AskMe screws the pooch December 5, 2007 6:43 PM   Subscribe

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

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

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

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

You should all be much, much more careful. We should all be much, much more careful.
posted by ikkyu2 to Etiquette/Policy at 6:43 PM (254 comments total) 41 users marked this as a favorite

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


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

Wise words.
posted by dirtynumbangelboy at 6:53 PM on December 5, 2007 [3 favorites]


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


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


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

.......


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


.....

You have to focus on your therapy and medication.


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

Those are in the first three or five comments. Seems pretty good to me for asking strangers on the internet.
posted by shothotbot at 6:55 PM on December 5, 2007 [3 favorites]


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


You'd have to be crazy to get mental healthcare advice from random internet people.
posted by pompomtom at 6:58 PM on December 5, 2007 [26 favorites]


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


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

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

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


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


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

I think that's a good idea.

What is to be accomplished by this post, ikkyu2?

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

hypervenom doesn't sound resentful of AskMe's advice

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

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

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

Well-intentioned advice, gratefully received, can cause great harm if it is wrong.
posted by ikkyu2 at 7:07 PM on December 5, 2007 [9 favorites]


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


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

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

There are exactly two reasons for this. One, even the best informed answerers don't have enough information to render advice safely. Two, even the best informed askers lack the expertise, background, and context to evaluate the advice they're receiving on its merits.
posted by ikkyu2 at 7:11 PM on December 5, 2007 [2 favorites]


Seriously, why did you post this?

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


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



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


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

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


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

Shame on you, dipshits?
posted by mr_crash_davis at 7:21 PM on December 5, 2007 [14 favorites]


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

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

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


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

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


My experience is that really smart people tend to have difficulty boxing in exactly where their knowledge is strong or weak, or defining those areas where they have none at all. The problem is that a well educated, smart person can make an argument that has no basis in knowledge or expertise sound very authorative by force of rhetoric. There are a lot of smart people here that don't understand that their general knowledge accumulation doesn't extend into certain fields of expertise with specified knowledge that a layperson doesn't have access to, nor will be able to logically intuit. That doesn't stop them from making an authoritative statement because they figure they're smart, well educated and whatever answer/solution they intuit is probably the right one anyway, or at least is logical considering the information that has been given by the poster.
posted by The Straightener at 7:23 PM on December 5, 2007 [29 favorites]


I think you may be reaching a bit

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

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


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


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

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


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

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


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


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


PATIENCE?

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


Seriously, why did you post this?

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

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


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

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

Sheesh. Follow that up with a "THEY COULD HAVE KILLED THEMSELVES AND IT'D BE YOUR FAULT" and there's way too much condescension in here.
posted by puke & cry at 7:30 PM on December 5, 2007 [1 favorite]


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

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

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


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

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

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

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


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

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

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



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


Ikkyu2: Ask MeFi: 32 questions, 4266 answers.

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


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


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

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


Thanks for posting this, ikkyu2.

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

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

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


Oh, and this:

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

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


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

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


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

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

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

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


How does the process get fixed?

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

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


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

I'm surprised to hear that.

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

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


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


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

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

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



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


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

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

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

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


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


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


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

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


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


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

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


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

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

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

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


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

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

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

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

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

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

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

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


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


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

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

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

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

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


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

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


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

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


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

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


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


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

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

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

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

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

As to this site, as long as it is clear to people that none of us can diagnose, I think it is a wonderful thing to be able to query the hive mind on these sorts of things. I suspect that if the truth were known, Askme has saved some lives here and there, and for sure made lives better.
posted by konolia at 8:04 PM on December 5, 2007 [4 favorites]


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

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


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


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

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

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


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

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


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

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


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


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

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

And here are some of the responses:

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

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

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

You have to focus on your therapy and medication.

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

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

So the poster said that she was given a PROFESSIONAL diagnosis of anxiety disorder and a PSYCHIATRIST prescribed her medication. The majority of people are telling her to do what her therapist says, to stick to it. How is this bad advice? It looks like it's the pros who screwed up, not the Mefites.
posted by Evangeline at 8:15 PM on December 5, 2007 [7 favorites]


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

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

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

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


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

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

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


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

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

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


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

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

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

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


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

ikkyu2 says:


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


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

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

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

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

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


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

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

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

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


Thankfully, this isn't about you.

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


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

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


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

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

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


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

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

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

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

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

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

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


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


Seriously, why did you post this?

Dear puke & cry,

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


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

So yeah, this callout is useful. I think there should prominent warnings in AskMe that there is a high chance your medical or legal question will be answered by someone who has no fucking idea what they are talking about
posted by Krrrlson at 8:49 PM on December 5, 2007 [1 favorite]


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


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

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

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


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

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

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

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


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

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

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

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

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

Does that make sense? I feel like there are probably complexities that I haven't thought about?
posted by ikkyu2 at 9:00 PM on December 5, 2007 [4 favorites]


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

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


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

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


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

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

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

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

Virtual health care: unresolved legal issues.

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

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


Do Internet interventions for consumers cause more harm than good?

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


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

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


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

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

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

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

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

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

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

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

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


It's not arrogance if you're right.

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

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

It's probably the cheapest therapy in the world just to know other people experience the same things as you do.
posted by docpops at 9:17 PM on December 5, 2007 [3 favorites]


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

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


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

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

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


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

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

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


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

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


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

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

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

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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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


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

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


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

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


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


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

Careful with that axe, Eugene...

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


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


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

Many of the responders got it dangerously wrong.

..is arrogant, overreaching bullshit.

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

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


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

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

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


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

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

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

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

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


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

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


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

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


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

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


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

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


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


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


oh.

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


ha! even when wrong, I am right.

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


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

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

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


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

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

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

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

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

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

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

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

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


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

It would need to say something like:

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

Even doctors can't diagnose you without examining you.

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


It seems to me that the discussion is a bit too focussed on the specific incident cited - as tkolar mentioned, the larger issue that IS a special case is that of the mentally ill, or potentially mentally ill, posting questions seeking advice. All of the internet is essentially a mine field for those with some types of mental disorder. We can't diagnose them remotely, but I think at least an explicit warning might be worthwhile, for those who are at least self-aware enough to realize they are disordered. Something along the lines of: "If your question is about psychological or psychiatric symptoms, please appreciate that asking here, instead of face-to-face with some sort of professional, might not be the most appropriate course of action. All advice is provisional AT BEST." - or some such - perhaps someone more familiar with suitable boilerplate language could pipe up. (On preview - LobsterMitten would appear to agree)
posted by birdsquared at 10:49 PM on December 5, 2007


It seems inevitable that at some point something is going to go very wrong when advice handed out on AskMe is taken too seriously by a vulnerable or gullible person. Having dealt with suicidal and schizophrenic people myself (although not in a professional capacity), I can see how this is a concern in ikkyu2's example. Some people are simply not capable of judging. The best thing to be done for these individuals, by strangers on the 'net, is to encourage them to be hopeful about their situation and to seek help from people who are in a better position to act appropriately.

A disclaimer here and there certainly wouldn't hurt. I like Lobstermitten's there. :)

Still, I don't see how asking Metafilter is any worse than asking Joe who happened to be standing at the water cooler, or cousin Bernie who called you up to dish about cousin Stewie, or any other busybodies who populate your confused life. People give messed up advice all the time. People also ask for advice from the wrong people all the time. Heck, my friends and family are constantly asking me for advice simply because my BS degrees make me the best convenient option. I have to remind them that I am not a doctor [veterinarian, psychiatrist, organic chemist, geothermal physicist... fill in the blank]. Fortunately for them, I somewhat understand the limits of my own understanding (being regularly humbled by professors seems to have that effect!).

At least on AskMe you're likely to get several perspectives all at once. While disconcerting, this does effectively point out that these Internet people may not all know what they're talking about. And while some answers may be misleading, they are also likely to contain personal stories, encouragement to follow up and follow through, and indications that the people answering actually give a damn, and these things are all very valuable.
posted by zennie at 10:50 PM on December 5, 2007 [1 favorite]


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

Best disclaimer ever.
posted by mediareport at 10:52 PM on December 5, 2007


It does seem like a good idea to add a psych-specific thing in the pre-post screen.
posted by LobsterMitten at 10:54 PM on December 5, 2007


With the advent of mefi mail, what about an auto-generated email to anyone who asks a question in either the health or law categories which points out that they may receive specific medical or legal advice which should be vetted by a professional before being followed? Conversely, that same statement could be displayed to only that user when they revisit the thread, perhaps.

I think such a statement could be written in a friendly way. And (maybe?) because it was presented to the asker after the rush and anxiety of getting an extremely personal and stressful question typed up and sent out it would be considered more carefully than a "check it and ignore it" disclaimer box.

Incidentally, does this look infected to you?
posted by maxwelton at 11:01 PM on December 5, 2007


I think that the difference between asking a health question on AskMe and asking one in real life is that the people in real life are much more likely to figure out if you're in desperate need of medical attention. Anyone can post things to the Internet, even people who aren't acting as rationally as you or I, and it's hard to see through the post to the person who's behind it and tell whether when they posted, they were fully aware of the value (or lack thereof) they would get from asking the question in this forum.

When I call my campus infirmary, the first thing I hear is, "if this is an emergency, please hang up right now and dial 911." Why do they need to say this? You should know that calling the campus infirmary is not a good way of receiving an immediate emergency response. Yet they put the message there, and other non-emergency medical phone numbers have similar messages. Clearly, people sometimes call a non-emergency number, a number that is unlikely to get them the response they need, when in an emergency situation. So clearly, not everyone deals with major medical (especially psychological) situations rationally. As such, the normal mechanisms of assuming that people will value AskMe's answers appropriately can fail, perhaps even spectacularly.

So I think it would be perfectly appropriate to have some sort of health-specific warning or deterrent to prevent people from using AskMe as a diagnostic source. Even if you wouldn't make that particular mistake, even if nobody in the right state of mind would make that mistake, someone might.
posted by goingonit at 11:08 PM on December 5, 2007


Is there some kind of script available that just automatically favorites every single one of ikkyu2's posts?

Cause I'd like to install it.
posted by Cool Papa Bell at 11:09 PM on December 5, 2007


I believe that it's really important for people (both lay and "expert") to be able to discuss medical and legal questions on the internet, even if parts of the discussion are done badly. Often the non-expert has a lot of great information and insight.

In my area of expertise (where no one dies, usually), sometimes I get tired of the OMG call a lawyer! advice. Sometimes it's true, sometimes it's entirely possible to solve the problem without hiring a lawyer. I think it's important for non-lawyers to have access to accurate legal information.

I vote for no changes. I definitely vote for no psychiatric-specific changes/warnings (please). An umbrella warning would be way better than a warning targeted toward a particular group of us.
posted by ClaudiaCenter at 11:10 PM on December 5, 2007 [4 favorites]


Mental Health questions should be deleted with a nice letter sent to the poster about seeing their own physician. There is no upside to having them stay and a very large potential downside.
posted by afu at 11:15 PM on December 5, 2007



Mental Health questions should be deleted with a nice letter sent to the poster about seeing their own physician.


Do you honestly think that the questioner won't just go find another site that will allow them to ask their question?
posted by tkolar at 11:22 PM on December 5, 2007


Mental Health questions should be deleted with a nice letter sent to the poster about seeing their own physician. There is no upside to having them stay and a very large potential downside.

Why mental health specifically? Care to provide a draft of that "nice" letter, which all persons with mental health problems will take as not in the least contemptuous or patronising? How do you clearly distinguish mental health questions from human relations questions? What if they don't have a physician yet?

What if they're needing to be talked into seeing a physician, and your dismissive rejection pushes them over the line? Hey, one less in the queue at the bus stop ... is that an upside?
posted by aeschenkarnos at 11:22 PM on December 5, 2007


Mental Health questions should be deleted

...

Something along the lines of: "If your question is about psychological or psychiatric symptoms, please appreciate that asking here, instead of face-to-face with some sort of professional, might not be the most appropriate course of action.


Wow, this psychiatric-specific reaction really bums me out. My experience is that many mental health experiences and questions are particularly well suited to (non-expert) peer support and feedback. I learn as much from my friends and communities as from the professionals I see. Most of the mental health questions I have read are about day-to-day issues (work, relationships, managing), and I've seen some really helpful responses.
posted by ClaudiaCenter at 11:23 PM on December 5, 2007 [5 favorites]


Mental health questions are damned popular. AskMe categories aren't sufficiently granular to sort them out from other types, but we do tend to get 'em dailyish, don't we? They seem to run second to RelationshipFilter in frequency, but I may be oversensitive. Perhaps Mac questions are more common.

Actual point being, I don't think you can just declare mental health questions to be off limits and delete them. There's an obvious need/desire out there, and I doubt it would go away if they were against the rules. If we must do something about this, better to attach some kind of messaging so that if you categorize your question as Health, you are served a nicely-worded disclaimer about how we can speculate for you, but that you should please go to see a professional. Ditto Legal questions, I suppose. Meh.
posted by mumkin at 12:07 AM on December 6, 2007


It's doubtful that every little mental health problem requires professional advice. In reality the green already does a piss poor job with many of these questions by recommending the asker seek out a doctor for even the most trivial events. People have been recommended Your hands are cold? Go see a doctor! You ate a day-old sandwich? Go see a doctor! You hear a buzzing sound? Go see a doctor! It's ridiculous.

Any sort of disclaimer is silly since nobody will read it. Still, just to be on the safe side, it'd probably be a good idea to put up a variation of Yahoo! Answer's Disclaimer.
posted by nixerman at 1:02 AM on December 6, 2007


Just coming in to say that I asked an anonymous mental health question and found the answers really helpful (they led to me going back to my GP and getting different treatment). Looking at the questions tagged with depression there's a huge range of things people are asking about related to mental health, and I value the opportunity to have those discussions here. I found the answers to my question helpful, I think, partly because I tried to make the question as specific as possible.
posted by paduasoy at 1:03 AM on December 6, 2007


To me, I think the least successful aspects of modern medicine is that mediocre general practitioners don't keep up with current science.

For example: I suffered a number of times over the past few years from vertigo. I went to a number of different doctors who did things like give me an EKG and prescribe me some heavy depressants and anti-nausea medicine. If any of them had referred me to an ear/nose/throat doctor, I would've been immediately correctly diagnosed, had a simple maneuver performed on me, and improved within a day. The manuever was clearly unknown to all of the doctors I saw -- when I asked to see an ENT, two of them said "you could, but if it's vertigo, it really won't make a difference." When I saw an ENT, I was diagnosed as a "classic case" and healed within 20 minutes.

Having people be able to share their own experiences with similar symptoms so that you know what to ask for can help bridge the gap in G.P.'s knowledge.

I'm not saying that all dizziness will be cured by the Epley maneuver, but had I known that it wasn't junk science earlier in my treament, I would've been a happier person. This is an example where I was going to a doctor anyway, who did (at the least) perform tests to make sure it wasn't anything serious, so that I was in no danger of making a poor choice based on peoples' responses.


My experience is that really smart people tend to have difficulty boxing in exactly where their knowledge is strong or weak, or defining those areas where they have none at all.

You and I have very different definitions of "really smart."

posted by one_bean at 1:45 AM on December 6, 2007 [1 favorite]


Sorry, that was poorly articulated. My point is this -- medicine is so specialized that many doctors no longer have a complete command of every single condition. Getting input from non-professionals who suffer from similar conditions can help raise the level of information for your own treatment, and that is a good thing.
posted by one_bean at 1:49 AM on December 6, 2007


On the larger issue posed by ikkyu2, I have nothing to add, other than I agree that increased awareness and care in dispensing advice in areas like law and medicine can only be a good thing. It's a good thing to bring up the question, to point out when and how bad advice could be potentially damaging; it's good to talk about it in Metatalk, and to ask people to stay on their toes and think twice about how they answer certain questions. We need to exercise care.

More specifically, I'd like to say that answerers should try to police their tone when responding in AskMe. Active instead of passive language, absolute pronouncements instead of "dithering" language, authoritative presumption, and even hyperbole and aggressive stances make for more vivid (if not always the most nuanced or thoughtful) discussion on Mefi and Meta, but is exactly wrong for Askme... so we have some people jumping between Mefi, Meta, and Askme, and being as careless, outspoken and absolute in all three places because they are in their MeFi or Internet "mode".

If you find yourself doing this, I would urge you to slow down, take a breath, and apply a bit of thought before committing your thoughts to AskMe.
posted by taz at 3:20 AM on December 6, 2007 [2 favorites]


Posting before reading everything because, goddamn, I should be asleep

1. There is no "AskMe." There are a bunch of people posting their thoughts, all signed and understood to be the thoughts and ideas of only that one user. This fact is AskMe's strength, in fact, and it's the thing that makes mental health questions difficult but ultimately useful. Asking a room full of strangers for their various, contradictory can, it seems, have a much more positive effect than just googling for answers. AskMe is comparatively warm, and hearing other people's experiences—relevant or not, in the end—may animate someone to take action in a way that sitting alone with their thoughts doesn't.

2. The specific questions in, erm, question are a really poor example. In March, the person asks "What [can] I do to stop going crazy?" Nine months later, she's back with a (supposed) diagnosis of schizophrenia. With only these two data points I don't see a problem. Hell, for all we know AskMe got her to where she is today. Obviously we don't know, and I'm not saying that AskMe couldn't use some tweaking, but.

That's it. "but." I'm going to bed.
posted by wemayfreeze at 3:38 AM on December 6, 2007


To be honest I think half the time Askme just acts as peer pressure to get someone to go to the Dr that didn't want to. A lot of people don't have health insurance (or have crappy worthless health insurance like me) and being able to ask a group of people do you think I really need to go to the Dr/ER is generally not a bad thing. While people could get it wrong virtually no threads overwhelming tell people not to go to the Dr and to ride it out and for painfully obvious one where no one can believe the person hasn't gone to the Dr. (I'm thinking of the askme where it sounded like the girl had had a stroke after passing out for several hours in her apartment after part of her body went numb) it acts as a wake up call. It is pretty rare that the hive mind tells people to take an aspirin and wait a few weeks for things to get worse before going to the Dr.
posted by whoaali at 4:46 AM on December 6, 2007 [1 favorite]


The membership of MeFi is always in flux; for that reason it seems unlikely that all answerers will "try to police their tone when responding in AskMe" (no matter how reasonable an idea this is). People have all kinds of motivations for asking and answering questions at this website, and there is no way to control for that.

A checkbox requirement that posters acknowledge that AskMe responses may or may not be of any value, phrased in a way that points out that authoritative language does not necessarily = an authoritative answer (following LobsterMitten's suggestion) seems to me an adequate and appropriate measure to take.

I'm of the opinion that the burden of responsibility ultimately lies with the individual who chooses to consume information from this (or any other) source, whether or not that individual is experiencing disordered thinking at that time. This is not to say that people who respond to AskMe questions shouldn't use their best judgment, especially in cases where it seems ("seems" being the key word here) that someone isn't thinking rationally.

In aggregate, answerers of AskMe mental health questions tend to follow the "IANAD-go-see-a-doctor" pattern, and/or offer empathetic responses. Part of the beauty of AskMe lies in the fact that most questions get enough responses whereby the asker can differentiate the middle-of-the-pack, sensible answers from the ill-advised, potentially harmful outliers. Of course the sensibility of middle-of-the-pack answers is not guaranteed, and this is one more argument for why ultimate responsibility for the use of information lies with the person who uses it (or decides not to).

If there was a way to promote a healthy(!) skepticism by everyone who uses this site (or consumes information from any source, which would be...everyone), I would argue in favor of implementing it. Personally, for example (and this is not a callout per se, but rather an exercise in picking the low-hanging fruit in this case), I would be skeptical of someone I've never met who hints at having a medical degree, who has been "incredibly generous" to humanity by way of 4266 answers, and who is regarded by other people I don't know as being full of "wise words" and worthy of "automatic favoritism." I would wonder whether somebody like that has found even better ways to put his or her knowledge to use, for example by volunteering in a free clinic. Not to suggest that feeling "crappy and anxious" about medical suggestions made at a free clinic wouldn't be potentially an issue (as it necessarily is when making them at a website not intended for that purpose), but it does seem like a more appropriate venue for putting one's expertise to the best possible use. But perhaps that's too harsh.

It never ceases to amaze me how limited an idea many people have of "expertise." Credentials do not (necessarily) an expert make; there is more than one way to be an expert. Then again, if I should ever have the need for an appendectomy, I'll probably look into having a medical expert take care of it (once I get the go-ahead from 17 internet strangers who clearly know something about appendicitis).
posted by splendid animal at 5:35 AM on December 6, 2007


The only thing I really have to add is: if she HAD just had an untreated/undertreated anxiety disorder with possibly some depression mixed in, how much worse (or possibly triggering of a suicide) would it have been if people (doctors or no) had jumped in and said, "Actually, you really ARE going crazy...it's almost certainly schitzophrenia."
posted by sock it to me monkey at 5:46 AM on December 6, 2007


I remember a few years back after a spate of police shootings of black men reaching for ID seeing an ironic parody police training video which repeatedly showed alternating images of a wallet, then a gun, while a narrator slowly enunciated "Wallet... Gun... Wallet... Gun..."

What's that got to do with this?

"Website... Doctor... Website... Doctor..."
posted by Horken Bazooka at 5:58 AM on December 6, 2007


I do think Ask Mefi does a great job of providing support to people in distress, and I think that's very significant. There are lots of questions I read where AskMe provides good general advice.

The issue I have is with the specific answers that may or may not be accurate. Many folks in this thread have drawn a comparison with MDs giving poor diagnoses, perhaps even in the case of the question under consideration. I think this is a false comparison, though, for at least two reasons. The first, and perhaps most important, is that consumer protections exist in order to help people who feel like they've been wronged by their medical providers. No such protections exist for Ask Me. For the purposes of this website, though, the second reason seems more applicable: many illnesses, perhaps particularly mental illnesses, present progressively. That's why a history is needed in order to provide accurate diagnosis. In this case the questioner's psychiatrist or therapist may well have seen symptoms of social anxiety, but the situations in the question exceeded that. While it's possible she was misdiagnosed, it's just as possible that she presented as having social anxiety at first and that more symptoms were developing.

It really doesn't seem untoward that we consider our answers when answering medical questions, nor do I think it would be difficult to make such consideration a part of the expectation of the site. I find it ironic that for all the comments here decrying the notion of "expertise" the only group consistently advocating such consideration are the people trained and licensed to provide diagnoses and advice.

splendid animal, your final paragraph savors more of the animal and much much less of the splendid. Why such an asshole?
posted by OmieWise at 5:58 AM on December 6, 2007


ikkyu2, thanks for posting this. I think it's a problem that needs to be addressed - I've thought about asking a similar question about inappropriate diagnoses on AskMetafilter before. I think a disclaimer would help, both on the asking and the asker's end.
posted by fermezporte at 6:17 AM on December 6, 2007


I just want to point out to the "but what do you want us to do about it?" people that a valuable service is provided just by bringing it up and giving us a chance to discuss it. If it makes even a few people think twice about jumping in with a top-of-the-head remark on AskMe, it's been worth it. It's like those sexism threads: the point is not to put some procedure into place but to get people thinking.

Also, so what if ikkyu2 is arrogant? Yeah, it's an occupational hazard for doctors, and it can be annoying, but he admits it himself and is trying (in my view, pretty successfully) to keep it from diminishing the value of his comments here, but if you refuse to listen to truth because it comes in an arrogant tone of voice, you really need to grow up. (Mind you, I speak as someone who also has to fight his own tendency towards arrogance.)

I see what you're saying, but by that token we get things "wrong" every day.

But most of those things don't risk people's lives.
posted by languagehat at 6:28 AM on December 6, 2007 [2 favorites]


I think there should prominent warnings in AskMe that there is a high chance your medical or legal question will be answered by someone who has no fucking idea what they are talking about

I know the "fixed that for you" thing is trite and overdone, but I couldn't resist here.
posted by DevilsAdvocate at 6:43 AM on December 6, 2007


Splendid animal, what the hell? You don't think ikkyu2 is a doctor, and that he answers too many questions? That's what it sounds like you're saying.

He's a known person, as in Real Life... unless all the people here who know him in real life are in on the Big Lie. And what, according to you, is the maximum number of questions one should answer without becoming a suspicious character?
posted by taz at 6:50 AM on December 6, 2007


Who knows how often this has happened in other threads, with well-intentioned, authoritatively stated, wrong advice?

It is undeniable that there is terrible advice offered in medical AskMe threads, and that it sometimes verges on the dangerous. Here's a recent clanger in which the OP expresses concern about latex anaphylaxis, and someone suggests wearing latex gloves as a challenge.

About 2 years ago when I was a genuine $5 n00b, I also asked about bad AskMe medical advice. In that thread I inadvertently picked a question where I though ikkyu2's advice was way off the mark, and at risk of causing unmerited anxiety for the OP. I got what at the time I thought was a serious MeTa hazing. I now believe that the majority of doctors and non-doctors who weigh in on AskMe threads do a damn good job. I try and stay out of them because too often I've woken up in the middle of the night worrying that my well intentioned answer might have somehow caused harm. Everyone is at risk of making mistakes regardless of qualifications; as ikkyu2 says, an AskMe is never an adequate substitute for history and examination.

When questions get posted to health I would suggest a note for the OP that says something like:

"Ask Metafilter is rarely an appropriate substitute for medical advice. If you have an immediate medical problem, or are seeking a diagnosis consider calling 1-800-NURSE or NHS Direct instead."

And at the top of each health thread could be a reminder that says:

"Please remember that you may be legally liable for advice given in Ask Metafilter. Do not directly suggest any diagnosis, without carefully considering the ramifications."
posted by roofus at 6:52 AM on December 6, 2007 [1 favorite]


Perhaps if someone selects the "health" category a message box comes up with a warning like: "(1) AskMeFi is not the proper place to obtain a medical diagnosis, (2) the answers received will primarily be from laypeople, not experts, and (3) the asker should always follow up with a trained professional"?

People always have and always will ask family, friends, and neighbors about these issues. Why make AskMe less useful than the backyard fence?

Finally, I don't think it's wise to make policy decisions based on the most egregious examples. For every hypervenom, there are many who obtained helpful, accurate information.
posted by pardonyou? at 6:56 AM on December 6, 2007


human health question get a mix of answers and experiences but pet questions have an heightened sense of urgency and appeal to professionals.

Humans can generally decide to take responsibility for their own health issues, can describe how they feel, can answer questions about it. Animals can't do any of those things, and their owners often have no idea about how to describe or accurately assess their behaviour, and many owners don't do any research whatsoever into the pets they own, and as such actually need professional advice a lot more often than they'd normally seek it, even if that advice is just "this is nothing to worry about" from someone who actually knows how to tell.
posted by biscotti at 7:10 AM on December 6, 2007 [1 favorite]


A medical disclaimer is too specific. As others have mentioned, AskMe is a font of conflicting advice in all fields, whether it's medicine, law, language, mathematics, finance, interior decorating, cooking, or car repair. It stands to reason that ikkyu2 would lobby for his area of expertise, but if there's going to be a disclaimer it should be all-encompassing. People can get harmed doing all sorts of things the wrong way.
posted by cardboard at 7:15 AM on December 6, 2007


That's facetious. There's a gulf between getting bad advice on how to bake a cake, and bad advice about what to do about an alarming black mole that seems to be growing. Medical threads often have a very real potential for psychological or physical harm that is absent from almost all other threads.
posted by roofus at 7:24 AM on December 6, 2007


I find it a bit unsettling that we are talking about someone with schizophrenia in a thread that she doesn't know about.

ikkyu2, I appreciate your level-headedness in presenting the issue and your personal acknowledgment that yes, you have to temper your "arrogance." I never got that sense from your responses but good on you for being cognizant of it. I hate doctors more than Hamas hates Israel but people like you

After sitting on this thread overnight I can see ikkyu2's point. I know with a hot-button/sensitive issue like mental health, who hasn't has some personal and/or professional experience with this? I know I get blabby when talking about recovery, treatment or anything smacking of mental health concerns since it's a part of my nature to want to help and I have some experience in that area.

Sometimes too much. Point well taken, ikkyu2.

I really don't think a disclaimer will do anything more than provide MetaFilter Inc., some level of security in case of legal problems. People in pain will generally ignore such warnings and ask away. Thats not to say it shouldn't be done though. I really think that it is all we can do at this point given the nature of AskMe.
posted by KevinSkomsvold at 7:42 AM on December 6, 2007


faaaack! I hit post too quick. Edit: "I hate doctors more than Hamas hates Israel but people like you make me rethink that."
posted by KevinSkomsvold at 7:43 AM on December 6, 2007


That's facetious.

No, it's not. There's been plenty of terrible legal advice posted, too, some of which has lift-changing ramifications. Cardboard's right - if there's going to be a disclaimer, it should at least include legal issues, veterinary issues, personal finance issues...and probably a few others.

A general disclaimer like "No really, the people answering your question may not know what they're talking about at all. Even if they sound very authoritative." followed by "Please be particularly aware of this in regard to medical and mental health issues" seems to me like the best way to go.
posted by mediareport at 8:04 AM on December 6, 2007


For what it's worth I really do seem to have a gift in spotting folks with [bipolar disorder], both online and in person. I've done it numerous times.

Broken clock, etc.
posted by ook at 8:05 AM on December 6, 2007


lift-changing

*debates making edit, explodes*
posted by mediareport at 8:06 AM on December 6, 2007


Yes, please don't single out health and mental health for bad advice. Bad advice comes in all forms, can affect people on a wide variety of topics (from home repair, legal questions, relationship issues, career issues, etc.). Don't single out health for special treatment, and definitely don't add to the stigma surrounding mental health by targeting only people with mental health questions.

BTW, people have been asking for online advice regarding their health and mental health issues for, oh, like 2 decades now. And getting both good and bad advice. This is neither new nor unique to Metafilter. It's just one of the joys of the Internet -- take what you need, leave what you don't.
posted by docjohn at 8:17 AM on December 6, 2007 [1 favorite]


It never ceases to amaze me how limited an idea many people have of "expertise."

The true experts are the ones saying what you wanted to hear.
posted by chlorus at 8:25 AM on December 6, 2007


There seems to be a "wisdom of crowds" sentiment that is running through some of this thread. I would like to propose that such an idea is dangerous when taken to extremes -- the rejection of authority and expertise at the expense of aggregated bad advice.
posted by proj at 8:27 AM on December 6, 2007


OmieWise wrote...
[...] are the people trained and licensed to provide diagnoses and advice.

Did your training include how these topics should be handled in a large, amorphous and semi-anonymous internet setting?

Or are you taking your clinical training that specializes in one-on-one, or perhaps even group therapy, and attempting to extrapolate public policy from there?

The reason I ask is that there appears to be a sense that the writings in AskMe (our poor little $5 corner of the immense world of on-line questions) can even be mentioned in the same breath as a professional diagnoses. That somehow the professional environment you work in is related to AskMe in any sense other than people ask questions there.

To turn this around, would anyone posting to this thread use AskMe as anything other than a resource for polling the community? And if not then who are we talking about protecting here, the great unwashed heathens who can't tell the difference between an internet questions forum and a doctor's office? That would make us all pretty arrogant.
posted by tkolar at 8:28 AM on December 6, 2007 [1 favorite]


I seriously don't understand some of the hostility that comes out in this thread. It's a sensible and necessary discussion, well presented by one of the lions of AskMe. I think, at the very least, some sort of reminder that "hey, this is the internet, and which has no shortage of people who know how to sound like authorities" would be a prudent move.
posted by absalom at 8:48 AM on December 6, 2007


The reason I ask is that there appears to be a sense that the writings in AskMe (our poor little $5 corner of the immense world of on-line questions) can even be mentioned in the same breath as a professional diagnoses. That somehow the professional environment you work in is related to AskMe in any sense other than people ask questions there.

Wait, what? You seem to be misreading my comments. Many folks are commenting here in a sort of "damn experts, they want to reserve the right to make definitive comments for themselves, what unabashed arrogance" way. My point is precisely the opposite, that what's interesting is that the "experts" are saying precisely the opposite of that, instead cautioning that the nature of this internet site makes concrete medical or mental health advice fraught with all kinds of problems. I'm arguing for more circumspection on the part of all involved. That's it, that's all.

People make decisions about what course of action to take based on responses they get to AskMe questions. There are a range of potential harms associated with questions at least partly based on the subject of the question. There are also certain subjects which call forth more reflexive anti-expert sentiment from people on the internet. I would argue that health questions, and also legal questions, both rank high on the potential harm axis and on the "anti-expert" axis. I have no idea why it seems controversial to discuss that and suggest that perhaps that should shape what the culture of answering is like on AskMe.

Did your training include how these topics should be handled in a large, amorphous and semi-anonymous internet setting?

Although I suspect that this question was meant to be rhetorical and to point out my lack of expertise to comment on this issue, the answer is, in fact, that my training did include extensive instruction on what does and does not provide adequate grounds to offer meaningful and reasonable advice or diagnosis. Determining the parameters of safe and effective care were a primary focus of both my classroom and practical training. I know the same is true for MDs. That's part of the point of this thread: people not trained in medical or mental health diagnostic interviewing frequently have a misunderstanding of how it works, which is understandable, because they haven't been trained in it. My point about irony before was that not only is it the decried "experts" (as a group) who are arguing for more circumspection across the board, it is by virtue of their training that they are arguing that we're all in the same boat here.
posted by OmieWise at 8:54 AM on December 6, 2007


Isn't that as ridiculous and unnecessary as "Coffee is HOT" on a McDonald's cup?

Oh, right, this is America...

So for legal/liability reasons, one might want to place something like that here. But for common-sense reasons, I think most everybody knows that if they go to an advice forum seeking advice, there's no guarantee that advice is going to be (a) accurate, (b) useful, or (c) potentially not making your situation worse if you follow it without regard or consultation with an appropriate professional (whether it be medical, mental health, legal, career, etc.).
posted by docjohn at 8:55 AM on December 6, 2007 [1 favorite]


Sorry, my comment was in response to absalom's suggestion, "I think, at the very least, some sort of reminder that "hey, this is the internet, and which has no shortage of people who know how to sound like authorities" would be a prudent move."
posted by docjohn at 8:57 AM on December 6, 2007


I've said it before, and I'll say it again:

There is a reason that professionals are licensed and non-licensed people are prohibited as a matter of law from attempting to perform professional services. There is a reason why there are legal prohibitions against the unauthorized practice of medicine and the unauthorized practice of law. There are good reasons for these restrictions that are intended to protect those who seek professional services.

Lay individuals should not be giving advice. Even if they are correct, they shouldn't be giving advice. It's bad practice. The site shouldn't facilitate that practice either.

I know there is broad support for permitting these questions, but it is just a bad practice.
posted by dios at 9:17 AM on December 6, 2007 [2 favorites]


As far as what to *do* about this problem, I have said earlier and others have said, the most valuable thing is just to generate the discussion and raise awareness. Toward that end, I think sidebarring this thread would be a good thing to do. I also think that we have placed the original AskMe questioner under a terrible amount of scrutiny and maybe the admins should scrub the poster's name and make all of this discussion more anonymous?
posted by Slarty Bartfast at 9:24 AM on December 6, 2007 [1 favorite]


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

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

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

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

Does that make sense? I feel like there are probably complexities that I haven't thought about?
" - posted by ikkyu2

This seems like the best formulation I've seen so far.
posted by tdismukes at 9:38 AM on December 6, 2007


I'd like to add that it should be considered a perfectly reasonable waiver for an Asker to append a question with, "I know that you are not a [licensed professional], and that if you are, you are not my [licensed professional], and will consider all advice accordingly, so bring it on."
posted by pineapple at 9:40 AM on December 6, 2007


There's been some discussion of legal questions here, and as someone who wouldn't dream of giving specific legal advice (because I'm a lawyer) but frequently makes specific medical suggestions (because I'm not a doctor, but I happen to have a seizure disorder which I think just makes me the bees knees on all things epilepsy related), this thread has really given me reason to think.

And what I think is this: I'm going to be a lot more careful in my posts from now on. Leaving aside issues of arrogance (which don't particularly bother me, since I'm arrogant myself), I think Ikkyu2 makes some excellent points and just the presence of this thread should change some behaviors among AskMe's professionals posters.

I do have a question though. I'm a big fan of Ikkyu2's (for the record, I requested the Ikkyu2 autofavorite script back in May, though I thought he was a woman at the time), so I wonder if he and the other docs here think that all lay advice is necessarily going to go astray.

For example, I feel like a some doctors don't necessarily have time to keep up with current trends in anti-convulsant meds. That's because of my personal experience, which got much, much better when I found a nerologist who was able to get me on some fairly obscure new meds and off some fairly common old ones that had been fucking me up for many years. So in the (occasional) threads from people with seizure disorders whose meds are messing with them (or may be messing with them) I make it a point to chime in and say: "If you think it might be your meds, talk to your neuro and maybe ask him or her if X, Y, or Z might be appropriate for you, because I was on A and it fucked me up good". That seems close to medical advice, but as I always tell people I'm certainly not a doctor, just a fellow sufferer, and I suspect that hearing that advice from someone who is not in a white coat may be helpful for some subset of the population.

Do you docs think otherwise?
posted by The Bellman at 9:57 AM on December 6, 2007


I find it a bit unsettling that we are talking about someone with schizophrenia in a thread that she doesn't know about.

Well, I sent her a MeFi mail alerting her to it.

As a cautionary example I think it was worthwhile for ikkyu2 to point this out with the basic messages that the situations of people asking questions in AskMe may be different and more serious than they appear on cursory inspection, and of being circumspect in answering any question with potentially serious repercussions.

But with respect to site policy I have to side with those who favor a minimum of concrete restrictions. If the issue is the potential seriousness of consequences there is really no subject that is immune. I recall a thread about some mundane topic like cleaning where someone gave the (lousy) joke response that the poster should try "mixing bleach and ammonia." Their defense was that it didn't occur to them that anyone wouldn't know that was dangerous. There was a recent extensive thread about the practicalities of hopping trains. The only universal defense against bad advice in AskMe would be shutting it down. If we are not willing to assume that people on AskMe are first aware of the difference between professional service and advice from basically random, semi-anonymous strangers, and second entitled to seek advice from what sources they wish and in the final analysis apply their own judgment to the advice they receive, then AskMe shouldn't exist, period.

And yes, there are cases where these assumptions seem more poorly founded than others. I think the mechanisms already exist to address these: concerned individuals can leave opposing advice or disclaimers in the thread, particularly egregious responses can be flagged and/or brought to the attention of admins (as that bleach/ammonia zinger was flagged and quickly deleted and commented on), specific questions and answers can be brought to MetaTalk if someone feels they need to be particularly considered. Now there is MeFi mail so a private dialog can be initiated with almost all askers if someone is really concerned with the advice someone is getting.
posted by nanojath at 10:00 AM on December 6, 2007


If House, MD has taught me anything it's that you can't properly diagnose anyone, ever, without first breaking into their house and rifling through their underwear drawer.
posted by grapefruitmoon at 10:06 AM on December 6, 2007 [5 favorites]


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

Still bad, but maaaaaaaybe less bad for things that physicians notoriously misdiagnose. Someone with an assortment of appropriate symptoms might benefit from any random person saying "You might think about getting screened for MS if you have good insurance," since MS seems to be something that usually takes several years and many front-line physicians to get diagnosed.

"YOU GOTS THE MS" is still terrible advice. But if someone describes symptoms, asking "Have you been screened for X?" doesn't seem like the worst thing, if you happen to know that it's One Of Those Things That's Hard To Catch.

(I'll admit I'm thinking of my mother, who eventually had to go to her physician at the time and pushily demand "Convince me I don't have MS" to get thoroughly screened.)

Isn't that as ridiculous and unnecessary as "Coffee is HOT" on a McDonald's cup?

That is a bad example. McDonald's didn't serve coffee that was hot like hot coffee is hot. They sold coffee that was so hot that it destroyed human flesh on contact. Arguably, if I sell you food, you should be able to touch it without killing your flesh.
posted by ROU_Xenophobe at 10:20 AM on December 6, 2007 [1 favorite]


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

Good lord. Those comments are a perfect example of what's wrong - not the medical questions themselves but the people who jump in to answer the medical questions...


I dunno that it's so off target - when I was diagnosed with lymphoma 8 years ago, the primary symptom was swollen glands, and mono was one of the things that had to be ruled out first (or at least, one of the things they kept saying, don't worry, it's probably just mono, but we're gonna do a bunch of tests for blood and lymph cancers just in case). I had other symptoms, like night sweats and a bad cough, but those were secondary to the blockages in the lymph system that had built up to a point where they were pushing on the lungs etc.

Anyway, I didn't post about it in that thread because there was already mention and it seemed outside-chancy enough not to merit further attention, but awareness that swollen glands can be indicative of more serious problems isn't completely misguided, and in this case the poster is already going to see a doctor. It's possible he has other symptoms he hasn't connected. And worst case scenario, he can just be assured by his doctor that no, the symptoms are definitely not presenting in a way which would indicate cancer (I had uneven swollen glands, two bumps on the right side, dunno if that was significant). I think we tell people "go see a doctor" often enough.

Maybe now that AskMe is so big that a lot of users don't even really connect it to MeFi we should make sure there's a clarification that it's just asking the opinion of a bunch of people at a party, not getting any sort of professional advice, but really that seems pretty intuitive to me.
posted by mdn at 10:25 AM on December 6, 2007


There is a reason that professionals are licensed and non-licensed people are prohibited as a matter of law from attempting to perform professional services. There is a reason why there are legal prohibitions against the unauthorized practice of medicine and the unauthorized practice of law. There are good reasons for these restrictions that are intended to protect those who seek professional services.

Lay individuals should not be giving advice. Even if they are correct, they shouldn't be giving advice. It's bad practice. The site shouldn't facilitate that practice either.
I know there is broad support for permitting these questions, but it is just a bad practice.


There is absolutely nothing wrong with lay individuals expressing their opinions; we are all free to discuss health in an online forum or in line at the grocery store without it coming anywhere close to "unauthorized practice of medicine" or "performing professional services." Your assertion that no-one should give medical advice unless they're a doctor, period, sounds bizarre to me. There's a lot of nuance to the diagnosis and treatment of medical conditions that isn't necessarily covered in the checkup. At best, MeFites sharing their experiences and opinions can arm someone with a list of questions and the willpower to ask them.

The advice given on this site happens to be GO TO A DOCTOR! so frequently that questioners frequently post their own disclaimer acknowledging that they are familiar with the concept of doctors/patient vs. internet discussion.
posted by desuetude at 10:27 AM on December 6, 2007


If AskMe wasn't here, people asking about their health would ask friends and family. If they're anything like my family, they'd ostracize the person for "being crazy" (their words for having any kind of mental health issue.) Here, they get a wider spectrum of answers... maybe none of their friends and family have the same disorder, so on the internet they can get helpful advice, and even support, from people who have had similar symptoms.
posted by IndigoRain at 11:07 AM on December 6, 2007 [1 favorite]


Mental Health questions should be deleted

I sort of feel like at their core almost all relationshipfilter posts are metal health questions. I do think the site could benefit from

1. a ToS somewhere that mentions the explicit liability issue
2. a guideline for not using the site for free medical/legal advice when you really know already you need to be seeing a doctor or a lawyer.
3. sightly more rigor about enforcing a guideline for questions that are like "what does this set of symptoms indicate - going to doctor NOT AN OPTION"

I think the questions about people trying to put things into words before they see their doc seem okay, and questions where people are trying to assess "is this doctor time or ER time, or put a bandaid on it time" but we do need to be mindful of the fact that even if it's obvious to one of us that homeopathic remedies are not indicated for broken bones, there is a certain implication that not deleting wrong answers might imply endorsement.

I don't have anything concrete except to add this to the "things to think about for now" pile, but I wanted to write this all down someplace.
posted by jessamyn (staff) at 11:32 AM on December 6, 2007


To be clear, I was not really interested in the issue of legal liability when I brought up this topic. For one thing, I'm not a lawyer to determine how that would play out or be addressed; for another, I take care of my own liability by watching what I say; and third, I trust Matt to take care of his own liability issues, if any, without my help.

The reason I brought this up is because I think someone's going to be badly hurt if this keeps up - maybe already has been, we don't know - and I was hoping to think of constructive ways to address that possibility with an eye towards preventing it.
posted by ikkyu2 at 11:37 AM on December 6, 2007 [1 favorite]


There is absolutely nothing wrong with lay individuals expressing their opinions

There is absolutely nothing wrong with lay individuals expressing their opinions on things on which they are qualified to render an opinion. There is something wrong with lay individuals expressing opinions on things which they are not qualified--which is what occurs every time here--when the person seeking advice might rely upon that opinion.

Your assertion that no-one should give medical advice unless they're a doctor, period, sounds bizarre to me.


Really? Why do you think it is that we require doctors to get graduate level degrees, internships, residencies, and pass medical board exams? Maybe its because we recognize that making a medical diagnosis or rendering medical opinions is a really important thing from the patient's perspective so we are going to require education and training from the people who are going to do it.

If you listen to someone who is not a doctor about your medical care, then you are a damned fool. The problem is that that patient doesn't know anything about medicine so they lack even the ability to properly evaluate whether a seemingly analogous situation is in fact analogous in a way upon which it could be relied.

There's a lot of nuance to the diagnosis and treatment of medical conditions that isn't necessarily covered in the checkup.

Huh?

The advice given on this site happens to be GO TO A DOCTOR!

That should be the only thing ever said in response to these questions. Every time I see those disclaimers, I go through the same mental thought. IANAD and IANAL should uniformly be followed with the sentence: "and therefore I can't answer the question, sorry." Unfortunately, people say that then go ahead and try to play one and offer opinions.
posted by dios at 11:37 AM on December 6, 2007 [1 favorite]


To be clear, I was not really interested in the issue of legal liability when I brought up this topic.

I don't think it is an issue of legal liability. I think it is an issue of common sense. People shouldn't relying on advice from unqualified people because people are unqualified themselves to properly evaluate the advice that is being given. Furthermore, other people should not be opining on topics on which they are not qualified to render opinions because these other people cannot control whether the asker is going to rely on the advice.

It is bad practice, irrespective of the legal liability question.

In my mind, its like people grabbing a hot skillet with their hands. They shouldn't be doing it. Should we be all paternalistic and ban them from doing it? I don't know, and I don't think there is any support for doing such. But one would hope common sense would prevail in such a situation and the practice would just stop.
posted by dios at 11:43 AM on December 6, 2007


Imagine a situation where anonymous is a 60 year old man sitting at home with blood in his urine, secretly terrified he has cancer. He posts a question in AskMe to try and get some (false) reassurance:

I have some symptoms of a bladder infection like rushing to the toilet, burning pain when I pee, and a little blood. Is it OK to use an over-the-counter medication or should I see my doc right away?

Even if everyone else recommends a trip to the doctor, someone in that thread will chime in recommending potassium citrate, saying how great it is for their bladder infections. The OP who is looking for reassurance may take it from a totally misguided answer.

Now imagine the converse situation where a 19 year old woman posts the same question, and someone replies suggesting she might have bladder cancer. She could spend days freaking out until she gets a correct diagnosis. This isn't anyone's fault, it's just a risk of the system.

Lay individuals are relatively unwary about the risks their advice may hold. Most, but not all of the MeFi docs run scared of these threads, and with good reason.
posted by roofus at 12:01 PM on December 6, 2007


Sohn said Santa's lewd comment was sparked by someone "pushing this thing to make it do things it wasn't supposed to do."

Wait, did they just blame the reporter's niece?
posted by roll truck roll at 12:02 PM on December 6, 2007


dios: If you listen to someone who is not a doctor about your medical care, then you are a damned fool.

Dios, unfortunately, this is the core of the problem so I've quoted it out here again for emphasis. A lot of the posters above, tkolar probably most vociferously, have said that anyone who is dumb enough to take AskMe medical advice seriously deserves what they get. That strikes me as cruel and sadistic and here is why:

Unfortunately there are people foolish enough, deranged enough, mentally retarded enough, crazy enough, or just plain in so much trouble that they're not thinking straight; so that they come on here, take some half-assed comment from God knows whom as Gospel Writ, go on CanadaPharmacy.com, get some pills that they never should be taking, and do all kinds of bad things that, by the time they finally get to the doc, the doc is clutching his head like a stunned monkey saying "what have you people been DOING all this time when you should have been in my E/R?"

It's not our job to play net.cop and protect these people from themselves and all the consequences of their actions. But I don't think we have to go along with this collective fantasy that we can somehow provide appropriate concrete medical advice tailored to their case in AskMe, either. That is going to get someone hurt bad.

And I don't think we have to call people damned fools or behave condescendingly or call them "the great unwashed heathens" like tkolar does, either. If people are coming to us in need of wise counsel that we can't provide, it is not condescending to say "what you need can't be found here."

Then again, I'm beginning to feel like tkolar is that guy who, when he sees someone about to jump off the Golden Gate Bridge, pauses to let out a big belly laugh and then whips out his camcorder. So I'm not sure how much more to bother refuting his points. Because if you don't care what happens to people, you don't care, and there's no changing that.
posted by ikkyu2 at 12:09 PM on December 6, 2007 [3 favorites]


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

That's not necessarily the right question. The question is whether it does harm, period. Any good that it might accidentally do in some cases does not mitigate harm done in other cases.
posted by George_Spiggott at 12:11 PM on December 6, 2007


Imagine a situation where anonymous is...

Yeah, we're being asked to imagine a lot of things in this discussion, aren't we? Imagine some dude with a clogged toilet reading "mix ammonia and bleach" and thinking, hey, I've got those under my sink right now."

The bottom line remains that in a lightly moderated, open response system like this where inclusion is the default and there can't realistically be a serious attempt to insure that administrative coverage is around the clock, bad advice, including potentially fatal bad advice, isn't just a danger, it's a practical guarantee. Car advice, drug advice, advice about how to get sober, advice about how to deal with a significant other or family member (there's a big piece of the pie of those most likely to commit homicide against you), travel advice: any of these subject could generate potentially fatal advice based on things you can't know about the question asker.
posted by nanojath at 12:17 PM on December 6, 2007


puke & cry: "Thankfully, this isn't about you.

Yeah, it isn't about you either. We both have opinions so don't act so fucking high and mighty, asshole.
"

You're right, it isn't about me. Which is why I chose not to come into a meaningful and important discussion and drop steaming piles of shit. But by all means, continue to scapegoat me if it helps with the discomfort of that stick up your ass. Protip: If you want to know why someone posted something, try reading the post before you fling poo at them.
posted by lazaruslong at 12:18 PM on December 6, 2007


I'll repeat what I said earlier because I think it bears repeating. The latest trend amongst trendy net-type MeFi people is to think that, when they put their minds to it, the crowd can do anything. They think that doctors, when recommending that people seek medical advice, are just protecting their market share and are acting as big, bad gate-keepers of knowledge that wants to be free. "I mean, how hard can it be, anyway? I've got WebMD and Google and Wikipedia." Unfortunately, that kind of attitude, besides being cavalier, is downright dangerous. Take it from someone who has self-diagnosed on the internet before, VERY often, the diagnosis is wrong.

This, I think, stems from the fact that often there is a great deal more information available online about truly terrible disorders and diseases because catching them is so important. Therefore, when people search their symptoms, the first results will often be a terrible disease that they may or may not have.

Furthermore, no symptoms exist in a vacuum. Various elements of your behavior and physical status that you may not notice or feel are trivial will be detected (hopefully) by a trained professional.

Do I think that some doctors feel threatened by the internet and want to protect their market share? Absolutely. Do I think that this warrants taking the attitude that doctors aren't worth a damn? Of course not. Nor do I think it warrants the position that the crowd's opinion is more valid than the professional's.
posted by proj at 12:29 PM on December 6, 2007


This debate goes round and round:
Do other doctors get this horrible sinking feeling when they read a medical question in Ask Metafilter?

Is there some kind of script available that just automatically favorites every single one of ikkyu2's posts?

We all have off days. However, the link above I mentioned makes it quite problematic for any professional health practitioner to dispense medical advice. Even disclaimers may not be a sufficient defence.
posted by meehawl at 12:52 PM on December 6, 2007


But I don't think we have to go along with this collective fantasy that we can somehow provide appropriate concrete medical advice tailored to their case in AskMe, either. That is going to get someone hurt bad.

What gives you the impression that anybody on AskMe is claiming to provide concrete medical advice? There is no intent to deceive on AskMe and there's nothing about the site's presentation that might fool any reasonable person into thinking they're talking to real doctors.

And who cares if somebody gets hurt? People get hurt every second of every day. Are we to believe one death is so especially tragic that discussion on a forum between consenting adults must to be quashed?

And if there is a moral case to be made against giving out bad health advice it's homologous to a case to made against giving out bad advice concerning any problem. And while there might be something to such thinking it's ultimately irrelevant to the everyday reality of the green. A collective decision has been made that an open discussion about all sorts of problems is more valuable than the off chance that somebody will get bad advice and cause harm. Otherwise the green wouldn't be as enormously popular as it is.

Some sort of disclaimer should be put up for liability reasons. (I'm actually kind of shocked that none is there already.) But anything more than boilerplate legalese will, in reality, probably do more harm than good. A lot of the advice on the green is terrible but there's still a great deal to be said for just hearing many different points of view about one's problems. So any kind warning that discourages people from communicating freely on the green either by raising the threat of The Law or by legitimizing "Think of the Children!" thinking will go against the very spirit of the green and tremendously devalue both its culture and its utility to members.
posted by nixerman at 1:06 PM on December 6, 2007


smart person can make an argument that has no basis in knowledge or expertise sound very authorative by force of rhetoric.

And so can a "not-so-smart person." Examples: WMD in Iraq; Nuclear Weapons in Iran.
posted by ericb at 1:07 PM on December 6, 2007


Dios, people like you are enough to give me a rash.

Laymen BETTER be discussing these things because otherwise we will always be assuming that doctors and lawyers ALWAYS get it right, and how dare we question these godlike figures. Yeah, right.

I can look out for my own best interest. I don't need YOU to do it for me.
posted by konolia at 1:15 PM on December 6, 2007 [1 favorite]


I actually am an arrogant jerk in real life. It's not a secret. have to spend a lot of energy on cooling my jets and trying to deliver my wisdom, if any, in a way that people can receive without being offended or affronted by it.

I read somewhere in a previous health forum that taking Celebrex or, it might have been Caduet, helps your condition. You should get a prescription. I think the poster said 20 mg. twice daily works best. Good luck. FWIW -- IANAD.
posted by ericb at 1:32 PM on December 6, 2007


Your assertion that no-one should give medical advice unless they're a doctor, period, sounds bizarre to me.

Mea culpa. "Advice about health matters" would be more accurate to what I was thinking. dios, I don't want to get into a big back-and-forth with you. My point is that there are plenty of opinions about health and medicine that lay people are qualified to offer, most notably sharing their own experiences.

I can confidently say that I am qualified to tell my nasally-congested co-worker that it sounds like she caught our boss's cold and that she should take it easy. I gave her some sudafed. This does not equal me "diagnosing" or "medicating" her.

Most people won't go to a doctor to discuss what they feel are relatively minor issues, or things about which they're embarrassed. Meanwhile, doctors can sometimes tend to downplay non-life-threatening "discomfort" or "inconvenience." (No offense meant, MDs. I get that you must prioritize.) So yeah, it's good to hear from regular folks how painful mammograms can be, and that the "exercise helps depression" advice is not just a sneaky way for your doc to also lower your cholesterol, and that quitting smoking does indeed fuck up your digestion for weeks.

You're not a doctor either, but you have the expertise necessary to be so firm in your belief that no-one should discuss anything about medical conditions in any capacity with anyone other than a medical professional? Not even the MDs here are going that far.
posted by desuetude at 1:40 PM on December 6, 2007


dios -- to be honest with you -- from some of the "legal expertise" you have exhibited (and often refuted by others) in some previous threads, you would be the last person I would take legal advice from -- online or in person.
posted by ericb at 1:44 PM on December 6, 2007


Dios, people like you are enough to give me a rash.

Go see a doctor.

Laymen BETTER be discussing these things because otherwise we will always be assuming that doctors and lawyers ALWAYS get it right, and how dare we question these godlike figures.


Doctors and lawyer don't always get it right. They are not godlike. They are just trained and educated in the very area of their expertise. But laymen are very likely to be wrong because they lack the requisite knowledge to factor the relevant things in.

Look, no matter what you think, you do not know more about medical conditions than a doctor who is trained and experienced with that condition. I don't mean to be rude about it. But you don't. In fact, you don't even know enough about the topic to know why you are wrong about a topic. I know you might take that as insulting, but it isn't meant to be insulting. You may have some knowledge about various medical things that have occurred in your life, but you lack the knowledge to know how that knowledge applies elsewhere. By saying this, I'm not saying doctors are godlike or that you are a lesser person. They have just have a specialized expertise that you do not.

This whole issue applies mostly to doctors and lawyers. You don't see many people trying to second guess or play armchair electrical engineer. In fact, I doubt you would find any layperson trying to question one with an electrical engineering doctorate. But the law and medicine is different... for some reason people think they experts of areas because of all the medical and legal shows we watch or something they picked up in a newspaper or book or because of some personal experience they had with medicine or the law. And, I can tell you this without any intended condescension: laymen are very likely to be wrong opining on legal and medical issues because the topics are so multifarious; doctors and lawyers are very likely to be correct with respect to an area in which they are trained or experienced.
posted by dios at 1:45 PM on December 6, 2007


*which has often been refuted by others*
posted by ericb at 1:46 PM on December 6, 2007


Oops. Wrong thread. And site.
posted by roll truck roll at 1:47 PM on December 6, 2007


dios -- to be honest with you -- from some of the "legal expertise" you have exhibited (and often refuted by others) in some previous threads, you would be the last person I would take legal advice from -- online or in person.
posted by ericb at 3:44 PM on December 6


Care to point out specifics? Didn't think so. Thanks for the input. Lucky for me that I know you don't even know enough to accurately make that judgment. (And I'm sure that you opinion might be slightly effected by some dislike for me arising out of some disagreement you believe exists with respect to my politics)

But thanks for sharing the unsolicited insult.
posted by dios at 1:48 PM on December 6, 2007


dios -- like how you insisted that Cindy Sheehan got arrested for wearing a protest shirt at the State of the Union address because she broke the law "or some ordinance; First Amendment; Cohen case, blah, blah, blah) when the following day the Capitol Police admitted they made a mistake and it was erroneous to "arrest her" and remove her from the State of the Union. The group discussion in that thread sussed-out the legal issues (correctly) better than "a licensed professional" could do (incorrectly).

I think we at MeFi will continue to feel confident that we can have informed discussions about legal and medical issues -- albeit with caution in certain instances.
posted by ericb at 1:54 PM on December 6, 2007


*you insisted that Cindy Sheehan, wearing a protest shirt at the State of the Union address, did break the law ("or some ordinance; First Amendment; Cohen case, blah, blah, blah")...*
posted by ericb at 1:57 PM on December 6, 2007


dios -- your politics have nothing to do with it.
posted by ericb at 1:58 PM on December 6, 2007


dios -- like how you insisted that Cindy Sheehan got arrested for wearing a protest shirt at the State of the Union address because she broke the law "or some ordinance; First Amendment; Cohen case, blah, blah, blah) when the following day the Capitol Police admitted they made a mistake and it was erroneous to "arrest her" and remove her from the State of the Union. The group discussion in that thread sussed-out the legal issues (correctly) better than "a licensed professional" could do (incorrectly).

Lol. As I thought... your bitch is politically motivated. And you obviously aren't grasping what this discussion is about if you think that I was providing legal advice there--it was a response to a theoretical discussion about the first amendment and relying on the statement of the police who claimed their was an ordinance. But whatever, this is a derail and irrelevant to the issue. No need to rehash an argument when at its core, its nothing more than you saying "I hate you."

Next time, if you don't have anything substantive add to the topic being addressed, why don't you just save the personal insults instead of derailing the thread?
posted by dios at 2:00 PM on December 6, 2007


nixerman: who cares if somebody gets hurt?

Nixerman, if that's your argument, it's irrefutable.

I care. The other people discussing this issue care. If you don't, why don't you butt out of this discussion. There's no point in your being in it; we're not threatening anything that's of value to you.
posted by ikkyu2 at 2:06 PM on December 6, 2007 [3 favorites]


dios -- " Again, I thought I made this clear, but people should be arrested if they don't follow the rules. Freedom of speech doesn't guarentee you the right to protest in the State of the Union"

Wrong. And if you can't get the basics of Constitutional Law correct I sure as heck have found your legal opinions and advice to be suspect at other times.

My point is that those who profess to be experts on MeFi should not disuade/disparage others from talking about certain topics. Granted, everyone should take any advice with caution on the Internet -- even from "licensed professionals."

My comments regarding you are not meant as insults, but to point out the potential for error from someone who claims to be an expert (i.e. American law).
posted by ericb at 2:08 PM on December 6, 2007


...its nothing more than you saying "I hate you."

FWIW, I don't hate you. I find your contributions to the site to often be valuable.
posted by ericb at 2:10 PM on December 6, 2007


Laymen BETTER be discussing these things because otherwise we will always be assuming that doctors and lawyers ALWAYS get it right...

dios -- my point is the same as konolia's.
posted by ericb at 2:13 PM on December 6, 2007


Look, if you want to take this off-site, then email me. I'm not going to waste my time explaining my words to you because I've done it enough in the past to know that you don't listen and don't want to try to understand what I am saying. There is nothing in my comment that is wrong. The fact that you think it is proves my point that I've making herein about not even knowing enough about a topic to be able to even evaluate it.

I know you think you have a point and are making one, but you aren't.
posted by dios at 2:15 PM on December 6, 2007


dios -- no interest or desire to take this offline. I have made my points and I stick by them. Back to the topic at hand regarding professional versus non professional; expert versus layman discussions, conversation and advice-giving online -- here and elsewhere.
posted by ericb at 2:19 PM on December 6, 2007


ikkyu2, I'm very torn about this issue, in large part because I gave a little anecdote about a family member's experience in one of those "medical advice" threads that you were kind enough to point out was monumentally stupid for the OP's situation. (I still cringe when I think of it.) I wasn't really thinking, "Oh my, this poster will run out and do this without consulting a doctor" - in fact, my reasoning was more that I wanted to point out that talking to doctor vs. toughing it out or trying herbal remedies might result in solutions that he/she hadn't thought of, so it was worth it to talk to one - but I see your point that the availability of drugs and other medical devices online means that the stakes are higher in terms of someone following bad advice.

On the other hand, I also get the impression that you're *really* good at what you do. And I think that might sometimes lead you to think that most doctors are as good as you, and so in every situation it's always preferable to have the diagnosis and treatment process remain solely between doctor and patient. As someone who has suffered through some really incompetent doctoring (by a perfectly nice doctor in a very rural state who merely hadn't been to medical school for 40 or 50 years and hadn't kept up), I very much see the value in someone having a forum to come to and ask, "Hey, my doctor diagnosed me with X, he's giving me Y treatment, but I'm still feeling cruddy, does this sound right?" (And I think the thread you linked to is actually a good example of that--she does point out that she's been diagnosed and treated by doctor, but it doesn't seem to be getting better, and she doesn't know how to deal.)

What it really comes down to for me, though, is that medicine (for better or worse) has undergone a shift in the past 50 years to recognize that patient autonomy and consent is a higher value than almost anything else, including the medically indicated treatment when the two conflict. We've passed laws to make sure that people aren't forced to undergo medical treatment--even in cases where they might be mentally ill, where everyone else agrees that it'd probably be better if the person in question was forcibly medicated. Hospitals have stopped allowing med students to do pelvic exams on women who are passed out, and OBs no longer are allowed to ask husbands whether they'd like the doctor to "tighten everything up in there" while they're delivering the baby, as a favor to him, without asking the wife. (True story, circa 1979.) Patient consent for any procedure is a big deal and a critical foundation for the medical system, for a good reason - while doctors may have the expertise and training, it's ultimately the patient's body, and it's got to be their decision.

I recognize that there's a lot of problems in the whole idea that patients can ever really give informed consent: what does it mean to talk about "informed consent" in a situation of such vast information asymmetry? But I would never say informed consent is something that we shouldn't keep aspiring to, as an ideal, and a big part of that is making sure that laymen have some sort of tools to make their own decisions about what doctors recommend. I see AskMe as a part of that, in the same way that querying friends and family members about a tough medical decision or problem, and I think that these questions are something that we shouldn't discourage as unethical to answer (although I certainly understand legally why a doctor would prefer to not participate).

I do think answerers should hedge more, explain where they're getting their information, and let the poster know whether they're qualified to comment and why. I think the even better answer would be less authoritative pronouncements, and more linking and pointing to helpful resources for the asker, so they could empower themselves to ask the doctor about alternative diagnoses or treatments. But answering every question with, "Go ask your doctor!" - even if the doctor is ultimately correct in their diagnosis and recommended treatment - is counter to the very idea of empowering people to participate in their own medical care.
posted by iminurmefi at 2:27 PM on December 6, 2007 [1 favorite]


And, holy shit, I must be channeling EB with the length of that comment. I apologize, and promise to not do it again.
posted by iminurmefi at 2:30 PM on December 6, 2007


splendid animal, your final paragraph savors more of the animal and much much less of the splendid. Why such an asshole?

I disagree that questioning (a) commonly-held assumptions of what expertise is or (b) the tendency most of us have to privilege certain types of expertise over others is a beastly, rather than splendid, thing to do. Merriam-Webster online defines an expert as:

2: having, involving, or displaying special skill or knowledge derived from training or experience

I was simply pointing out that a healthy skepticism is a good idea when it comes to assessing information from any source. I would regard the advice of a single doctor who has treated psychotic individuals as a form of (professional) expertise; I would regard the advice of a single person who has experienced psychosis herself as a form of (personal) expertise. In neither case would I accept their expertise as absolute, prima facie. This especially if said expert is someone whose advice I am reading online.

Splendid animal, what the hell? You don't think ikkyu2 is a doctor, and that he answers too many questions? That's what it sounds like you're saying.

He's a known person, as in Real Life... unless all the people here who know him in real life are in on the Big Lie. And what, according to you, is the maximum number of questions one should answer without becoming a suspicious character?


Known to you, I guess, and others. But not to me. I'm not saying that the magnanimous ikkyu2 is or is not a doctor; rather that I'm not going to believe that, because he is, I should unquestioningly follow his online advice. Nor would I do so at the behest of other people I don't know, simply because they tell me they've met him in "Real Life." That's not enough assurance for me to stake my trust on.

Likewise, the fact that someone has answered x number of questions doesn't convince me that their advice is beyond error. Answer away, and know that I will continue my skeptical ways whether you've commented once or 4,266 times.

Then again, I'm beginning to feel like tkolar is that guy who, when he sees someone about to jump off the Golden Gate Bridge, pauses to let out a big belly laugh and then whips out his camcorder. So I'm not sure how much more to bother refuting his points. Because if you don't care what happens to people, you don't care, and there's no changing that.

What a horrible thing to say. I didn't read any of tkolar's posts as insinuating that he "doesn't care what happens to people." Rather, it sounds to me like he's trying to point out that AskMe is what it is: "a resource for polling the community," and suggesting that we treat it as such.
posted by splendid animal at 2:41 PM on December 6, 2007


But I would never say informed consent is something that we shouldn't keep aspiring to, as an ideal, and a big part of that is making sure that laymen have some sort of tools to make their own decisions about what doctors recommend.

You are correct about the importance of consent and informed consent in certain list procedures. But I would note that it is the nondelegable duty of the physician to obtain informed consent. That is, it is the duty of the physician to do the informing.

It would be wholly insufficient to claim there was informed consent because a patient read about the procedure on the internet.

I don't think anyone is opposed to medical information. The problem comes when issues of diagnosis of course of treatments are discussed. It is bad practice to have people getting advice that they may rely on regarding their medical condition or course of treatment.
posted by dios at 2:45 PM on December 6, 2007


You don't see many people trying to second guess or play armchair electrical engineer. In fact, I doubt you would find any layperson trying to question one with an electrical engineering doctorate.

Well, you're very wrong.

In any sort of practical matter that someone might actually want concrete advice about dealing with electricity, an electrical engineer with a doctorate would be a *terrible* person to ask. I really don't think that electrical engineers are trained in the costs and benefits of different types of service panels. Or in what types of romex are allowed for what purposes. Or to diagnose problems in car alternators and starters.

If my handy neighbor and some egghead EE were giving me conflicting advice about how to wire up a new addition, I'd feel comfortable telling the engineer to go fuck himself, because what the fuck does he know about that?
posted by ROU_Xenophobe at 2:54 PM on December 6, 2007


The issue of consent is certainly important, iminurmefi.

What do you think about someone in the middle of a psychotic break? (hypervenom may or may not have been, in March - stipulated that we can't know for sure.) You seem to know a little about informed consent; are you aware that someone in the middle of an acute psychotic break would not be considered able to render it?

We've passed laws to make sure that people aren't forced to undergo medical treatment--even in cases where they might be mentally ill, where everyone else agrees that it'd probably be better if the person in question was forcibly medicated.

Well, actually, there's more to know about this topic. It is actually routine to medicate someone in the middle of an acute psychotic break without their consent. It's done because these people aren't thinking clearly enough to receive information or give meaningful consent.

Here is a story for you. I once tapered a patient off their anticonvulsant in the epilepsy monitoring unit (EMU), for the purpose of inducing a seizure, which is routine in the EMU. The anticonvulsant happened to be one with antidepressant and antipsychotic properties. I was called into the hospital late at night by a nurse who was concerned that my patient wanted to leave. No reason given; she just wanted to walk out.

I spoke to the patient instead of just letting her walk out. It turned out her plan was to leave the hospital, go to the Golden Gate Bridge, and immediately jump off. The reason was that she could hear voices of angels ordering her to do so and she could not resist their commands without breaking faith with God. She was about to do it. She'd stayed in the hospital just because I'd asked her over the phone to wait until I arrived, and for some reason this was a person who chose to respect my request because I was her doctor. She could have walked out.

What would you do in this case, iminurmefi? Let her go, because we recognize the mentally ill person's right to autonomy? This is not a textbook case for discussion; it happened to me.

I was able to get the patient to take some meds and sleep on it, but if I hadn't been able to, there would have been leather restraints and forcible medication, rather than the alternative of letting this wonderful woman go end her life because I tapered her off her meds too rapidly.

You cannot be too careful with fragile people, like my patient; possibly like hypervenom in the middle of her psychotic break. And on AskMe you don't even get enough information to know that you need to be careful, or what you need to be careful about.

In fact, the majority of people answering don't understand the risks involved. Even after I laid it out for tkolar above, in the clearest possible terms, outlining the most catastrophic and disastrous scenario, he's still able to come out with a comment like:

the overriding and clear message in that thread was to keep up with the therapy and to take the medication as prescribed

and therefore

While [ikkyu2's] general concern is valid, I think [ikkyu2] really missed the forest for the trees in this particular case.

Well, no, I didn't. The therapist, who was not an MD, had the diagnosis wrong and the medication was the wrong medicine and it was hurting, not helping. Telling that poor woman to go on as she was doing, checking in with her non-MD therapist and taking her SSRI, is probably usually the good advice; it happened to be the wrong advice in this case! Telling her that her symptoms and feelings were normal and not reflective of a disorder? Also wrong; contradictory, and confusing to boot!

If tkolar, a presumably competent and sane person, even after my clear explanation and with 6 months of hindsight and an eventual correct diagnosis in hand, still can't understand that the majority opinion in that March thread was wrong, how exactly are we to expect someone without all those advantages AND ALSO going through an acute psychotic break to boot, to figure it out? It's impossible.

And frankly, I'm sorry to say so, iminurmefi, but your limited understanding of the role of consent and who can or can't provide it really seems to have prevented you from understanding the point I'm trying to make with regard to hypervenom's post, and more generally. You answered in that post, but you were talking to a person who probably at the time wasn't competent to receive your information or come to a reasoned conclusion about what to do with it. There was no way for you to know that. No way for me to know it either, which is why I stayed out of the thread.

"A little knowledge is a dangerous thing" is an old aphorism that applies here.
posted by ikkyu2 at 2:58 PM on December 6, 2007 [4 favorites]


Splendid animal: I'm not saying that the magnanimous ikkyu2 is or is not a doctor; rather that I'm not going to believe that, because he is, I should unquestioningly follow his online advice.

The only point I've been trying to make, splendid animal, is that I should never GIVE you online advice, nor should anybody else! So we're in complete agreement, as far as I can see.
posted by ikkyu2 at 3:00 PM on December 6, 2007 [1 favorite]


Well, you're very wrong.

Come on. Really? You're a smart guy. I think you know what I was trying to say. And I think you that I was not referring to the hypothetical issue you thought up and beat me over the head with.
posted by dios at 3:01 PM on December 6, 2007


I look at the evidence. Doctors make mistakes. People make mistakes. In all of the medical literature over the past 2 decades that people have been offering online medical advice, there isn't a single case of a person taking someone's online opinion and dying from it. (Well, I couldn't find one in an extensive lit search I did this afternoon, YMMV.)

Now, you may argue, just because it hasn't been documented doesn't mean it hasn't happened. Sure, true. But let's keep discussions based in data, not wild speculation. Let's not ignore the thousands, if not hundreds of thousands, of medical opinions already given out in twenty years online.

Go talk to the founders of ACOR to understand how much benefit people gain from talking to one another about medical and mental health concerns. Including treatments.
posted by docjohn at 3:03 PM on December 6, 2007 [1 favorite]


Well, dios, I completely disagree. I think a physician explaining the risks and benefits of a procedure is necessary, but not sufficient.

To assume that the only person that an individual needs to listen to in order to make medical decisions about their own care is their doctor - particularly when we're talking about serious or chronic illnesses - is to assume that all doctors are infallible and unbiased. I think that many doctors are very, very good at what they do, but not all of them are; even among those that are very good, medical knowledge is simply to vast to assume that they would be able to diagnose and correctly treat every single thing that crosses their path, particularly with rare or underdiagnosed illnesses; and even if they can correctly diagnose and recommend treatment - it's paternalistic to claim that the doctor should be able to make that decision for the patient, even if the diagnosis is correct.

"Informed consent" is always more meaningful with more information versus less, and if that means we run the risk of sometimes putting out bad information among the good, I think we have to assume that it's the patient's right to determine what they trust. Even if that scares us. (Paraphrasing Churchill, the patient is probably the worst person to make the decision, except for everybody else.)
posted by iminurmefi at 3:05 PM on December 6, 2007


iminurmefi: I also get the impression that you're *really* good at what you do.

I don't think that's an accurate impression. You probably get the impression that I *think* I'm really good at what I do. That's an accurate impression. But it turns out, when studied formally, that most docs think they're better than most of their colleagues; obviously they can't all be right.

I try hard to do my best, but the counter to that is that I try really hard to be aware of my own limitations so I don't screw the pooch. I'd like to see more of this attitude in AskMe health questions.
posted by ikkyu2 at 3:08 PM on December 6, 2007


docjohn: I don't think anyone disputes that there is value in information sharing. If I know I have cancer, then there is great value to me to go to ACOR and learn as much as I can and talk to people similarly situated.

But I think what we are talking about here is when an asker seeks medical information about a diagnosis or course of treatment and gets that information from someone who isn't qualified. I'm more than willing to accept the claim that no individual has ever died from taking advice online. But I don't think "no reported deaths" is exactly the answer to the question or the standard that should be applied. There certainly can be harm or unnecessary delay in treatment or recovery which, while its not death, is not de minimis.
posted by dios at 3:12 PM on December 6, 2007


dios, point taken, but the masses of the Internet don't care. They will route around attempts to limit such sharing of information, even bad information, because that's the toolset provided. Provide better tools (e.g., to rate and review users who provide answers, the answers themselves, etc.) and you obtain a new level of at least trying to discriminate good answers from bad ones.

I agree, no one should come online seeking a diagnosis and expect to walk away with a reliable one. But one can come online, share a list of symptoms, and then ask for other people's opinions knowing full well that other people's opinions does not equal "diagnosis."

I think there's a lot of room here not to be reactionary and act as though this is some sort of huge problem when it's not really.
posted by docjohn at 3:16 PM on December 6, 2007


Also:

Doctors make mistakes. People make mistakes.


While this is undoubtedly correct, I think there is a false equivalence between those two statements. There are doctors who will get a diagnosis wrong. But when presented with insufficient information and a doctor and a non-doctor are both asked to make a diagnosis or suggest a course of treatment, I'm sure you would not suggest that they are equally likely to be correct or incorrect. So if you are talking about making a diagnosis, I would think that it would be more accurate to say "doctors make mistakes. People are much more likey to make a mistake than the doctor." (Or did I misread you there?)
posted by dios at 3:17 PM on December 6, 2007


ikkyu2, I agree with you that we're in complete agreement. I have no beef with you. What I have beef with is people who suggest I need not be skeptical of information I read. I also have beef with the seeming apotheosization of you by other people who frequent this website (just as I abhor anything approaching deification of any mere mortal), but that's neither here nor there.
posted by splendid animal at 3:19 PM on December 6, 2007


Wow, shoulda previewed.

ikkyu2, I'm talking not talking about the legal definition of informed consent, which is certainly satisfied by a doctor shoving a piece of paper with boilerplate language in front of a patient and having them sign it. I'm talking about the principle behind it, which is that the patients should be able to make their own medical choices, even if those medical choices are wrong.

I don't know if the OP in question met the legal definition of incapacitated when she posted the original question. I suppose I was talking about the larger point you were seeming to make, which is that people should hesitate to answer medical AskMes if they are not the doctor of the OP, because they can't hope to have full information. To say that people in AskMe should never be able to suggest alternative explanations, possible diagnoses, and alternative treatments--even if some of those are likely counterproductive or outright wrong--seems to me to be throwing the baby out with the bathwater, and to be taking a very paternalistic stance that I don't agree with. In no small part because doctors are sometimes wrong--contrary to what you wrote, it wasn't her therapist who prescribed the meds; her therapist referred her to a psychiatrist who wrote the prescription, as she said in the thread.

With that, I think I'm gonna duck out of this conversation for a bit (sorry). As much as I like to hash out big issues in metatalk, I'm a bit thrown by the vehemence of your response and I think I need to walk away from the computer for a spell.
posted by iminurmefi at 3:20 PM on December 6, 2007


I think there's a lot of room here not to be reactionary and act as though this is some sort of huge problem when it's not really.

I certainly don't think it is a huge problem. I think it is not a best practice, and when the time comes that something bad results from it, I will think that the harm in that instance is serious problem that could be averted.

But right now, I think I am just talking about this in the same way we would talk about whether chatfilter is appropriate.
posted by dios at 3:20 PM on December 6, 2007


What is wrong with ya'll, or am I just misreading the hostility level in here? Where the fuck did it come from?

I mean, really. Now, I shot my load above, so I guess I'm vested enough to count as biased, but I really do not understand the genesis of the venom. Not of the disagreement. Not of the discussion. Of the spite.

As far as I can tell, ikkyu2 points out that, you know, AskMe might end up getting someone seriously hurt. Which almost immediately became "well, what do you suggest we do about it" which became "what, you want us to moderate medical posts!" which then became a flaming shitstorm. Unless I missed something, it seems that because we are so (rightfully) sensitive about moderation, that - even though no one actually outright *suggested* the deletion or moderation - the mere specter was enough to turn us all into shit slinging primates.

I mean, maybe it's just that the hostility level yesterday was bad all around - and I certainly detracted at least as much as I contributed - so please tell me that, somewhere, someone suggested that we started deleting or banning these sorts of posts? Or, at the very least, that ikkyu2 suggested that we do so. It was a long thread, and I could have missed it.

Otherwise, this must be what we want MeTa discussions (at the very least) to be. I mean, I suppose the possibility exists that the mere suggestion of so much as a small "be thoughtful in what you post, and if you are not an expert, be doubly so" splash text is so abhorrent that it must be fought with every measure of your being?* Or, perhaps people really have the attitude that any attempt to passively look out for someone else is a total waste of time**. Since I cannot believe that, I can only assume that we secretly thrive on MeTa as a haven for vendettas and argument. Because, if this were really a place to discuss and debate community policy, we wouldn't reach for the guns at the earliest opportunity.

But, perhaps that's Matt's secret genius. I recall reading in some book on the history of usenet that the earliest groups quickly became toxic morasses (ha), but once some thought to come up with a flame channel, the noise level went significantly down just about overnight. (Perhaps it was the history of the Well. My thesis work all blurs together.)

*This should be the standard, but clearly it is not. And not just on AskMe.

**In which case, I hope it is I who notices you having trouble on the highway.

posted by absalom at 3:28 PM on December 6, 2007 [1 favorite]


Short of negligent doctors, I'm not sure what professional would take a person who comes to them and says, "Well, I believe I have X condition," and still not do the exact same diagnostic workup they would've done if they hadn't heard the person say that. Heck, even if a patient is adamant they have X condition, that usually makes most doctors all the more suspicious that they likely *don't* have X condition. Throw the phrase, "which I know I have because I found out on the Internet," and that pretty much guarantees the doctor will rigorously ensure your diagnostic screen is accurate.

So my question is, "Who's being hurt by these advice sites?" And why limit it to the medical world?

"Some lawyer online told me I definitely had a case, so I quit my job and sued my employer. Then I spoke with a real attorney and found out I didn't have a case and my employer has already rehired for my job. My career and my life is ruined..."

"Some relationship expert online told me to dump my loser boyfriend, so that's what I did! Then, a week later when I talked to my therapist, she couldn't understand why I had done such a thing, when the week before in therapy I was going on and on about how much I adored him. I ruined my entire life!"

"Some electrician online told me it was okay to put my new refrigerator, electric range, hairdryer, and 72" HDTV all on the same circuit breaker and not to worry about surge protectors if I had a single 5 amp circuit breaker. Came home from a business trip, after a thunderstorm, and found my house burned down. I could've been inside it and died!"

I could go on... but I think you get the point. People can ruin their lives in many, many different ways. I hope people take online advice sites with a healthy grain of salt.

* * *

And yes dios, I have had direct experience with enough physicians (and psychologists) to meet a few who gladly give their opinion to anyone who listen, no matter how little information they had on a patient. Negiligence? Unethical? Who knows, but they are definitely out there.

My point was more to the fact that somewhere around 40,000 people die each year due to preventable medical mistakes, most caused by trained and experienced physicians.

I don't know of a single case of death by bad Internet advice. I'm sure there have been a few (how could there not be?), but in terms of focusing on things that could make a real difference, I think far more people have been helped by such advice-giving and sharing amongst empowered consumers (e-patients) than not.
posted by docjohn at 3:29 PM on December 6, 2007 [2 favorites]


ikkyu2 wrote...
Then again, I'm beginning to feel like tkolar is that guy who, when he sees someone about to jump off the Golden Gate Bridge, pauses to let out a big belly laugh and then whips out his camcorder.

Between that, this, and your generally strident tone in this thread I'm starting to wonder if things are okay with you ikkyu2. I genuinely hope they are.

And for what it's worth, I did miss the fact that you felt that telling the OP to continue working with her therapist and psychiatrist was dangerously bad advice. That stills seems an odd viewpoint to me.

In any case, I already said what I had to say on the topic of AskMe being an entirely different construct then a professional venue upthread. I'll be in the bar if anyone wants me.
posted by tkolar at 3:30 PM on December 6, 2007


The bottom line remains that in a lightly moderated, open response system like this where inclusion is the default and there can't realistically be a serious attempt to insure that administrative coverage is around the clock

But there is active moderation, oversight, and occasional deletion of comments and sometimes entire threads by salaried staff acting as official representatives. IANAL, I am most definitely not your lawyer, but I am going to present an entirely unqualified opinion anyway. Based on what I've heard on teh Internets and on TV, active moderation like this forsakes some of the protections from liability you might otherwise enjoy. Your site is no longer acting as a simple conduit for random people's opinions, but you are now (implicitly) endorsing the material that remains by failing to remove it. You have ranked material according to quality, established an imprimatur, and casual readers could claim to take that as publishing.
posted by meehawl at 3:32 PM on December 6, 2007 [1 favorite]


Short of negligent doctors, I'm not sure what professional would take a person who comes to them and says, "Well, I believe I have X condition," and still not do the exact same diagnostic workup they would've done if they hadn't heard the person say that. Heck, even if a patient is adamant they have X condition, that usually makes most doctors all the more suspicious that they likely *don't* have X condition. Throw the phrase, "which I know I have because I found out on the Internet," and that pretty much guarantees the doctor will rigorously ensure your diagnostic screen is accurate.

docjohn, I don't think this applies at all to what the concern is. I am not saying that someone will get a misdiagnosis from the internet and a physician will listen to it. What the concern is that someone will say "That sounds like what I had 3 years ago. Just drink some prune juice and some milk thistle and you'll be better in 3 days" and that the asker will sit around and do nothing causing unnecessary harm that would not have occurred if the asker would have sought medical assistance instead.

People shouldn't make medical decisions about their diagnosis or course of treatment from answers on AskMetafilter from non-medically trained individuals. That seems like an entirely reasonable statement. Do you disagree? I guess the question is whether anything should be done about it.
posted by dios at 3:42 PM on December 6, 2007


even though no one actually outright *suggested* the deletion or moderation

At least one person did. ikkyu2, of course, did not.
posted by enn at 4:05 PM on December 6, 2007


tkolar: To be fair, the third post in that thread is essentially "You're right, sorry, I overreacted please close this thread," which is an attitude this thread could use a whole lot more of.
posted by absalom at 4:10 PM on December 6, 2007


Doctors make mistakes. People make mistakes.

On a related note -- I found this article today to be of interest:
Doctors Unlikely To Report Peers Who Make Mistakes

"Nearly half of doctors may be more likely to protect their colleagues than their patients, according to a recent survey by researchers at the Harvard-affiliated Massachusetts General Hospital (MGH).

The study, released Monday, reveals that 46 percent of doctors admitted to not reporting a serious medical error they had witnessed.

Likewise, 45 percent admitted to not reporting a physician who they knew to be impaired or incompetent.

...The study also found that physicians failed to live up to standards in preventing the waste of medical resources, with over one-third of physicians accommodating a patient who insisted on a test that the doctor knew to be unnecessary.

And the doctors surveyed were also poor at managing economic conflicts, with a majority of respondents saying that they would refer patients to facilities in which they had financial stakes.

Nearly one-quarter added they would not inform patients of the potential conflict, even though such activities could be considered illegal under Medicare rules."*
posted by ericb at 4:20 PM on December 6, 2007 [1 favorite]


MetaFilter: [All of us] shit slinging primates.
posted by ericb at 4:30 PM on December 6, 2007


By the way, Dios, you might be amused to know that one day in Spin class one of my fellow Spinners (who is a local psychiatrist) was annoyed by one of the other class participants who was talking to her friend during the class. (The talkative one being someone I knew fairly well as she was a regular.) After class the psychiatrist went on and on complaining about my friend and telling everyone in earshot(but thankfully not in my friend's hearing) that she must be bipolar as she showed the characteristics. (Which my friend did NOT, but still.) I was ticked off enough to tell her"-hey, I wasn't talkative, but I'M bipolar-" which made her do a little backpedalling.

No way in hades would I go to this woman and expect a proper diagnosis. I don't care how many stinking sheepskins she has nailed to her office wall. I'd trust a room full of other bipolars WAY more-and I'd listen to those bipolars when it was time to pick a doc.

No, I don't have a degree. But I have talked to enough docs and read enough literature and educated MYSELF enough to be able to look after myself quite well -and to point others in the direction of help when necessary. Don't you dare tell me that I need to shut my mouth and leave others at the mercy of such as that doctor in my class. My friend was NOT acting bipolar, has NEVER acted bipolar in my presence, and even if she WAS bipolar -which she isn't - the facts were NOT and never WERE in evidence.

What really cracks me up is I suspect Dios is the kind who would try to sell his house as a FSBO instead of consult a realtor. Heh.
posted by konolia at 4:30 PM on December 6, 2007


Isn't that [including a disclaimer] as ridiculous and unnecessary as "Coffee is HOT" on a McDonald's cup?

Oh, right, this is America...

So for legal/liability reasons, one might want to place something like that here. But for common-sense reasons, I think most everybody knows that if they go to an advice forum seeking advice, there's no guarantee that advice is going to be (a) accurate, (b) useful, or (c) potentially not making your situation worse if you follow it without regard or consultation with an appropriate professional (whether it be medical, mental health, legal, career, etc.).
posted by docjohn at 11:55 AM on December 6 [1 favorite +] [!]


(Many) people come here because they think there will be people here who know better than them.

I think that it's naive to say "people who ask here usually are canny enough to know that most answerers are just answering off the top of their heads". An authoritative tone is extremely persuasive to a lot of people, without their even realizing it. Being articulate and firm is like a Jedi mind trick. Many people -- in real life and even more so onlien -- just succumb. Add to this the fact that there is a patina of professional respectability around Ask (since we do in fact have a lot of general-purpose smart people answering), and I think the average Asker is quite likely to imagine people answering as being smarter, better informed, etc than they really are.

So I think a reminder to be wary, even of comments that sound very firm and certain, wouldn't be a bad idea.
posted by LobsterMitten at 4:48 PM on December 6, 2007


nixerman:
What gives you the impression that anybody on AskMe is claiming to provide concrete medical advice? There is no intent to deceive on AskMe and there's nothing about the site's presentation that might fool any reasonable person into thinking they're talking to real doctors.

And who cares if somebody gets hurt? People get hurt every second of every day. Are we to believe one death is so especially tragic that discussion on a forum between consenting adults must to be quashed?
As I understand it, the Hippocratic oath--"first, do no harm"--requires doctors to exercise restraint, to refrain from intervening if they are likely to make things worse rather than better. ikkyu2 evidently feels that responsibility very strongly.

Under this ethical rule, if someone posts a health question with limited information, and a doctor knows there's a significant chance their advice might turn out to be wrong or harmful, they should refrain from giving advice.

A layperson might not feel the same restraint, reasoning that some information is better than no information, even if it's potentially unreliable or dangerous. (Plus, of course, they may not be as aware of the possible dangers.) Unfortunately, the overall effect is to make the quality of health advice available from AskMe lower rather than higher.
posted by russilwvong at 5:29 PM on December 6, 2007


Looking at the Ask MetaFilter thread again, it looks like it was the people who came up with the social anxiety disorder diagnosis. They shouldn't have done that and ikkyu2 is right to say they shouldn't.

But ikkyu2 has a problem with the medication and the people didn't prescribe it. A psychiatrist she saw did. If the psychiatrist was quick to diagnose depression and prescribe an antidepressant and then not closely track the patient's progress, that's lousy medical practice and the fault lies with the doctor, not with the people answering the question. They assumed that the authority was right in prescribing it. And their responses about taking an antidepressant were good ones (give it time to work, don't just stop taking it, talk to you doctor about how will it's working).

I'm not seeing what they did wrong except the social anxiety diagnosis, which is a big deal. But the rest of it, ironically, they followed the authority's lead and didn't question it. "Getting it right" would have required that the people in the thread attempt to contradict her professional advice and diagnose schizophrenia. In my opinion, that seems like exactly the wrong thing for people to be doing, even if they might be right occasionally. You can't criticize the social anxiety misdiagnoses at the same time as you expect people to have offered a schizophrenia diagnosis. Good advice and conduct would have been to not challenge authority's diagnosis, but encourage her to keep getting help and explore all possibilities. Which, other than the SA misdiagnoses, was mostly what people did.
posted by pussyfoot at 5:36 PM on December 6, 2007


I'm wondering if some differentiation might be useful here.

In British Columbia, the provincial government has set up a HealthGuide program, centered around a printed handbook distributed for free to all households in BC. The handbook describes common health problems--fever, for example--and provides general advice, as well as indicating when to see a medical professional. (Unfortunately I couldn't find an online version.) The government also runs a 24-hour line staffed by nurses.

The program makes basic health information more readily available to laypeople, while making it clear when people should get professional medical care. This has helped to control the overall demand for medical care.

I'd suggest that this kind of basic health information would be reasonable material for AskMe. Complicated and potentially life-threatening problems--the kind of problem where the nurses on the hotline tell you to go see a doctor--need to be handled more carefully.

The tricky thing is that the Internet can be a great resource for handling uncommon problems. When it comes to software problems, it's likely that at least one other person somewhere on the Internet has run into the same problem, no matter how obscure. But when it comes to health, it sounds like it's dangerous for AskMe to try to handle this kind of problem.
posted by russilwvong at 5:47 PM on December 6, 2007


But there is active moderation, oversight, and occasional deletion of comments and sometimes entire threads by salaried staff acting as official representatives.

My understanding is that because we're not making quality-based assessments of posts' content, that this is not something we have to worry about. If we were editing for truthfulness or removing posts because of accuracy, possibly, but my understanding of the idea that this is still a forum where people are responsible for their postings and not the moderators/owner of the site. I'm aware that us just saying it doesn't make it so, but that's my impression based on similar cases I've paid attention to. IANAL, etc.
posted by jessamyn (staff) at 7:34 PM on December 6, 2007


I think you know what I was trying to say.

I suppose. Let me restate:

I think this isn't a law and medicine thing.

I think it's a thing about topics where people want concrete, practical advice about something directly affecting their life.

I'll grant that if people are having an argument about the way that large-scale power systems work and someone chimes in to say, "You know, I'm an electrical engineer. Let me tell you how they work," people might pay attention and not armchair-quarterback.

But that's not the kind of askme anyone is worried about here. In the kinds where people might be worried, saying "I am an electrical engineer. You can go ahead and use lamp cord instead of romex." will get you pounced on, just as "I'm an electrical engineer. I know code allows it, but you'd be crazy not to replace all of your extension cords with [something ludicrously in excess of needs]."

If electrical engineers and nuclear weapons designers seem to catch a break, it's only because the problems they deal with in the course of their work are so far from the practical concerns of ordinary people.

The catch is, of course, that concrete advice about something directly affecting their lives is exactly when you'd like the best advice.
posted by ROU_Xenophobe at 8:00 PM on December 6, 2007


I appreciate the post, because the reminder is good. AskMe is so popular and more and more people use it, and some of those people answer questions every day. I think it is possible that you can get so used to answering questions that you might forget to take extra care in the medical threads. I also think it is possible that because AskMe is such an above-average resource, askers may give more respect to answerers than they should. Yes, we all know it's the internet...but it's Metafilter! Just like HBO is not TV, even though it really is.

While I appreciate the reminder, I must say that with regard to Ikkyu2's specific concern (someone might get hurt), I agree more with Docjohn and Konolia. While it's hard to know for sure, I'm more inclined to think medical professionals get it badly wrong more often and hurt far more people than lay advice-givers. So I'm not sure some big warning is really needed. In this particular case, it was the medical professionals who got it wrong, and apparently AskMe got it wrong by encouraging the woman to trust the medical professionals. Now it's just weird for a medical professional to use this as evidence that AskMe could hurt people, when really the medical professionals are far more culpable. And it extends beyond this particular case, especially with mental health issues. I don't think any harm is being done by these AskMe questions, I do think a lot of good is done, and quite frankly, the alternative is for people to do as dios suggests, trust only the doctors for medical advice....and I personally believe that would cause more harm, I really do. I hope people continue to ask these questions on AskMe.
posted by Danila at 8:01 PM on December 6, 2007


I think there is a lot of potential good that can come from health questions, but that's been covered elsewhere in the thread.

I think the most valuable thing to do, if you do see a comment that suggests a diagnosis when you feel such a suggestion shouldn't be made, is to write a comment that says so (e.g. user suggests that you may have pdq but you could also have any number of problems, or no problem at all, so go see a doctor). If someone suggests doing something you think is medically unwise, then speak up and let them know. Disclaimers or no disclaimers, someone taking the time to add to the thread to point these sorts of problems out directly is going to be the most effective safeguard against bad medical advice.

ikkyu2, I realise that you can don't want to offer diagnostic medical advice online, but I don't see how your ethics would require you to avoid pointing out bad advice.
posted by ssg at 8:29 PM on December 6, 2007


AskMe may have jumped the shark when lawyers show up, asking for legal advice.
posted by paulsc at 9:12 PM on December 6, 2007


ikkyu2, is this case is a very good example? Pulling this quote of yours out for reference:

The therapist, who was not an MD, had the diagnosis wrong and the medication was the wrong medicine and it was hurting, not helping. Telling that poor woman to go on as she was doing, checking in with her non-MD therapist and taking her SSRI, is probably usually the good advice; it happened to be the wrong advice in this case!

I see this in the original question: "I've been going to an awesome therapist for an hour a week for about three months, and I started Zoloft last month for the extreme social anxiety" and "My therapist just referred me to the psychiatrist who prescribed Zoloft. She is really great." And then this in the more recent question, "was in college and had a psychotic break which revealed that while I do have severe anxiety, it's only a part of the schizophrenia."

Taking hypervenom on her word, obviously, but it seems that she was being treated for social anxiety by a therapist, who referred her to a psychiatrist, who prescribed Zoloft. I can imagine plenty of scenarios why a therapist and psychiatrist could both be wrong, but those who took hypervenom's therapist and psychiatrist on their word and provided advice on social anxiety and how SSRIs feel weren't the ones who were getting it wrong, here, were they?
posted by desuetude at 9:31 PM on December 6, 2007


Also, hypervenom, if you're reading all this, I sincerely hope that it's not upsetting to you that your questions are being analysed as what is and is not a good candidate for advice here.
posted by desuetude at 9:53 PM on December 6, 2007


Lay individuals should not be giving advice.

*laughs*

What planet are you on?

Oh, it's dios.

Never mind.
posted by mediareport at 10:17 PM on December 6, 2007


desuetude: those who took hypervenom's therapist and psychiatrist on their word and provided advice on social anxiety and how SSRIs feel weren't the ones who were getting it wrong, here, were they?

They weren't the only ones. Doesn't make them right. Makes them wrong, in fact.

This is evolving into a funny thread. On the one hand we have a lot of people arguing that doctors make mistakes in their exam rooms all the time and therefore lay Internet advice is no worse; on the other hand we have people saying that even if the doctor is wrong, supporting the doctor's wrong opinion is always right. Neither argument is tenable; both are fallacious.

ssg: ikkyu2, I realise that you can don't want to offer diagnostic medical advice online, but I don't see how your ethics would require you to avoid pointing out bad advice.

They don't. It's often hard to distinguish bad advice from good advice, though.

docjohn: I don't know of a single case of death by bad Internet advice.

Is the argument, then, that we should wait until someone posts a followup explaining how bad Internet advice caused them to die? What about lesser morbidity like infection, scarring, loss of limb, loss of sight - do those things count? I'd be pretty embarrassed if I took dumb internet advice and lost my hand because of it. I might not even come back to that forum.
posted by ikkyu2 at 2:19 AM on December 7, 2007


dios wrote: What the concern is that someone will say "That sounds like what I had 3 years ago. Just drink some prune juice and some milk thistle and you'll be better in 3 days" and that the asker will sit around and do nothing causing unnecessary harm that would not have occurred if the asker would have sought medical assistance instead.

That's the beauty of these services, if you believe in the "wisdom" of the crowds. There is far more likely to be a dozen other opinions in the same thread, many of which will call out the phony advice for what it is. It happens all the time on the health forums I oversee. People are generally smarter than we give them credit for.

ikkyu2, sure, those things could happen. They could happen under a doctor's care too. And I guess that's my point from above -- nobody is going to not get their hand looked at if it hurts and they can't use it any longer based upon one lone opinion on the Internet.

Again, I'd ask, where's the data that shows any of this bad stuff is happening? Advice-giving online has been going on for over 2 decades. Shouldn't we have heard of some cases or reports by now?
posted by docjohn at 5:12 AM on December 7, 2007


What I have beef with is people who suggest I need not be skeptical of information I read.

You went well beyond rational skepticism in your first comment, seeming to imply that ikkyu2 was misrepresenting himself and lying for some sort of personal gain. Perhaps you didn't mean that, and simply meant that on the internet no one knows you're a dog, but, if so, you should perhaps be more careful of what you write. Since, as you point out, the only thing we have to go by are our words here, it's worth remembering that when you act like and asshole people will take you as one.
posted by OmieWise at 5:49 AM on December 7, 2007


There is far more likely to be a dozen other opinions in the same thread, many of which will call out the phony advice for what it is.

This paper: Accuracy and self correction of information received from an internet breast cancer list: content analysis provides a good model for an analysis of AskMe. If anyone else is keen, I'd be happy to help assess a sample of health posts and see how often potentially dangerous information is being left uncorrected.

I think it would also be useful for Matt and Jess to "lawyer up", and tell us if this is actually a problem that needs fixing legally as well as ethically.
posted by roofus at 6:15 AM on December 7, 2007


One reason that people show up in AskMe with health questions, sadly, is that they see doctor-patient relationships they'll be facing as both adversarial and unbalanced. As much as most American doctors would like that not to be the case, and genuinely feel that they encourage a trusting therapeutic relationship, the experience of patients is often far different.

As patients, people often see doctors as:
  • Mandated reporters
  • Insurance gatekeepers
  • Medical businessmen, with a clear economic motive
  • Record keepers
  • Judgmental authorities
  • Uncommunicative and sometimes dismissive
  • Frightening
And so, they often show up in AskMe, looking for some reassurance that their concerns aren't strangely uncommon, and for at least some anecdotal support for a course of action they hope will be correct. Sometimes, they just need some help prioritizing the cost of health care they need, against other demands on their income. Although it may be obvious to others that they should be approaching a doctor with their concerns, because of their perceptions of doctors and/or previous experience with the health care system, it's not their first desire. And some apparently feel, that when it comes to money, or lifestyle choices, that doctors may not be impartial sources of advice.

If AskMe can get people with those concerns to go see doctors (as it sometimes successfully does), who clearly need to do so, earlier than pain or other symptoms would drive them to seek care, finally, at some emergency facility, I think a karmic good offsetting ikkyu2's concern for ill occurs. But that good inevitably comes with the risk that as a non-expert general discussion forum, the random responders to any given question will give bad advice, and perhaps, even dangerous advice.

Thus, the operative principle has to be caveat emptor, even for those whose non-normal psychology might make that a difficult or impossible principal to understand, much less follow. I think so far, that's generally served Askers pretty well, but obviously, it's an uneven resource, in terms of quality and depth, question to question. At it's best, AskMe is a fairly informed forum. But the expertise available varies enormously, and isn't certain for any Asker. There's no guarantee that any question is going to get the best responders, or even the best responses from the responders who do comment, and the clarity and precision of the questions posed often drastically affects the responses. That's the nature of Internet discussion forums, and I don't think too many people find their way to AskMe, completely ignorant of those operational principles.

All that said, I do think, that if a question was posted, with the characteristic language and disordered thinking often evidenced by people in deep psychological crisis situations, it would appear "different" enough even to the lay people responding in AskMe to warrant notice, and special treatment. I think my previous comment, alluding to the inherent Turing test for lucidity (meaning Askers have to be able to operate computers sufficiently well to post to AskMe, and make sense to potential commenters) provides an entry hurdle that protects AskMe from getting involved with people in the worst throes of psychological crisis states.

But AskMe is not the only source of medical mis-information on the Internet. Closing it to health questions and comments doesn't ensure that people with problems won't get bad advice, it just sends them elsewhere to get it. And while I think many mefites tout AskMe as a much better resource than it actually is, it's far from the worst of the lot, as Internet discussion forums go.
posted by paulsc at 6:45 AM on December 7, 2007 [4 favorites]


This is evolving into a funny thread. On the one hand we have a lot of people arguing that doctors make mistakes in their exam rooms all the time and therefore lay Internet advice is no worse; on the other hand we have people saying that even if the doctor is wrong, supporting the doctor's wrong opinion is always right. Neither argument is tenable; both are fallacious.

I'm not arguing at all, actually. I was asking how this case was such a good example. She got advice on social anxiety...which is still acknowledged as a issue by her doctor. She was counseled to communicate the lapses in her Zoloft with the prescribing physician. Egads, mental health diagnoses are ridiculously tricky -- it's incredibly common to go through a few diagnoses and courses of treatment before it's agreed. (This is assuming that her doctor sticks to the current diagnosis of schizophrenia.) I don't see any pooch-screwing.

I guess we're just understanding the site differently. I see the replies to the medical questions being akin to a support group. Plenty of informal support exists in person that is not mediated by an MD, including, of course, our friends and families, but also informal support groups. This is generally considered to be A Good Thing.
posted by desuetude at 6:49 AM on December 7, 2007 [1 favorite]


AskMe: Better than WoW?
posted by zennie at 8:56 AM on December 7, 2007


inurmefi said: I do think answerers should hedge more, explain where they're getting their information, and let the poster know whether they're qualified to comment and why. I think the even better answer would be less authoritative pronouncements, and more linking and pointing to helpful resources for the asker

This seems a pretty good idea to me. Perhaps the note at the bottom of question pages could be amended to something like (clumsy edit - too late here):

Ask MetaFilter is as useful as you make it. Please limit comments to answers or help in finding an answer, and be clear about what knowledge you are using to answer the question (direct experience, professional, anecdotal etc) and where the questioner might find resources to investigate your suggestions further, particularly for complex issues. Wisecracks don't help people find answers. Thanks.

As I said earlier, I think AskMe is a valuable resource, perhaps especially for issues like mental health where it can be hard for lay people to find intelligent discussion, but LobsterMitten's right that it is hard to ignore authoritative-sounding advice - and most of us sound more authoritative online than we might in person.
posted by paduasoy at 5:21 PM on December 7, 2007


paulsc, I know that you're very close to folks who've suffered with similar problems.

Would you really have wanted that person you care about, in the middle of an acute psychotic episode, to go on AskMe unsupervised and get the random advice that was doled out in that March thread I linked? Do you really think that would have been a net good for that person?

I'm not asking for rhetorical effect; I want to know what you think.
posted by ikkyu2 at 5:25 PM on December 7, 2007


Lay individuals should not be giving advice. Even if they are correct, they shouldn't be giving advice. It's bad practice. The site shouldn't facilitate that practice either.

I know there is broad support for permitting these questions, but it is just a bad practice.
posted by dios at 12:17 PM on December 6

and it is better when professionals give advice on the precious little information available in most askme questions? askme is a valuable resource as lots of information flows from many sources. it is up to the reader to parse it out knowing that many of the sources may be ill informed, etc. still, that leaves a lot to draw from and think about in most instances. if only professionals gave their views it wouldn't likely be very useful. there are only a handful of doctors here, and the specialties don't always match up either. medicine has changed with the internet and direct to patient advertising and patients now arrive at their doctor's office far better informed about their conditions than in the past. this is a good thing as they can point their doctor to important diagnostic clues and better manage their own disease. it is not always comfortable for older doctors who are used to being unquestioned, but more information, used wisely, is usually better than less. most people can make informed judgments about the information they receive on askme and it is frankly pretty patronizing to think that only professionals have valuable information. you're a lawyer and I am sure you cringe at some of the awful legal advice given here, but usually there are caveats, pointers to source material, strong suggestions to consult a real lawyer about the specifics and treat the askme advice as background only, and of course opposing opinions to balance it all out. I think people who ask a question here first walk into their lawyer or doctor's office armed with better information to have a better interaction with their hired expert.
posted by caddis at 6:40 PM on December 7, 2007


"I'm not asking for rhetorical effect; I want to know what you think."
posted by ikkyu2 at 8:25 PM on December 7

For those who don't know, my brother is a 54 year old man, who has had schizophrenia since his mid-20's. I have his permission to discuss his case, as I have here before on MetaFilter and in other public circumstances, in efforts to aid others understand this condition. My brother's mental illness has been managed over the years, with varying degrees of success, but much more effectively since 1999, thanks to his being switched to a newer, atypical anti-psychotic medication, augmented with a well-known SSRI.

If he were to go off his medication, or when he has problems absorbing his daily meds (such as when he gets the flu or other GI ailments, where his med uptake can be adversely affected), his thinking rapidly deteriorates (within 24 to 48 hours), and he quickly evidences agitation and fear resulting from the return of his auditory hallucinations. He has a religious pre-occupation that accompanies this, and will quickly evidence typical speech patterns and intense religious ideation, as he tries to avoid "thoughts" he believes he is hearing. His thinking rapidly becomes disordered to the point that he has trouble remembering how to turn on simple devices like an iPod, much less a computer. He'd be incapable, in such a state, of starting a computer, logging in, opening a browser, finding AskMe, and posing a reasoned question of the type I saw in the March question at issue, much less return to it later to interact with other commenters.

My experience with my brother, over more than 25 years, and with many other mentally ill persons we have come to know, is that the profound degradation of mental processes that occurs in these people, even in situations of high stress, much less psychotic episodes, render them quickly incapable of effectively communicating, even verbally, much less in online forums. In the throes of a severe unmedicated episode, my brother is able to understand that people are talking to him, and to communicate with them, but because he can't reliably distinguish hallucinations from real dialog, a conversation with him is clearly not normal, to the point that even 6 year old children have sensed it, quickly. Because his rational thinking processes are characteristically affected, his speech can appear wild and unfocused, consisting of snatches of fearfully uttered prayers interspersed with somewhat normally directed conversation, and he is unable to plan any cohesive series of new actions, or remember simple procedures or directions. In that state, he couldn't probably exit a house on fire, without aid. His attempts at writing in that state are focused on his religious pre-occupation, but have characteristic spelling, phrasing and grammar that are not present in his normal writing. Although he put much more energy into writing and drawing in his 20s and 30s than he does now, as seems typical for many people with schizophrenia, his writings from that time would not be hard to recognize as the product of a person suffering major mental illness, by any layperson.

He has, at the worst of times, had to be physically restrained by myself or my father, to prevent his running amok in attempts to save himself or others from his demons. He could hurt himself then, but he couldn't ask for help online. He has had, in his 20s, run-ins with the law, and involuntary confinement, for acts he committed in psychotic episodes, like breaking a store display window at a religious bookstore, to help Jesus down from the Cross. While he can appear agitated, he is generally spared the dark paranoia other profoundly affected persons with this disease sometimes evidence.

My brother is nearly the classic case of a Turing test limited individual, insofar as participation in online forums might go. If he could read and post to AskMe (he doesn't), he wouldn't need help or advice concerning his mental health; if he needed mental health aid, he almost certainly wouldn't be in a condition to seek it from a source like AskMe. And from what I have seen of other people in similar conditions, during my brother's hospitalizations and outpatient care over the years, his capabilities and limitations in the throes of psychotic episodes aren't that much less or greater than others. So, ikkyu2, I think that your postulated condition of people showing up in AskMe in the throes of major psychotic breaks, and not appearing abnormal, to even the casual respondents, is pretty unlikely. I'm wondering, now, if your clinical experience with profoundly disturbed people in the midst of such episodes is that they generally want to get online in Internet text forums, and do the first things suggested to them there? And I'm not asking this rhetorically, either.

But, not all people with this disease are as severely affected, as my brother is, as you know, ikkyu2. Some number of the lesser affected are able to recognize that their thought processes aren't entirely normal, and may even self-medicate for some time with alcohol or street drugs, as hypervenom suggested she had in her March post. A person able to communicate in writing as effectively as hypervenom did in March seemingly still has some capability for rational thinking and problem solving, even though she mentions feeling anxious, particularly in regards to the opinions others may have of her. But she was seeking additional help IRL. She had working inhibitory mechanisms, and a concern that her mistake in entering another girl's room might get her in trouble. She returned to the thread to offer additional information in response to comments, and seemed to appreciate that some advice that she was getting was broader or more relevant to her situation than other advice, and weight that, however imperfectly. A person like hypervenom, from her March posting, would seem to me to have a net capability, even though she was experiencing anxiety, and perhaps even some physical dis-orientation, to sort lay advice that might be as great, or greater, than many person with different limitations, without psychosis.

And apparently, she did find additional help in the intervening months, and has returned in December to post, looking for time management solutions. Knowing what I do of schizophrenia, especially its negative symptoms and affects, I see that as a wonderfully self-aware, self-caring question, and I hope she does well, into the future, in learning to manage her mental health, if, in fact, she is managing schizophrenia.

I agree with you that suggestions regarding social anxiety disorder in that thread might have over-reached, and not been applicable to hypervenom's situation, but I think that the tone of her post and follow up comments indicated to other Commenters she was able to weight and respond rationally to their suggestions, and consider their advice in light of her ongoing professional management. I suspect that had she evidenced severely disordered thinking in her post and follow up, any responses she would have got would have been narrower in tone and communicated less anecdotal suggestion. AskMe commenters may not be saints, or even of above average sensitivity, but in my experience, they are pretty good at recognizing outliers from social norms, and changing their comments in response.

So, what you see as an instance of "screwing the pooch," I see as a fairly normal functioning of AskMe to an Asker, who, despite her problems, got something from some responses she got, and was able to disregard others. I think, in the main, this worked.

And while I'm appreciative of what I perceive as your genuine and thoughtful concern for those who might not be so capable, I think we disagree profoundly on the likelihood that severely disturbed people will be posting questions in AskMe and taking all responses uncritically, and at face value. I bow to your greater clinical experience, but that is so far from my anecdotal experience with psychosis that I'm hard pressed to imagine patients you might regularly see that would represent, in the real world, your concerns.
posted by paulsc at 1:03 AM on December 8, 2007 [5 favorites]


There is no way I can catch up on this thread, but I think what ikkyu2 is asking for is, basically, impossible in a community site such as this.

Unless you make some draconian ruling that "no health or mental health questions of any kind", then there is, quite simply, no other alternative.

What confounds me about this is that ikkyu2 has to be among the top 5% of MeFites intellectually, already a pretty smart group, and he couldn't see that. This post really seems quite petty and finger-waggy, and strikes me as quite odd to come from ikkyu2. Someone above said this post heightened their opinion of him, I have to say it has done the opposite for me, or rather reduced my opinion of his critical thinking skills.

Some people find value in AskMe's approach towards mental health. Some do not. I think that is all that is required.

If someone asks why their car won't start, and I say to check the battery terminals for corrosion, and it turns out they have a blown fuse, should we dismantle AskMe because I gave potentially helpful but ultimately incorrect information?

That's what this sounds like, some sort of requirement that unless AskMe can be correct, it should be silent.

I think this is a fundamental misunderstanding of what AskMe is for. Plus, in any mental health thread, there are numerous "see a therapist" recommendations.

AskMe is a compact way of asking advice from a bunch of people at once. That's all. It's not the Oracle at Delphi.

What more do you want? What possible good is some silly disclaimer going to do? Do you really think a disclaimer would have altered the query by the poster in question? Really?
posted by Ynoxas at 7:33 AM on December 8, 2007


Ynoxas: "There is no way I can catch up on this thread, but I think what ikkyu2 is asking for is, basically, impossible in a community site such as this.

Unless you make some draconian ruling that "no health or mental health questions of any kind", then there is, quite simply, no other alternative.

What confounds me about this is that ikkyu2 has to be among the top 5% of MeFites intellectually, already a pretty smart group, and he couldn't see that. This post really seems quite petty and finger-waggy, and strikes me as quite odd to come from ikkyu2. Someone above said this post heightened their opinion of him, I have to say it has done the opposite for me, or rather reduced my opinion of his critical thinking skills.

Some people find value in AskMe's approach towards mental health. Some do not. I think that is all that is required.

If someone asks why their car won't start, and I say to check the battery terminals for corrosion, and it turns out they have a blown fuse, should we dismantle AskMe because I gave potentially helpful but ultimately incorrect information?

That's what this sounds like, some sort of requirement that unless AskMe can be correct, it should be silent.

I think this is a fundamental misunderstanding of what AskMe is for. Plus, in any mental health thread, there are numerous "see a therapist" recommendations.

AskMe is a compact way of asking advice from a bunch of people at once. That's all. It's not the Oracle at Delphi.

What more do you want? What possible good is some silly disclaimer going to do? Do you really think a disclaimer would have altered the query by the poster in question? Really?
"


I know it's tough to catch up on a long thread, but ikkyu2 has already answered your questions several times over, and the reasons for posting the thread, the value of a disclaimer, the explanation of the problem and why your car-battery analogy is useless, have been provided time and again.
posted by lazaruslong at 3:05 PM on December 8, 2007


Also, the thread is done.
posted by nanojath at 1:08 PM on December 9, 2007


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