55 PM on December 5, 2007

The idea that only professionals are allowed to give advice (even on important matters) is really narrow-minded.

Frankly, I find many of the comments that Ikkuyu2 makes, strike me as "arrogant doctor." I think it's part of the training.

Well, you're welcome to that opinion, but ikkyu2 hasn't suggested that only professionals should be able to give advice, he's suggested that advice of the type required by the patient was impossible to deliver over the internet.
posted by OmieWise at 7:57 PM on December 5, 2007

I don't think AskMe got it badly wrong. The poster left out critical details about her health history, so she has some responsibility for the quality of the answers. (Even doctors deal with this, so the problem is not limited to faceless folks on the internet.) If people who are members more than a year and who have a posting history that looks fairly balanced treat AskMe as a medical journal rather than a friendly chat with folks who may have similar experiences to share, then the "problem" is not the responders.

Who knows how long these wrong opinions delayed the diagnosis, or what other harm they may have done?
I think you're taking a lot of responsibility away from the OP. I think you have specialized knowledge and high standards of professional practice that attune you to what could go wrong, and that you take that seriously enough to raise the issue here, which is the right thing to do ethically. I just don't think there's much to be done about it. Or maybe there's too much to be done about it to be effective in every case, which makes it helpful for none.
posted by cocoagirl at 7:58 PM on December 5, 2007

iamabot: ... at some point in the ask and answer dance the Asker needs to be held responsible for the context and content of their question, so how does the process get fixed?

Well, perhaps. However, answerers really should be more hesitant with throwing negative 'diagnoses' around. By which I mean the "Don't worry, that's completely normal" stuff.

Specifically, I'm reminded of a trainwreck of a question from months and months ago in which the asker wanted advice on how to deal with dogs that terrified/disgusted her to the point of vomiting and crying, etc. Lots of people chimed in with "Meh. You just don't like dogs. There's no anxiety problem here". The asker marked a whole bunch of them as Best Answers.

In questions where the asker really, really, really wants those (possibly/probably unfounded) negative 'diagnoses', they'll be a lot less likely to consider other answers. Even the pretty neutral "You should see a [blank] about that" ones.
posted by CKmtl at 7:58 PM on December 5, 2007

Matt: in your opinion should I as the person running the server do something beyond a big disclaimer telling askers to take any advice/answers in the health category with a huge grain of salt?

Matt, someone asked for my opinion about that, so I thought I'd put it out there. I'm not sure my opinion is correct and I really am sort of tentative about to do about it.

I had never tried to ask a health question on AskMe but I just did a dry run and I didn't see any particular health-related warning come up.

It might not be a bad idea to put a warning or reminder there about the uncertainty involved in soliciting for specific diagnoses or treatment advice - it might give someone who's really struggling with mental health problems a reality check at the right stage in the process.

And it might likewise not be a bad idea to put a similar reminder atop the answer box for health-related AskMes. I think that could probably be technically feasible? But honestly I don't know if it'd be useful, or dumb, or what. Would people consider it, would they tune it out after awhile? What should it say?

I also think letting this thread perk for a while to see if any clever ideas come up is a good idea, there are always a lot of clever ideas around here.

People do use the health category in AskMe all the time in ways that to me seem appropriate and obviously useful, I'm not suggesting that all health related questions be banned at all.

Finally the reason I picked this specific example is because it was there and I saw it and I thought, "here's something concrete I can point to as an example of how things could go badly wrong," I didn't mean to pick on any particular MeFite or suggest that anyone should be ashamed of anything.
posted by ikkyu2 at 8:02 PM on December 5, 2007

Er, that should read, I am tentative about what to do about it.
posted by ikkyu2 at 8:02 PM on December 5, 2007

Well, perhaps. However, answerers really should be more hesitant with throwing negative 'diagnoses' around. By which I mean the "Don't worry, that's completely normal" stuff.

But that's the whole point! You can't make a diagnosis of any kind, I didn't think we were talking about "negative" answers... I thought the issue was more to the point of:

1) Do askers get cautioned about the nature of the answers they may get as it pertains to medical questions (or any i suppose).

2) Do medical/legal questions have any place on AskMe as they are not answered by experts.

Am I discussing the wrong thing here?
posted by iamabot at 8:03 PM on December 5, 2007

In questions where the asker really, really, really wants those (possibly/probably unfounded) negative 'diagnoses', they'll be a lot less likely to consider other answers.

But by that same token, my parents are like that about financial advice. They'll ask me or my brother or friends what they should do, and I'll give a tough but qualified answer and they'll refute it saying their friend said their credit card bills are perfectly fine and not out of control. Does that make their friends responsible for their money problems? Or were they wanting to hear what they wanted to hear?
posted by mathowie at 8:03 PM on December 5, 2007 [1 favorite]

Well, hypervenom might've gotten crap advice and wrong diagnoses from random internet strangers. But she was misdiagnosed my doctors who saw her in person, as well.

Most folks seem happy to say "get a lawyer" when the question is law-related; culturally, maybe we can encourage that trend in medical questions as well. (Although of course we'd tell people to see a doctor, not a lawyer!)
posted by rtha at 8:04 PM on December 5, 2007 [1 favorite]

I don't support any safety rules on Ask Metafilter besides "Can't get Mathowie arrested." Perhaps put up a warning label:

-DANGER!-
This is the
INTERNET!
posted by TheOnlyCoolTim at 8:04 PM on December 5, 2007 [1 favorite]

by doctors, that is.
posted by rtha at 8:04 PM on December 5, 2007

Pardon me, ikkyu2 if I don't fall in line agreeing with you.

I'm pretty sure the vast majority of people who ask questions of this type realize that AskMe is not the same as going to a medical professional. But what Askme is good at is giving a good overview of people's experiences which can prove invaluable when one does go into see the doctor. PARTICULARLY when it comes to mental health issues. As a former consumer in that area I can tell you that 75 % of the useful info that came my way came from the educated layman, NOT the professional.

While we are at it, a couple of years ago I was perusing blogs and realized that one of the people whose blogs I read on a regular basis sounded a heckofa lot like they were dealing with the same issues as I was...I asked them if they had ever been screened for bipolar. All hell broke loose as all their friends came out of the woodwork and called me everything but a child of God.

Meanwhile, she went and got screened. Lo and behold, she had bipolar, which from the looks of things got caught just in time. She went into hospital, which from what I could tell from her posts SAVED HER LIFE.

But I suppose you would have rather me keep my mouth shut.

As to this site, as long as it is clear to people that none of us can diagnose, I think it is a wonderful thing to be able to query the hive mind on these sorts of things. I suspect that if the truth were known, Askme has saved some lives here and there, and for sure made lives better.
posted by konolia at 8:04 PM on December 5, 2007 [3 favorites]

1) Do askers get cautioned about the nature of the answers they may get as it pertains to medical questions (or any i suppose).

2) Do medical/legal questions have any place on AskMe as they are not answered by experts

I'm inclined to discuss 1) but rule out 2). And I'm thinking an added disclaimer on comment threads and the posting page might be the best approach.
posted by mathowie at 8:06 PM on December 5, 2007

You know what's funny? From my personal experience asking for advice here, I recall when I asked if my appendix was bursting I got mostly subdued replies of either "naw, doesn't sound like it" or "go see a doctor to be sure" but when I asked about some minor strange behavior in my cats everyone flipped out and told me to drop everything and go to a pet hospital immediately.

In the end, I just had a bunch of weird sore muscles in my gut and when I took my cat to the vet they couldn't find anything wrong.

I don't know what that says about Ask MeFi but I've noticed the trend since then -- that human health question get a mix of answers and experiences but pet questions have an heightened sense of urgency and appeal to professionals.
posted by mathowie at 8:10 PM on December 5, 2007 [5 favorites]

I am still not 100% sure the pooch has been screwed here. The best possible advice was go see a doctor and that advice was given repeatedly.

ikkyu2: Do you really think that it would be a net improvement if all medical questions were banned? Or just mental health questions? Or would it be a warning (perhaps by MeFiMail) to the poster to seek a doctors advice be sufficient?
posted by shothotbot at 8:10 PM on December 5, 2007

I'm inclined to discuss 1) but rule out 2). And I'm thinking an added disclaimer on comment threads and the posting page might be the best approach.

Not suggesting you do either, just trying to determine if the discussion was along the same lines I was under the impression it was. I do see value in 1), no idea how it's phrased, no idea bout the scope.
posted by iamabot at 8:12 PM on December 5, 2007

Does anyone remember this beauty from last year? Pure snark bait, and I think some responders were egging the poor woman on. The MeTa thread on it had the same type of copouts. You're not doctors, and you're not liable for anything you post, so you can post anything you like. So can ikkuyu2. Why is it OK for others to say any crappy thing they like, but not him?
posted by RussHy at 8:12 PM on December 5, 2007

Hypervenom wrote: I've been going to an awesome therapist for an hour a week for about three months, and I started Zoloft last month for the extreme social anxiety (I haven't been able to afford refilling my prescription for about three weeks, but I should be able to tomorrow).

Later Hypervenom wrote: My therapist just referred me to the psychiatrist who prescribed Zoloft.

And here are some of the responses:

It sounds like you have some flavor of an anxiety disorder, perhaps social. I agree that getting stablilized on some meds will probably help a lot. Of course, the hard part is finding what meds will work for you, but I'm glad to hear you have a therapist you trust.

I think you should print out what you wrote here and hand it to your therapist and your prescribing physician. They need to know this.

I was relieved to read in the last paragraph that you are seeking help from a therapist and taking some medication.

You have to focus on your therapy and medication.

I think you need to be working with a competant (sic) therapist right now.

You are way, WAY ahead of the curve by seeking therapy and by demonstrating the facility to talk about how you feel

So the poster said that she was given a PROFESSIONAL diagnosis of anxiety disorder and a PSYCHIATRIST prescribed her medication. The majority of people are telling her to do what her therapist says, to stick to it. How is this bad advice? It looks like it's the pros who screwed up, not the Mefites.
posted by Evangeline at 8:15 PM on December 5, 2007 [6 favorites]

I completely agree that people should be careful and that AskMe can sometimes be very dangerous.

But, at the same time, I recently had reason to ask a health-related question. And the responses I got to that question really helped me. I had never dealt with an issue like that before, I couldn't find any useful information elsewhere, and seeing how other people had handled similar symptoms allowed me to understand the type of problem I was dealing with. (And the vet this morning said everything was healing up just fine--it was just a little infection. My kitty is okay.)

I am not claiming that my cat's abscess in any way compares to a human being's mental health. I only mean to point out that there are very good uses of AskMe for health-related issues. There are also bad uses, too.

It's good ikkyu2 brought this to our attention. It's good we've had to look our failure's in the face. I've learned from it, at the very least. But I caution against lumping all health-related questions as beyond our scope.
posted by Ms. Saint at 8:18 PM on December 5, 2007

I guess my problem with your logic ikkyu2 is you are comparing the advice people receive on Askme to professional advice, rather than no advice at all. And while I'm not saying the Askme advice is always superb, I can't say it is worse than nothing, maybe it isn't better maybe for every good suggestion there is a bad one, but I don't think the person is worse off than nothing at all.

A lot of people are more likely to fish around on the internet than make an appointment with a doctor or they may not have medical insurance. Also, most of the advice in that thread would require going to a doctor regardless and only in rare cases can you sit and dictate to your doctor what you think your diagnosis is and what prescription medication you can go on. There is an automatic filter there and if Askme is the impetus to make an appointment with a Dr, I don't think that's a bad thing.

I also think for psychiatric problem Askme can be particularly helpful, because often people don't seek help because there is a stigma in doing so or they don't realize what they have is a disease that can be treated. They may walk away with the wrong diagnosis, but they walk away knowing that there are other people out there like them who can sympathize and that a Dr likely can help them. It is irrelevant that people recommended SSRIs to a schizophrenic because he'd have to go to a psychiatrist to get them anyway, who would independently diagnose him (who may still be wrong but the Askme question isn't going to affect the Dr's diagnosis).
posted by whoaali at 8:21 PM on December 5, 2007 [1 favorite]

Does that make their friends responsible for their money problems? Or were they wanting to hear what they wanted to hear?

In the end, I guess I'd have to say their friends aren't wholly responsible. It's hearing what they want to hear, in both cases.

But. Bearing that aspect of human nature - people hear what they want to hear - in mind... I think AskMe answerers (and I suppose your parents' friends too) should think a little more before dismissing the problem. Maybe think a little longer before hitting 'Post', and consider that they could be wrong about it being No Big Deal since it could (likely will?) colour how the asker views advice to the contrary.
posted by CKmtl at 8:21 PM on December 5, 2007

I don't get it. This post I mean.

I'm an adult, and I'm glad I have the right to ask anyone I please for advice about whatever I please. I've gotten good and bad advice from lay people and good and bad advice from experts and you, a doctor, should know better than any of us that even doctors can misdiagnose - even with physical exams and health histories.

So what? The person figured out their condition (assuming that they have a correct diagnosis now, which we don't know for sure). Perhaps some of the original askme advice was helpful to them. I'm going to guess it was since they've chosen to come back to the same forum for more help.

PS - the holier than though attitude is a total turn off. The experts I trust the most are the ones who acknowledge the limits of their own understanding and point out the value in other people's knowledge and experiences.
posted by serazin at 8:26 PM on December 5, 2007 [7 favorites]

but ikkyu2 hasn't suggested that only professionals should be able to give advice

ikkyu2 says:


There is absolutely no doubt in my mind, and there hasn't been since I joined this site, that trying to answer health-related questions in AskMe with concrete advice does more harm than good. I've occasionally suggested that people go see their doctor, but other than that, I've tried my doggonedest not to post anything that could ever be construed as advice applicable to specific cases.

he's hedging a bit since he's distinguishing between 'concrete' and 'vague' advice.

I think he is in a different position because he is a doctor and people know this and as a result will take his uninformed internet opinion more seriously than they should.

But I can only conclude that he feels the answer to any medical or potential mental health issue should be: "go talk to a doctor." Just because I ask for advice doesn't mean I have to follow what I hear.

My "arrogant doctor" comment wasn't very constructive, but I think Ikkyu2 is displaying the sort of somewhat self-serving naivety that doctors have about the job they are doing.

The idea that somehow only therapists and psychiatrists are capable of responding to someone who says they feel depressed and anxious in college is really wrong-headed to me. If someone is in that position, they need to be talking to people, not waiting until things are bad enough that they are forced to talk to a doctor.
posted by geos at 8:27 PM on December 5, 2007 [1 favorite]

Frankly, I find many of the comments that Ikkuyu2 [sic] makes, strike me as "arrogant doctor." I think it's part of the training.

I think this point is well taken. I am definitely a product of my education and insofar as docs have a "party line" I am pretty likely to toe it.

I know that watching AskMe over the years has taught me a lot about how people approach health problems. I never learned about this in med school and I never learned it from my patients either, probably because they were too polite or too cowed by the system to say anything; or maybe because being a patient is scripted in unconscious ways just as being a doc is scripted in unconscious ways.

But that's the point of having a discussion here, right? If I were really in "arrogant doctor" mode I would fire off an imperious email to mathowie, explaning exactly how modern medicine thought he should clean up his act, and if he didn't immediately comply, I'd shut my account down and walk. That seems like sort of a jackass way to behave, especially to a community that's brought so much good stuff into my life.
posted by ikkyu2 at 8:28 PM on December 5, 2007 [7 favorites]

Thankfully, this isn't about you.

Yeah, it isn't about you either. We both have opinions so don't act so fucking high and mighty, asshole.
posted by puke & cry at 8:28 PM on December 5, 2007 [1 favorite]

This site is not AskMD. It's not specifically a health-focused site. There's no reasonable expectation that we would even happen to have any MDs hanging around.

Anyone who does think that they are getting sound medical advice here, as opposed to just a sounding board, is getting MUCH worse advice from the rest of the internets.
posted by desuetude at 8:29 PM on December 5, 2007

ePsychiatry is dangerous. I am aware that site rules are fuzzy and based mainly on hindsight risk (for example, ban torrent aggregator links, allow copyright busting YouTube links and WoW selling). But I do think a disclaimer might be warranted, if in fact this would have any effect (IANAL, and this is not legal advice). What if a Megan Meier-type event was mediated by or through a Metafilter interaction? Sad, angry parents are unpredictable, as is the mass media's response to them.

I've seen a few longtime posters consistently dispense critical, prescriptive advice outside their knowledge domain that is often fundamentally wrong, lacking or weirdly muddled as only random facts gleaned from Wikipedia can be. Bullshitting about cultural minutia or programming constructs is one thing, but health advice is different. I recall one recent thread that gave props to some NAMBLA propaganda and whose veracity was asserted as a result of a fundamental misunderstanding of European academic titles.

Is this where we start asking for flags to mark advice as "medical/health"?
posted by meehawl at 8:36 PM on December 5, 2007

whoaali: It is irrelevant that people recommended SSRIs to a schizophrenic because he'd have to go to a psychiatrist to get them anyway

This is just another example of not enough information in the answering community. Anyone in the US, and many other places too, can go online and get the real damn deal, nearly any medicine you want that's not Schedule II or an opiate, without a prescription. Should this be true? Irrelevant - it is true.

shothotbot: Do you really think that it would be a net improvement if all medical questions were banned?

For the third time, no, I think this would be a bad idea, not a good idea.

As I said before, I think useful and helpful things happen in AskMe health questions all the time. I think there's probably also a way to distinguish these useful AskMes from the ones I have brought attention to here.

konolia: But I suppose you would have rather me keep my mouth shut

No, never. You've consistently been one of the most careful, thoughtful and helpful people on this site and I would never tell you to keep your mouth shut. I think you may somehow have misread my intent here.
posted by ikkyu2 at 8:38 PM on December 5, 2007

You're right desuetude, it's much worse over at Yahoo! Answers. I found and joined MetaFilter after reading a Yahoo! Answers thread where people were telling a teen girl the best ways to commit suicide. Of course Yahoo doesn't care, because they have a disclaimer. Is not being the worst the same as being good enough?
posted by RussHy at 8:41 PM on December 5, 2007

Seriously, why did you post this?

Dear puke & cry,

Your symptoms appear to be constipation, which caused by an overabundance of iron in your diet. Make sure you take plenty of Zoloft (available without a prescription through several helpful Internet providers), and it will clear up in no time at all.
posted by Krrrlson at 8:43 PM on December 5, 2007 [2 favorites]

Oh, and, for fuck's sake, in a recent thread someone asking for advice on which medical tests to request from a doctor got diagnosed simultaneously with mono and leukemia by someone with a history of poor medical advice.

So yeah, this callout is useful. I think there should prominent warnings in AskMe that there is a high chance your medical or legal question will be answered by someone who has no fucking idea what they are talking about
posted by Krrrlson at 8:49 PM on December 5, 2007

Perhaps a check box when a question is submitted to the health catagory that the user acknowledges "advice given is mostly anecdotal and should not be taken as the final word, go see a professional".
posted by edgeways at 8:49 PM on December 5, 2007

I'm sure that ikkyu2 feels very strongly about this point, and there is something to what he says. However, while it's true that ill-informed amateur advice is nearly always worse than well-informed professional advice, it is also true that even ill-informed amateur advice, so long as it is well-intentioned and not completely random, is better than no advice at all. Everyone who posts a medical question to AskMe knows that they're not asking a community of physicians, and they know they should see a doctor, and if they for some reason don't know that going in they get told they should pretty quickly (in which case I think even ikkyu2 will agree that AskMe did a good thing).

So, then, why do they ask? They ask because not everyone has good, or even any, health insurance, and they may not be able to afford to see a doctor unless it's an emergency, but they can afford $5 to join Metafilter. They ask because even people who can afford to see a doctor whenever they feel the least bit sick may not be able to get an appointment right away with a doctor competent to help with their specific problem. Some people probably ask because they simply don't like going to the doctor (lots don't), and if they can fix their problem without going, so much the better.

In those cases, I think it's always better to get advice than to not. We have three excellent moderators, and any obviously bad advice will be removed pretty quickly by one of them, I'm sure. Yes, I'm sure some bad advice will get through, because it's often unclear what's bad advice, but, y'know, I've gotten bad advice from doctors, too. I think that it's not worth getting rid of all the good that can come from such threads just to get rid of the bad that might.
posted by cerebus19 at 8:55 PM on December 5, 2007

If it makes you feel any better, ikkyu, I know a lot of people pay attention to whose advice they're getting. I asked a question last year about a cough and a funny bleach taste, and a med student offered his opinion, and you offered one, too.

Since I knew you were a doctor, and he claimed to be a med student, I averaged it, and decided you guys were both sufficiently persuasive enough for me to eat ramen for a couple of weeks and see the doctor that day instead of waiting. (PS, the mass turned out to be histoplasmosis!)

Just like people put out the biscotti signal for pet questions, and jessamyn is the go-to mod for all your personal entanglement issues, you and docpops I think tend to carry more weight in medical threads, and I don't believe that's just for me. I was *so* glad for your presence in that hymenectomy post today, for example.

So even if all you're saying is, "Go see a doctor," I think that answer carries more weight than five or six yahoos saying "Nah, go ahead and tough it out."
posted by headspace at 8:59 PM on December 5, 2007

Funny you should bring up that question, Krrrlson. Reading the question I thought mono was pretty likely, maybe the most likely diagnosis, what with the severe fatigue and the swollen lymph nodes. Of course I didn't say so, because I don't believe AskMe's the right place to get or give a diagnosis. I also agree with you that certain posters, some of which you may have referred to explicitly, frequently give terrible medical advice, which is fine, because boy howdy do I make a mess when I try to explain the innards of my cell phone.

I'm thinking it over, and I'm thinking the following:

GOOD uses of AskMe Health include asking for people's own experiences with symptoms, illnesses, procedures, or treatments, or their own reactions to diagnoses or things their doctors proposed. Also GOOD is asking for general information about an illness, disease, procedure, symptom, or drug. GOOD is also asking how to carry out medical advice ("My doctor said I have to be gluten free, what can I eat?!?!?")

BAD is asking for a diagnosis or asking for specific treatment advice.

Similarly it would be GOOD to provide the things asked for under GOOD above, and BAD to suggest a diagnosis or a particular kind of treatment usually prescribed by a doctor?

Does that make sense? I feel like there are probably complexities that I haven't thought about?
posted by ikkyu2 at 9:00 PM on December 5, 2007 [2 favorites]

cerebus19: it is also true that even ill-informed amateur advice, so long as it is well-intentioned and not completely random, is better than no advice at all.

I've already given as clear a counterexample as I possibly could think of above. Do you care to respond directly to it? I already said, "Well-intentioned advice, gratefully received, can cause great harm if it is wrong" and I really believe that I'm right about that.
posted by ikkyu2 at 9:03 PM on December 5, 2007

cerebus19:We have three excellent moderators, and any obviously bad advice will be removed pretty quickly by one of them, I'm sure.

Holy cow, that's a lot to put on our mods. I agree they're excellent but I don't think they can be that good, any more than any of us or anyone at all could be.
posted by ikkyu2 at 9:07 PM on December 5, 2007

Lo and behold, she had bipolar, which from the looks of things got caught just in time. She went into hospital, which from what I could tell from her posts SAVED HER LIFE.

Anecdotes like this lack repeatability. It may be that you have an innate gift for finding the "bipolar" in people, and that would be great. If so, you should work at it, and help people. Or it may be that you got lucky... your sample size here, after all, is n=1. Is this the first time you have suspected this of a person, or told them? If so, then your sample size increases, and your diagnostic success rate goes down.

Now imagine you're working as a psychiatrist. Your job is to see 40-50 people a week, every week, with unknown but potentially severe mental and physical problems. From a vast potential pool of diseases, you must diagnose some of them for the first time and and decide on treatment plans. For the others, following potentially toxic or damaging treatments that you prescribed for them, you have to monitor their progress and decide if they are getting better, worse, or maintaining. And you have to evaluate is this the only, best way to treat them with minimal harm or is there a better way? Should you ask them to consider a more toxic treatment if it meant you thought their symptoms might improve?

Would you feel comfortable doing that? I wouldn't do it in person, now, and I certainly wouldn't do it over HTML. You say that people can canvass opinions using unmoderated forums, and then use this to obtain informed treatment. That might be true but I woukld think that doctors are probably more likely to make a false diagnosis if a patient presents with strong groupthinked convictions about their disease (there's also an observer effect!). For people seeking prescriptive health advice, the best thing anyone can say, aside from the usual "Seek professional help!" is to send them to websites affiliated with serious organisations dedicated to addressing these problems. U of Derby did a study that found out that random advice from strangers led to "cyberchondria" and an extremely high rate of false positives.

Virtual health care: unresolved legal issues.

Medical information on the Internet: a study of an electronic bulletin board.

Patients using the Internet to obtain health information: how this affects the patient-health professional relationship.

Do Internet interventions for consumers cause more harm than good?

Health related virtual communities and electronic support groups
posted by meehawl at 9:09 PM on December 5, 2007 [2 favorites]

it is also true that even ill-informed amateur advice, so long as it is well-intentioned and not completely random, is better than no advice at all.

How do you know this is true, that there will be little or no iatrogenesis? Extraordinary claims require extraordinary proof. Some of the links I posted above have been trying to see if this indeed true and under what conditions (random internet strangers, health-related community, specific disease-targetted community, etc). This is still very much an active field of study.
posted by meehawl at 9:15 PM on December 5, 2007

Frankly I think putting a health disclaimer on AskMe would be overreaching and kind of silly. If nothing else, it would imply that other sections of AskMe *were* meant to be taken seriously.

For an example, I would have laughed my ass off if this thread had been followed up by a question about repairing fire damage from a gas explosion.

Frankly I would be equally unsympathetic about bad results from a general medical thread. If you're oozing green pus from your private parts and you think that following the advice of random strangers about it is a good idea then I'm sorry: I have tremendous compassion for your pain, but I am unwilling to share my time and energy in protecting you from the ongoing catastrophe of your life.

Mental health issues are arguably different though. Poor judgment (like following the advice of random strangers) seems to be a symptom of many mental health issues. So how do we help people who are in this state?

Refusing to answer their questions may absolve AskMe, but it doesn't help the asker. They'll just go find a site where someone *will* answer their question.

A disclaimer seems kind of pointless. Someone showing poor enough judgment to take health advice from random strangers is not going to be put off by boilerplate legal talk.

Some restraint on the part of the people answering. I believe this is what ikkyu2 is proposing. If the answers to a person who is clearly struggling mentally are overwhelmingly "We don't know and you need to see a professional about this," perhaps some good will come of it.

The good news is that many of those threads already look exactly like that. The bad news is that some don't.

So if I were going to propose an actionable item for this thread, it would be that people who answer mental health issues in AskMe should a) recognize that the person reading the answers may not be displaying the good judgement you'd hope, and b) tone down the creativity appropriately.
posted by tkolar at 9:16 PM on December 5, 2007

It's not arrogance if you're right.

Ikkyu ventures into territory I don't feel comfortable getting near and does it so well and so often that I really can't see the health section on AskMeFi being more than a navel gazing circle jerk if it weren't for him and a few other brave health professionals that regularly have the courage and generosity to put their thoughts online. And yeah, it can range from comical to thunderously frightening to see what sorts of answers are posted in health questions. I think it's the nature of the beast. Everyone has a mind and a body and generally most people are fascinated enough by both that an opportunity to discuss either is hard to pass up, unlike, say, hydrangeas or HTML coding or engine blocks or pork loin recipes.

But at the same time health questions are incredibly, monumentally helpful because what they really solicit are the collective experiences of thousands of people that might otherwise suffer in existential isolation that now, thanks to the medium of the internet, can discover just how normal and shared and completely ubiquitous their bizarre, chaotic, scary and brilliant thoughts and symptoms are.

It's probably the cheapest therapy in the world just to know other people experience the same things as you do.
posted by docpops at 9:17 PM on December 5, 2007 [2 favorites]

Well-intentioned advice, gratefully received, can cause great harm if it is wrong.

You're right, it can. Virtually anything can cause harm. Doctors cause harm, and sometimes great harm, every now and then, but I would never advise people to avoid doctors as a matter of course. Now, if a particular doctor were known to harm his patients, I would certainly advise people to avoid him. I haven't run the numbers, and probably don't have nearly enough data to do so, but I would make an educated guess that the majority of medical-related questions on AskMe have received helpful, if not necessarily perfectly right, answers.
posted by cerebus19 at 9:17 PM on December 5, 2007 [1 favorite]

Headspace: Histo, huh? At the time I was worried that you might have something bacterial, like Strep. pneumoniae pneumonia, which could have killed you in the intervening 4 days.

I really wasn't sure whether or not to post or what to do; I didn't want you to die but I was pretty sure that you were pretty sick. But I didn't want you to have to go through a $3000 E/R visit if I was wrong, either. I felt crappy and anxious about the whole thing.

I still have the email I sent to gramcracker, apologizing for contradicting him. I seem to recall corresponding with you about the mass, too, but I can't find those emails. I do recall worrying at the time and several times since in the past couple years that you had lung cancer, so I appreciate the followup.
posted by ikkyu2 at 9:19 PM on December 5, 2007

Ikkyu2 is laboring under a misconception. No one in the thread advised her to begin antidepressants, she had told them that she was already on them and had been taking them inconsistently. The response: don't do that. Does ikkyu2 think that was bad advice? The respondents told her to talk to her psychiatrist and disclose all her symptoms and medicine usage. Does ikkyu2 think that was bad advice?

True, respondents diagnosed her with both depression and social anxiety disorder. However, from her comments, it seems that one or both is what her doctor had diagnosed. Whether or not this is the case, the respondents who offered that diagnosis did not do so while advising her to stay aware from her doctor. Quite the contrary. Ikkyu2 asserts that somehow the proper treatment was delayed, or likely delayed, by the advice she had been given. There is no evidence of this. If anything, the comments urging her to see her doctor, discuss her problems with her medicine, and all her symptoms may have led to the correct diagnosis.

Ask MetaFilter sometimes does get things badly wrong and some people have pet diagnosis they offer at the drop of the hat. That's bad. But this particular case? Ikkyu2 is wrong. The advice given was fine.
posted by pussyfoot at 9:19 PM on December 5, 2007 [3 favorites]

Holy cow, that's a lot to put on our mods. I agree they're excellent but I don't think they can be that good, any more than any of us or anyone at all could be.

I referred to "obviously bad advice" for a reason. I mean, for example, telling someone to go to a holistic healer for a broken leg.
posted by cerebus19 at 9:27 PM on December 5, 2007

docpops: It's not arrogance if you're right.

I don't know about that. For the 3 people on this site who may not have realized it yet (and that may be generous), I actually am an arrogant jerk in real life. It's not a secret. Everyone knows it, including me. I have to spend a lot of energy on cooling my jets and trying to deliver my wisdom, if any, in a way that people can receive without being offended or affronted by it. It gets easier with time and practice, but I am still often reminded by my patients and others that it can be hard to accept an opinion if it is presented in a way that is too arrogant. And I certainly know that if my right opinions are to do any good they have to be accepted by the people I'm giving them to. I'd be surprised that that issue cropped up in this thread, because I tried hard not to be arrogant; except that I stopped being surprised about people accusing me of arrogance decades ago.

cerebus19: Doctors cause harm, and sometimes great harm, every now and then, but I would never advise people to avoid doctors as a matter of course.

Well, I've met some people who would. I've even treated patients who felt this way, and that's a difficult thing to do.

i don't think your analogy really holds up. If there's a certain aspect of AskMe that's harmful and we can add some safeguards or even just raise awareness about it, we probably ought to do that.

There are certainly some docs out there who are not competent to be practicing medicine; we have malpractice attorneys and licensing boards who are tasked with revoking their license, those are the safeguards. I wouldn't argue in favor of getting rid of the safeguards, would you?
posted by ikkyu2 at 9:30 PM on December 5, 2007 [2 favorites]

Anecdotes like this lack repeatability. It may be that you have an innate gift for finding the "bipolar" in people, and that would be great. If so, you should work at it, and help people. Or it may be that you got lucky... your sample size here, after all, is n=1. Is this the first time you have suspected this of a person, or told them? If so, then your sample size increases, and your diagnostic success rate goes down.

For what it's worth I really do seem to have a gift in spotting folks with it, both online and in person. I've done it numerous times. I think the time I cited was the only time I'd made the suggestion and THEN had them confirm it medically. Usually I ask them and then they tell me they already have the diagnosis.

And frankly your scenario doesn't bother me. My own doctor admitted to me that most shrinks miss the bipolar type two diagnosis the first time. Even he did, in my case. With this particular condition it is crucial to try to catch it before mistaking it as regular depression because the antidepressants used to treat normal depression are NOT a great idea with the bipolar. It has been my observation that those of us who have had it have an easier time recognizing a fellow traveler and distinguishing it from unipolar depression. Doctors are not magicians so it won't hurt them to have a reminder that not all depressions are created equal.
posted by konolia at 9:31 PM on December 5, 2007

I would submit that many people ask health questions on AskMe because they really dislike doctors. Not as some hazy phobia, but because doctors have, in the past, been arrogant know-it-alls to them who discounted their concerns and questions, ordered them to do as they're told, encouraged them to be terrified of and mystified by their bodies, and then wandered off to be impressed with themselves some more.

"Please go see a medical practitioner" is probably good advice for many health questions, and it's probably helpful advice when something like "I promise they won't laugh at you: I'm a doctor, and I see things like this all the time." is added.

A dismissive lecture to get your ass to the doctor, not so much.

On preview: but then Ikkyu2 knows all that and doesn't consider it a flaw. So. Oh well.
posted by thehmsbeagle at 9:35 PM on December 5, 2007 [3 favorites]

Oh, and, for fuck's sake, in a recent thread someone asking for advice on which medical tests to request from a doctor got diagnosed simultaneously with mono and leukemia by someone with a history of poor medical advice.

Good lord. Those comments are a perfect example of what's wrong - not the medical questions themselves but the people who jump in to answer the medical questions - and especially psychiatric questions - without knowing what the fuck they're talking about. If we could get the folks like den Beste to stop pontificating where they know nothing, we'd probably go a long way to minimizing crappy health-related answers.

It's probably the cheapest therapy in the world just to know other people experience the same things as you do.

The help goes beyond "cheap therapy," docpops. When I was diagnosed with GI problems a dozen or so years ago, I got more information from strangers on Usenet than I did from my GP. I'm not blaming him - you can't be up on all diseases all the time - but what I learned from internet acquaintances helped frame my questions and guide my treatment, even after I switched over to a GI guy. There's a wealth of personal experience online that, honestly, you're a fool to ignore as a patient.

And, as folks have said above, AskMe does some medical questions very, very well - e.g., "Does anyone have any personal experience with treatment X? What was it like for you?" And some mental health threads actually do provide decent suggestions and open-hearted support, which is about as good as you can hope for.

Folks who like to jump in to medical threads need to learn to better recognize when they should clam up, but aside from that I'm not sure what else can be done.
posted by mediareport at 9:35 PM on December 5, 2007

I am so glad you posted this, ikkyu2, because the question rubbed me strangely as well (also an MD here). The clue is in the OP's story about locking the door of a neighbor whose room he walked into, suggesting really significant impairment of judgement. Sometimes the best way to deal with a mistake or a "near miss" is to simply air it out publicly. I don't believe there needs to be a major policy change with regards to medical questions on AskMe, unless someone wants to volunteer to be a medical moderator and actively manage these questions. What a liability nightmare.

The thing people should keep in mind here is that psychiatric problems do impair people's judgement. Only an idiot would accept that they had appendicitis because someone on AskMe thought they might. But in a thread like this, someone invariably says "Hey I feel that way too, maybe you have XYZ syndrome" and I think it's possible that kind of statement carries more weight than it should. AskMe is incredibly useful for getting advice, but I have to agree that this was a wake up call.
posted by Slarty Bartfast at 9:38 PM on December 5, 2007

The clue is in the OP's story about locking the door of a neighbor whose room he walked into, suggesting really significant impairment of judgement.

Wasn't that odd? It set off my red flag too, it just didn't make any sense the way it was explained. It's what made me decide not to respond to the thread.
posted by ikkyu2 at 9:43 PM on December 5, 2007

OK, I tried my best, you arrogant fucking bastard.
posted by docpops at 9:43 PM on December 5, 2007 [3 favorites]

For what it's worth I really do seem to have a gift in spotting folks with it, both online and in person. I've done it numerous times. I think the time I cited was the only time I'd made the suggestion and THEN had them confirm it medically. Usually I ask them and then they tell me they already have the diagnosis

Careful with that axe, Eugene...

Konolia, you may indeed have a preternatural gift for spotting bipolar disease, but you might also keep in mind that it's one of the most over- and mis-diagnosed mental illnesses out there.
posted by docpops at 9:45 PM on December 5, 2007

I really pick and choose what medical threads to drop into. I never mind at all when friends ask me for advice, but I am so worried about being the asshole who led someone down the wrong path just because I didn't recognize when I didn't have all the necessary information.
posted by Slarty Bartfast at 9:49 PM on December 5, 2007

Okay, I just reread that thread and I have to say that this:

Many of the responders got it dangerously wrong.

..is arrogant, overreaching bullshit.

A few of the responders *may* have gotten it dangerously wrong -- that would be the "drugs and therapy don't help so don't bother" crowd -- but the overriding and clear message in that thread was to keep up with the therapy and to take the medication as prescribed.

While your general concern is valid, I think you really missed the forest for the trees in this particular case.
posted by tkolar at 9:56 PM on December 5, 2007 [1 favorite]

There seem to be some frequent posters to the site who are medical professionals. I certainly don't want to put any special onus on them and their advice is gratefully received. However: what if they happened to see a response that they thought was harmfully wrong or misguided (and not just more-or-less wrong) that if they flagged it (offensive, or breaks the guidelines, it really doesn't matter), somehow that would get the attention of cormatamyn. The comment could then be swiftly deleted, or replaced with "bad advice deleted" as a reminder to all to not shoot from the hip.

Also, I believe the affirmative "check this box, poster, to acknowledge you aren't getting any medical advice" is a good idea for Matt's CYA.

I can't help noting the thread today where this problem is writ small: a rash on the thumb, and one answer was to use both fungicide and cortisone, which, it was pointed out, would be counter-productive
posted by Rumple at 10:04 PM on December 5, 2007

With all due respect to the opinions of ikkyu2, and the questions he's here posed, there's nothing in either the March or December posts by the OP that rules out that she's been misdiagnosed by professionals in clinical settings before March, or has been clearly re-evaluated professionally, and re-diagnosed by December. Her December post just announces that she's schizophrenic, and has a single sentence alluding to having had a psychotic break "which revealed that while I do have severe anxiety, it's only a part of the schizophrenia."

Maybe the poster is schizophrenic, maybe she's not actually. It's kind of an assumption on your part, ikkyu2, that her December post is accurate, now, as to her medical diagnosis, whereas her March one wasn't. And even her March post doesn't seem, particularly, so much a call for medical advice or diagnosis, as it does a request for anecdotal suggestions about getting along with sometimes overwhelming feelings and ideas. The good news is, she's not asking for medical or psychological advice at all in her December post.

She asking for suggestions about organizing her daily tasks. She wants to know more about systems like Getting Things Done.

If this is your best case for showing how bad it can get on AskMe, I guess I'd say it doesn't seem to me all that horrendous. I suppose incorrect answers to her December question could have caused her to miss some appointments. What you deem incorrect answers to her March post clearly didn't result in her taking unwarranted actions. And the tone of her March post was pretty organized in describing what must have been some fairly dis-orienting behavior. She might have been in trouble, but she was still clearly able to write grammatically, and operate a computer to post and follow-up. She seemed to me to have met the Turing test for lucidity, even in March.

If I had a nickel for every time I've been mis-diagnosed in person by a doc with a folder full of test results and an eye on his code sheet for Blue Cross/Blue Shield billing, I'd be exactly $6.30 richer tonight. Mistakes happen, even in clinical settings, and I've experienced them. But I hope that simple fear of ever making a mistake doesn't paralyze you, or AskMe, because I think that either of those two results would be far worse, in the main, than you or AskMe commenters making best efforts to help, by the lights each is given.
posted by paulsc at 10:13 PM on December 5, 2007 [4 favorites]

I can't help noting the thread today where this problem is writ small: a rash on the thumb, and one answer was to use both fungicide and cortisone, which, it was pointed out, would be counter-productive

That's actually done all the time by dermatologists. One of those things that didactically seems incorrect but tends to work fine if you don't feel like waiting six weeks for a dtm culture (I stopped looking at skin scraping slides years ago).
posted by docpops at 10:15 PM on December 5, 2007

paulsc, you must be the most medically complicated mofo on the planet.

What color is your blood?
posted by docpops at 10:17 PM on December 5, 2007

Yeah, you missed how that actually went down, docpops. The idea presented was to do a crossover trial, alternating fungicide and cortisone, to see which one worked, as a way of establishing the diagnosis. You know as well as I do the problem with that, but does Joe Random Internet? Hell no.

I tried to correct this well-intentioned, completely erroneous advice but who knows what will actually come of it.
posted by ikkyu2 at 10:26 PM on December 5, 2007

I was thinking about it some more. I have people come in to my office all the time after having received some crazy misinformation through some on line forum. It's odd to be on the other side of this situation. I have to say, the amount of relentless self-policing displayed in this MeTa thread really elevates the quality level of the advice people receive around here.

However: what if they happened to see a response that they thought was harmfully wrong or misguided (and not just more-or-less wrong) that if they flagged it (offensive, or breaks the guidelines, it really doesn't matter), somehow that would get the attention of cormatamyn.

Because, as paulsc just pointed out, there's no way to really know for sure who is right and who is wrong. My MD degree doesn't allow me to read any closer between the lines than anyone else.
posted by Slarty Bartfast at 10:27 PM on December 5, 2007

oh.
posted by docpops at 10:28 PM on December 5, 2007

oh.

meant for ikkyu2
posted by docpops at 10:28 PM on December 5, 2007

ha! even when wrong, I am right.

retires at the top of his game
posted by Rumple at 10:32 PM on December 5, 2007

"What color is your blood?"
posted by docpops at 1:17 AM on December 6

Chartreuse. Sure, medicos poke and pry, and call in students, when they can. But it's never slowed down a billing cycle, so I guess it's not that unusual. Why'dya ask?

Should I be worried?????
posted by paulsc at 10:34 PM on December 5, 2007

Your concerns are very much valid from an ideal point of view ikkyu2 but I don't think there's anything that can or really should be done about it in practical terms. Some points in response:

(1) Almost all medical questions that get posted here won't be about life-threatening conditions, at least in the short-term, for the simple reason that almost anyone with a short-term life-threatening condition who is smart enough to work the 'net will go to a doctor instead.

(2) As others say, these tend to get answered with "GET TO HOSPITAL RIGHT NOW!", which is ideal really.

(3) Doctors are expensive, often prohibitively so, and it's good to have at least some vague idea of what one might be in for, in terms of treatment options, medications, costs, etc before actually going to the doctor, at least as reassurance.

(4) As others say, a lot of answers are pitched more towards helping the questioner clarify exactly what symptoms he/she has, to tell the doctor, eg: "my auntie's friend Clara had cerebal agnosis and she complained of dizzying headaches too, do you have any of these other symptoms?", and some thought put into possibilities--at least, relatively common ones--might be helpful to the doctor the questioner will eventually see.

(5) The outlandish diseases AskMe members suggest tend to come in three categories: (a) common as dirt, in which case, sure, it's entirely possible that's what it is; (b) of some really horrible nature, in which case, well, better make sure that's not what it is; (c) diseases the member themselves or someone they know were probably diagnosed with, in which case, they probably do have a fair idea what it's like.

(6) A lot of advice that isn't technically medical can and does shade into "medical" territory, ie relationship or work questions evoke psychological issues, making/repairing questions evoke first aid issues, veterinary or animal behavior questions evoke both of the above.

(7) Some of these areas have at least as great a chance of an answer provoking suicide (or accidental death) as any psychomedical question does.

(8) Wrong answers which are corrected in-thread are still useful; they educate readers besides the OP (remember the questions database is intended to be searched), and if the answerer is smart and self-aware enough, educate the answerer too. I think it's more valuable to let a misconception and its correction stand, than to have both quietly deleted.
posted by aeschenkarnos at 10:44 PM on December 5, 2007 [1 favorite]

If mathowie wants to add a click-this-box step before health questions get posted, it really shouldn't be just a standard CYA "I recognize that this isn't really medical advice" -- because nobody will listen to that, they'll just click and be done.

It would need to say something like:

No really, the people answering your question may not know what they're talking about at all. Even if they sound very authoritative.

Even doctors can't diagnose you without examining you.

Use your head and don't make major decisions without consulting a doctor in real life.
posted by LobsterMitten at 10:44 PM on December 5, 2007 [2 favorites]