If it's not answering the question, can it be deleted? November 2, 2014 10:14 AM   Subscribe

I know asking medical questions here is controversial. I don't expect to resolve that all here. But I do think there's a consistently problematic answer found in medical threads that has no answer-value and I wish this kind of answer would be deleted as such.

The most recent example is this one: Consult your doctor- who knows your medical history- please. in a question about whether it's Ok to split your controlled-release medication.

a) the answer to this question is not specific to the individual or their medical history
b) there is a ton of useful information on the internet and in the general interest knowledge base about this particular question. This is not a question you need to go to med school to understand.
c) nothing dangerous is going to happen whether or not the OP splits the pill in half.

Basically, the first answer in this thread is not helpful or necessary, and IMHO these kinds of answers, a reflexive, "go see a doctor" to anything related to anything even vaguely medical, should be deleted if they offer no actual information and do not answer the question.

I frequently see the same thing in legal threads but I'm not in a legal field so I can't speak to this issue as well, but I am in a medical field and I think these answer are just weirdly chastising and do not answer the question. Yes I flag them when I see them.
posted by latkes to Etiquette/Policy at 10:14 AM (222 comments total) 11 users marked this as a favorite

I think the main contention here between your opinion and the comment is in your point c) where you say "nothing dangerous is going to happen whether or not the OP splits the pill in half".

I would say that's not a given in every situation, and the best person to give an opinion on that is a doctor, and especially the asker's doctor that might know about other ailments or specifics of their situation (maybe it causes stomach irritation and maybe they have acid reflux, etc).
posted by mathowie (staff) at 10:16 AM on November 2, 2014 [32 favorites]


For sure, that is not true in every situation. In this situation, it is true (this is a sleeping pill not a heart medication) so the person's answer is basically just wrong.

I think non-medical providers imagine doctors to have more special powers than they do. Some stuff is just common sense or is totally addressable by a broad, non-professional audience.

I mean, if someone says, "Is there any reason not to eat this rotten fish?" we don't answer, "Consult your doctor", we say, "It's likely to give you a stomach ache and maybe even hospitalize you!"

Likewise, this particular question is one that is being well-answered, correctly answered, by a lay-audience.

If there are any doctors reading this, I'm curious how they'd feel about a lay audience answering this question. As a nurse I have zero problem with this being answered by random internet strangers.
posted by latkes at 10:26 AM on November 2, 2014 [4 favorites]


Very often people come to AskMe to avoid doing the obvious thing, whether it is talking to a doctor, a lawyer, to their aunt, or getting therapy. Sometimes the right answer is just to tell them to do that thing. There's generally nothing wrong with that.
posted by alms at 10:27 AM on November 2, 2014 [42 favorites]


And I guess while the mods may not always be able to make the call - whether a doctor needs to answer the question - the people who give these answers are almost never medical providers themselves. IN other words, they have no specific knowledge that leads them to say, "This is a question best asked of your doctor", instead they are most often giving this as a reflexive answer because they assume all medical questions can only be addressed by doctors.

Sometimes "See a doctor" is the right answer. Often, it is meaningless advice that is not based on reading the specifics of the question.
posted by latkes at 10:28 AM on November 2, 2014 [3 favorites]


a) the answer to this question is not specific to the individual or their medical history
b) there is a ton of useful information on the internet and in the general interest knowledge base about this particular question. This is not a question you need to go to med school to understand.
c) nothing dangerous is going to happen whether or not the OP splits the pill in half.


If you're asking that a certain answer be deleted because of the three reasons above being true, you're gonna have to back those wide assumptions with evidence.

Are you a medical doctor?
posted by Ironmouth at 10:42 AM on November 2, 2014 [5 favorites]


I feel the same way about the myriad "go get counseling" answers that always crop up in almost every question, but I just ignore them.
posted by masquesoporfavor at 10:45 AM on November 2, 2014 [7 favorites]


It is a sleeping pill, which means that it has psychoactive effects. Alteration of someone's mental state can be extremely serious for that person, even if there are no "physical" effects at the level of a heart attack.

I think you are downplaying the seriousness of the question because it's not "real" medication that needs to be taken seriously.

That is separate from your larger point in some ways, but in other ways, it speaks to it directly: there are all kinds of things that seem "obviously" safe to a layperson (or even the wrong kind of doctor!) that actually are not safe. Of course, that's not to say that we should avoid doing anything without medical clearance from 10 specialists, but when we're talking about:

1) a substance that has known effects on the human body
2) a person who wants to take this substance in a non-standard way
3) a person who seems to have access to the prescribing physician, and likely a pharmacist
4) a decision that does not need to be made immediately, they have time to consult an expert

There's no real reason why laypeople should even be attempting to answer this. What's the benefit, besides avoiding the minor inconvenience that it may be for this person to call a doctor or pharmacist? And yet there are serious risks, despite it not being a med for a "heart condition".
posted by internet fraud detective squad, station number 9 at 10:46 AM on November 2, 2014 [13 favorites]


Additionally, you might be interested in this article about ambien. It's not necessarily a benign drug just because it's for sleep and not for a stroke. It's not necessarily going to do any harm when taken non-standardly, either, but you have no way of knowing that (and neither do I) and the insert that comes with the medication says that it's not recommended.
posted by internet fraud detective squad, station number 9 at 10:50 AM on November 2, 2014 [2 favorites]


Finally--sorry for the multiple posts--I think that fewer people should attempt to answer legal questions, not more. I know I've written stupid, wrong answers because the question seemed totally simple. It seemed simple because I didn't know what I'm talking about. It's a serious risk and when the results can be seriously bad, it's best to err on the side of caution when it comes to giving advice. That flies in the face of a lot of what happens here, but so be it.
posted by internet fraud detective squad, station number 9 at 10:52 AM on November 2, 2014 [12 favorites]


If factually incorrect answers aren't worthy of deletion, there's no way that "ask your doctor/lawyer" rises to that level.
posted by one more dead town's last parade at 10:52 AM on November 2, 2014 [28 favorites]


I think that there's a distinction to be made here between "Ask your doctor because X, Y, Z thing that you may not have thought about," and just, "Ask your doctor."

The first is a really good answer because it says, "Hey, I know you've probably already thought about talking to your doc decided against it but you need to consider it again because here are some factors that mean you REALLY need to ask". The second is just sort of white noise and I suspect not terribly likely to make a difference and I would be comfortable with deleting them. Raising the bar slightly for answers of that ilk seems like it would have a net positive effect. If you can't tell someone even in relatively general terms why they need to be asking their doctor this, you probably shouldn't be answering the question.
posted by WidgetAlley at 11:06 AM on November 2, 2014 [26 favorites]


If someone in the medical field is getting upset about answers from internet strangers that advise a person to go see their personal doctor, I'd ask that someone if they were drunk or high, because their point of view makes not a lick of sense.
posted by Brandon Blatcher at 11:09 AM on November 2, 2014 [6 favorites]


WidgetAlley this states my feelings very well. I'm not trying to stop people from ever saying "call your doctor", I'm instead hoping people say "call your doctor" when they have a specific reason to suggest that doctor call, based on some actual knowledge or information. From a moderator perspective, I see that one might want to err on the side of caution, however, if someone says "call a doctor" and then provides no reason why, it might be considered for deletion.
posted by latkes at 11:10 AM on November 2, 2014 [4 favorites]


In this situation, it is true (this is a sleeping pill not a heart medication) so the person's answer is basically just wrong.

Wait, what difference does that make? Getting a sleeping medication all-at-once instead of time-release can DEFINITELY make something bad happen.
posted by KathrynT at 11:20 AM on November 2, 2014 [17 favorites]


I think Maya's answer is fine. Granted, I would have padded it out a bit.

"We are not your doctor and we don't know your medical situation, nor are we experts on this medication... so talk to your doctor before you take this off-label step" is the only right answer here in my book.
posted by Old Man McKay at 11:28 AM on November 2, 2014 [1 favorite]


Getting a sleeping medication all-at-once instead of time-release can DEFINITELY make something bad happen.

Hmmm. This is worth thinking about.

I'm not sure that what you say would happen, but I"m not sure it wouldn't, and that would be a good question for a pharmacist. So I see how this really undermines my basic concern about these kinds of answers. So I'm going to bow out of this thread for a while and think about the issue before I respond more.
posted by latkes at 11:34 AM on November 2, 2014 [7 favorites]


I mean, if someone says, "Is there any reason not to eat this rotten fish?" we don't answer, "Consult your doctor", we say, "It's likely to give you a stomach ache and maybe even hospitalize you!"

I'm Norwegian. We're fine with rotten fish.
posted by cjorgensen at 11:38 AM on November 2, 2014 [8 favorites]


I understand your point of view, latkes, but I would say that in general people overrate the importance of someone "being wrong on the internet" in all threads on Metafilter. That is, the fact that there is an answer to an AskMe that you, personally, think is wrong really isn't that big a deal. The "answer" to any given question on AskMe is all the answers together. Collectively they offer the community's advice. If the predominant view is "nah, this is fine" and there are a few voices saying "hang on, you really need to consult an expert" then that's a useful representation of the collective understanding of the issue--and purging the few "hang on" answers doesn't make the collective answer more representative, it makes it less so.

I think people have a tendency to see the comments they disagree with as far more representative of the overall tone of a given thread than those they agree with, even when, in fact, they represent a distinct minority view. In general, if you see an answer you disagree with the most useful thing you can do is indicate your disagreement in your own answer--and give evidence to support your view. That way the Asker gets a good, rational basis on which to decide whose advice they ultimately choose to follow.
posted by yoink at 11:39 AM on November 2, 2014 [17 favorites]


I agree that sometimes MeFites get a bit too heavy on the "call your doctor, get a lawyer, see a therapist" type answers, but yoink is exactly right that it is the totality of an AskMe thread that is important.
posted by Rock Steady at 11:47 AM on November 2, 2014 [1 favorite]


The gestalt of AskMefi answers may be appropriate for the more "Human Relations" ethical questions.

In the situation of a medical question, however, relying on the gestalt of anecdotal and "X feels right to me" answers (in a setting where a majority of the users are not medical providers) may lead the asker down the wrong road.

The way health/medical questions are handled here is often inappropriate. Sometimes it's due to lack of expertise, other times it's because you cannot answer a health question without a full history. At the very least, people should be willing to provide evidence for their answers. 99% of the time this probably isn't necessary, the answers are fine and the asker will be safe (or will not avoid medical services when he or she needs it). But you should always consider that 1%.

For what it's worth: latkes, I would like to see your evidence for bringing this up.
posted by bittermensch at 11:57 AM on November 2, 2014


Part of my professional work experience has been in health education. I regularly tell people here to talk to their gp. I am not a doctor.

I do this because a gamut of people reinforcing that having conversations with degree-qualified health professionals is in the best interest of the individual and society is a good thing.

When people start looking to random strangers on the internet for health advice we end up with fucking anti- vaccinators being given oxygen.

If you're a nurse, you're probably tired of dealing with "trivial" issues at work which says more about your employment conditions and your health care industry than anything else. People not playing fast and loose with their health is in your long term best self interest at work, and for the economy, and weirdly enough...for the person. You don't really want people who's experiments with meds went wrong, on your ward, do you?
posted by taff at 12:11 PM on November 2, 2014 [7 favorites]


It's a pretty common internet phenomenon for people to assume that everyone has ready, affordable access to honest, competent authorities to resolve their problems. There's always going to be someone telling you "Talk to your [doctor|therapist|friendly local police]" pretty much anywhere you go on the internet. And I don't think I've ever seen a reliable way to prevent it, even if you specifically say you're not interested in or don't have access to that sort of solution.

I figure most people who aren't interested in that advice have learned to tune it out.
posted by ernielundquist at 12:12 PM on November 2, 2014 [4 favorites]


> So I'm going to bow out of this thread for a while and think about the issue before I respond more.

This, my friends, is a mensch.
posted by benito.strauss at 12:15 PM on November 2, 2014 [19 favorites]


The giving of some few slapdash half-helpful non-answers is something that happens in almost every Ask. It's a function of how this kind of site works. I think there's a way out:

1) give an answer that summarises carefully all the points that - according to you - should be standing in a good/correct/helpful answer.

2) flag whatever you think is unhelpful or wrong.

3) (it needs to be said): move on.


My pet peeve is answers to questions about classical music. There are people who seem to get so excited about these questions that they just have to write something, no matter what. 'Give me some peaceful, soft, contemplative music.' Answer 'Berlioz, Wagner, Bartok.' 'I want to know this thing about the organ.' Answer 'I know this really cool other thing about the banjo.' etc.
posted by Namlit at 12:20 PM on November 2, 2014 [4 favorites]


I would think that the most common reason a US-person wouldn't want to see/contact a doctor is that it would cost money. Is there really another good reason? So - if that's the reason most people are asking metafilter rather than a health professional, it's good to address WHY it's worth spending the money in the answer. "X or Y bad thing could happen if you don't get that checked out" makes me a lot more inclined to spend money on an appointment than just a reflexive "see a doctor."
posted by desjardins at 12:21 PM on November 2, 2014 [5 favorites]


Seems like this answer was given as a matter of principle. Fundamentally because this person seems to disagree with you OP, whether medical questions have a place here. So they refer anyone who has a "medical" question to a medical professional.
posted by travelwithcats at 12:37 PM on November 2, 2014


c) nothing dangerous is going to happen whether or not the OP splits the pill in half.

I am asking in all seriousness, what is your medical/pharmacalogical training that leads you to state this as fact?
posted by feckless fecal fear mongering at 12:53 PM on November 2, 2014 [6 favorites]


I fail to see how "consult a professional" is ever bad advice. IMO, far from being discouraged, it should instead be in bold flashing capitals as the automatic first answer to every question.
posted by Sys Rq at 1:41 PM on November 2, 2014 [1 favorite]


Perhaps people should see askme as a repository of 'people talking' rather than a place where facts and logic are used to answer questions.

It's just people talking. You don't correct that guy on the bus who talks about going to Senn High School with Obama or the dude who says t-swift is the greatest musician ever. You just let them continue on...cuz hey, it's just people talking, and that's how it should be viewed.
posted by hal_c_on at 1:42 PM on November 2, 2014 [6 favorites]


It's a useless answer but banning unhelpful favorite-seeking/superiority-demonstrating is impossible. They'll just pad the answer and say the same thing and threads will have even more noise in them.
posted by michaelh at 1:58 PM on November 2, 2014 [2 favorites]


Telling people to consult an expert isn't unhelpful, it isn't favourite-seeking, it isn't superiority-demonstrating. It's purely good sense.

If you have a medical problem, consult a doctor. If you have a tax problem, consult an accountant. There's no difference.
posted by feckless fecal fear mongering at 2:26 PM on November 2, 2014 [11 favorites]


Maya's answer would have been an excellent one if the poster were looking for the kind of medical advice that AskMe is not at all well suited to, even these days MDs need to take enough pharmacology classes to know to either that this specific medication is not splittable or to request that a patient consult the insert. The poster, thankfully, had already done the correct thing and consulted the insert and instead seem to only be asking out of the kind of idle curiosity that AskMe is actually well suited to. However, while it may be poorly placed in that thread, this kind of answer is one that we desperately need more of.

AskMe being used for medical advice should scare us a hell of a lot more than it does. Between the terrifyingly lethal advice in this old thread that still sticks with me, and the horrifyingly infection happy advice in this recent thread, and the time AskMe was involved in the death of a beloved poster - I rarely stop by anymore. It seems every time I do I find the site being used in a way that takes the kind of advice that one would get from a friend, which is necessarily bad and ill-informed with regards to anything as complicated or important or context dependent as medicine, and amplifies the worst of it to an audience of tens to hundreds of thousands. Medical questions take all of the great strengths of AskMe's collective amateur wisdom and pervert them into something lethal and awful.

For so many medical questions, CONSULT YOUR COMPETENT PHYSICIAN OR URGENT CARE FACILITY with perhaps some good questions to ask and things to keep in mind or YOU REQUIRE EMERGENCY SERVICES IMMEDIATELY, are the only conceivably good answers. There are a lot of questions here, like legal ones or tax ones or whatever, where the only right answer is the correct service to consult and medical questions are only different in how much more absurdly important it is that we do that right. We consistently don't, and that is a big problem worth a hell of a lot more respect.
posted by Blasdelb at 2:37 PM on November 2, 2014 [23 favorites]


So - for the record, pharmacists are not only way, way better trained in drug administration and pharmacology, but they vast majority have a revenue model that allows you to ask basic questions. People suggesting they go to a doctor are sending them to a less-trained and less-accessible option. Pharmacists (particularly the one who administered the sleeping pill) have access to a lot of information - not to mention your doctor - and are better equipped to deal with this question.

c) nothing dangerous is going to happen whether or not the OP splits the pill in half.

My pharmacist wife (who's not your or anyone else's pharmacist) read this and suggests dialling whatever confidence you have in your ability to accumulate internet pharmacology back about 50 notches if you actually believed this to be true. This is categorically wrong, a dangerous blanket statement to make without knowing anything else about the patient's history (other than an unreliable partial internet question), and exactly why "see a health professional" is often the best possible answer to a question - because getting a medical degree affords you a better set of analytical skills in what is required to answer questions.
posted by buoys in the hood at 2:54 PM on November 2, 2014 [30 favorites]


"I'm Norwegian. We're fine with rotten fish.

I'm from New England. We're fine with releasing the double extra Ambien goodness.
posted by cedar at 3:20 PM on November 2, 2014 [6 favorites]


It's weird, you posted these two points:

a) the answer to this question is not specific to the individual or their medical history
b) there is a ton of useful information on the internet and in the general interest knowledge base about this particular question. This is not a question you need to go to med school to understand.


and then this one:

c) nothing dangerous is going to happen whether or not the OP splits the pill in half.

So apparently you yourself had trouble understanding "the ton of useful information" out there, because as plenty of people have already explained, c) is flat out wrong. That is incredibly dangerous advice for a controlled-release drug - depending on formulation, you risk getting the entire dose hitting your bloodstream all at once. You also seem to have a bizarrely blase attitude to sleeping tablets in general - they aren't smarties and I have seen plenty of morbidity due to over-sedation, particularly if somebody is old, frail, drunk, or has pre-existing lung disease, any of which may be the case for the asker in this question.

I can't think of any situation where "ask the person who prescribed it" is the wrong answer to a question about your medication. "Ask a pharmacist" is also an excellent answer. Neither of those should be deleted - if we're deleting anything I'd be much happier with medical questions being deleted straight off the bat with "ask a professional" as the deletion reason.
posted by tinkletown at 4:04 PM on November 2, 2014 [7 favorites]


Yeah, I'd also be cool with letting answers that suggest alternative resources other than the screamingly obvious to stand. "Hey, you know you can call your pharmacist to ask them exactly these sorts of questions, right? No appointment needed!" is a pretty far cry from a reflexive standalone, "Ask your doctor."
posted by WidgetAlley at 4:25 PM on November 2, 2014 [5 favorites]


I will note that not only do the people who answer have a tremendous variability in their qualifications to answer, but the people who ask the questions have a tremendous variability in their understanding of the problem space.

My experience has been that some tolerance for a diversity of answers is for the best in terms of trying to get useful answers to the individuals who are seeking them. Some people may not really need to hear "consult your doctor (or lawyer, tax advisor, etc)" but some people really do need to hear it. We should have a little faith in the ability of the asker to determine which answers best met their particular need. (Yes, some folks will still do stupid things, but some folks will go "duh, yeah, I really did need to just be told something basic that might seem obvious to many of the people here." and then they will, in fact, go do that "obvious" thing that maybe they didn't realize they needed to do -- we all have different backgrounds, different levels of education, etc.)

My experience has also been that online communities have something of a tendency to divide up into two (or more -- but usually two) camps on specific topics, each of these camps seems to generally agree there is one particular "right" answer and they often revolve around a prominent personality leading the charge. When discussion of topics on x topic comes up, arguments basically divide up socially among the different camps as to what is the right answer, often somewhat oblivious to the specifics of the person asking. Again, fostering an environment that tolerates a diversity of answers, many of which do not neatly fall into either of the two prominent camps, tends to get better answers for the OP to figure out what they specifically need to do to best meet their own unique needs.

If it isn't threadshitting, I don't see a problem here -- even if there is a pattern of behavior for the particular person (as suggested above, which I have not gone and looked at to verify). We all have certain biases. One of the strengths of crowdsourcing is that the act of getting multiple answers has the potential to compensate for the fact that some people will fairly consistently advocate for a particular solution or approach, sometimes when it doesn't really seem to fit all that well in a particular case.
posted by Michele in California at 4:28 PM on November 2, 2014 [1 favorite]


I have a complaint about Doc Mathowie's Patented Cure All, the label claims it is 99% pure grain alcohol with trace elements of opium and cocaine, but I'm pretty sure it is no more than 80 proof. Who should I contact about this?
posted by Drinky Die at 4:46 PM on November 2, 2014 [3 favorites]


Have you even bothered to try the contact form?
posted by MoonOrb at 5:25 PM on November 2, 2014 [7 favorites]


and the time AskMe was involved in the death of a beloved poster

That's a sweepingly accusatory and fairly offensive reading of a tragic situation, in my opinion.
posted by donnagirl at 5:32 PM on November 2, 2014 [34 favorites]


Ummm, the usual advice is to SLAM IT AND MOVE ON!
posted by taff at 5:34 PM on November 2, 2014 [1 favorite]


We have doctors and several nurses and EMTs who answer questions on AskMeFi, so we're not short in the experts department. But we also have a great number of people who have experienced legitimate incidents in their non-expert lives that have given them insight they didn't have before and those experiences have valid lessons, as well.

The person who asks the question knows they're asking a mixed bag of people from all sorts of backgrounds. They expect to hear, "consult your doctor," of course - that's good advice for medical questions, but sometimes personal experiences/anecdotes can teach, as well, and those lessons shouldn't be summarily dismissed as meaningless, either.

I think it's best to let the person who asks the question decide what works for him/her. There are websites all over the internet where persons can actually ask a doctor or a medical expert specific questions and get "expert" advice. I don't think that's the idea here.

If an answer that recommends a person consult their physician gets flagged for "having no answer value," then flagging is itself pointless IMHO.
posted by aryma at 5:39 PM on November 2, 2014


Getting a sleeping medication all-at-once instead of time-release can DEFINITELY make something bad happen.

Hmmm. This is worth thinking about.

I'm not sure that what you say would happen, but I"m not sure it wouldn't...


latkes, I'd say both you and Kathryn are pretty much right. Getting a sedating medication all at once instead of as controlled release can definitely make something bad happen. However, in the context of the question, it doesn't actually take a pharmacist or a physician to give a reasonable answer (just my opinion). The asker is inquiring about taking half a dose of a 12.5mg Ambien CR. They have in the past taken 10mg of the immediate release without a problem. Logically, this suggests that getting 6.25mg dose of Ambien all at once will not be a problem for them, as their doctor has provided them for a prescription that gives them significantly more of the drug at once than they would by taking half of the CR pill. I think most people missed the part that the OP's usual script is for immediate release pills, and that they were just trying the CR pills for one round to see if it would help them sleep better (and wanted to split a few leftover pills from this trial).

Thus, folks who are saying that generally, splitting CR pills is a bad idea that could result in negative outcomes or in the medication being ineffective for them are right. But I also don't think that it takes a doctor to answer the question you linked to. It bugs me very minimally when people just respond "ask your doctor" reflexively to a straightforward question that doesn't require an MD to answer. I'm always fine with the concept of people asking their doctor ANY medical question - heck, that's our job - but actually, the way our healthcare system is set up doesn't make it easy to do this, and most doctors don't actually get compensated for answering questions via phone or email that wouldn't require an appointment to address (thus their offices/protocols are not really set up to make it easy for patients to ask them a quick question). I can understand why people do turn to the internet. I try to do my part to make sure that people aren't getting dangerous or very misleading advice around here to whatever extent I can. I get much more irritable about people referring every little thing to the emergency department, because that is a misuse of medical resources, but I've considered a MeTa about that and realized likely nothing good would come of it. Generally, just asking your doctor questions, even minor ones, is not a misuse of medical resources (as long as you don't always do it in an emergency department), and is something that would probably help avoid a lot of errors and misunderstandings about health if people did it more often. So, in summary, I'm cool with these answers.

I would recommend that instead of flagging answers about asking a doctor for deletion, those of us with medical training make an effort to try to provide some advice to the asker, even if it's just the addition of an elaboration on WHY it's so important to ask your doctor this particular question and what sorts of things that your doctor might be able to tell you that the internet can't.

For what it's worth, I think in general AskMe does a pretty good job of answering medical questions for a site with only a few physicians occasionally dropping in to answer. Answers that are dangerous or very misleading are greatly in the minority. With all due respect to Blasdelb, I don't find the threads linked very concerning (except of course the one about a user committing suicide, but I wouldn't say based on my reading of the situation as laid out there that ikkyu2 did contribute to the user's death at all - I think he was being too hard on himself). There have certainly been answers here that upset me or that I thought could potentially cause harm to the asker, but no more so than what would probably happen if the asker asked friends and family without any medical training, and generally the consensus will overrule or undermine those answers.

Thank you for posting about this issue, though - I think it's good that we discuss medical questions sometimes here.
posted by treehorn+bunny at 5:51 PM on November 2, 2014 [41 favorites]


Many people are also hesitant to "bother" their doctor (or, really, their doctor's office) for what they think are "trivial" issues. Someone saying "This is a question that your doctor's office will be willing to answer" can be helpful for people in that category.

Often, we don't know whether the asker is someone in that category.

And any doctor who gets seriously annoyed at patients asking questions about their medications is a bad doctor. And while money may be a concern for patients in the US, a question about an existing prescription should generally only take a phone call to the office, and while I'm sure there are doctors out there who charge for phone calls, I doubt they're serving economically disadvantaged populations. I'd be willing (though unhappy) to be told I'm wrong, but "Talk to the health care provider who prescribed the medication" is not bad advice, or deletion-worthy, or ignorable. It's the first step any poster asking such a question should take.
posted by jaguar at 5:56 PM on November 2, 2014 [6 favorites]


I get tired of the ubiquitous SEE A DOCTOR and GET THERAPY TOMORROW posts - often it seems like a hit and run by a poster who isn't really engaging with the question, just stopping by to gawk, pronounce judgement, and leave.

I'm more accepting of the GET THAT ANIMAL TO A VET posts because often people seem to need the urging to overcome inertia and take their sick pet to a vet, but even that gets old.

I am pretty confident that every single post I see that has anything related to medicine or health will include at least one post exhorting the OP to go see a doctor ASAP. To me that is just part of the noise in MeFi - and I assume most OPs tune it out just as much as I do. I'd like to see the substanceless SEE A DOCTOR posts get deleted more in large part because most people who could see a doctor would - those consulting Ask have bigger issues, but I assume it won't change all that much.
posted by arnicae at 6:27 PM on November 2, 2014 [6 favorites]


I understand the annoyance some people have with the "see a doctor" answers in Ask threads. I have the same annoyances oftentimes with stuff people tend to bring up here or there every once in a while; and after a few years of being on here, something that happens 'once in a while' ends up being something you've seen dozens or even hundreds of times, so it's easy for it to become annoying. But what I realized a while about that that is – that's largely a function of how much I've participated here, not a function of how much everyone else says particular things.

See – if I read a dozen Ask posts a day, and if even half of those are about medical stuff, I'm going to see "talk to a doctor" so often it's going to make me want to scream. But when I feel that way, it's easy for me to forget that the person who asked the question has probably only ever posted the question that once; and they've only received that answer as many times as it appears in that thread, which is usually twice or thrice at most. For the asker, that one little answer might be a perspective they hadn't thought of, or a perspective they'd subconsciously dismissed without realizing it was really the best course of action. I might read the answer a hundred times a day, but to any one particular asker, "go see a doctor" might actually be the best advice that they individually could have received.

Add to this the fact that, from my own experience, many (if not most) people who ask questions in Ask are not the obsessive readers and answerers that many of us here in Metatalk are. So the stuff we're totally fed up with might actually be kind of new to them, and could really be helpful.

I think it's probably a good idea to remember that advice in Ask isn't for us answerers; it's for the Askers, to try to solve their problems. We may get tired of a particular answer, but the fact is (as Blasdelb highlights pretty well above) in many situations it really is the right answer. The alternative is just assuming that they'll read that answer on some other thread, since it occurs so much here. And I don't think that's a good option. "Please talk to a doctor" may get boring after a while, but it remains good advice in the majority of medical questions, so it's not something we should be afraid of telling people.
posted by koeselitz at 7:08 PM on November 2, 2014 [19 favorites]


Secondary question: is there any value in having multiple "Talk to/see a doctor" posters pile up on one another? Is there real value on having 4 or 10 or 20 people say this, as opposed to one? (Again, not talking about the "No really talk to your doctor because X, Y, Z" posts, which I generally find informative and useful.)

It's my instinct that having multiple variations of the same single-sentence answer lowers the value of an Ask because it gets repetitive. If we want to keep the advice "Ask your doctor because they know best," do we need to keep all instances of that advice? Or can we suggest something along the lines of a one-and-done?
posted by WidgetAlley at 7:22 PM on November 2, 2014


I think there is value in multiple people recommending the same course of action, yes. That's more or less how the modern medical system works, anyway. "Here's a idea that we're going to recommend to most people."
posted by jaguar at 7:39 PM on November 2, 2014


If we want to keep the advice "Ask your doctor because they know best," do we need to keep all instances of that advice?

From experience, AskMe is collectively quite good at avoiding repetition in those situations thanks to the [+].

advice in Ask isn't for us answerers; it's for the Askers

I agree with koeselitz here: while AskMe is obviously a repository of answers, each question begins as something meant to assist the OP.

In the US, 'get thee to a doctor' is advice that can feel like it comes from a position of privilege. (Sometimes I'd like the site to detect those kinds of answers and provide an optional donation link on preview.) This is why the vitamin aisles are stacked high and deep, and why quasi-medicine is a multi-billion dollar industry that enriches a lot of quacks and shysters. But oftentimes it's the correct answer, and one that the OP needs to hear in order to get past any reluctance to spend money (or run up debt) until it's really serious.
posted by holgate at 7:55 PM on November 2, 2014 [6 favorites]


but actually, the way our healthcare system is set up doesn't make it easy to do this, and most doctors don't actually get compensated for answering questions via phone or email that wouldn't require an appointment to address (thus their offices/protocols are not really set up to make it easy for patients to ask them a quick question). I can understand why people do turn to the internet.

This. A fucking bazillion times this.

I'll not go into details but I've avoided asking at least two questions here that I think involves things that can be safely and effectively done by informed and competent folks lest I be swamped with the myriad of "Doctor. Do not pass go. blah blah blah". Even asking in a hypothetical sense about meta medical questions (pulling a tooth on a deserted island or amputating a toe or draining an absecess or the like are fair enough examples of this I suppose).

Anyway, would I ask said questions here as things are now? Nope. Too much 'get thee hence to your apothecary or begone heathen' for me to stick my internet neck, regenerating and bulletproof though it may be, out for my taste.

A few people like treehorn+bunny buck that trend here and that's amazing. Truly, really and truly, thanks for that and I do make an effort to watch for their replies in particular both for the well phrased and educated opinions and also because it's ballsy to come out as any professional (MD, lawyer, engineer, welder, contractor, plumber, whatever) and say "skip the phone call", "just file form 42-D yourself", "don't drive all the way into town for that part, the pros use a rubber band", "no, they won't sue you, if they do, they will lose because ...". Maybe it's the because part that makes it great and I feel like folks dropping in and saying "Doctor. Go." without the because are, all too often, trying to be cool and score internet points instead of actually contributing to the person in need because their aloof driveby response like this really, not always of course, can miss the target with regards to the asker and the question or the need at hand.

Not everyone has the means or ability to consult a doctor (because, as treehorn said, Amurica healthcare woooooo!) for every issue, large or small, that comes across their physiology or front the money for a lawyer's retainer or pay the going rate for a blue collar worker to come out and fix his/her pipes. Or what-the-fuck-ever reason they have to ask for a certain thing in a certain way, I try to respect that nowadays.

[disclaimer] Sure, there's a line, many lines even. Like if someone is asking how to hang themselves with the least amount of pain or where a good place to jump off the golden gate bridge is or if someone wants to mix ammonia and bleach just to see what it smells like. 999 times out of 1000 those questions don't deserve straight answers, even if cunningly phrased as being "for science" because of what they are. But if someone wants to know more about a simple headache when they're hungry and we respond with the old axe about going to see a doctor we're just doing the AskMe equivalent of stating 0 = 0 without the fun of a mathematical proof or a cute kindergartner to show for it..

Sure there's a time and a place to say, plain and simple, don't jump off that cliff but I think that if the asker is asking the question with full knowledge of implications and risks of the situation they're asking about, providing decent information, and is interested in getting specific information we can do a lot better than a myriad of people saying...

"Go to the doctor you specifically said you don't or can't see even though you specifically said you couldn't or wouldn't because you have reasons that I deem unworthy or don't agree with because I feel like saying something pithy and quick without adding any reasoning as to why I think a doctor is anything but the trivial or nominal solution to the question you asked."

But I've probably had too much leftover bridal shower punch to be writing posts at all, let alone long ones on Meta, so thanks for listening and I'll take responses to my, hopefully not too incoherent babble, off the air. Or not, I'm ok with that as well. [retracts internet neck back into shell]
posted by RolandOfEld at 8:10 PM on November 2, 2014 [9 favorites]


But the thing is, a doctor here saying, "You may not need to consult your doctor" is working from an immense set of knowledge and training that non-doctors don't have. Do you want a bunch of people who don't know what they're talking about giving advice that doesn't indicate they don't know what they're talking about, without any recognition of, "Hey, we may not know what we're talking about"?

It's all well and good when medical professionals do come into threads and give specialized knowledge. But given the way AskMe works, where askers are asking the general community and not specific individuals, no individual question should be assumed to be vetted by a medical professional. I think it's horrifically dangerous for the community to proceed as if MDs or RNs are reading every medical question and responding to every medical question.
posted by jaguar at 8:19 PM on November 2, 2014 [1 favorite]


and the time AskMe was involved in the death of a beloved poster

oh, do go on. your self-righteousness is very interesting and i would like to subscribe to your newsletter.
posted by liketitanic at 8:37 PM on November 2, 2014 [9 favorites]


And any doctor who gets seriously annoyed at patients asking questions about their medications is a bad doctor.

I've never had a doctor get annoyed for something during a visit when I was in the office and paying for their time. Fair enough of course. I've always, childhood-smalltown pediatrician (I'm 30 years old now) exempted, had doctors and nurses get annoyed or become damn hard to get in touch with at all when trying to get any question answered over the phone, even about prescriptions. It may be red car syndrome but in talking with other people like my wife, friends, and family this seems to be a common, nigh on universal, trend. For the record, I've played many economic roles in my life, from upper-lower class,at best, to middle and back down again. YMMV.

On preview:

Do you want a bunch of people who don't know what they're talking about giving advice that doesn't indicate they don't know what they're talking about, without any recognition of, "Hey, we may not know what we're talking about"?

No, I want them to keep walking instead of dropping in to type 9 characters that are, or can be I should say, just as valid as talking about how ice-cream might help. Seriously, instead of "go to a doctor" insert "get some ice cream". Fun and, often, just as helpful because, as you say, it's coming from a place of uninformedness in the first place.

I think it's horrifically dangerous for the community to proceed as if MDs or RNs are reading every medical question and responding to every medical question.

I don't think people should proceed as if this is true. Obviously you think they do. I don't know which of us is more reasonable but I do think that the burden of AskMe isn't to make it known that relevant licensed professionals aren't reading each and every question on every topic out there. The burden of AskMe, to me at least, is to convey, and in a sense compile and archive, relevant information on a given question to a given audience. That means one line or pithy answers tend to be more of a negative, or at least not a positive, thing. Another part of AskMe, sad but necessary, is the entertainment value and good feels that comes from responders hitting submit with a reply to a question. That is a bit at odds with the first, and more important purpose, because it actually rewards one line, quick, and often unhelpful or at best neutral responses with said good feels or internet points. "Go to a Doctor" as a one line response, for better or for worse. I lean to the latter.


An aside:
I'm sure there are doctors out there who charge for phone calls
I currently work for a firm that makes software for law firms. They enjoy charging, automatically and programmatically, folks for phone calls in increments down to 6 seconds. No doctors that use it that I'm aware of, but I'd not be surprised if it bleeds over somewhere.

posted by RolandOfEld at 8:44 PM on November 2, 2014 [4 favorites]


and the time AskMe was involved in the death of a beloved poster

WHOA.

I'm often critical of the site and mods. But what you're saying sounds rather...really uncool.

Clicking on your links, I don't see how metafilter was involved in the death of someone. Thats really not cool for you to say. Nobody here said or did something that lead to someone's death.

I hope everyone understands that it isn't metafilter's responsibility to take someone out of a deep dark depression that would lead to something horrible.

Everyone should log off right now and tell their real friends and family how much they love them.
posted by hal_c_on at 8:50 PM on November 2, 2014 [7 favorites]


And y'all have docs that answer emails? Wow, I can't even begin to imagine... what's it like in the future? Or is socialized healthcare just that damn good? That would just be... so amazing.
posted by RolandOfEld at 8:52 PM on November 2, 2014 [5 favorites]


No doctors that use it that I'm aware of, but I'd not be surprised if it bleeds over somewhere.

It's not at all the same thing, because medical care in the US is usually paid through insurance, and so the doctor needs to tell the insurance company they think they should be compensated, and an insurance company needs to agree that the doctor was providing medically required care in a manner that is covered by the contract between the doctor and the insurance company. Many of those contracts do not cover phone calls.

Lawyers charge clients directly by the hour. Doctors do not.
posted by jaguar at 8:57 PM on November 2, 2014


Doctors do not.

Not even 90210 plastic surgeons or doctors in *insert country a mefite lives in here*? I was including them in my figuring and assumption-eering, but yea, shouldn't have mentioned the doctor angle, doc derail over. Lawyers are still gonna get their dollars.
posted by RolandOfEld at 9:02 PM on November 2, 2014


Clients who are paying cash directly to doctors can, pretty much by definition, afford the call to check on their prescriptions. That's my point. Other patients in the US should be able to call their doctor, and either get an answer by phone that doesn't cost them anything or get the runaround or a requirement that they come in and pay a copay, and people who get the runaround or can't afford the copay should certainly ask their questions here, but they should indicate the steps they've already taken to run the question by a medical professional and why those steps didn't answer their question, and they should be prepared to hear that AskMe can't help them.
posted by jaguar at 9:06 PM on November 2, 2014 [1 favorite]


And any sort of expectation that's set up that licensed medical professionals will step in and solve problems is creating a liability issue for those medical professionals and making it more fraught for them to provide expertise.
posted by jaguar at 9:16 PM on November 2, 2014 [1 favorite]


I get tired of the ubiquitous SEE A DOCTOR and GET THERAPY TOMORROW posts - often it seems like a hit and run by a poster who isn't really engaging with the question, just stopping by to gawk, pronounce judgement, and leave.

This is one of the few weak points of AskMe, really. Some types of question have this kind of general, context-free answer that is not very novel or helpful, but provides an easy way to be Right On The Internet - it's like answering "RTFM" or "Get a Mac" in technology questions. You can't delete it in some fields though, because it is basically sound or at least not dangerous advice, and the possibility for real harm from a bad answer, however remote, is there. Best to ignore it and wait for the people who actually do think before answering.
posted by Dr Dracator at 9:20 PM on November 2, 2014 [2 favorites]


Dr Dracator: “Some types of question have this kind of general, context-free answer that is not very novel or helpful”

This really isn't the case here. If it isn't novel – if it's literally the dozenth "please see a doctor," with no other help – then I would bet mods would be happy to delete it if we flagged it. And I don't see how you can claim it just "isn't helpful." Like I said above, you may be tired of "go see a doctor," because you may have seen it a billion times; but I guarantee you that the poster asking the question has not seen it that many times, and it may be entirely novel to them.

A lot of this sort of smacks of power-user privilege here to me. I mean, yes, we are the people using this site most. We read every question. Certain answers get annoying. But we need to keep in mind that that's probably not how most people come to this site; and given that answers are question-specific, we need to be open to the possibility that "see a doctor" is a good specific answer to a lot of specific questions.
posted by koeselitz at 9:45 PM on November 2, 2014 [6 favorites]


Whatever. If you say you've seen a
doctor, everyone on MeFi tells you the doctor is wrong and they know better, so medical questions really shouldn't be asked here. MeFi does med stuff really poorly.
posted by pineappleheart at 9:47 PM on November 2, 2014 [6 favorites]


pineappleheart, if you're referring to this question, I think people are just responding to recent developments that the doctor wasn't aware of, not saying any doctors were wrong. "I was bitten by a cat" is a very different set of information than "I was bitten by a cat and that cat has been staring at my door ever since, for hours, with blood running down its face."
posted by dialetheia at 11:09 PM on November 2, 2014 [6 favorites]


Can I also add, without meaning to derail, that not all of the posters here are in the States. There are many nations, and their healthcare systems, represented here. It's nice to hear Americans noticing that we may be making assumptions about their situations and that we non Americans are not the centre of the universe....as they are not.

If I have been guilty of this in the past, I apologise. I hope we can all remember that this truly is an international site.
posted by taff at 11:12 PM on November 2, 2014 [5 favorites]


Just thinking - the second frequent answer in some medi-question threads is, in fact, "see another doctor," isn't it...

The issue with doctors, trust and expertise is a little more complicated than "they know the answer." At least in good old Europe, a luck of trust may well be keeping certain people away from going to the doctor for what they maybe think is a minor issue. In some such cases, an Internet chorus that says "do go" may actually be helpful.
posted by Namlit at 11:51 PM on November 2, 2014 [1 favorite]


A lot of this sort of smacks of power-user privilege here to me. I mean, yes, we are the people using this site most. We read every question. Certain answers get annoying. But we need to keep in mind that that's probably not how most people come to this site; and given that answers are question-specific, we need to be open to the possibility that "see a doctor" is a good specific answer to a lot of specific questions.

This is a good point, because it brings out _why_ I think this kind of answer is not helpful: I have seen it so many times, I am very likely to attribute it to mefite knee-jerk responce and disregard it, even if it's correct. If it's a good specific answer to the specific question, it would be very helpful if we could qualify "see a doctor" or "get a lawyer" with a reason why this specific OP should not be relying on strangers on the internet for advice.

If Matt plastered a generic "GET A DOCTOR" banner on every health-related AskMe, many people would disregard it - it's not much different if we do it in the comments.
posted by Dr Dracator at 11:54 PM on November 2, 2014 [4 favorites]


The "ask a doctor" responses seem to presume a lot, namely that most people have a doctor that they can actually ask. I don't know if the people who constantly make those suggestions all live in strange, northern European fairylands of socialized healthcare and biscuits that are really cookies, or have just stepped out of time machines from some mythical time in the past where they could just call up the cheerful, friendly, town doc when they had a few burning questions, but if "ask a doctor" was an option that most people had readily available, they probably wouldn't be asking strangers on the Internet.

At the very least, before hitting the 'post' button on an otherwise content-free "ask a doctor" response, it'd be nice if people at least clarified what sort of doctor they think the OP should ask. Because "ask a doctor" could mean a lot of things.

Do you mean that they should call 911 and go directly to the ER, do not pass go, do not collect $200? If the instruction is "ask a doctor", and the recipient of that pearl of wisdom has no access to a doctor except by picking up their phone, is that still the advice you want to run with? Because for a very large number of people, that's the position you've just left them in. Perhaps the suggestion should be a bit more nuanced.

Or is the advice really more like "hey maybe you should go to Prompt Care" or "maybe try the Minute Clinic in CVS"? Those are both pretty reasonable suggestions in a lot of cases, but not something that a lot of people are likely to get from a kneejerk "ask a doctor". (In fairness, neither are likely to actually put you in front of an M.D.-possessing doctor.)

"Ask a pharmacist" is another reasonable suggestion that seems frequently neglected in the rush to tell everyone to call up the nearest doctor. IMO, pharmacists are only a step or two down from MeFi's Favorite Profession, librarians, in terms of being paid to actually answer strange questions.

But what I think people imagine when they say "ask a doctor" is that the asker should just phone up their GP, who of course they have an ongoing relationship with, paid for presumably by their totally comprehensive health insurance, and will be able to fit them into their schedule no problem at all, just drop by tomorrow why don't you, the doctor will totally love to spend some quality time talking to you, and I can't even write this with a straight face anymore because it's just laughable. It's like having someone ask how to change their car's oil and getting told "well just have your butler or perhaps a trusted manservant run it down to the dealer for a service." It's not that it's an incorrect response, and it's not even that it doesn't answer the question, broadly interpreted ... it's just ... not useful.

(My annoyance is, of course, highly US-centric, but I think that's fair since AskMe--particularly with regards to health questions--is pretty US-centric. If there's some indication that an asker is from one of those strange socialized-medicine-and-biscuits fairylands with functional healthcare systems, then all bets are off; they should in every case report directly to a doctor for quality medical advice and/or cookies.)
posted by Kadin2048 at 12:21 AM on November 3, 2014 [21 favorites]


I don't see the problem with the "ask a doctor" answers. The poster knows what is relevant to them and can ignore advice that they don't need. I definitely do not think they are noise, and are a necessary salve. Sometimes the best choice is to consult a professional, and it is not unhelpful to remind people of that option. A thread which is nothing but "ask your doctor" might be frustrating but is

a)very rare
b)probably indicative that the person in question should ask their doctor.

I love ask, but people do have misconceptions which they spread. For a for instance, I asked essentially a physics question about cooling my son's bottles here, and got quite a few answers which claimed it wasn't actually necessary to boil the water in the first place. Which is directly in contravention of WHO advice (see page 10). I didn't make a big deal of it at the time, because my question wasn't actually about that, although part of me does worry slightly that someone could stumble across that question and come away with misconceptions.
posted by Cannon Fodder at 2:56 AM on November 3, 2014 [3 favorites]


But what I think people imagine when they say "ask a doctor" is that the asker should just phone up their GP, who of course they have an ongoing relationship with, paid for presumably by their totally comprehensive health insurance, and will be able to fit them into their schedule no problem at all, just drop by tomorrow why don't you, the doctor will totally love to spend some quality time talking to you, and I can't even write this with a straight face anymore because it's just laughable.

You're just jealous and I can't say I blame you. Everyone should be in the position you just described, and it's pretty fucked up that so many people aren't.
posted by Too-Ticky at 2:58 AM on November 3, 2014


I would think that the most common reason a US-person wouldn't want to see/contact a doctor is that it would cost money. Is there really another good reason? So - if that's the reason most people are asking metafilter rather than a health professional, it's good to address WHY it's worth spending the money in the answer. "X or Y bad thing could happen if you don't get that checked out" makes me a lot more inclined to spend money on an appointment than just a reflexive "see a doctor."

I agree. An underlying factor of a lot of AskMe questions is a lack of resources, including financial, social, and emotional. Answering the immediate need ("See a doctor!") without addressing the factors that have prevented the person from already doing that obvious thing isn't particularly useful, in my opinion.
posted by Dip Flash at 6:06 AM on November 3, 2014 [2 favorites]


Answering the immediate need ("See a doctor!") without addressing the factors that have prevented the person from already doing that obvious thing isn't particularly useful, in my opinion.

Then the OP needs to provide information on those factors, because many of the issues are extremely individual. If you have X kind of insurance, do this thing; if you have Y kind of insurance, do this other thing; if you have no insurance, do a third thing. If you have X insurance and already have a doctor, do A; if you have X insurance and don't already have a doctor, do B... pretty much ad infinitum. And in the US, those insurances are all going to vary by state, as well.

People answering the questions should absolutely leave open the possibility for those factors, but I don't think answerers should be expected to be mind readers about information the OP has not provided. It's one thing to read between the lines of a relationship question; it's quite another to magically divine whether a poster has an HMO or a PPO or Medicaid.
posted by jaguar at 6:38 AM on November 3, 2014 [6 favorites]


the time AskMe was involved in the death of a beloved poster

Yeah, Bladelb, I agree with most of what you're saying here, but this aside is really fucked up. We don't have to go into it since this thread isn't about it, but let the record show I too find it very unfair that you'd toss off a link to that comment as an example of AskMe being dangerous.
posted by Potomac Avenue at 7:05 AM on November 3, 2014 [18 favorites]


I think that, in this particular case and in a few others, "ask a pharmacist/doctor" is the only relevant advice. There are some cases when people could be more specific about the most likely place to get help, but often the poster does not even include their location which makes it difficult to give specific advice.

As an engineer, to me the linked question is akin to someone asking, "Can I build this deck while ignoring code requirements for the number of supports per square foot?" The answer depends on a whole host of factors which the OP is likely unaware of, not being an engineer. The best case is it is safe. The worst case is the deck fails, killing people. How is that answer more helpful than saying, "Consult a professional engineer" which is the necessary course of action to resolve the question completely and safely?
posted by muddgirl at 7:20 AM on November 3, 2014 [4 favorites]


the time AskMe was involved in the death of a beloved poster

Step off. AskMe is "involved" with the death of everyone who has used AskMe to ask about their lives who has died. If you think things in that thread were that-level fucked up, talk to the police, don't come here waving your hands around implying a bunch of shitty things about basically everyone who interacts there and the people who run this place.

It's terribly tragic that some people are grappling with things that are beyond AskMe's ability to help. The solution to that isn't to just stop helping, it's to try to direct people to appropriate resources and realize that people's lives are hard and that on a personal level people need to figure out where to draw their own lines with deciding how involved to get. And even people dealing with fucked up stuff in their lives whether it's mental illness or family disasters or questionable legal situations still have the right to make their own decisions, to take and leave information that is or is not helpful for them personally.

these kinds of answers, a reflexive, "go see a doctor" to anything related to anything even vaguely medical, should be deleted if they offer no actual information and do not answer the question.

People who sort of repetitively and unhelpfully just say "See a doctor/lawyer" in every thread sometimes see those answers deleted. Anyone who makes an effort to show that they've read the question and are giving the best advice they can is welcome to comment. Mods don't delete answers for being wrong, nearly all the time. This causes nerd rage. This may be unavoidable.
posted by jessamyn (retired) at 7:25 AM on November 3, 2014 [61 favorites]


To the extent that "doctor. now." may be unhelpful in some circumstances, I think the best response is to provide more helpful advice (IF YOU HAVE IT) rather than place the burden on moderators to try to figure out when or when it is not sound/valid medical advice.

This additional info might be why it's important to see a doctor, or that a pharmacist or your insurance company's nurse hotline might also be another good resource, or what bits of information may be relevant to share with your doctor. Even if ultimately the final step is to consult a doctor (or lawyer, or accountant, or structural engineer), an informed patient/client is in a better position to make optimal use of those professional resources.
posted by drlith at 7:54 AM on November 3, 2014 [3 favorites]


For example, while ultimately almost anyone involved in a divorce situation that involves child custody needs to consult an attorney, there is really an unfortunate lack of awareness or understanding of the legalities of divorce. Shedding a little light on the subject is, I think, an important public service: whether that means "this horrible outcome that you fear is actually not likely" or "this horrible outcome that you seem unaware of is a very real possibility".
posted by drlith at 8:00 AM on November 3, 2014 [3 favorites]


the time AskMe was involved in the death of a beloved poster

What a bullshit comment.
posted by a lungful of dragon at 8:24 AM on November 3, 2014 [1 favorite]


The correct way to ask slightly off-label medical or legal questions is to preface it, "For my novel ..."

People will give you terrifying extensive details about how to launder money or perform wilderness surgery as long as you preface it properly. "So, for my novel, I need a massively successful fraudster to perform abdominal surgery in non-sterile woodland conditions. Please explain both how to leave the US after a shoot-out with police leads two characters into hiding in a remote woodland cabin in Montana, and how one might remove a bullet lodged in their BFF's abdomen. Assume the character has a scalpel, but only dental floss for closing. The character has a lot of access to chemicals and can hotwire cars near the Canadian border if necessary. Oh, are there any difficulties in international bank transfers after you leave the country? Thanks!"
posted by Eyebrows McGee at 8:31 AM on November 3, 2014 [15 favorites]


The correct way to ask slightly off-label medical or legal questions is to preface it, "For my novel ..."

Especially at this time of year - the green already has a bunch of these in progress.

As for the caused-the-death-of-someone thing....Man, if I really thought that about the online place I hang out and the people who hang out there and run it, I think I would not hang out there any more, because it sounds like a terrible place I wouldn't want to be associated with.
posted by rtha at 8:33 AM on November 3, 2014 [6 favorites]


There is some class of questions where a "yes" isn't wrong or a big deal, but you'll never get a professional to state as much because of liability concerns and reflexive employment of their learned models.

In this case, you'll probably never get a doc or a pharmacist to say "yeah sure" for the above reasons--it's very unlikely--yet it's also very unlikely to matter if you split this pill. Now if someone were asking about crushing long-acting tramadol or messing with a nitroglycerin patch, nobody in their right mind would say "do that".

As others have mentioned, there are plenty of professionals who aren't exactly listening extensively and carefully amending the advice they offer based on context. People at work run off a lot of algos to make their lives easier and protect them. I find it difficult to get specific information from just about anyone at work, whether in customer service or medicine. So often they are answering questions that have answers that exist in their head, not answering the question actually asked!

Sometimes the community can step up to fill in the gaps.

And when it comes to therapy, I'd say that having people at some distance to you willingly listen, and respond with advice based on their own life experiences, and even offer to talk privately a bit--well, to a first approximation, that is therapy. It's kind of weird that we conjur up "experts" who own the field of giving advice on how to live life, don't ya think? Laurie Anderson said it best. The internet has likely helped people who would really benefit from therapy realize that they would, and allowed a lot of "everyday problems" folks to get by just fine without it.
posted by sylvanshine at 8:42 AM on November 3, 2014 [3 favorites]


For what it's worth, I'm the OP of the question latkes used as the most recent example of the kind of consistently problematic answers he's objecting to. I didn't get any particularly helpful information; I'd hoped to, but wasn't too surprised that I didn't. I do realize that this is the kind of question that should be answered by a medical professional of some kind, not by MetaFilter, but it's not something I was willing to talk to my doctor about, and I was wondering if anyone had any information that I wasn't able to find or get on my own. It turned out that no one did. The reflexiveness of some of the answers bothered me a little (very little), but I liked the amount of concern that some of the "see your doctor" answers indicated. I would not wish for any of them to be deleted.

Somewhat related, I once had a comment deleted, on a thread about someone being bothered by noise in their apartment. It took me a quite a while to figure out that my comment could have been read as chastising, which was absolutely not how I meant it. I see the value in comments being deleted on MetaFilter (pretty much every time I look at any less-well moderated site), but I'd err on the side of not deleting when it's a question. But I do agree that no one should take online answers to medical and legal questions as anything other than what they are.

And I'm finding this discussion pretty helpful too.
posted by still_wears_a_hat at 8:51 AM on November 3, 2014 [4 favorites]


It's not necessarily a benign drug just because it's for sleep and not for a stroke. It's not necessarily going to do any harm when taken non-standardly, either, but you have no way of knowing that (and neither do I)

I've told this story on MeFi before, and I will tell it again. It's why I stayed out of the post altogether.

My young relative* was a pharmacist. They took Z-drugs frequently due to insomnia and a hellacious work schedule, and a few years ago, they took a calculated risk when taking Ambien that they'd made several times in the past, and it had worked out. And people do take this particular risk often. But it's...riskier than you'd think.

This miscalculation cost my relative--a professional in the field of understanding medication and medical interactions, and they weren't a slouch; they worked their asses off at their field--their life. A qualified medical professional evaluated the situation and had intimate knowledge of the personal history and immediate context in which they were taking the drug and in what amounts, and the safety range, and got it wrong. If it's easy enough for someone like them to fuck it up badly enough to die, I don't particularly see "consult doctor/a medical professional" to be off-topic or unnecessary. I mean, the pro can still get it wrong with serious consequences, cf, my relative.

It really, really sucked, and still sucks, and although it was an accident and this doesn't ALWAYS happen every time you take a risk with them, and although I am not anti-the-Z-drugs in any way, I very much disagree with the argument they're just sleeping pills and that=benign.

I know not everyone agrees with me on this, and that's why this thread exists. I just happen to think "consult a professional" is okay advice and doesn't deserve deletion in these cases.

Also, I've met still_wears_a_hat, and she is very nice, and I didn't want to freak her out with Ambien gone wrong horror story. (Please don't be freaked out.)

*i.e., young, healthy, male and in the demographic most likely to get away with the risk. Usually.
posted by Uniformitarianism Now! at 9:34 AM on November 3, 2014 [16 favorites]


Since the OP requested responses from physicians I thought I would weigh in. Having more information about the person asking a medical question never hurts. In this particular case splitting a time realease pill is definitely something that a knowledgeable professional should be consulted about, and there might be relevant information in the patient's history; for example, if they are on other medications that might interact with Ambien. While it is unlikely that anything really bad would happen, there is that possiblity. So I do think it is not a good idea for lay people to anwer this sort of question and it is reasonable to suggest that the OP from AskMe get advice from someone familiar with the particulars of their situation. In this case a pharmacist might be the best option, but suggesting that they ask their doctor is not unreasonable. I give that advice myself from time to time in AskMe, but usually try to give some explanation as to why answering the question over the internet is suboptimal.
posted by TedW at 9:38 AM on November 3, 2014 [11 favorites]




Wow at that link. I believe there has been something like 1 identified rabid cat in New York City in 5 years.
posted by Justinian at 9:45 AM on November 3, 2014


Huh, on the other hand the City issued a health alert one month ago after a rabid raccoon attacked a bunch of feral cats. So I guess you never know.
posted by Justinian at 9:47 AM on November 3, 2014 [1 favorite]


We shouldn't be asking medical questions here, because the only reasonable answer is to ask a professional (i.e., the doctor, pharmacist, whatever... the people with the education, training, licenses and experience to answer the question). I feel like I have a pretty good grasp of a lot of medical topics, but I still defer to the licensed people. And when I see an answer that even I can see is wrong, I cringe.

My assumption is that medical questions are the same as legal questions. Any answer other than to see a professional is wrong because (1) answers from unqualified answerers are almost certainly wrong and (2) being wrong can have lasting and negative impact (either medical harm or a negative impact on a person's legal rights). Unqualified answerers simply do not have the education, training and experience to be answering legal (or medical) questions. Unlike Socrates, they don't even know what they don't know. They think they know about some part of the issue, but don't even recognize the other problems. Amazingly, they don't realize that questions are unanswerable without more information about 99.5% of the time because the answerers don't realize why that other information is necessary or important. Instead they (negligently) assume the asker gave all the necessary information.

This is exceedingly problematic because Askers suffer from the same problem every patient or legal client has: they don't even know what information to report in their question. So when the asker doesn't know what information to share, and the answerer doesn't know what information is missing, you have the blind leading the blind. I see this problem all the time in the law, and I have heard many times the old saw about how patients are terrible historians when seeking medical care.

People don't know what is important, and it is the professional's job to ask the questions to get the necessary information before making the qualified opinion. This process is not followed on AskMe: the opinions are not coming from qualified people and the opinions are not based on the necessary information. It is why all medical and legal questions are terrible: they produce mountains of terrible answers that are more dangerous than they are useful.
posted by dios at 9:54 AM on November 3, 2014 [3 favorites]


For what its worth, I do think the link PA provided is very problematic. "Talk to a doctor" is a perfectly reasonable think to suggest to someone bitten by a wild or feral animal. But the answers in that thread go considerably beyond that. They urge the OP to insist upon a course of treatment despite any medical advice, not simply urge the OP to seek medical advice. We're talking about a disease that, no matter how awful, has so far as I am aware seen no human cases in New York City since like the Second World War.

So, yeah, by all means suggest people talk to a doctor. But unless you have something to back it up perhaps less with the insisting on specific medical treatments even if a doctor thinks it unnecessary. Which is the opposite of "talk to a doctor".
posted by Justinian at 10:09 AM on November 3, 2014 [3 favorites]


On the third hand, I disagree with dios that legal and medical questions should not be allowed. I'm sure lawyers think that the answers to lots of legal questions are terrible. But I'm also sure that, say, electricians think the answers to lots of electrical issue are terrible. I mean, I'm pretty familiar with written science fiction and fantasy and I sure know the answers to a lot of recommendation questions are terrible and that's not even something I had to study for 6 years at above a college level to learn, or whatever.

Any time you ask random people for advice you're going to get a lot of terrible answers whether it be about naming your pets, recommending books or music, how to treat a possibly infected wound, how to get rid of an annoying roommate, how to deal with the fact that you are hearing voices and are paranoid despite not recognizing that you are hearing voices and are paranoid, or knitting.

You roll the dice and you take your chances.
posted by Justinian at 10:14 AM on November 3, 2014 [4 favorites]


I hope the people who answered in that cat thread donate to the poster's medical fund if he/she has to pay for the ER visit.
posted by desjardins at 10:23 AM on November 3, 2014 [3 favorites]


I thought many of the answerers did a good job of pointing the poster to free rabies resources at the local and county level. It seems to me like it contained a few good models for clearer, more precise answers than "talk to a doctor!"
posted by muddgirl at 10:27 AM on November 3, 2014 [8 favorites]


So, my parents are a doctor and a nurse, my stepmother is a nurse, and I have a lot of other medical professionals in my family and social circle. One thing I've learned is that medical practitioners have a MUCH more lax attitude toward self-diagnosis and self-medication than the average bear. Maybe this is a good thing. Maybe this is a bad thing.

But I think it's a huge mistake to set Metafilter site policy on the fact that sometimes medical professionals read people's questions and think they're overthinking or over-relying on specialist knowledge when honestly what they want to do is perfectly safe. If you think that, answer the question thusly! Or don't, and just decide to ignore laypeople's dumb medical questions because you know it'll set off paroxysms of Someone Is Wrong On The Internet. I feel like all of us have AskMe topics we avoid because we just Cannot Even with that shit.
posted by Sara C. at 10:37 AM on November 3, 2014


When you're bitten by a feral cat and that cat is behaving in a way that no healthy cat would behave, it's not unreasonable to be worried.

Rabies is a death sentence if untreated and that cat was acting extremely oddly in ways that rabid animals have been known to act. I didn't respond to the thread because it seemed the 'this is more serious than a cat not leaving your yard' position was adequately represented.

I did wonder how pineappleheart described the incident at the ER, because it's very odd to me that they didn't automatically start the rabies protocol with a feral cat displaying extremely hostile and strange behavior. Even if it had been a cat known to her but without proof of vaccination in my area they give you the rabies shots if you're bitten.
posted by winna at 10:46 AM on November 3, 2014 [4 favorites]


I imagine that ER doctors deal with a lot of people who really don't have [problem] but who are incorrectly convinced that they need immediate, risky treatment for [problem].
posted by internet fraud detective squad, station number 9 at 10:53 AM on November 3, 2014


They urge the OP to insist upon a course of treatment despite any medical advice, not simply urge the OP to seek medical advice.

This isn't really true, though. The OP came home and observed the cat acting very strangely for several hours after the doctor visit for the bite. The commenters in the thread are responding to new information that the doctors weren't aware of when they saw the OP; people are saying "this new development makes it seem more likely that you might want to consider rabies," not saying that the doctors were wrong to dismiss it based on the information available to them when they initially saw the OP.
posted by dialetheia at 11:08 AM on November 3, 2014 [8 favorites]


Yes, I've heard that ER deals with overly worried patients and parents - and that people show up in full-blown crisis because they're part of a population that has spotty, if any, access to health care and they were too confused or uncertain or feeling too beaten down and excluded to seek help until their problem was unbearable.

Cuts both ways...
posted by Lesser Shrew at 11:12 AM on November 3, 2014 [3 favorites]


c) nothing dangerous is going to happen whether or not the OP splits the pill in half.

I'm not trying to be a dick, but as a fellow nurse - what? I wouldn't ever split a controlled release medication and administer it to one of my patients without checking with a pharmacist.

There have certainly been answers here that upset me or that I thought could potentially cause harm to the asker, but no more so than what would probably happen if the asker asked friends and family without any medical training, and generally the consensus will overrule or undermine those answers.
posted by treehorn+bunny at 1:51 PM on November 3


This is the conclusion I have come to as well, thanks for putting it so succinctly.

I personally don't like the medical related questions on AskMe. Not the casual ones like, hey what's an angiogram like? But more like, I've been feeling dizzy should I keep taking my medications? But the way I deal with this is to not read them for the most part. If AskMe didn't exist people would just ask their friends, so it's not like the phenomenon would vanish.
posted by supercrayon at 11:16 AM on November 3, 2014 [6 favorites]


If AskMe didn't exist people would just ask their friends, so it's not like the phenomenon would vanish.

If they trusted their idiot friends as much as they trust AskMe, they wouldn't be on AskMe in the first place.

Some people place an obscene amount of trust in the validity of the information that flashes in front of their faces on the internet. AskMe is the beneficiary of that trust, wrongly in many cases related to medicine and law. Just because some harm might still exist if medical or legal questions weren't on AskMe doesn't absolve the site of responsibility for the harm it could potentially cause.
posted by toomuchpete at 11:23 AM on November 3, 2014 [2 favorites]


Also there was an article on Cracked lately about a dude who accidentally shot his lower leg off, and one of the comments I absolutely loved was something like "Once again, we have another Cracked article where the subtle, background villain of the entire piece is the United States healthcare system." That's what I feel like is going on in a lot of these questions - as Kadin2048 I think rightly observes, a lot of people just don't have the access to the health care system to get these things sorted out, so of course they're going to try to find answers where they can. Rather than being annoyed at people for asking or answering maybe the ire is better directed at a system which consistently fails people?
posted by supercrayon at 11:24 AM on November 3, 2014 [10 favorites]


If they trusted their idiot friends as much as they trust AskMe, they wouldn't be on AskMe in the first place.

I'm not sure if that's true though, I get the sense that people come looking to sort of crowdsource answers, rather than because they don't trust their friends. Like "If I ask 4 people that's not enough, but if I ask 40 people then I'll have better information." I'm just conjecturing of course, and obviously I'm not agreeing with this because 40 people can be just as wrong as 4.
posted by supercrayon at 11:29 AM on November 3, 2014 [1 favorite]


I mean, I'm pretty familiar with written science fiction and fantasy and I sure know the answers to a lot of recommendation questions are terrible and that's not even something I had to study for 6 years at above a college level to learn, or whatever.

And what about bad written science fiction recommendations is going to cause the asker to potentially medical harm themselves or permanently and irrevocably waive valuable legal rights?

The situations are not remotely analogous. That you perceive them to be underscores why people shouldn't be answered legal or medical questions: they don't understand the gravity of what the bad answers may do. There is a reason that every state in this country requires schooling and a license to practice medicine and law: because the issues are serious, and unqualified people should not--under any circumstance--be trying to practice them.
posted by dios at 11:51 AM on November 3, 2014 [1 favorite]


I fully understand the gravity of what bad legal or medical answers can do. That's why I wouldn't ask a legal or medical question of any real significance. The difference is I don't think we should be acting as gatekeepers if other people do want to ask those questions in the full knowledge that a lot of advice you get on the internet is crap. It's not AskMe's job to reinforce the guild-like status of the legal profession.
posted by Justinian at 12:03 PM on November 3, 2014


I once asked a "so like is this a real serious medical problem or am I OK to just go on my upcoming vacation and see if it goes away on its own?" question once. I think most of the answerers confirmed my suspicions that it was a wait and see kind of thing. The problem was almost certainly connected to stress and went away as soon as I left the toxic work environment where the symptoms first presented themselves.

I'm not really a fan of "should I disregard the obvious conventional wisdom about this known medical issue because of Reasons" type questions, though.
posted by Sara C. at 12:20 PM on November 3, 2014


This isn't really true, though. The OP came home and observed the cat acting very strangely for several hours after the doctor visit for the bite.

Re: the rabies post. I am the OP. I did observe the cat staring at me and the door BEFORE the ER. The doctors heard all of the info re: the blood dripping down its mouth and decided there was no rabies threat. This happened exactly as I described in the original thread. I did return home to see the cat was still in my yard, but the doctors did know how strangely the cat was acting.

On the advice of MeFites, I went back to another ER at a better hospital where another ER doctor told me I was being ridiculous. I insisted on the shot anyway. Yes, it will be very expensive. No, the "free" resources do not necessarily protect me from having to pay a lot. I am conflicted as to whether AskMeta got me riled up for no reason because people tend to be alarmist on the Internet, or if it was essential for me to miss hours of work when I'm really broke to get this shot, or if I should've listened to the advice of two separate ER doctors. I'm getting tons of favorites for bowing to popular opinion and insisting on getting the shot, but I'm legitimately conflicted. Both ER doctors had enough info to make the call, and I chose to ignore it on the advice of Internet strangers because I didn't want to take a chance they could all be wrong. It's interesting and something I'll be thinking about for months to come.
posted by pineappleheart at 12:34 PM on November 3, 2014 [32 favorites]


Oh, I apologize for misreading you then - I got that impression from this part of your question:

"a friend somehow shooed the cat off the door while I wrapped my hand and prepared to go to the ER for a proper cleaning and a tetanus shot. The cat's been standing on our back stoop and staring into the house since then. It literally has its blood dripping down my face. It's been several hours; I've gone to and returned from the hospital."

I imagine many other commenters were under a similar misapprehension. It really sounds like the staring & blood-dripping continuing for hours was not something the doctors were aware of when you went in for the initial visit.
posted by dialetheia at 12:37 PM on November 3, 2014 [7 favorites]


No, I definitely did not word that correctly and see where I caused the confusion. I didn't expect the post to become about rabies so I wasn't very specific about the cat's exact behavior before I left. I just wanted it to leave and not come back.
posted by pineappleheart at 12:39 PM on November 3, 2014


Like "If I ask 4 people that's not enough, but if I ask 40 people then I'll have better information."

And some folks are not currently in a position to ask four people IRL anything as deep and meaningful as "What do you think of my (medical or any) problem here?" Some folks are either geographically or socially isolated, for various reasons. Plus, asking people you are sort of familiar with but not really close to can cause weird social stuff to happen because of it. It can involve revealing personal information you don't want revealed to that particular person or group, it can be stigmatizing, etc. Questions here can be asked anonymously or under a sock puppet handle if there are any privacy concerns.

There are some questions/situations where, if you can't ask 40 strangers on the Internet, you are just stuck with what you think about them while knowing you are freaking out about some of the possibilities that have occurred to you, so not really in a great place to be objective, etc.
posted by Michele in California at 12:41 PM on November 3, 2014 [4 favorites]


Man, if I really thought that about the online place I hang out and the people who hang out there and run it, I think I would not hang out there any more, because it sounds like a terrible place I wouldn't want to be associated with.

And such small portions!

…which is to say, of course that's what a person looking for discussion among peers would say, but we're not all there all the time; the moral high ground is sometimes, in practice, the place where people really like to hang out. If scolding is effectively your hobby, then of course you have to spend your time near the richest sources of both scolding targets and scolding rewards, dudgeon-delving.

I sure know the answers to a lot of recommendation questions are terrible and that's not even something I had to study for 6 years at above a college level to learn

Please allow me to assure you that if you had, they'd seem even more terrible yet.

posted by RogerB at 12:47 PM on November 3, 2014 [3 favorites]


pineappleheart - I think it's completely understandable that you're conflicted about what happened in your AskMe. I think a lot of the time we focus on how AskMe can help in urgent situations - it's part of our mythology now, but it's important to see this from the other perspective as well.

In my last comment, by saying that "free resources" were given I didn't mean to imply that Metafilter had ways to pay for expensive health care + a missed paycheck - just that some of the answers were better than "go see a doctor!" and included links relevant to your location, but on rereading my comment comes off as pretty callous to your situation. I'm sorry.
posted by muddgirl at 12:54 PM on November 3, 2014 [1 favorite]


No worries, muddgirl; didn't think it was callous at all. I also think a lot of the answers in that thread were good ones. I'm just chewing over how worked up I let myself get in so little time and whether it was a healthy, wise response (maybe) or if I need to recalibrate my relationship with AskMe next time (maybe).
posted by pineappleheart at 12:58 PM on November 3, 2014 [2 favorites]


I dunno. I am kind of in the anti-vax crowd and I thought you made the right call. Rabies is serious stuff and sometimes doctors in some locations have blind spots that make them think "X medical issue is an issue for the third world/a rural community/some other definition of Anywhere But Here." And that's kind of how it struck me -- not as "Doctor had all the facts and was clear the animal was not rabid" but that the very possibility of rabies was sort of dismissed as "something we don't get in this ER."

fwiw.

So sorry you were bit and even had to face this at all.
posted by Michele in California at 1:06 PM on November 3, 2014 [1 favorite]


I mean, not to dismiss your sense of conflict. I have seen people told DTMFA!!! by a jillion people until they did so post haste and I ended up wondering if the person in question was really better off bowing to being told what to do by a bunch of internet strangers vs bowing to what their dysfunctional bf/gf was telling them to do. Not exactly the best expression of personal agency.

So I do think that's a real danger on AskMe -- that a person feeling vulnerable can feel like they got voted into a particular action.
posted by Michele in California at 1:13 PM on November 3, 2014 [4 favorites]


I suppose its possible that the ever-vigilant warriors of AskMe prevented the first human case of rabies in the largest city in the United States in the last 75 years. Or they freaked someone into ignoring the informed medical opinion of two highly trained doctors and made OP miss work she couldn't afford to miss and get a shot she couldn't afford to get.

Could be either, really. Odds are probably 50/50.
posted by Justinian at 1:43 PM on November 3, 2014 [11 favorites]


You know, I am really having trouble parsing what your point is and this is my third attempt to respond. I am guessing you feel pretty strongly that the OP was basically wronged and is due compensation (and are, on some level, being dismissive of me).

And if you feel that way, I think if it were me, instead of (apparently) attacking someone with whom you disagree, I would try to find something constructive to do, like take up a collection to compensate the OP for time lost and medical expenses incurred. But, then, I hesitate to say that kind of thing because I suspect that my framing of how stuff that goes on in Internet-land has real world impact and is not just words on a screen and should be taken seriously as such is part of what gets me in social hot water with people who seem to want to make noises about injustice but not really take action. Or something.

I mean, I imagine such a suggestion would ruffle a lot of feathers and potentially sets a dangerous precedent where other askers will expect money or something. But if you don't want to redress what happened here that you seem to think was an injustice to a specific member, then it seems to me that the focus needs to be on what needs to be done differently such that this kind of thing is less likely to happen in the future on MeFi.

I don't understand what your point is. It just doesn't really quite parse for me. But it appears you aren't happy about what happened. So I guess I wonder what you think should happen next. Because I kind of feel like plenty of people here have a terrible opinion of me and are hugely dismissive of me on a routine basis and, okay, being dismissive of me maybe gives you some emotional gratification, but I fail to see how it does anything to improve the site or make right a wrong (or make right a thing you seem to feel is a wrong -- and I am not saying you are wrong to feel that way, just that I personally don't comprehend being snarky instead of trying to problem solve).

Anyway, I don't really want to get dragged into this, but it does seem like you are merely dismissing me and I didn't even participate in the Ask. So I am not someone that encouraged anyone to go to the ER or anything.
posted by Michele in California at 2:14 PM on November 3, 2014 [1 favorite]


I suppose its possible that the ever-vigilant warriors of AskMe prevented the first human case of rabies in the largest city in the United States in the last 75 years.

That's sort of an unkind way to characterize the people commenting in that thread. Part of the reason there are so few human cases of rabies anymore is that many doctors are very generous with pre-emptive vaccinations in situations like this (see e.g. stories in the thread of simply being near a bat being deemed enough for vaccination), and erring on the side of caution makes some sense given that we're talking about a condition that would be fatal by the time you know you have it. Besides, nobody "made" the OP do anything, and people who thought the shot was overkill were more than welcome to chime in as well.
posted by dialetheia at 2:15 PM on November 3, 2014 [17 favorites]




Michele in California: "Anyway, I don't really want to get dragged into this, but it does seem like you are merely dismissing me and I didn't even participate in the Ask. So I am not someone that encouraged anyone to go to the ER or anything."

I do not understand to whom you are responding with this long, long comment about people being dismissive of you for personal emotional satisfaction.

However, I have noticed you taking MetaTalk very personally in the last several MetaTalk threads you have participated in; I just want to remind you that you do not have to participate in MetaTalk to participate on Metafilter generally, and even a lot of us who read MetaTalk find it much healthier to AVOID MetaTalk threads that might hit on our personal hot-button issues. If it is this upsetting to you and makes you feel so unhappy and so defensive, it's probably a lot healthier to simply ignore the subsite, especially if you haven't been called out by name. If you're being a problem, the mods will contact you. Otherwise, people complaining in MetaTalk is, in the end, just some jerks* on the internet saying some stuff. If you don't respond, they're just shouting into the void.

This is twice in the past few weeks I've seen you say you didn't want to get "dragged into" a MetaTalk where, both times, you initiated the participation in the thread and were not "called out." If MetaTalk is a source of stress and unhappiness for you and you feel dragged into it, do not read the subsite. The surest way to avoid MetaTalk drama is to avoid MetaTalk. Lots of users never read MetaTalk threads, ever, and find it a net positive in terms of their Metafilter experience.

*Handsome jerks, obviously, I find you all very handsome.
posted by Eyebrows McGee at 2:45 PM on November 3, 2014 [35 favorites]


Because I kind of feel like plenty of people here have a terrible opinion of me and are hugely dismissive of me on a routine basis and, okay, being dismissive of me maybe gives you some emotional gratification,

I too am clueless as to whom you are addressing. You inserted yourself into this conversation and then you reacted in a very predictable MiC way. And if it is your repeated perception that people are being dismissive of you perhaps you should examine why.
posted by futz at 2:55 PM on November 3, 2014 [4 favorites]


Eyebrows McGee

I was responding to what Justinian said, right after my previous remark. It looks to me like it is probably responding to me in a dismissive fashion. And maybe it isn't, which I allowed for. To try to be clearer, I don't understand the point of anyone, Justinian or otherwise, just injecting what looks to me like snark with no real constructive purpose that I can tell.

Your essentially personal attack of me, which is also entirely optional and not a requirement of your participation here, is hardly the first time you personally have done this sort of thing to me specifically. And it is also an example of what I wish would not happen that makes me feel dragged into the discussion.

If Justinian was in no way responding to my remarks, then it was a misunderstanding on my part. Whether Justinian was or was not responding to my remarks, I remain baffled as to what the point of that was. What does this person want to see happen here? Redress for the OP? Changes to site policy? Because that is not clear to me.

And while I am well aware that metatalk is an option I can choose to opt out of, I would like to think it is an option open to me and not one an influential member should be allowed to try to run me out of for reasons I cannot fathom.
posted by Michele in California at 2:57 PM on November 3, 2014 [1 favorite]


I remain incredibly grateful to the mefites who whacked my feverish, blurry, fuzzy head and made me get to the ER when I had malaria, but couldn't convince myself of the fact. When I got there, I had a fever of 105.4, and spent a week in the hospital with (among other things) blood transfusions, IVs, x-rays, and lots of ice cream. And incurred a bill of $35,000 - but I didn't die, and six+ months later, most of that bill has been forgiven. It can be easy to talk yourself out of seeking medical attention, especially when you are without insurance and much money. It can be good to have people validate the fact that something is not right and it is worth getting a professional to look into it, if that is something that the situation warrants.
posted by ChuraChura at 3:00 PM on November 3, 2014 [32 favorites]


(and I have basically no memory of writing that question).
posted by ChuraChura at 3:00 PM on November 3, 2014 [6 favorites]


Michele: It was a general comment on how people approach certain kinds of AskMe. I'm on record in this thread as saying I think Metafilter should allow medical and legal questions. The flip side of that is that people should be careful how they answer those questions. In this case I think the OP was not at all well served by AskMe and was frightened into undergoing an unnecessary and significant medical treatment which she could not afford even though two different doctors told her it was unnecessary.

I don't see how that can be seen as anything like a bad result to come out of that AskMe. I'd really rather not go into the AskMe and pick out any individual answer as the problem, I think the overall tone of the answers ended up being more than the sum of their parts.
posted by Justinian at 3:07 PM on November 3, 2014 [1 favorite]


Thank you Justinian.

I am curious if you have any ideas as to how you think it could be improved? What would you like to see happen here?
posted by Michele in California at 3:10 PM on November 3, 2014


Michele in California: "Your essentially personal attack of me"

Another MetaFilter member seeing you repeatedly upset about by the same thing, and suggesting you stop engaging in the thing that makes you upset, is not actually intended as a personal attack, but I do think the fact that you took it as a personal attack is illustrative of your extremely defensive stance when in MetaTalk, which distorts your response to other members and makes you take things extremely personally, and seems to cause you a great deal of personal upset.

It just seems like that joke about the guy who keeps poking himself and saying "it hurts when I do this" and the doctor says "well stop doing that!" MetaTalk seems very distressing to you. But it's not something you have to do! It's not like traffic court or school or HR meetings; you're not required to be here. In general I am happiest, on MetaFilter and in life, when I disengage from things that I find upsetting and am not required to deal with. I, personally, frequently choose to remove specific MetaTalk threads from my recent activity or to close them without responding if they start to stress me out.
posted by Eyebrows McGee at 3:12 PM on November 3, 2014 [19 favorites]


Just popping in for a quick response and maybe raise some ideas that people should consider.

One thing that people should keep in mind is that all questions on AskMe are visible by everyone, including non-MeFi members. Everyone. So when some random person out there is looking for advice or information on something, that person might be directed to AskMe. This is fine for most questions, like gift ideas from Las Vegas, whose answers might, at worst, result in harm to someone's interpersonal relationships. It's not necessary fine when it comes to questions regarding medicine, whose answers might not only be wrong, but harmful.

Case in point, and something that still bothers me, is a question regarding asthma from a number of years ago. I felt compelled to answer, and strongly at that, because I felt that some of the answers given could result in death. Some random person online might have come across that question, followed the poor advice, and died. This is not good.

I agree that a lot of questions seek affirmation for a decision that's already been made, and that many questions are asked by people who already know that they should consult a professional: of COURSE we should consult our doctor who prescribed the medication. Of COURSE we should consult our lawyer who's handling our case. Of COURSE we should talk to our mechanic who's in the process of fixing our brakes.

But it's not always obvious and in the forefront. We have questions, and we have this tremendous resource that is AskMe, and hey, let's just ask? I mean: look at the questions. Many of them, as the OP suggests, can be answered by a quick search. We might forget that a quick and easy answer from a readily available resource might be better found through a more difficult and time-consuming way.

Such is my impression, anyway. And I'm pretty confident in it because I'm guilty of it myself, when it comes to questions of all sorts. I'm also guilty of it when it comes to medical things, even though, and perhaps because I'm a doctor. I have training and knowledge, but also enough wherewithal to realize that I'm not my own doctor. I'm also not my family's or friends' doctor. It's not a matter of malpractice, or malfeasance: it's a matter of knowing that I may not be objective when it comes to dispensing medical advice, that I might have an unconscious bias from such relationships, and that I simply might be taking certain details for granted: that I don't know enough because of the position I'm in. This is why I have my own doctor. It's also why, when friends or families are in the hospital, I try to abandon my role as a medical professional and embrace the role of son or brother or friend.

And it's the reason why I find even the most obvious answer of "consult your doctor" as helpful. It's a reminder. Sure, it might be stupidly obvious, but it isn't, always, especially when I'm in the position where I need help or answers myself. I know enough to know that a) I don't know a lot of things, and b) I might not always be in the frame of mind to remember even the most obvious of things.

We've got an amazing thing going on with AskMe. I don't think medical questions are particularly handled well, here or on the internet as a whole, but sometimes they are answered in a way that is genuinely productive. When I read responses by docpops, treehorn+bunny, and TedW, (to name a few who come to mind), I always feel like I've come away with more that I started with, especially when I didn't know the answer, and even if I did know the answer, or had the same impression, or shared the same opinion, because they make me think again to confirm, or they remind me to remember something that I already know. And it only helps that they have their own, unique backgrounds, and styles of practice and styles of writing (internet bedside manner?). So, too, with the folks who are EMTs, or nurses, whose experiences and perspectives when it comes to patient care is, by nature, vastly different from mine.

I know these things, and value them as reminders. Sometimes I need reminding. Sometimes people need reminding, too, when it comes to the obvious. And sometimes it's not what we want to hear, but the number of similar responses gives us pause to reconsider our perspectives.


Look: I don't question where you're coming from. I think you're wrong, but I don't question your intent. Medical questions on AskMe trouble me for a number reasons, some of which you've mentioned. Sometimes, some of the askers need answers like "go to the ER" or "go to the doctor." Sometimes people will derive the answer they need from many people saying the same thing over and over again, whether it's about their cat, or their partner, or their medication, or the meat that's been sitting on the counter.

I have absolutely no problem or issue with people telling other people to "go see a doctor."
Apart from issues regarding systemic problems such as access to healthcare, but that's another can of worms.
posted by herrdoktor at 3:16 PM on November 3, 2014 [17 favorites]


Eyebrows, you personally have a history of speaking to me only when you wish to criticize and that's it. If you genuinely do not mean it as a personal attack and are genuinely trying to be supportive, you are failing to come across that way to me.

In the interest of not derailing this discussion into another Michele Show, I would appreciate it if you would drop this line of discussion at this time.

Thank you.
posted by Michele in California at 3:22 PM on November 3, 2014 [1 favorite]


Michele: I think people should try not to scare AskMe users into acting like a vanishingly unlikely worst case scenario is something that should be taken so seriously that they are willing to undergo very real costs and risks despite being reassured it is unnecessary by two different doctors. I mean, there are people in that thread literally calling the doctors idiots because they were reluctant to give OP the shots.
posted by Justinian at 3:22 PM on November 3, 2014 [4 favorites]


FWIW, once the OP said she had asked doctors about rabies that should have been the end of it unless someone in that thread has a lot more data and expertise than I think they probably have.
posted by Justinian at 3:26 PM on November 3, 2014 [1 favorite]


Doctors can be wrong. Often wrong. Ask me how I know.
posted by futz at 3:28 PM on November 3, 2014 [5 favorites]


> In this case I think the OP was not at all well served by AskMe and was frightened into undergoing an unnecessary and significant medical treatment which she could not afford even though two different doctors told her it was unnecessary.

This is the NY State Dept. of Health decision tree for rabies post-exposure prophylaxis, which was linked in the AskMe thread. Following that flowchart results in calling the county health dept AND beginning RPEP if the animal is not available for testing/observation (which, as far as I'm aware, it is not).

The OP considered both the advice in the AskMe thread and the opinions of the doctors who saw them in the context of their own situation, and made a risk/benefit decision that was in line with the expert guidance of the NY State Dept of Health. I don't think there's any clear evidence that they were "frightened into undergoing unnecessary medical treatment."
posted by Westringia F. at 3:28 PM on November 3, 2014 [11 favorites]


Given the sorry state of access to health care in many places, I do wish more "see a doctor" responses were more specific about possible ways to do that that would work for the asker. A bit of help with navigating hospital websites to find things like nurse hotlines or non-ER urgent care locations, and definitely suggestions to contact pharmacists about drug questions, can go a long way to help someone who's probably feeling pretty crappy or they wouldn't be posting medical questions on the Internet. When you're already unwell is an unpleasant time to try to figure out how to get medical advice and treatment. "See a doctor" isn't generally wrong, it's just not nearly enough.
posted by asperity at 3:40 PM on November 3, 2014 [6 favorites]


I do, too, asperity. But it's pretty difficult to do without knowing where the person is. Apart from "try your local public health department," such answers can be nearly impossible to give.

I've a lot of knowledge about free clinics/vans/prescription drug programs/social services support/etc. around me, but such programs don't just vary country-to-country or state-to-state, but even amongst cities and counties. Unfortunately, I just can't fathom trying to give the helpful advice you suggest without knowing a lot about the person asking the question and a lot of time.
posted by herrdoktor at 3:47 PM on November 3, 2014 [6 favorites]


For sure. And there's always a limit on how much time and information any of us has to help with that sort of thing, and posters don't always provide info about location (or much of anything else). Where possible, though, it'd be nice to use that information to help, or ask the poster for more info in case they'd like help with the "see a doctor" thing.

I'd be OK with "see a doctor -- get back to us if you need ideas about how to do that" being more the standard response in these situations.
posted by asperity at 4:07 PM on November 3, 2014 [4 favorites]


Any answer other than to see a professional is wrong because (1) answers from unqualified answerers are almost certainly wrong...

This take on medical and legal questions is so overgeneralized it isn't even remotely true. Every user should be cautious about medical/legal advice from strangers, yes, but there are many, many cases where members' experiences with somewhat similar situations can provide useful, if not definitive, information for askers with medical/legal questions. The idea that no one, ever, anywhere, can provide useful answers to questions about medical/legal problems unless they've graduated from medical/legal school is so absurd it's almost not worth addressing.

As noted above and many times before, AskMe is no different than asking a friend or neighbor across the fence what they'd do in X or Y situation. Unless you're willing to ban in-person conversations between acquaintances about medical and legal problems, you have no reason to ban them on AskMe, and should stop complaining about them here.
posted by mediareport at 4:16 PM on November 3, 2014 [6 favorites]


Metafilter readers come from all over the world and many of these places do not have reliable healthcare options. The $5 fee to join plus whatever the expense is to go to an internet cafe and check your responses is far more affordable than wasting your money on a doctor who may or may not know what they are doing. And sadly there are many awful doctors out there.

I am not familiar with the American health system but from what I do read here it is different from Europe and Canada (a lot of it is free) but similar to the Caribbean (you have to pay). Because this is a site mainly people living in the US post to, I assume the sort of person posting here is American and therefore seeking medical advice because they can't afford a doctor. This is why they are asking you before they determine whether they should go hungry for a week to pay a professional. It is a reality for most people because there are no doctors around that they can reasonably access.

I would not be alive right now if I was not living in Canada when I had sepsis. It happened so quickly. Had I been living in place where I had to pay for health care I would have put it off a day or two and would have died before anyone even realized the severity.

I agree with others above who say it is like telling someone to go see a therapist. If they could afford one they would be there already. But they can't and this is a more intelligent site than Yahoo Answers so they come here.
posted by partly squamous and partly rugose at 6:04 PM on November 3, 2014 [3 favorites]


I agree with others above who say it is like telling someone to go see a therapist. If they could afford one they would be there already.

It's called a lack of perspective. Sometimes it takes someone viewing our situation from the outside to give us the nudge in the right direction we're too close to see on our own. Some people need to be told to go see a doctor, or go see a therapist, because they are too close to the situation to see the need for themselves.
posted by Apoch at 6:17 PM on November 3, 2014 [5 favorites]


Regarding the OP, I wanted to say throw those pills away, it's not worth it. My husband takes Ambien, and it's so cheap under our insurance, I couldn't conceive of someone wanting to use pills that didn't work for them and chop them up. Are they that expensive? It reminds me of my Mom re-using tinfoil. I think the premise of the question was wrong: it should have been: stop using that XR pill and continue to use your regular pill and don't look back. Like changing BP pills or some such. Throw those motherfuckers out.

I'm not sure how this was even a question. If I had 5 pills from a bad prescription that didn't work, I would throw them away (and I have).

So I think "ask your doctor" was a great response, because the doctor probably would have said, "dude, throw that XR out and take the regular pills like I told you."
posted by Marie Mon Dieu at 6:31 PM on November 3, 2014 [1 favorite]


Folks interested in the medical risk tolerance of AskMe a la pineapple heart's question might also be interested (as I was) to see this past example of a poster asking about whether they need to have rabies shots after a squirrel bite.
posted by treehorn+bunny at 6:50 PM on November 3, 2014 [3 favorites]


Regarding the OP, I wanted to say throw those pills away, it's not worth it. My husband takes Ambien, and it's so cheap under our insurance, I couldn't conceive of someone wanting to use pills that didn't work for them and chop them up. Are they that expensive?

Yes! It can be very expensive. Not all of us have insurance or disposable income.
posted by futz at 7:11 PM on November 3, 2014 [3 favorites]


OP here, it's not the money. It's that my doctor doesn't like giving me as many prescriptions as I'd like. Not that I take that many, but I do like having extras, and she's very cautious.
posted by still_wears_a_hat at 7:19 PM on November 3, 2014 [1 favorite]


I am totally against the "See an expert" mindset on Askme and I wish everyone who believes that anyone is an expert would just STFU . I have recently lost someone dear to me who saw all the "experts" and they totally misdiagnosed her cancer as back pain until it was too late. We got better advice from uneducated neighbors who had seen things play out like that before. Should have gone with that.

I have two people helping me with the aftermath. One is an art major who went to NYU and then Fordham and got a law degree after the police beat her up during a Critical Mass protest. The other is an MD who thinks the system is flawed and is now a technical writer. She is an expert on the many ways doctors fuck up and make it seem like it was inevitable.

The other side is employing "experts." We have a very good chance of clipping those wings right off in court.
posted by Mr. Yuck at 7:32 PM on November 3, 2014 [7 favorites]


I'm sorry for being cavalier about the cost of things. But I am curious about what your doctor said about splitting your pills.We get Ambien for $5 here. So I was like, WTH? It's $5? Then if it's changed, to another prescription, it's also $5.
posted by Marie Mon Dieu at 8:01 PM on November 3, 2014


You getting your whatever meds for whatever you're paying is (in the US) heavily dependent on where you are and what insurance plan you have. Five bucks is not going to be the regular cost for other folk by a long stretch.

I am lucky to have stellar insurance through my work, where all prescription co-pays are $5. This is not the case for most people in the US.
posted by rtha at 8:14 PM on November 3, 2014 [3 favorites]


Unless you're willing to ban in-person conversations between acquaintances about medical and legal problems, you have no reason to ban them on AskMe, and should stop complaining about them here.

This is just nonsensical because none of us have any ability to ban in-person conversations we're not a part of. And there are lots of things that are and should be banned on Metafilter that aren't/can't be banned in person - racial slurs, for example.

That said, I don't think medical and legal questions should be banned - I plan to ask one myself soon! - but I do think that answers should take into account that there's probably a reason the OP hasn't immediately taken the most obvious step of seeing a doctor/lawyer.
posted by desjardins at 8:18 PM on November 3, 2014 [1 favorite]


but I do think that answers should take into account that there's probably a reason the OP hasn't immediately taken the most obvious step of seeing a doctor/lawyer.

I agree, but that's WAY more likely to happen if the poster includes information about why they haven't immediately taken the most obvious step of seeing a doctor/lawyer.

I think some people posting here seem to think that it's the answerers' job to assume the poster has already taken the obvious initial steps, even when they haven't said so. I realize that the standard "Have you tried turning it off and then turning it back on?" questions are annoying, but there's a reason they're standard. If posters don't want them turning up as answers to their questions, they need to indicate why they're inappropriate. I don't think it's at all reasonable for all answerers to assume the poster has already gone through those basic steps without confirmation that they have.
posted by jaguar at 8:34 PM on November 3, 2014 [5 favorites]


I'm more accepting of the GET THAT ANIMAL TO A VET posts because often people seem to need the urging to overcome inertia and take their sick pet to a vet, but even that gets old.

Some people have to be urged to overcome their inertia to go to the doctor.
posted by John Cohen at 8:50 PM on November 3, 2014 [5 favorites]


Okay, well the obvious solution is to put a prompt when someone chooses the health or law categories: "Explain why you are asking us instead of a doctor or lawyer." (Someone can edit that for tact.)
posted by desjardins at 9:11 PM on November 3, 2014 [3 favorites]


It can take a week for my doc to get back to me and a lawyer isn't cost free. An initial call to a lawyer may be free but I may not even know which type of lawyer to contact or even if it is applicable. Hence, askme.
posted by futz at 9:17 PM on November 3, 2014 [1 favorite]


And people (me) sometimes need reassurance that it is ok to contact your doctor. Social anxiety can be a hinderance.
posted by futz at 9:22 PM on November 3, 2014 [8 favorites]


As an RN who occasionally answers medical questions, including this one, I don't often respond with a simple "go see your doctor" because I realize it's unhelpful, at least to those of us living in the US. Even people with excellent insurance can't simply ring up a doctor with a question like this and get an answer on a timely basis. I suggested that the OP call a pharmacist and I believe I'm the only one who did so. Based on the OP's update, it doesn't sound as if she took my advice. I wish those users who answer medical questions would realize "DOCTOR!" is not the only answer, and doctors are certainly not our only resources. In many cases, such as the question referenced here, a doctor wouldn't necessarily even be the best resource.
posted by pecanpies at 9:23 PM on November 3, 2014 [6 favorites]


I suggested that the OP call a pharmacist and I believe I'm the only one who did so.

A full third of the answers (5 of 15) did that.
posted by Sys Rq at 9:28 PM on November 3, 2014 [1 favorite]


Well, fuck. I guess it's my turn to be the person who's wrong on the internet!
posted by pecanpies at 9:32 PM on November 3, 2014 [6 favorites]


I asked a medical question here once where the correct answer was 'talk to the pharmacist'. I didn't want talk to my doctor because I kinda felt like an idiot, but the idea of calling the pharamacist was not something that had crossed my generally intelligent mind. I called the pharmacist and everything turned out fine. If it wasn't for a large portion of responses telling me to, I might not of, and at the very least my day would've been ruined. Sometimes pointing out the obvious is the right answer, because a single person caught up in a situation can't always see it. So thank you mefites for that!
posted by cgg at 9:38 PM on November 3, 2014 [6 favorites]


I'm with futz and jaguar: "call your doctor!" can actually be quite helpful for Askers who need encouragement that their concerns aren't trivial or that this is actually something that can be answered by your doctor. For all the (very valid) concern about people who don't have health coverage, it's also important to consider the people who *do* have health care and then are too intimidated to, you know, actually get what they're paying for. I'm someone like that--I talk myself out of calling the doctor for ages because of all sorts of blah blah reasons. But when I do finally call, I might not get *my* doctor when I call, but my doctor's office will happily put me on the phone with a nurse or a PA to discuss my problems. I pay a shitton for healthcare, and many AskMe posts are a helpful reminder that hey, that foot pain that's been bothing me for 6 months is worth at least a phonecall to see if I need an appointment.
posted by TwoStride at 9:47 PM on November 3, 2014 [4 favorites]


Just a couple of days ago, a question was asked on AskMeFi regarding a microbead stuck under the OP's eyelid; the person had tried every conventional/OTC method to dislodge the bead. It was answered by a person who did not identify herself as a medical professional, but the answer she gave worked perfectly and immediately.

Years ago I got a birdseed hull stuck under my eyelid. I tried everything I could come up with, including an eyewash with cup, but it wouldn't move. I had to drive myself to the ER late in the evening with one eye closed; they lifted my eyelid up, turned it inside out, and used a tiny tweezers to remove the seed hull.

I had nice insurance at the time so I don't know what it cost, but in this case the OP was saved a pretty amount of money by a layperson who knew what the answer was and explained the procedure.

And just for the record, it's time to get away from the awe and absolute trust that we seem to have for any medical professional. They're like everyone else - most are experts in some things, average in other things, poor in other things; none are experts at everything just because they're MDs. If you ever want a busy thread, start one about the experiences of those who've managed to live through mistakes by physicians. That doesn't mean they aren't the right place to go with a medical problem, but it does mean that they can be wrong, so if you come away feeling uneasy and unsure that you've been treated appropriately, you could be right. It also means that the stories that laypersons contribute can have some very real value and shouldn't be dismissed out of hand.
posted by aryma at 11:05 PM on November 3, 2014 [10 favorites]


FWIW I tried to suggest in the rabies thread that it was absurd for AskMefi to over-rule actual medical advice, but my first attempt was deleted (for use of sarcasm, I assume). I don't know whether other dissenting comments were axed, but IMHO, FWIW, YMMV I'm still inclined to think that that probably wasn't the intervention the thread required.
posted by Segundus at 5:16 AM on November 4, 2014 [2 favorites]


> And y'all have docs that answer emails? Wow, I can't even begin to imagine... what's it like in the future? Or is socialized healthcare just that damn good? That would just be... so amazing

I do and I live in the US and have just plain old normal insurance. It happens!
posted by The corpse in the library at 7:00 AM on November 4, 2014 [7 favorites]


I'm also lucky enough to have doctors and nurses who answer questions like this pretty much immediately. I have Medicaid, MassHealth specifically. I'm very lucky of course, but it's not crazy to expect that someone who can get an rx like ambien can access additional medical advice.

Psychiatry here is a completely different story in terms of access, but that's another story and I'm lucky I don't have a serious need for it.
posted by internet fraud detective squad, station number 9 at 7:38 AM on November 4, 2014 [2 favorites]


I might not get *my* doctor when I call, but my doctor's office will happily put me on the phone with a nurse or a PA to discuss my problems.

When I worked in insurance, a big thing was whether or not and/or how much we covered the less expensive medical professionals, like nurse practitioners and chiropractors. This varied by things like what state the person was in (in some states, nurse practitioners were covered, period, and in other states they were only covered if they were supervised by an MD). From what I gather, people wanting insurance to cover chiropractic care and insurance companies wanting to limit how much they pay out on chiropractors is apparently kind of a big thing industry-wide, not peculiar to the particular company I worked for. Many of the policyholders we had would go to a chiropractor for all kinds of minor medical stuff, not just the things I thought chiropractors treated -- I mean, they would go for minor cuts and stuff, not just "I think I strained my back." This was kind of an ongoing shit-show, because THEY AREN'T REAL DOCTORS and blah blah blah, but they cost a helluva lot less than REAL DOCTORS and, apparently for many people, especially in some of the less population-dense states or areas, this is a very important part of their life and a significant alternative to a licensed MD.

So maybe it would be helpful to say something like"Have you contacted (or can you contact) a medical professional, such as a nurse's hotline, physician's assistant, nurse practitioner, or physician?" (In place of "see your doctor" -- a phrase which assumes a great many things, including: that this person HAS a doctor of their own; that the top of the line medical professional is the only one who can be helpful and other "lesser" medical professionals, like RNs or PAs, are completely irrelevant to life, the universe and everything; that the person can afford it; that they are someplace where medical access is readily available, etc.)

And maybe the wiki for mefi could get a medical section similar to the "there is help" section that addresses depression/suicidal ideation and this medical section could talk about some of the interim options (in terms of cost and professionalism/expertise) that lay between "ask strangers on the internet" and "see your doctor." (And if there is such a medical section already, maybe it could be beefed up and/or pro-actively mentioned more.)

Also, I only had to deal with medical insurance as a consumer for a few brief years when my husband was on recruiting duty and we were not at a military base. Nurse's Hotline was a new concept for me. I grew up near a big military base as a military dependent and then I got married and he joined the army and I know how the military system works, which is a whole 'nother animal from civilian insurance. Also also, when I worked in insurance, it became very clear that how this stuff works varies significantly from one state to another.

I mean, "state" means basically "nation" or "country" in most places and that is what it meant at the start of the U.S. -- it was a loose grouping of independent nations, in essence, who wanted to pool their resources for purposes of defense and what not. It changed because that form really didn't work and, over the years, the federal government grew more powerful and we now sort of seem to think of states in the U.S. as something more like counties, but on a larger scale. While I was in insurance, it was much more apparent to me the degree to which America is still kind of 50 smaller nations, with a lot of internal differences between them. The exact same policy could be administered very differently depending upon the state the individual was in. We somewhat routinely had to look up state laws to determine how to pay a claim.

Which is a long way of saying that even people who are savvy, educated, have insurance and so on can move within the U.S. and really be blindsided by how drastically different the medical system is from what they are used to dealing with. Since these types of questions are an on-going thing on mefi, maybe we can work on putting some info together to help mitigate the burden it represents or potential danger it represents here with regards to the various issues people have brought up in this meta.
posted by Michele in California at 10:28 AM on November 4, 2014 [1 favorite]


I would have no problem with the chorus of "see a doctor" if more people gave an explanation for why exactly a doctor is needed. If the answer is just "doctor, now!!!!111", which is extremely common, I tend to assume that the commenter A) has no idea but wants to answer anyway; B) believes that the first step for absolutely any remotely-medical problem should be going immediately to a doctor, and wants to instruct the OP to follow this philosophy too, without any particular rationale; and/or C) is afraid to give any advice that isn't "doctor asap" on any non-zero chance that the asker possibly has a serious medical problem, even if the odds are low enough that no doctor would actually consider the possibility. None of these are particularly helpful attitudes. Obviously the askers in these questions have thought about going to a doctor, but didn't feel like the problem was urgent enough (or have problems getting to a doctor, etc), and wanted to research the problem a bit first.

I would really love it if the culture shifted a bit towards explaining why a given question requires a doctor's input - what are the potentially serious medical conditions that we're worried about, how dangerous are they, and are they very likely, moderately likely, or vanishingly unlikely to apply to the asker in the given scenario? Maybe some guidance about what kinds of things to watch out for, and go to a doctor if they start happening?

I totally get that a lot of people don't have the expertise to answer these questions....and that's OK! There is absolutely nothing forcing anyone to answer a question they don't have a good answer for. I think people forget that more often for medical questions because it's just so easy, and safe, to tell people indiscriminately to go to the doctor. There's no downside, for the person answering. They don't have to waste time and money at the doctor's; they get to feel good about telling someone to be responsible with their health, dammit.

But not all of us are going to go to the ER for a hangnail, even if all of AskMe tells us to. I'm in Canada so my health care is free, but I still don't want to waste the doctor's time and taxpayer money (or my own time, waiting for half a day or more in a walk-in clinic) for something that's extremely unlikely to be a real issue. I'll take the 0.00001% risk that my cough is lung cancer, you know? It's not like doctors will give you a barrage of tests on demand anyway. Now if you tell me instead "you need to go to a doctor because you're coughing up blood and that can be a sign of lung cancer or something else really serious", that might convince me to get my hypothetical cough checked out.
posted by randomnity at 12:30 PM on November 4, 2014 [8 favorites]


> hahaha nerd rage jessamyn i love you so much
posted by liketitanic at 3:19 PM on November 4, 2014 [2 favorites]


I do think the fact that you took it as a personal attack is illustrative of your extremely defensive stance when in MetaTalk, which distorts your response to other members and makes you take things extremely personally, and seems to cause you a great deal of personal upset.

And I think you are overstepping your bounds as a peer commentor (vs. say, a moderator). This type of meta-analysis of users by other users isn't cool. Characterizing someone's response as a distortion, and judging their responses as them taking things "extremely" personally, makes it sound like you consider your own response levels the norm, and that you are attempting to characterize MoC's as not-normal, relative to your standards. Not cool.
posted by nacho fries at 4:39 PM on November 4, 2014 [4 favorites]


. Characterizing someone's response as a distortion, and judging their responses as them taking things "extremely" personally, makes it sound like you consider your own response levels the norm, and that you are attempting to characterize MoC's as not-normal, relative to your standards.

Without implying any judgment to the observation, there are several users (MiC among them, but far from alone) who are very much not-normative in their site interactions. In some cases you can see that ebb and flow and with others it's more of a constant, but there are definitely people who are more visible in their behavior.

As with people one encounters on the street or in a meeting, sometimes those differences are fantastic moments of color in your day, and in other cases they are disruptive and dissonant, and people can and will absolutely disagree about which is which. I'm (happily) not a moderator so it is 100 percent Not My Problem, but I'm aware of those frequent creators of dissonance and adjust my interactions accordingly.
posted by Dip Flash at 5:10 PM on November 4, 2014


I think we should remember also that people who ask medical questions on AskMeFi have the entire internet at their command in their search for advice - they're not limited by any means to this site. It isn't necessary to know the names of specific websites to go to nor is it necessary to know the medical terminology associated with the problem - all they have to do is type the question into their search engine; for instance, "do I need to see a doctor?"

Then:

I twisted my knee when playing basketball - do I have to see a doctor?

I have something in my eye and can't get it out - will it come out by itself or do I need the ER?

I've had a stomachache all day and it really hurts and now I'm freezing to death and shaking - can I wait until Monday to see a doctor?

I went to the doc this morning with a bad headache and he said my blood pressure was high but that's all - now I have a bad nosebleed and I don't feel right - what should I do?

There are a hundred medical websites where they can find answers to such questions.


I think it's more likely by far that people will use other, more medically-oriented, sites before they come to AskMeFi unless they're members here, in which case they know what they're getting before they ask - intelligent, concerned help from a variety of caring persons, some of whom may be professional medical persons but most of whom are not.

I keep wondering why this is even a question.
posted by aryma at 7:19 PM on November 4, 2014


The microbead question is a good example of how lay advice can be useful to a minor medical question. I'd not heard of that trick, and actually when I read the question at first my thought was that there may not be a micro bead in the eye anymore - often times people get a corneal abrasion that feels like a tiny foreign object in the eye and that sensation persists long after the object is gone, and I was going to recommend seeing a doc to evaluate for that. However, in a lot of these very specific/obscure questions, I have found that the hive mind has a better answer than this doctor does, so I held off on posting, and voila - someone else solved the problem!

I've noticed that in numerous other threads that usually relate the story of some very chronic and bizarre/random sounding symptom, usually which is bothersome to the poster but has been going on for months to years, or maybe they just want to figure out why a part of their body is looking like or doing something weird. I read the question and think 'Jesus, this is why I went into emergency medicine, so I wouldn't have to figure out problems like this. Moving on…' And then someone else on AskMe whips out this incredibly rare or obscure diagnosis that I never would have thought of but seems very plausible. I usually don't comment in these questions at all, so after admitting this I guess I can't expect people to presume that I might have gotten the diagnosis had I answered… Oral allergy syndrome is one that I think there have been several questions on over the years that is not something most emergency physicians are familiar with - I learned about it here!

I admit though that I have a different perspective on the answers to medical questions than most people, because as I read through the list I can usually easily distinguish which and how many of the answers are potentially good, or either implausible or downright incorrect, whereas clearly many other posters are not going to have the background knowledge for that.
posted by treehorn+bunny at 7:24 PM on November 4, 2014 [6 favorites]


Anecdotal, but relevant: in Texas, my employer-provided PPO health insurance allows 4 Ambien refills per year, and because they are not "medically necessary" (ie life-saving or maintenance meds), they cost $210/refill. Because I have seen a therapist before due to extreme insomnia issues, I must 1) visit my doctor for a handwritten script, 2) have my blood pressure taken and given a quick interview asking if I have anxiety or depression, and 3) fill out a ledger and show my photo ID when I pick it up at the pharmacy.

Apparently getting by on less than 4 hours of sleep 3-4 days per week since I was 11 is preferable to whatever "abuse" scenario this song-and-dance is sparing me from, so thank Cthulhu for NeuroSleep, Benadryl, melatonin meltaways and weekends. Oh, and a job that lets me work from home when I am unsafe to drive from sleep deprivation psychosis.

I get 10 prescriptions filled a month for various health issues, all of which cost $0 after meeting my annual deductible. Ambien is the only thing I occasionally take that makes me feel like I'm living in Orwell's 1984, so I am always sympathetic to and interested in AskMes that address insomnia meds, so asking about cutting a time-release pill seems totally normal to me. The amount of draconian bs I deal with getting my Ambien refilled would push me to AskMe before even my pharmacist in seeking different options, mostly out of laziness or the pharmacy being closed at an hour where a simple call would otherwise suffice.
posted by Unicorn on the cob at 7:07 AM on November 5, 2014 [5 favorites]


Random related question for the mods - has MeFi ever been sued or involved in a legal suit that involved the quality or accuracy of an AskMeFi answer? For example, has anyone tried to take legal action against MeFi because they got bad advice on AskMeFi? Just curious.
posted by Salvor Hardin at 8:15 AM on November 5, 2014


Are you asking if someone has tried? I've wondered, too, but would understand if this will not be made public.

Posts are the property of the author, not MeFi. (Cite: FAQ. )
posted by Lesser Shrew at 8:22 AM on November 5, 2014 [1 favorite]


has MeFi ever been sued or involved in a legal suit that involved the quality or accuracy of an AskMeFi answer?

Not when I was working here. Not at all.
posted by jessamyn (retired) at 8:31 AM on November 5, 2014 [1 favorite]


I've been following this discussion with interest and I totally don't understand why the suggestion that it would be better if site culture preferred specific advice for someone to see a doctor -- why this might be serious, what options they might have for seeing a doctor if cost is a factor, whatever -- over just the bare "go see a doctor" responses. Human psychology being what it is, people are going to be far more likely to take the advice of going to a doctor when it's specific to their situation and seems to be a thoughtful response to their question. If your goal is to get people to go to the doctor, then how you advise them to see a doctor should, naturally, be important to you.

Alternatively, if you're not so concerned with that individual person in that individual circumstance, but instead your giving someone the advice to see a doctor is really about you, about your feelings on AskMe medical questions, on how people deal with medical situations and whatnot, then I can see that "go see a doctor" is really more performative, it's a kind of protest.

Which may or may not be a reasonable stance and motivation. But, you know -- and I'll be frank that this is my own long-time grudge against AskMe -- supposedly answering questions isn't about your performance and pleasure as an answerer, but rather about being helpful to the asker and to those who later find the thread with a similar issue. The point of AskMe is to be helpful, not perform a social identity. "See a doctor" by itself is just lazy and, on its own, not likely to be helpful. When it is, it's only because there are ten examples of it. But, you know, just one elaborated "see a doctor, here's why... and how..." counts as much as all ten of the other. If you really want people to take this advice, because you really want to be helpful, then you should be putting more effort and thought into that answer.
posted by Ivan Fyodorovich at 8:59 AM on November 5, 2014 [8 favorites]


I don't think anyone's objecting to people including more of the "why" and "how" in the suggestions to seek medical care. I was saying earlier that the askers don't always provide enough information in their posts to make the "how" recommendations. (And I actually find it extremely annoying when people act as if the way their own insurance works is the way all insurances work, because they really vary a great deal, as do resources for people without insurance.)
posted by jaguar at 10:57 AM on November 5, 2014 [2 favorites]


The elephant in the room is that doctors don't know jack about pharmaceutical questions most of the time. Ask your pharmacist for free and get a qualified answer. And yes reflexive "ask a doctor" answers are dumb and I'm personally thrilled that the brusque doctor who flamed out over this years ago isn't still flaming people about using askme to frame questions that only holy Oracle doctors who kill patients left and right through errors can answer.
posted by aydeejones at 11:47 AM on November 5, 2014 [6 favorites]


(ie if you don't think you're qualified to answer a question at all you may not know whether asking a doctor is the right course of action, so a stock "ask your doc" answer proffered in reflex is a massive meh to me)
posted by aydeejones at 11:50 AM on November 5, 2014


"And I actually find it extremely annoying when people act as if the way their own insurance works is the way all insurances work, because they really vary a great deal, as do resources for people without insurance."

Sure, but that cuts both ways. It seems to me that in the spirit of your objection, one oughtn't assume that "ask your doctor" is the most timely and practical solution. It may well be and, of course, one oughtn't assume that it's not, either.

"I don't think anyone's objecting to people including more of the 'why' and 'how' in the suggestions to seek medical care."

Likewise, if it seemed to you that I was setting up a strawman of people objecting to more detailed "ask your doctor" answers, it seems to me that some are setting up a strawman of general opposition to "ask your doctor" answers. I don't think that anyone here is advocating either position.

On Preview: "The elephant in the room is that doctors don't know jack about pharmaceutical questions most of the time."

My PCP a few years ago had me seeing a clinical pharmacologist for most of these kinds of things (med maintenance, changing meds, prescribing for related stuff) and the clinical pharmacologist was so much more knowledgeable and aware and on-the-ball about my medications than any doctor I've ever seen, before or since -- which is important, since so much of contemporary medical care is pharmacology. And with regard to pharmacists, I have the impression that many or most of them are very happy to utilize their expensive and very extensive post-graduate professional school education to answer such questions.

But that doesn't mean you're not going to find disinterested pharmacists who only take a cursory look at your records and answer your question in a rote fashion, just as many MDs will. With regard to pharmacology, MDs are overestimated and Pharm.Ds are underestimated, but that's no guarantee of the kind of infallibility that I feel many patients are subconsciously looking for in medical professionals.

And with regard to the rest of your comment -- that comment and Blasdelb's from the other direction are examples of how this thread is very much about larger issues than the specific issue raised by the post. People have strong feelings about non-expert answers to high-risk questions such as those involving health and law. But that ship's sailed. The issue was settled with the argument with that other doctor, long ago, and AskMe will continue to allow medical questions and to not require that answers be expert or verified as correct.

Both sides seem to have simmering resentments about this. And it goes to some larger culture stuff about expert authority. But, you know, having that argument in this thread is totally un-helpful. Besides the fact that site policy has already been decided, having this larger argument in proxy (or explicity) just means that it's impossible to deal with this much more specific and far more tractable issue. The tendency to strawman other people's arguments is a function of how this has been about the larger argument. But if we stay focused on the very specific issue that's been raised, I think it's pretty obvious that encouraging more expansive and particular versions of "see your doctor" would result in a win for everyone.
posted by Ivan Fyodorovich at 12:09 PM on November 5, 2014 [4 favorites]


"The elephant in the room is that doctors don't know jack about pharmaceutical questions most of the time. Ask your pharmacist for free and get a qualified answer. And yes reflexive "ask a doctor" answers are dumb and I'm personally thrilled that the brusque doctor who flamed out over this years ago isn't still flaming people about using askme to frame questions that only holy Oracle doctors who kill patients left and right through errors can answer."

You know, some of us read current journal articles about medications and newly-found side effects, or conditions that would limit their use. Some of us read up on how drugs are metabolized, or know which drugs are contraindicated for certain medical conditions or when used with another drug. Some of us carefully consider the information patients provide: their stories, medical or otherwise, their labs such as renal or liver function, blood counts and parameters, and consider drug dosages or stoppage.

Some of us do consult pharmacists and Pharm.Ds as a matter of routine. Some of us have even incorporated them into their healthcare team.

Some of us have no ties to the pharmaceutical industry. Some of us have kicked out and set policies to prevent drug reps from stepping foot into the office. Some of us are still aware that despite these measures, physicians are still influenced by Big Pharma, and try to make decisions keeping this in mind.

Some of us care, and try to do our best, and try not to make mistakes.

I'm sorry to read when doctors, or anyone, are described as brusque, and I take no pleasure in reading about anyone's negative experience with medicine, or anyone's flameout for that matter.
posted by herrdoktor at 1:14 PM on November 5, 2014 [17 favorites]


wrt herrdoktor's remarks:

I had a good friend many years ago who was a physician. He told me once that one factor in medical decisions is that many doctors live in terror of a malpractice suit, so they order extra tests or whatever to try to make sure it is defensible just in case it winds up in court. When I worked in insurance, this absolutely was a big thing for the insurance company: Many internal policies were driven in part by considerations of the worst case scenario of being sued.

I think there is a lot wrong with the system. I think it makes us all victims, doctors included. I don't know the answer. One of the problems I see is that physicians used to know their patients better than they know them now. Physicians used to be more like tribal witch doctors insofar as they were sort of community leaders and local Wise Men whose main responsibility was physical health but who were not so limited to drugs and surgeries. What I am trying to say is that, historically, doctors were dispensers of wisdom and now they are dispensers of drugs and gatekeepers on who gets what test. They have become more like technicians in some sense.

Historically, doctors did house calls with a little black bag of medical stuff. From what I have read, that died due to modern technology -- doctors no longer go see you because they can't carry an x-ray machine and cat-scan machine and so on with them. The tools of the trade are no longer portable. This has likely deprived them of vital information that they now need to ask for and may not know they need to ask for it and, even if they ask, may not get told about it.

If you do not know your patients as well as some local tribal elder would, then you no longer are in a position to be a dispenser of wisdom. And I think that is part of where the problem occurs.

FWIW, when I was very ill and being pretty jerked by physicians who were sometimes implied I was a hypochondriac, I was much more bitter about the 15 minute appointment than I was about anything else in medicine. I once typed out my long history to bring in to see the doctor. He did not have time to read it and was clearly stressed out that I expected him to. He may have been behind schedule as is.

I think we still expect of physicians the kind of care they once gave when they were de facto village Wise Men and have not yet figured out that they simply don't have that kind of information anymore. I think there is no way to go back to that model. We area mobile society with many large urban centers. We aren't going to go back to small town life where an older GP may have personally delivered many of his current adult patients and knows all their relatives and most folks live in the same area their entire life. So that ship has sailed.

Presumably, someday we will figure out some answers as to how to make this work better. At least until we find better answers in that regard, people are likely to continue to try to crowd-source medical wisdom when they have an issue. Metafilter cannot fix the problem with the changes in the whole world and what that has done to the doctor-patient relationship. It can only try to figure what works well here.
posted by Michele in California at 1:32 PM on November 5, 2014 [3 favorites]


I think that these answers can be helpful, especially for people who have little to no exposure to the system involved (medical, legal, therapeutic, etc). For many people, you'd see a doctor only if you were bleeding from an open head wound or broke your leg, you'd see a therapist only if you were hearing voices or tried to commit suicide, you'd see a lawyer only if you were arrested or sued. They don't know the range of services that these professionals provide, because they haven't had much, if any contact with that system.

As a lawyer, I've often had to inform people what a lawyer can and cannot do. Many people are shocked to learn that most lawyers spend little to no time in a courtroom. Or that you can speak to a lawyer without having to engage them on an irrevocable, long-term, expensive basis.

I was lucky to have very good health insurance growing up and saw my pediatrician for regular well child visits as well as the occasional strep test or sprained ankle. My husband did not grow up with that experience and thus (prior to our relationship) wouldn't even think to see a doctor for anything other than a true acute emergency.

Sometimes people need to know that [Professional] exists and it is part of their job description and skill set to address [problem].
posted by melissasaurus at 1:36 PM on November 5, 2014 [7 favorites]


When I had my first visit with my new PCP, she asked me to give her a rundown on my medical history, but only for the last year; she had no interest in anything before that.

I'm old and beat up, so I have a lot of medical history, which is in the chart that she gets through the electronic medical records setup with Providence, but the idea that any doctor could have time to actually read that mess is ludicrous. It occurred to me, though, that asking a patient to summarize their medical history over the last year and let it go at that could be incredibly dangerous - I found it confusing and difficult to mention one thing without tying it to other older stuff and I'm more aware of medical stuff than the average person. I can easily see someone forgetting to mention that they had a stent placed in their LAD five years ago or they've had surgery and treatment for cervical cancer in the past - and many etcs.

Michele is certainly right about the changes in medicine from a patient's standpoint over the years. My old doc in Tucson, 30 years ago, knew everything about me and my family and, at the same time, was a wizard at noticing something was different and therefore worth investigating when he saw you in his office. In fact, two years after we moved to Colorado I called him on a Friday evening from a pay phone in tears because they'd found a bone tumor on my daughter's femur and I was told I'd have to wait a few months to find out if it was malignant because it was on the growth plate in her leg. Wait??!! Could not do!! So I held on for a few days and then, when my daughter was asleep, I finally lost it and ran to the phone booth and called Dr. King. I knew he'd get back to me immediately - that's the kind of doctor he was. He called right back and listened to me bawl for a few minutes, then told me I had an appointment in his office for the following Friday. I cried, "How can I get to Tucson? I have no way to do that!" He said, "That's YOUR problem - be in my office next Friday." And we were. He had made arrangements for a STAT x-ray and a late afternoon appointment with an orthopedic surgeon, and, I found out later, an oncologist in case he was needed. The film was done, the surgeon consulted - who told us the tumor was NOT malignant and could be removed without stopping the growth of her leg. She had surgery on Monday and we were back home in Colorado in another few days. The tumor was an osteochondroma, not malignant, but we were advised that some folks tend to get more than one of them, so be aware. (There was a big question about whether my family health insurance from where I worked at a hospital in Colorado would pay for any of this in Arizona, but the doctors and hospital there did the surgery anyway; most of it was paid by the insurance eventually.)

Doctors today do the best they can, but the old-fashioned family doctor just is no more, as far as I can see, and the thing that really bothers me is that it seems that medical practice now is more about being a business than it is about healing; still, I can't paint all medical service with that broad brush, so ...

Just one of my own experiences, but if a question ever comes up about a bone tumor on a child and the child's parent is panicky, I will definitely advise that parent to not panic until they know they have to, but get a definitive opinion from a qualified specialist as soon as they possibly can. I will also tell them there are alternatives to bone cancer, which most people don't know; when they hear the words "bone tumor," the average person's brain goes immediately to cancer, does it not? Mine did.
posted by aryma at 5:48 PM on November 5, 2014 [2 favorites]


I don't have a comment on whether or not it's appropriate to tell askme users to see a doctor. I do have an anecdote: About ten years ago, I found a doctor, and my criteria for "hiring" him was his answer to the question "When should I come in for a physical with all the trimmings?" His answer was "Uh, do you need a physical? Because I think they're pointless. If you feel sick or think something is wrong, come in and we'll see what's up. Check in with me a couple of times a year to keep current on your antidepressant course, don't do stupid shit like smoke, and please join a gym. When you get older, we'll talk about old age stuff." As time went along, it was clear he hated the idea of testing to cover his ass, he hated drug reps, he really had no patience for insurance companies.

He encouraged me to investigate things on the Internet, he had an open email box policy, and he loved it when I'd make a case for doing some test or procedure and he'd talk me out of it.

Best doctor ever. Left me in complete control of my medical care. He died two years ago of a massive coronary, never knew what hit him. Not sure what I think about that, but finding a GP to replace him was pretty easy - he'd discussed it with his sons and they referred me to my current doctor.
posted by disclaimer at 7:24 PM on November 5, 2014 [2 favorites]


Look, pineappleheart, twice in that thread I provided you with ways to contact a public health expert for free. Next time I will say, "See your epidemiologist, ER docs don't know shit."
Justinian, I don't know where you got your figures, but there are two or three cases of human rabies in the US every year.
I am an epidemiologist and I struggle with threads about vaccination, because I can't give you professional advice - I'm the wrong kind of epidemiologist, to start with, and I don't work for your local health department - but when people just come up with random panicked garbage,it drives me batshit. I try to maintain a calm and neutral demeanor, but that puts me at a disadvantage relative to that one poster who puts her strong opinions in random capitals with a million carriage returns so her response takes up the whole page.
posted by gingerest at 1:33 AM on November 6, 2014 [11 favorites]


Justinian, I don't know where you got your figures, but there are two or three cases of human rabies in the US every year.

Except I said "in New York City", not "in the United States". None of those cases are in NYC.
posted by Justinian at 6:28 AM on November 6, 2014


(oh your link is borked, it should go to this page.)
posted by Justinian at 6:30 AM on November 6, 2014


Oh, I would like to weigh in on the idea that nobody "made" the OP do anything and people who thought the shots were overkill were also free to weigh in, as dialetheia says here. I think while that's technically true a few moment's thought should tell you why it doesn't work that way.

Telling someone not to get a medical procedure is as much medical advice as telling someone to insist on it. People with the ability to give legitimate medical advice are not generally going to do so in an AskMe thread. Secondly, telling someone not to get a medical treatment is very problematic. Do I really have to lay out why its a lot easier to tell someone to get a procedure than to not get a procedure? If you tell someone not to do something and then it turns out it was the one in a hundred million case that they needed it, well, ouch. On the other hand anyone telling someone to get an expensive but unnecessary procedure can just go on with their lives and never think on it again in the smug warm glow that they've done their bit for god and country.

I dunno, it gets my goat that someone think the answer to "people were giving potentially bad medical advice" is "give your own medical advice". Yeah, no. I'd rather people stop giving bad medical advice.
posted by Justinian at 6:37 AM on November 6, 2014 [2 favorites]


Look, pineappleheart, twice in that thread I provided you with ways to contact a public health expert for free.

I did call the first number you provided, and they told me that cats don't typically have rabies, just like the ER docs did. They actually did not provide the same advice as the posters in the thread. I did not call the second number as I do not feel the ER doctors need to be reported. I weighed the decision myself and chose to get the shots, but I do not feel the ER docs were right or wrong.

I do not have an epidemiologist and would like to know who does or who can easily contact one in an emergency.

I am not sure why you prefaced your comment to me just now with "Look," which is somewhat hostile.
posted by pineappleheart at 8:53 AM on November 6, 2014 [3 favorites]


Pineappleheart, your experience with multiple ER doctors doesn't confirm whether you did or did not get bitten by a rabid cat.

Unfortunately, all doctors, including ER doctors, are like any other professionals and they sometimes come to erroneous conclusions.

I have had extensive ER (and other medical) experiences, unfortunately, some of which have been significantly damaging.

For example, when I began taking lamictal, my neurologist who was treating me for epilepsy told me to call him if my skin reacted to the meds. It did (beginning with a rash that looked like hives), and he told me to go to the ER. The first ER doctor I saw looked at the hives covering my body, gave me a benadryl, and sent me home. I had stopped the lamictal immediately, but the hives spread and began to blister. I went to the ER again, and the second doctor gave me another antihistamine, and sent me home. The hives merged and worsened, and I went back to the ER. It had taken a week to get there, but I was diagnosed with Stevens-Johnson Syndrome, a rare disorder that can sometimes kill, but does cause severe damage. I was lucky, in that I was only hospitalized for 4 days, and out of work for a month.

Doctors can be wrong. Vaccinating you against rabies, given your circumstances, has an upside and not much of a downside. On the other hand, not doing that would kill you if you had been bitten by a rabid cat.
posted by miss tea at 12:48 PM on November 6, 2014 [1 favorite]


Because I was mad. I felt like you were complaining you were bullied into getting treatment you didn't want when I, at least, tried to be measured and do nothing but give you options to consult with the real experts. And I don't care, except that the first ER didn't, by your report, take your concerns seriously, and didn't, apparently, run it through the algorithm. That means they might have a systemic problem around infection control and mandatory disease reporting. Lots of hospitals do, because they shunt the work of disease reporting onto the infection control department, which does regular reviewed but which isn't going to be timely without the cooperation of the staff on the floor, who are overworked and time-stressed as it is.
If it's not apparent, I would have taken the advice of the DoH and not worried about Ask. The DoH collects information about local rabies prevalence in animal populations, and has access to all the other health jurisdictions' risk assessment data from which to generate guidelines. They are the epidemiologists I meant for you to consult. It is part of their job to provide the best possible information to the public and providers about preventing and managing< infectious disease. If the information they gave you by phone, considering the data you gave them, disagreed with the flowchart, then go with the phone advice. I am sorry I said I was glad you insisted, because what you are saying suggests you are getting expensive treatment the DoH deemed unnecessary and you don't really want, largely because Ask freaked out at you.
posted by gingerest at 1:03 PM on November 6, 2014 [3 favorites]


Vaccinating you against rabies, given your circumstances, has an upside and not much of a downside.

This is a fallacy that is often repeated in various forms here on metafilter.

Getting every possible medical test or intervention is not the most medically, epidemiologically or scientifically sound approach almost ever. And that's why even quite conservative doctors do not order every single test or procedure "just in case".

For example, the Cochrane review, which is close to a gold-standard of evidence based medicine, has concluded that routine mammograms are not saving lives and they cause harms which are not solely economic.

Likewise, vaccinating every individual who has been bitten by a cat, even if the cat is behaving in an odd manor, is not the standard of care. The vast majority of ER docs would not recommend getting those vaccinations for a number of reason including a) extremely low likelihood of rabies transmission by cat b) cost of vaccine c) potential side-effects of vaccine. Doctors and public health professionals, for the most part, seem to feel pretty much fine about this standard of care. It’s the lay public of metafilter who seems to object to it!

I always think it’s funny about the culture of metafilter that while doctors are enshrined here and people will be pushed to see a doctor for even rather routine questions, and we uphold Research(!) and Science(!) as the right way, at the same time we as a community do not tend to believe what doctors say or what the science shows about unnecessary tests and procedures. While your intuition may tell you that the more procedures the better, doctors and research do not support this. And that’s actually even more true in countries where money is less of a factor in medical care.

It’s like we want our mental picture of what a doctor is and what medicine should be, not the reality of what doctors do, or how medicine is practiced, or what science shows to be the course with the most benefit and the least harm.
posted by latkes at 1:22 PM on November 6, 2014 [7 favorites]


On the other hand, not doing that would kill you if you had been bitten by a rabid cat.

Yes, that's why I got the shot. I don't need to be convinced to get the shot. I already got it. I am aware that doctors can be wrong. That's why I got the shot. It's back-up in case the doctors are wrong. However, I won't assume the doctors are wrong in this case as I have no way and will not have any way--short of Animal Control finding the cat, which they haven't done--to know if these particular doctors were wrong this time. I am not arguing that doctors are always right. If I believed that, I wouldn't have gotten the shot. I'm not sure what you're arguing, but I don't need anecdotes of every time a MetaFilter poster has encountered a doctor who was wrong, not via the tons of MeMail I got about this and not via this post. I don't have to think doctors are always right or that I was wrong to get the shot to think MeFites got a bit hysterical over my post and enjoyed their own hysteria.
posted by pineappleheart at 1:26 PM on November 6, 2014 [4 favorites]


Because I was mad.

Okay, this is finally my cue to step away from AskMe. People taking it personally and getting mad because I do or don't take their advice is a sign that this is not a community for me. I'm sorry that you feel that, as an epidemiologist, you had authority that I ignored. I don't know you and had no way of knowing your profession, and frankly, your advice was not particularly helpful to me. You provided no background for me to know why your advice should hold any more weight than anyone else's.

I hope these medical AskMes get less hysterical. I still believe that people should defer to their doctors, and I wish I had. I am embarrassed that I was swayed by the responses in the post, and I'm embarrassed at the responses my post inspired.
posted by pineappleheart at 1:38 PM on November 6, 2014 [4 favorites]


I am just going to go on record here as saying that I think this was a crappy turn of events here and pineappleheart appears to have disabled their account (if that were not so, I would have memailed them instead to say "Hey, I think that sucks." but they are gone, so now I can't).
posted by Michele in California at 2:05 PM on November 6, 2014 [2 favorites]


"While your intuition may tell you that the more procedures the better, doctors and research do not support this."

This is very, very true.

This thread has frustrated me because underneath it is churning dysfunctional cultural attitudes about doctors and medicine. And I find that what's mistaken and dysfunctional is not really anything easily defined and therefore corrected, it's more subtle and very hard to address.

My sister, my mother, and myself talk about this quite often. My sister and I think and talk about it because we suffer from an extremely rare genetic illness (from our father's side) that was misdiagnosed and mistreated for a couple of generations of our family before us, and because we've both spent our entire lives dealing with doctors and health care, and my mother thinks and talks about for those reasons and especially because she's a retired RN.

And the thing is, people's expectations and understandings about doctors and health care are just miscalibrated. Generally, their expectations are way too high. But those unrealistic expectations, in turn, cause a whole bunch of people to err in the other direction and become cynical and/or embrace a bunch of nonsense. So what happens is that an undercurrent of discussions that involve these issues always ends up being a contest between two extreme and false viewpoints.

It's as if the argument, like some of the argument above, is "should I trust my doctor or not?" where the only acceptable answers are "yes, without reservation and to the exclusion of all others" or "no, doctors don't know very much and make many mistakes and other sources provide just as reliable advice". But the correct answer is "yes, generally, within reason, while anticipating both mistakes and ineffective treatment, and while being aware that the best health care happens with an informed and active patient cooperatively engaged with their doctors -- and being informed and active means using your own and community resources to learn about your illness and treatment". As you can see, that answer is not pithy.

Obviously, if you were to blindly choose between some random doctor's opinion and some random internet person's opinion, the doctor's opinion is much more reliable. But you shouldn't be blindly following anyone's advice about your own health. There are all sorts of occasions when "consult your doctor" might not be advice that people can actually follow on AskMe and, furthermore, there are many times when their doctor's advice will not be good advice. However, there will be many more times when a non-doctor's medical advice on AskMe will be bad advice.

People want easy answers about illness and health care and there aren't any easy answers, not even "consult your doctor". In relative terms, it's better advice than most; but that doesn't mean that it's always and everywhere the best advice or that it's never bad advice. I guarantee that there have been many cases where an AskMe doctor has misdiagnosed/mistreated something that AskMe answerers got right, and that there are many more cases where AskMe answerers were wrong. If you're playing the odds, then your doctor is a much better bet, but that's a bet people lose all the time. If you really want to maximize your health outcome, then you use what medical resources are available while being as informed about and active in your health care as possible. Even then, things will go wrong. That's just how it is.
posted by Ivan Fyodorovich at 2:25 PM on November 6, 2014 [10 favorites]


Oh, a correction to my comment. I wrote:

"...that there have been many cases where an AskMe doctor has misdiagnosed/mistreated something that AskMe answerers got right..."

What I meant to write was that someone who asked a question on AskMe then went to see a doctor and their doctor got it wrong while the AskMe answerers had gotten it right. I was trying to write something like "...an AskMe asker's doctor..." but mangled it in revision.

Maybe there's been times when doctor-mefites have given wrong answers on AskMe, I don't know, but that's not what I meant.
posted by Ivan Fyodorovich at 3:01 PM on November 6, 2014 [2 favorites]


that one poster who puts her strong opinions in random capitals with a million carriage returns so her response takes up the whole page.

When I find particularly egregious examples of this, I flag it as HTML/display error and a mod usually deletes the comment.
posted by grouse at 3:22 PM on November 6, 2014 [4 favorites]


Many, many years ago (1991), I worked in an online forum for a doctor that had published a book. It was called "Examine Your Doctor". I'm sure it's way out of print by now.

The author had a core belief about a patient's approach to medical care: Challenge everything. Challenge what your doctor says. Challenge their credentials. Question WHY tests are necessary. Get many different opinions about the course of treatment for medical issues. Don't blindly trust that your doctor has your best interests at heart or that they know the best course of action.

Doctors use google too, you know :-)
posted by disclaimer at 4:04 PM on November 6, 2014 [1 favorite]


> "cat is behaving in an odd manor"
posted by Pinback at 4:56 PM on November 6, 2014 [1 favorite]


Oy, spellcheck can only do so much for my shitty spelling.
posted by latkes at 8:31 PM on November 6, 2014


Sorry, pineappleheart, I meant my post to defend you and your decision against those who were criticizing it. Apologies if that wasn't clear!
posted by miss tea at 3:19 AM on November 7, 2014 [1 favorite]


Still silence from the mods on the rabies question? The OP wasn't even asking about rabies; none of the comments urging her to ignore proper medical advice were even admissible answers. Yet the only comment that was deleted - so far as I know - was my one suggesting that ER doctors might know better than random people on the internet.

Nothing to say about that? No implications? To be honest, I suspect we've done this kind of thing before: it's just that this is the rare case where the badly-advised person stays around long enough to explain the poor consequences of the bad advice, instead of silently leaving.

No offence intended to anyone: everyone meant well: but we really need to raise our game on this.
posted by Segundus at 6:11 AM on November 7, 2014


Admissible?
posted by rtha at 6:31 AM on November 7, 2014 [3 favorites]


Sheesh, you sound like Daffy Duck. "Out of sheer honesty, I demand that the mods show who they truly are....huh...out of sheer honesty? Huhhhh..."

The follow up comments from the OP in that thread showed that they were interested in the rabies angle, so there's no violation. What are the mods supposed to tell you?
posted by Namlit at 6:33 AM on November 7, 2014 [1 favorite]


Admissible? - yes: there's a rule that says responses must answer the OP's actual question; if they don't they're liable to be deleted.

What are the mods suppose to tell you? - They 're supposed to tell us all what safeguards they have in mind against Mefi giving bad medical advice.

Sheesh, you sound like Daffy Duck. Thanks, Oscar Wilde.
posted by Segundus at 7:57 AM on November 7, 2014


There's a guideline about answering the question that's asked; in practice, there is actually a sea of grey area where, um, admissible answers float. Since things get deleted (or not) by actual people and not bots, if the answers that are not admissible aren't flagged, then they're unlikely to get deleted. If they don't answer the exact question but do address why the question might be broader than the OP originally thought, they often get to stand.

I notice you didn't address the fact that the OP was interested in the rabies aspect of things, even though that wasn't initially spelled out in the question.
posted by rtha at 8:17 AM on November 7, 2014


...and so we end up having to state that Oscar Wilde, in fact, adores Daffy Duck.


*bows*
posted by Namlit at 8:22 AM on November 7, 2014


Still silence from the mods on the rabies question? The OP wasn't even asking about rabies; none of the comments urging her to ignore proper medical advice were even admissible answers.

It's not a court of law. Answers that are relating to follow-ups by the OP are "admissable" insofar as they are on-topic. Your comment, along with two other answers (as far as I can tell) was deleted for being fighty and barely on-topic. I'm not sure what other question you have for the mods relating to this question but I suggest emailing them since they do not appear to be reading this thread.
posted by jessamyn (retired) at 9:02 AM on November 7, 2014 [2 favorites]


Thanks. Interesting to know that two other answers were deleted: I really hope they weren't both suggesting she didn't need the shots.

The other question would be the one I just mentioned. It's not that I have a point I need clarified privately. It's more that when someone says the advice they got from us was hysterical, that they're embarassed to have followed it, and they feel so bad they're leaving, I'd expect there to be something said about how we avoid that in future.
posted by Segundus at 10:21 AM on November 7, 2014


I'd expect there to be something said about how we avoid that in future.

Why? People are dissatisfied with advice they receive all the time, especially in hindsight. Everyone tried to help her in good faith and it's not necessarily a site problem if she thought that the earnest advice she received was "hysterical" and "embarrassing." It was absolutely 100% her decision to follow or not follow any of the advice she received.
posted by dialetheia at 10:58 AM on November 7, 2014 [2 favorites]


"People taking it personally and getting mad because I do or don't take their advice is a sign that this is not a community for me......not via the tons of MeMail I got about this"

I got the distinct impression from her last post that she disabled her account because she got a deluge of abusive memails berating her for even thinking of getting the shots, and berating her for even thinking of not getting the shots, and just generally being fighty. Which is not cool at all.
posted by tinkletown at 11:38 AM on November 7, 2014 [4 favorites]


I love this place, and I try not to take it too seriously. But now and then it breaks my heart to see the low standards we set for ourselves.
posted by Segundus at 12:23 PM on November 7, 2014


Oof, yeah, that's terrible if that's what happened. I hope she forwarded those memails to the mods so that they can address it!
posted by dialetheia at 12:23 PM on November 7, 2014 [2 favorites]


We didn't get any contact information about harassing emails, or any complaint about mail (or about the thread) from pineappleheart.

If there is a question about abuse of Mefi mail, we could actually get pb to look into it, but I'm not sure that this is actually a charge from Pineappleheart? Typically we would not do this without a complaint. We usually talk to the people involved and get a transcript from them of the abusive text rather than just ripping into their mail. If the two people are reporting completely different conversations, we will probably have a look at those specific mails. If someone is getting a lot of unwanted (but not abusive) mail on a specific topic and they don't want to turn off their mefi mail (and dont want to ask themselves), I wouldn't have any problem asking in-thread for people to cease sending them personal messages because it's becoming too much for the OP.

Segundus: FWIW I tried to suggest in the rabies thread that it was absurd for AskMefi to over-rule actual medical advice, but my first attempt was deleted (for use of sarcasm, I assume). I don't know whether other dissenting comments were axed, but IMHO, FWIW, YMMV I'm still inclined to think that that probably wasn't the intervention the thread required.

Your comment was:

Go right back to the ER this minute and tell the doctors some guys on the internet say they're full of shit.

You could definitely have advised the OP to listen to the doctors and ignore non-MD advice, and that definitely would not have been deleted – as you know, since you did repost that advice without the snarky sarcasm, and it wasn't deleted. The other two deleted comments were one advising OP to kill the cat, rabid or not, because feral cats are pests, and sharing that the commenter shoots them on principle, and one telling the OP to threaten Animal Control with a lawsuit, and to "have a man call if you have one handy."

Segundus: Still silence from the mods on the rabies question? The OP wasn't even asking about rabies; none of the comments urging her to ignore proper medical advice were even admissible answers.

I have had this thread in my recent comments, but I've been off the last couple of days, so didn't see it until now – not at all trying to dodge any question. When an Ask Me thread derails into addressing a thing that is not the topic of the question or helpful info regarding surrounding aspects of the question, we usually delete the off-topic answers and ask people to stick to the question.

Occasionally, a thread will morph into advising about something that wasn't asked but seems to answerers critical to address nonetheless. We try to pick our way carefully in these cases because there's a range of possibilities from OMGWTF WHY ARE YOU ASKING ABOUT X INSTEAD OF Y (where Y is clearly the essential or emergency condition, and X is skirting that issue, and it's a pretty extreme and/or obvious situation) to questions where additional updates from the OP begin to show a different situation than described in the original post, to questions where the OP spends a great deal of time/effort describing certain aspects of the question, but then says something like, "all that aside, my question is blahblah," wherein it's very unrealistic to ask people to ignore all that information (and if they wanted it ignored, why did they go to such pains to include it?), to simply situations where the OP says "all thoughts / advice appreciated" which makes it much harder for us to say "please stick to [QUESTION]."

As usual with most moderation decisions, we take these on a case by case basis and try to determine if going beyond the original question is reasonable or not. If people are addressing an expanded aspect of the question and the OP is participating in that and seeming to find help in that, we are less likely to demand that everyone stop talking about the extended context.

In this particular case, if pineappleheart had said in the thread, "okay, thanks for the additional advice, but I've spoken to the doctors and will follow their recommendations, and I'd rather we drop this now," or similar, we would have asked people to desist and deleted further comments on that. It wasn't clear to us at all that this is what pineappleheart was saying in there and didn't realize at all that they were feeling bullied, so we didn't step in, and they didn't ask us to, so it was a problem of us not reading their follow-up comments as a desire for people to cut out the rabies-related advice, and pineappleheart not explicitly letting us know that they didn't want further comments on that. As a mod, I wouldn't have felt comfortable stepping in to cut off that development unless the OP wanted us to do that.

So, the short version is that none of us saw that situation as a typical "stick to the original question" sort of derail where we'd delete answers that weren't about getting the cat to leave the yard, and also didn't understand that pineappleheart was feeling bullied because it just wasn't obvious to us from their comments in that thread, and we didn't get other feedback from them.

Nobody flagged comments suggesting that rabies might be a real concern, and just speaking for me, personally, searching for rabies / Brooklyn brings up news and warnings about rabies in raccoons and rodents from Aug-Oct of this year, including, for example, this tagged with Brooklyn News from one site: "An alert went out this week warning that feral cats and kittens roaming Bensonhurst may have rabies, after city officials captured a rabid raccoon that was seen fighting with some street cats in the neighborhood on Aug. 20," so I really would not have wanted to just unilaterally delete any mention of concern about rabies.

I understand now that pineappleheart was feeling extremely pressured by so many people commenting, though, which I can definitely understand, and it's something I'm going to try to be aware of and more sensitive to, and add to my standard calculus of considerations when threads like this are developing.
posted by taz (staff) at 3:39 AM on November 8, 2014 [6 favorites]


When answering pineappleheart's question I consulted with a former public health official from another large east coast city. I also spoke from experience when someone I knew was bitten by a feral cat and went through the process of getting the rabies vaccine. At the time when this person was bitten by a feral cat I consulted with the former public health official, a friend who'd also been recently bitten by a feral cat and a vet tech who has a prophylactic rabies vaccine and deals with animal bites frequently.

The former public health official was shocked at the ER docs' behavior in pineappleheart's situation. The former public health official recommended calling the NYC health department and letting them know what happened.

I'm sorry that this has turned into an unpleasant discussion.
posted by sciencegeek at 4:14 AM on November 8, 2014 [10 favorites]


I consulted with etc.


Yeah but I think the discussion is now rather thoroughly moving past the question of whether rabies among feral cats in Brooklyn is a serious concern or not, and what kind of authority you can summon for your argument.
It now seems to me more about how to wield that authority well, in order to not bully the fainter-of-heart members into a crunch. The situation also seems to ask for something like: "if you feel overwhelmed by answers for any reason, do talk about it." Maybe add something explicit along those lines to the FAQ somewhere.
posted by Namlit at 5:19 AM on November 8, 2014


Thanks, taz. Forgive me if I say I think to some degree you're responding from within your comfort zone, and that doesn't really cut it this time. The real point here is that collectively we hurt someone with our advice; cost them money they could ill afford, made them get a medical procedure they didn't need, and caused them to feel so embarassed and bad about us that they left.

Something needs to be done to put that right as far as possible and stop it happening again if we want to go on thinking of ourselves as decent people. It's up to you, but I'd offer three suggestions as a kind of minimum;

1. delete the whole rabies thread;
2. make it a firm rule (none of the beloved grey areas or case by case stuff) that we don't advise people to ignore properly-qualified medical advice, period;
3. you send pineappleheart an unqualified apology on behalf of all of us. If you want to offer money towards the cost of her shots, I'm willing to contribute.

This is not a nerd argument over the rules of a forum, it's someone's actual life we messed up.
posted by Segundus at 6:29 AM on November 8, 2014


This is not a nerd argument over the rules of a forum, it's someone's actual life we messed up.

No. The advice the OP followed was reasonable. Advice given to the contrary was also reasonable. She made a decision and took action.
posted by in278s at 6:46 AM on November 8, 2014 [15 favorites]


Segundas, I was bummed that pineappleheart closed their account, but they didn't ask for any of the items on your list. They acknowledged the ambiguities and unknowables of the situation. Your tone here is intense and your suggestions are pretty far off from what any one else here suggests.
posted by latkes at 6:47 AM on November 8, 2014 [9 favorites]


It was always up to pineappleheart. I've asked questions and received answers and judgements and second guesses and some were kind and some were harsh. I haven't liked some of the answers, that's for sure. But in the end, you put something out on Askme and you deal with what people have to say in whatever way suits you best. Sometimes you regret your choice.

It's bullshit to ask the mods to delete the whole thread and to ask for a firm rule when they have always said that there are very few firm rules on this site. Not many rules, fuckloads of expectations. It's up to us as commenters to moderate what comes out of our keyboards and if it all turns pearshaped then it's up to us to consider what is the right way to approach this kind of subject again. You can't turn back the clock.
posted by h00py at 6:56 AM on November 8, 2014 [7 favorites]


> collectively we hurt someone with our advice; cost them money they could ill afford, made them get a medical procedure they didn't need, and caused them to feel so embarassed and bad about us that they left.

I find it strange and frankly a little insulting to the OP that you are totally dismissing her ability to weigh multiple sources of information and her agency in making what was obviously a difficult decision.
posted by Westringia F. at 6:57 AM on November 8, 2014 [17 favorites]


Or, indeed, to ask for redress on their own behalf.
posted by drlith at 8:03 AM on November 8, 2014


"It's someone's actual life we messed up."

You don't think DTMFA ever messes up someone's life? All sorts of questions that people ask are about things they have a very high stake in. People don't hold relationship answers to the same standards as medical answers, but that's because they recognize there's great ambiguity and that it's very difficult for anyone to ever say what the truly "right" answer is and that the asker, in the end, has to use judgment. But this is true of medical questions, too, though not to such an extreme. But more than people tend to think.

"The advice the OP followed was reasonable. Advice given to the contrary was also reasonable. She made a decision and took action."

and

"I find it strange and frankly a little insulting to the OP that you are totally dismissing her ability to weigh multiple sources of information and her agency in making what was obviously a difficult decision."

I'm not sure how pineappleheart is thinking and feeling about this, but basically both of these comments are right. A lot of this discussion takes for granted the idea that even if the advice that askers get on AskMe is good advice, they don't need to be able to use their judgment to be able to recognize that it's good advice. Which is to say, it doesn't really matter whether the advice is "see a doctor" or "don't see a doctor" or even what an actual doctor the askers visits decides to do ... there's always going to be the unavoidable necessity of using one's own best, informed judgment.

Which is why the whole binary thing about "consult a doctor" and the more general binary "should medical/legal/similar questions be allowed on AskMe" is just plain wrong. As we see in this example, there are convincing, authoritative arguments on both sides about whether pineappleheart should have gotten the treatment. Even when it's actual doctors or actual advice from the relevant health department, we see that can be disagreement. Expert opinion is no free lunch for avoiding using one's own judgment. Many people hate the bad answers, the dangerously bad answers on AskMe, and I hate them, too. But there's no easy fix for this.

There's only two things that help. First, that askers recognize that they will always in the end have to make the effort to sift information and opinions, evaluate expertise, and use their judgment about what advice to take. Second, culturally we can foster an ethos in AskMe of a strong sense of responsibility on the part of answerers.

Frankly, I think the latter is possible, but that the ship has sailed on that long ago. People enjoy just answering questions and the only reason this is so much better than, say, Yahoo, is because people here tend to be more knowledgeable. It's not because there is a strong culture of only answering when you actually have expertise and, even then, being very careful and responsible in the answers. It's why I don't like AskMe. But that's neither here nor there.
posted by Ivan Fyodorovich at 8:20 AM on November 8, 2014 [2 favorites]


Your comments are getting increasingly ridiculous, Segundus, and they started out silly; sciencegeek has made an excellent case that pineappleheart probably did the right thing, and that it was clearly a reasonable thing.

And if we read pineappleheart's actual comment, it's not clear that any of the memails she received were abusive:
I'm not sure what you're arguing, but I don't need anecdotes of every time a MetaFilter poster has encountered a doctor who was wrong, not via the tons of MeMail I got about this and not via this post.
It sounds as if they were merely a bunch of anecdotes about times doctors were wrong.
posted by jamjam at 8:42 AM on November 8, 2014 [4 favorites]


It's not about what pineappleheart asks from us; it's about what we ask from ourselves. Little enough, it seems.

Last word from me...
posted by Segundus at 10:44 AM on November 8, 2014


I'm also sure that, say, electricians think the answers to lots of electrical issue are terrible.

Downright horrible sometimes with at least a few cases where following the given advice would have had a good chance of being immediately lethal.
posted by Mitheral at 11:56 AM on November 18, 2014 [2 favorites]


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