Medical Advice on AskMe July 11, 2005 12:18 PM   Subscribe

Do other doctors get this horrible sinking feeling when they read a medical question in Ask Metafilter? Usually the questions are OK, but obviously would be better directed at a physician. It's the answers that cause me a headache. Lots of non-doctors seem to wade in with "This one time I had something similar, and...". No actual doctors declare themselves and give a sensible answer. I work in a fairly sub-specialized area (uro-gynae) so I'm not necessarily up to date on most of the questions. None the less, I just can't stand it to sit by and see terrible advice given Equally I feel there's something unethical about attempting to play web-doctor. Any tips on best practice?
posted by roofus to Etiquette/Policy at 12:18 PM (82 comments total)

No actual doctors declare themselves and give a sensible answer.

Incorrect. I've seen numerous medical threads in which actual medical doctors have done precisely that.
posted by scody at 12:23 PM on July 11, 2005


Were I a doctor, the very LAST thing I would do would be to wade into any online forum and start offering advice. If you enjoy being potentially sued into oblivion, feel free to ignore that advice. I would suspect that this is precisely the reason most physicians do not comment in forums.
posted by spicynuts at 12:23 PM on July 11, 2005


I agree that was a generalisation and a half. However most medical threads do ramble on and on with anecdote after anecdote. Being based in the UK, I feel fairly secure in not getting my ass sued off. I just want to say "See a doctor" to the original poster, and "Your advice sucks" to everyone else who replies.
posted by roofus at 12:26 PM on July 11, 2005


Here's one with terrible answers from a physician and from the assorted MeFites. I don't want to ruin their fun though.
posted by roofus at 12:33 PM on July 11, 2005


I would suspect that this is precisely the reason most physicians do not comment in forums.

I would suspect that it's because doctors don't have time to sit on internet forums that much. Funny how many lawyers there are around here though.
posted by Pollomacho at 12:39 PM on July 11, 2005


roofus, it may be because I'm not a doctor, but I'm not sure I understand what's terrible about the answers in the thread you link to.
posted by jessamyn at 12:41 PM on July 11, 2005


And roofus, are you criticising the reply supplied by the doctor? First reply in the thread, marked as 'best' by the poster.
posted by raedyn at 12:49 PM on July 11, 2005


anecdotes are all we have to offer, so we offer them, sometimes. I think that's what the posters expect anyway--they don't post expecting a real diagnosis from words on a page (It would be very Sen. Dr. Frist tho, no?).
posted by amberglow at 12:51 PM on July 11, 2005


Here's one with terrible answers from a physician and from the assorted MeFites. I don't want to ruin their fun though.

That's ethical?
posted by grouse at 12:53 PM on July 11, 2005


I'm not sure this is making the situation better or worse, but for the record:

"My guess is that you're feeling sutures used to close the muscular wall of the abdomen, beneath the skin."

Wildly untrue. The muscle layer in a Pfannenstiel incision isn't even closed for starters. The sheath layer is closed, but those stitches are safely buried beneath fat and skin. What she's probably feeling is entirely normal tissue, with some bruising.

"Some surgeons use dissolving gut for these, which goes away in a couple months, but when I used to do this sort of thing, I used 0 Prolene, which doesn't."

Catgut went out of fashion in surgery at about the same time it went out of fashion in tennis rackets. I don't think it's even available in the NHS anymore.

"Nobbly scar is far superior to surgical wound hernia, which is why the lower layers of muscle have to be closed with strong stuff."


This part is just confused. An incisional hernia is a serious complication, but it bears no relation to the nobbliness of the scar, and again it's the sheath layer of fascia that prevents a hernia, not the muscles.

The important thing to state would be that the nobbliness of scar immediately post-op bears little relation to its eventual appearance.
posted by roofus at 1:02 PM on July 11, 2005


roofus, why aren't you adding this to the conversation there? I'm just trying to understand.
posted by OmieWise at 1:07 PM on July 11, 2005


Strange, I don't see how those answers can be considered that terrible - not one of them says "Oh, I had that, drink a liter of XYZ Natural Snake-Oil daily and it will pass in a week" or "Rinse the scar with lemon in a full-moon night while holding your firstborn (if you don't have any children, use someone else's first-born)". Actually, none offer any treatment suggestion, only hints of what it might be. And the poster asserted "I will of course see a doctor, but from a purely aesthetic perspective I don't want a knobbly-feeling scar and would be interested to hear anecdotes from other people about what happened to them". I also don't understand why do you feel that correcting the technical mistakes you see in the posts would "spoil the fun" - if you have time to analise them and comment them in Meta, why not contribute to the AskMeFi thread instead?
posted by nkyad at 1:07 PM on July 11, 2005


IANAD, but my father is, so that certainly colors my opinion, but I cringe whenever I see medical questions on AskMe. Not so much the "Can someone else who has my condition give me a clue what I'm in for?", but the "I have X. What do I do?" questions almost always boil down to one of two solutions:

- See a doctor, if you're leaking something or in debilitating pain.
- Take some OTC painkillers and/or wait it out.

Everything else, as they say about the Torah, is commentary. Or, worse, misguided.
posted by mkultra at 1:08 PM on July 11, 2005


roofus: See, that was very helpful. I don't see what would have been the problem posting it in the AskMe thread. You're not saying anything (it seems to me) that could conceivably get you sued, just providing information.

As has been pointed out before in a similar discussion, you can't stop people from consulting each other (where "each other" = "people who are not doctors") about their medical problems. We do it all the time, just as we do about kids, jobs, sex lives, and everything else. Of course it pains you to listen in on it; believe me, it pains me to listen to people talking about language. But you can either grin and bear it or jump in and provide useful information; I'm not sure what other choices there are. (Telling people not to talk about it and just "go see a doctor" is pointless.)
posted by languagehat at 1:11 PM on July 11, 2005


I think everyone is missing my original point. I have no objection to people requesting some lay advice, nor to other people attempting to give it. I actually think the linked thread has a reasonably sensible question.
My only concern is that as a doctor I disagree with much of what is written, but feel ethically/legally compelled not to share my "wisdom". If a patient calls a doctor up over the phone it's exactly the same. In that situation if you have even a hint of concern, all you can do is ask the patient to come in to hospital for review. Anything else and you risk making the situation worse by having come to an incorrect hasty diagnosis.
posted by roofus at 1:14 PM on July 11, 2005


Then don't share it, move onto the next thread
posted by ajbattrick at 1:26 PM on July 11, 2005


roofus writes "If a patient calls a doctor up over the phone it's exactly the same."

I am not a doctor, but doesn't this depends highly on the case? I can obviously see you point. If I call my doctor and say that I woke up felling this or that, there isn't much he can do except, and that is my point, if this is a follow-up and he knows exactly what I am talking about.

But what you pointed there were incorrect general information being given in the answers. Why would correcting the facts (without trying to diagnose anything) be ethically or legally problematic? And how would this be analogue to diagnosing over the phone? Specially if you disclaim anything you say with "But please, talk to your doctor about it"?
posted by nkyad at 1:32 PM on July 11, 2005


How else would I have learned that dill pickles cure hemorrhoids?
posted by CunningLinguist at 2:15 PM on July 11, 2005


Get a sockpuppet account (I think "IANAD" is available). Go wild.

CluelessMefite asks: "I just cut my arm off with a band saw. Can I reattach it myself?".
IANAD replies: "Yes, but first spread maple syrup liberally on the cut ends. And wear your underpants inside-out on top of your head afterwards to promote healing."

Or just don't respond. We'll live without your pearls of wisdom. Or we won't. Whatever.
posted by TimeFactor at 2:17 PM on July 11, 2005


"My only concern is that as a doctor I [...] feel ethically/legally compelled not to share my wisdom."

And there you go. You answered your own question. We can beat it to death if you'd like. See? I have my mallet right here. But at the end of the day you have few options. And any of those will involve either staying away completely (probably too tempting to work), or using your best judgement. And if the later, only you can draw that line.

People write books about this question. I'll bet you had to read tons of them to become a doctor, didn't you? But here we are, in the real world, and it comes down to, "physician, decide for thy self".
posted by y6y6y6 at 3:11 PM on July 11, 2005


Here's one with terrible answers from a physician and from the assorted MeFites. I don't want to ruin their fun though.

Doesn't this contradict your original point that one should see a physician instead of posting to AskMe?

What is the point of seeing a physician if the physician gives terrible answers?
posted by rajbot at 3:16 PM on July 11, 2005


roofus, I think most people post to ask.mefi after already having gone to a doctor, or at least having already planned to do so. The rare exceptions are usually chastised. Ask.mefi can provide patients with something doctors qua doctors typically do not, which is the comfort of speaking with people who share their experience of a condition, and in some cases have recovered and can therefore reassure the patient that it's not the end of the world. I don't think anyone seriously sees ask.mefi as a substitute for a medical consultation with a doctor.
posted by ori at 3:55 PM on July 11, 2005


None the less, I just can't stand it to sit by and see terrible advice given Equally I feel there's something unethical about attempting to play web-doctor. Any tips on best practice?
posted by roofus to etiquette/policy at 12:18 PM PST [!]


Also, IANAL but I don't think you risk getting sued if you say something along the lines of: "As a doctor, I am uncertain about some of the advice given in this thread, and would urge you to see a medical professional."
posted by ori at 4:01 PM on July 11, 2005


You're a doctor? Great! I get these terrible pains when I take rusty needles and insert them in my legs. Do you have any idea what the cause might be?

Also, what ori said. I'm an engineer so I don't get to kill very many people (and electrical, so I don't even get to kill a bunch at once like civil engineers do) but in my engineering ethics course it was drilled in that as a licensed engineer you're responsible and negligent if you ignore safety problems in something whether you're actually involved with the project or not. Nobody really practices this, especially over something like the internet but ori's advice is probably good for especially dangerous advice.
posted by substrate at 4:13 PM on July 11, 2005


After my last answer to a medical question, I decided to stop. If anyone in the future asks about experiences as a patient with heart disease, I will email the asker.
posted by mischief at 4:14 PM on July 11, 2005


I'm not a doctor either, but I AM a skilled and experienced RN, and I now try to stay away from the medical question threads..... mostly out of frustration that sound advice is often ridiculed or ignored. People give some scarey advice sometimes; twice i've emailed a questioner with explicit information and links.

You, as a Physician, likely can't practice medicine efficiently online. I, as a nurse, can't practice medicine at all, but if you can handle your good advice being ignored and accept the fact that people seem to like anecdotal foolishness, give it your best shot and just move on.

Pickles don't cure hemmorhoids. The salty brine MIGHT help them to shrink temporarily. A raw piece of potato can do the same thing.

...oh well.
posted by reflecked at 4:40 PM on July 11, 2005


Roofus, I understand your frustration. I too have a measure of expertise in a certain field and find the amount of misinformation being touted as accurate on various message boards appalling.

It really isn't safe, employment and personal safety wise, for me to wade in correcting people. I could make it safer by anonymizing myself better, but am not prepared to do that. So... I sit back, shake my head in amazement and occasionally contact individuals directly if I see something that is actually dangerous. I expect them (and have never had a problem) to respect my confidences.

That said, it is a calculated risk and I have decided the benefits outweigh the potential harm. I could get burnt at any moment. You will have to find this line for yourself. Nobody here can help you with your ethics and by asking for guidance you are only further exposing yourself.

The sock puppet thing will work to.
posted by cedar at 4:50 PM on July 11, 2005


This thread seems to be turning into a pile-on Roofus, which doesn't seem at all fair to me.
I think that the knobly-wound-thingie thread is a great example: The first reply sounds very authoritative and any layman (such as myself) would probably accept that as correct and walk away. Yer man roofus then after prompting picks the entire answer apart and makes it look fairly ignorant.
Omniwise/languagehat, you suggest s/he should have posted that in the original askme thread, but that suggests that qualified medical practitioners should be 'policing' medical askme threads to vet unsound advice which would be unfair at best and haphazard at worst.
This of course assumes that roofus is correct (no offence) which for all any of us know may not be the case either: Anyone can pretend to be whatever they want on the interweb. Personally, I'm a rocket scientist and part time gynecologist.....

I, um, haven't worked out what the actual answer is, but if a legitimate reason for closing some askme threads is 'chatfilter', maybe these sorts of posts should be shut as 'dontbesuchadumbasscallyourdoctorfilter'
posted by qwerty155 at 4:52 PM on July 11, 2005


This got interesting, I didn't know how often really *bad* advice comes along. Most advice looked benign to my untrained eyes. There needs to be a mechanism to correct bad advice. Unfortunately a lot of us, me included, see it as "unless there's debate or it is corrected, it is right". Obviously I should stop doing that, but there needs to be a filter of some kind, especially if bad advice is found.

I'm almost recanting my position on medical advice being good from the anecdotal perspective. Perhaps no medical questions beyond "how do I cope with this/personal experiences"? Just because people do it with friends and coworkers doesn't mean that said responses are overheard by thousands of people.

Qwerty I think the pile-on was from the somewhat condescending tone of "I can't believe what's going on here, I find it funny", which comes from going to medical school and residency while watching us internet MDs.

In a perfect world doctors can comment without fear of litigation, but litigation exists to counter the bad advice such as given here. With the strong caveat emptor rule of AskMe, questions concerning health seem almost too dangerous to allow.
posted by geoff. at 5:07 PM on July 11, 2005


Pickles don't cure hemmorhoids. The salty brine MIGHT help them to shrink temporarily. A raw piece of potato can do the same thing.
Oh man, I thought I had trouble getting the pickle in there.
posted by dg at 5:09 PM on July 11, 2005


Pile-on wasn't really the right phrase really (especially as on preview there were a couple of serious replies before my comments). I guess I just find it difficult to understand why anyone would want to consult the internet where those giving advice have no requirement to go to medical school or show qualifications before dishing out potentially harmful advice, when it is possible to talk to a doctor in person.
posted by qwerty155 at 5:28 PM on July 11, 2005


"unless there's debate..."

I rarely see debates in AskMe, except for questioning the asker's motives. This is unfortunate and possibly due to the anti-chatfilter contingent.

I take answers, especially those marked 'best', with a grain of salt, and as AskMe matures, I find it less and less useful overall. A fine experiment, certainly, and one worth continuing, but it still has some metabugs as roofus indicates.
posted by mischief at 5:49 PM on July 11, 2005


The Internet is jammed full of misinformation. There are people on the Internet pretending to be what they are not.
Persons who choose to ignore those two facts do so at their peril.

posted by Kirth Gerson at 5:59 PM on July 11, 2005


Here's one backing up Roofus. Compared to some areas of the internet(s), AskMe is almost like Grand Rounds. But it still makes me cringe when people ask questions that I'd be asking *several* doctors in real life.

The best lately was the "how can I remove my own tonsils?" thread. Sure, it was hypothetical, sort of.
posted by realcountrymusic at 6:09 PM on July 11, 2005


Fthuckers... I tolth dem it was a bad fuggin id tu use da blowtorth. I dith it anywatay. Fthuckers.
posted by cedar at 6:22 PM on July 11, 2005


I understand from whence roofus comes. Given the higher than average IQ here on Metafilter, there are many of us who might be considered experts in our fields. However, in anonymity our expertise doesn't give us a higher posistion on the hierarchy of answers. With AskMe, you pays your money, you takes your chances. Those who are willing to entrust their health to well-meaning strangers with well-meaning advice, well.. caveat emptor.
posted by kamikazegopher at 6:42 PM on July 11, 2005


I guess I just find it difficult to understand why anyone would want to consult the internet where those giving advice have no requirement to go to medical school or show qualifications before dishing out potentially harmful advice, when it is possible to talk to a doctor in person.

Assuming that your financial circumstances allow you to talk to a doctor in person, there are still many reasons why you might want to consult the Internet. Your doctor may not have heard of a particular condition or treatment. You have a symptom that you find difficult to describe, but that you might find out has a name. Your doctor may have given you overly simplified information. You want to know if a test or procedure is painful. You want to know how someone else manages with a chronic condition you have. If the Internet had been around in the 50's, maybe women would have known that cramps weren't all "in their heads."
posted by transona5 at 7:01 PM on July 11, 2005


Pooh, expertise counts for nothing here. Look up above how roofus was more or less framed into owning the problem. Patooey on the notion that expertise is respected in most threads. Fie, I say. It's almost always an invitation for a pile-on by ignorant nosepickers.

Flag it and move on.

I doubt that anybody is going to get killed more than once by taking medical advice from a bunch of nerds. And the fact that they would solicit such advice and follow it means it's a miracle they aren't already dead yet, with their last words either "I know what I'm doing," or "Hey! Watch this!"
posted by warbaby at 7:14 PM on July 11, 2005


Personally, I wouldn't feel comfortable offering anything more high-tech than drinking hot water for heartburn, but that's all a lot of people are really asking for.

For those who missed the original thread, I did not suggest either sitting on a dill pickle or shoving it where the sun don't shine. I suggested eating one once a day for a while, and seeing if you feel better. It's not a drug, it's not anything likely to hurt you, and one assumes if you were violently allergic to dill pickles, you'd probably be aware of that by now. It won't conflict with anything else you'd like to try on the problem.

IANAD. Eat dill pickles at your own risk.
posted by deep_cover at 7:33 PM on July 11, 2005


Bad information is hardly confined to medical questions, there is some down right scary advice posted from time to time. Personally I think if you see something wrong, speak up. But I don't have doctor type ethics holding me back.
posted by Mitheral at 7:35 PM on July 11, 2005


What could possibly be unethical about offering advice in a subject area for which you have knowledge?

You must be using the word 'ethical' in some arcane fashion with which I am as yet unfamiliar.

Doctors are not special or magical. They are like any other technician, and their success rate, over the long term, inevitably reaches zero.

If you choose to give advice, because you are compelled by the nobility of your soul (or whatever) to aid the sick and wounded (or whoever), do it, and couch it in disclaimers, if you feel it necessary. If you do not, then don't, and forget about it. Simple.
posted by stavrosthewonderchicken at 8:02 PM on July 11, 2005


The medical system is out of reach for a big chunk of people in the United States. Elephant in the living room.
posted by gimonca at 8:05 PM on July 11, 2005 [1 favorite]


Ethically compelled NOT to share your wisdom? Excuse me, but isn't that the OPPOSITE of the oath you took? Then again, IANAD.

Fine, misters. Don't correct erroneous information or contribute to the discussion, even when you know you know better.

All that is necessary for evil to triumph is for good men to do nothing. And such.
posted by furious blush at 8:13 PM on July 11, 2005


There would be nothing ethically (or probably even legally) questionable about saying at the very least "From my experience, that answer is inaccurate. It wouldn't be wise for me to advise you further since I haven't seen what you're describing, so go see your doctor or read these links for more information...". Identifying bad advice in a forum asking for advice is to some degree good advice itself.

(Just as an aside since my particular question seems to have incited this: My question (the wound thing) specifically asked for personal anecdotes which I am hardly going to break out the home surgery kit over. To ask for anything more than that on an internet forum is stupid.)
posted by teem at 8:25 PM on July 11, 2005


As far as why people would ask strangers, even if they do have access to a doctor could be the personality of many doctors as well. I understand it, every doctor probably has a number of patients who worry themselves over every unlikely disease, but some doctors are dismissive of their patients worries. Because of this people might use questionable medical advisors to vet their concerns first.

Even my workplace advises calling up and checking whether you really need to see a doctor before seeing the doctor. Sure, they advise the HMO sponsored medical line which is staffed by nurses but I would seriously wonder whether the nurses opinions are impacted by their employers (i.e. how highly does saving the HMO dollars rank next to patient health?)
posted by substrate at 8:28 PM on July 11, 2005


Exactly what stav and blush said. Which is why I do sometimes post in those threads if I have something useful to say. If it's out of my field of expertise, I keep my trap shut. If it's a stupid hypothetical question that stands no chance of harming someone, I treat it as such. If someone is doing something potentially harmful (or getting harmful advice) unbeknownst to them, I try to clarify. When anything I see requires immediate medical attention I let it be known. And if I feel I'm taking on risk by offering advice, I'll add an honest and fair disclaimer.

I think this stuff is only common sense. Sometimes these days doctors unfortunately have started to conflate ethics with legal risk, and the two are clearly different. The reality is that people posting here are most often the type who don't or won't or can't see a doctor face to face. And if faced with the choice of giving advice based on limited information or letting them get poor advice, I'll pick the former as the more ethical option.
posted by drpynchon at 8:34 PM on July 11, 2005


these days doctors unfortunately have started to conflate ethics with legal risk

Precisely what I was thinking, but I didn't want to risk insulting anyone's motives by directly implying it.
posted by stavrosthewonderchicken at 8:41 PM on July 11, 2005


Ethics and legal risk are quite different, but for the purposes of keeping their jobs and houses many doctors treat them as the same thing. Our culture is sue-happy, and if I were a doctor I'd be terrified of dispensing advice on a medical problem on the Internet, even if I didn't expressly state my medical qualifications. The slightest mistake, or even the hint of one, or even someone mistaking a mistake for a mistake, and there could be months and thousands of dollars of legal repercussions.

If you see something dangerous, I'd send the person a private email or get a sock-puppet account. Whatever you're comfortable with.
posted by schroedinger at 8:59 PM on July 11, 2005


How sad, if the impetus to help people is drowned out by the fear of being sued.
posted by furious blush at 9:02 PM on July 11, 2005


Any tips on best practice?
Anybody here can claim to be a doctor. There's not enough in Rufus' profile to lend a shred of credibility. Anybody who takes medical advice here, beyond what people do for a cold, is taking a huge risk.

Physicians are held to a different standard by the courts. They can be, and are, sued for huge sums. They can lose their insurance, and be unable to practice. Anonymity here is only good until Matt gets subpoenaed. Rufus, I am not a lawyer, but I recommend you stay away from the medical advice threads. People should not be encouraged to get serious medical advice from the anonymous members of a website. Yup, the distribution of medical care in the US is really screwed up badly. Advice from strangers is probably not the fix.

The specific exception is that if really dangerous advice is given, and you see it, you are ethically obligated to intervene. There may be some "Good Samaritan" protection but how that would be interpreted in this context is a crap shoot.

A sock puppet account to be used for encouraging Askers to seek credentialed care might be good.

For what it's worth, my legal advice is subject to the same constraints - worth every penny you paid for it.
posted by theora55 at 9:22 PM on July 11, 2005


how highly does saving the HMO dollars rank next to patient health?

Not nearly as highly as limiting hospital liability. Look what happens when you walk into an ER and say "chest pain" - you'll probably get a workup you'll never forget for that bout of heartburn.
posted by caitlinb at 9:26 PM on July 11, 2005


Sometimes these days doctors unfortunately have started to conflate ethics with legal risk, and the two are clearly different.
Not to an insurance company, they aren't. The sad truth is that doctors have to answer to their insurnace companies if they want to continue to practice as doctors. This is slowly but surely leaching its way into any number of professions where risk management has become a way of life.
posted by dg at 9:38 PM on July 11, 2005


"Even my workplace advises calling up and checking whether you really need to see a doctor before seeing the doctor."

Umm, gee, that's not at all surprising.
posted by mischief at 10:03 PM on July 11, 2005


If you're really worried about that, five bucks for an 'DrAskMe' user account account, the password for which one could share privately with other people on AskMe that the account creator has privately verified to his his or her satisfaction to actually be doctors as well, if they claim to be, and with a standard disclaimer and info about the account on the userpage, might be a way to go.

If someone were really worried about, but felt compelled to do something. Not sure it would be effective as an anonymizer, but it might be a good thing.

Just a thought.
posted by stavrosthewonderchicken at 11:10 PM on July 11, 2005


English me not good speaking. Writing also today not.
posted by stavrosthewonderchicken at 2:44 AM on July 12, 2005


This is only my 9th comment ever, in 8 months on MeFi. According to the Wikipedia 100 Edit Guideline, I probably am a sock puppet.
posted by roofus at 3:15 AM on July 12, 2005


Given the higher than average IQ here on Metafilter

I challenge this assumption.

Anybody here can claim to be a doctor. There's not enough in [roofus]' profile to lend a shred of credibility.

Which would do roofus 0 good in a court of law. Honestly, I'm always a little saddened when people ask medical questions in AskMe. I appreciate what languagehat said about it being human nature and I know not everyone has health insurance, but there's gotta be something better than asking the rest of the passengers who happen to be on the AskMe bus at the time if anyone of them have ever seen pus like this before.
posted by yerfatma at 4:42 AM on July 12, 2005


Agreed, Roofus has zero protection in a court of law. But I could easily register DrAskMe and give answers freely. Of course, other than many fine hours watching ER, my qualifications are non-existent. That pus is worrisome; I recommend pickles.
posted by theora55 at 5:25 AM on July 12, 2005


Omniwise/languagehat, you suggest s/he should have posted that in the original askme thread, but that suggests that qualified medical practitioners should be 'policing' medical askme threads to vet unsound advice which would be unfair at best and haphazard at worst.

WTF? It "suggests" no such thing. It says what it says, which is that roofus could perfectly well have posted it in the AskMe thread. How you get from there to the idea that I think doctors should be forced to keep their eyes glued to AskMe and police all medical threads is beyond me, but you might want to do some remedial work in reading and logic.

I continue to find it strange that doctors are so horrified at the idea of saying "What X said is bad advice. See a doctor." How could you possibly be sued for that?

Also, what stavros said.
posted by languagehat at 6:27 AM on July 12, 2005


Given the higher than average IQ here on Metafilter, there are many of us who might be considered experts in our fields consider themselves experts in every field.
posted by mkultra at 7:25 AM on July 12, 2005


I continue to find it strange that doctors are so horrified at the idea of saying "What X said is bad advice. See a doctor." How could you possibly be sued for that?

Maybe they're worried about what it implies when there is no such comment. If it happened enough, people (being capable of stupidity) might say to themselves, "Well, no doctors have said that X's advice was wrong, so I'll go try it."

The medical system is out of reach for a big chunk of people in the United States. Elephant in the living room.
posted by gimonca at 8:05 PM PST on July 11 [!]


That bears repeating.
posted by callmejay at 9:08 AM on July 12, 2005


There's also the aspect that people love giving advice and getting involved in those threads. If all the actual doctors did was express disapproval and suggest seeing a doctor, people would enjoy the threads less.
I could have posted my comments in the AskMe thread, but it's considered poor doctor etiquette to criticize another doctor's opinion in public, outside of court obviously. (Though I realise that's exactly what I've done).
posted by roofus at 11:11 AM on July 12, 2005


"Doctor etiquette??" Isn't your responsibility to the patient?
posted by callmejay at 12:35 PM on July 12, 2005


Honestly, roofus, it's hard to read this without feeling like you are coming across as quite the asshole. You started by shitting on a reply from someone who is generally very decent about replying very thoughtfully to medical questions on askme, following up with a pointedly technical dissection of ikkyu's answer that only another surgeon could care about or understand, suggesting at some level you secretly, desperately wish your expertly honed surgical insights to be heard far and wide. Reading the thread myself, it seems likely that in fact, depending on the patient's body habitus, she certainly may be feeling some tissue distortion from a suture, but beyond that, who really cares? The poster isn't stating a symptom consistent with infection, or dehiscence, or internal bleeding. She's curious, maybe a bit concerned, and there's nothing I can see from the replies that merits a call out.

As has been said earlier, feel free to ignore the medical threads.
posted by docpops at 12:57 PM on July 12, 2005


a pointedly technical dissection of ikkyu's answer that only another surgeon could care about or understand

Technical the discussion may have been, and certainly not having life-or-death impact on the original asker, but I think to any layman some of the factual issues that roofus is pointing out seem fairly worrying. We may not know exactly what they mean, but they all look like things that two doctors who really know what they're talking about wouldn't disagree on - do you think there's room for factual disagreements between doctors about whether catgut is still commonly in use?

Besides, I don't think the callout was about that thread in particular - that was just an example given after several requests. I think it was about the general practice of posting (and answering) medical questions.
posted by advil at 3:13 PM on July 12, 2005


roofus writes "I could have posted my comments in the AskMe thread, but it's considered poor doctor etiquette to criticize another doctor's opinion in public"

Now this thread has entered the Twilight Zone - do you hear the music? Let us see:
a) We have no way of asserting the real expertise (or lack thereof) of someone answering a medical question in AskMe
b) From a, we don't know if ikkyu or roofus are real doctors
c) Worst, our "virtual" doctors disagree
d) But they can't disagree or even discuss in front of us, mere mortals, else we sue them (for bad oratory?)
e) On the top of it, The medical system is out of reach for a big chunk of people in the United States.

So some doctors won't give [innocuous] advise in a website because they might be misunderstood and even sued. They also don't want other doctors to give that advise, because sometimes they feel those doctors (who may even be in and from other countries, mind you) are wrong. But they can't correct those other doctors because, besides legal and ethical considerations, there is a "doctor etiquette". And then, the real world doctors are not available. Game, set and match for the gentleman in white pants.
posted by nkyad at 3:58 PM on July 12, 2005


Languagehat, woah, sorry to offend - honestly - but it's all very well roofus replying to that particular post correcting advice already given (again us laymen wouldn't know which of the two were correct) but that doesn't address the point of this thread: potentially dubious advice over more than one threads exists and it would be unreasonable to expect qualified medical mefites to go over all threads to check their advice.
If this 'callout' was only about that particular question then I would agree with you.
posted by qwerty155 at 4:35 PM on July 12, 2005


"do you think there's room for factual disagreements between doctors about whether catgut is still commonly in use?"

Absolutely! Especially if they practice in different places and/or were trained in different eras. In this case, one's in the US and, by his mention of the NHS, one appears to be in the UK.

Some of the anatomy issues roofus raised? Not so much. Docs can usually agree on what's connected to what.
posted by caitlinb at 5:10 PM on July 12, 2005


Docpops, I only picked Ikkyu's answer because it was the nearest medical thread to hand. As I've already indicated, I already felt bad about it before I did it. However it did illustrate that even the best medical advice on MeFi is suboptimal. That's partly because the poster's credentials are unverifiable, but mostly because the question can never supply the necessary information to give a full answer.
I don't know whether it's more unseemly having your opinion criticized by another (supposed) doctor, or being called an assh*le.
I think this thread has answered my question though; I'll definitely be steering clear of medical threads unless there's some obvious harm being caused.
posted by roofus at 5:26 PM on July 12, 2005


roofus writes "it did illustrate that even the best medical advice on MeFi is suboptimal."

That's the crux isn't it. And no doubt on most occasions the advice has to be suboptimal because there's no patient examination and likely inadequate history provided. Perhaps there should be a disclaimer come up on preview when one picks 'health' as a category.
Viz:
"Answers to health questions on AskMetafilter are not meant to substitute for actual medical consultations and may in fact be wrong. Please be cautious in the way you use or interpret any information supplied by Metafilter members."
posted by peacay at 9:24 PM on July 12, 2005


Catgut went out of fashion in surgery at about the same time it went out of fashion in tennis rackets. I don't think it's even available in the NHS anymore.

You're flat wrong, not to strain professional courtesy too much. Fast-dissolving gut is the only thing my friend, a plastic surgeon, will use to close a facial lac. When I used to close facial lacs it was the only thing I would use, too. You can still obtain all kinds of treated and plain gut from Ethicon and US Surgical Corp., to name two. (Browse the Ethicon site for a moment and you'll find a product search that shows all their offerings in treated and chromic gut - who knows whether it's from cats, though.)

God knows what you folks are doing across the pond under your Communized medicine system, though. Gut's *expensive*; I wouldn't be surprised if the Queen just decided that England couldn't afford it.

Also, you have no way of knowing if the original poster had a Pfannenstiel or not, or whether the underlying layers were closed. Neither do I - I was just offering some guesses.

I've linked to my California and NY medical licenses before, as well as my board certification; it's not ironclad verification, but there are enough professional pictures of me on the old Web to compare to last week's Mefi meetup photo that the interested browser could probably satisfy himself to the limits of his trust network.

Eventually someone is going to sue me because of something I post on the Internet, I fear, but until then I will keep diverting myself with helping with other peoples' medical puzzles.
posted by ikkyu2 at 9:35 PM on July 12, 2005


Lame shot by ikkyu2 for the communist remark; clearly doesn't know much about NHS outcomes, or was just insulted, and wants a cheap shot. (It's much easier to just rant on British dental hygiene, ikkyu2.)

But yes, we use catgut in the US still.

Oh, and as far as hemorrhoids go, the answer is sugar. Quoth my attending general surgeon and resident last week, "The sugar butt trick will save you so many late night hemorrhoidectomies." Pour some sugar on the hemorroid, the osmotic gradient causes the fluid to leak out of it, and wham, patient is much better. Tell them to take warm baths and eat more fiber. 4: profit!
posted by gramcracker at 10:22 PM on July 12, 2005


Does this mean I should market sugar coated pickles as the next great hemorrhoid cure: Picklesicles!

As someone who originally signed up to ask a health related question on AskMeFi,[ but then I got sucked in], I can say that in my case, I was asking purely for the anecdotal - figuring that among 25k odd members, there might be some who knew of people with a condition like mine, and what their condition progression was. I wasn't looking for any medical advice, and being Canadian, have good (though slow) medical care available to me, which I use. However, neither of my neurologists had similar enough cases in their practices, or experience, to give me any prognosis - so I asked AskMeFi. Unfortunately, I didn't get an answer to my question, but I knew going in that I wasn't going to get advice I was going to follow dogmatically.

To my mind, (and for the purposes of this, I assume that most MeFites are adults - I don't even know if that's a fair assumption or not), people asking AskMeFi health questions seem to be asking for the query terms to refine their internet searches - with the plethora of medical sites, and the sometimes gibberish terminology of medical jargon, it helps to know how to narrow your search terms, and I think AskMeFi is a very efficient way of doing just that.
posted by birdsquared at 10:59 PM on July 12, 2005


If all the actual doctors did was express disapproval and suggest seeing a doctor, people would enjoy the threads less.
And roofus doesn't think that would be a good thing? Confusing.

I could have posted my comments in the AskMe thread, but it's considered poor doctor etiquette to criticize another doctor's opinion in public, outside of court obviously.
If you really, seriously, think the "doctor's" opinion is that bad, why are you not questioning their doctor-hood (at least to yourself)? Any clown can buy a leftover PDR, Gray's Anatomy, and whatever other books real doctors use, and pretend to be an MD. See Ferdinand Demara. Granting someone a status merely because they can write that they have it is not a good technique on the Internet.

I'd say ethics would demand that you comment when you see possibly harmful advice.

posted by Kirth Gerson at 4:04 AM on July 13, 2005


I would say roofus, with his exquisite sense of medical ethics and his certainty about what turns out to be incorrect information, has been pretty thoroughly shot down. Thanks, ikkyu2 and gramcracker (who should get a sense of humor re the "communist" remark, which came across to me as sarcastic overstatement).

Also, I don't recall if anybody's mentioned that you can get "suboptimal" medical information, not to mention treatment, from actual practicing doctors with framed certificates on the walls when you go visit them and pay (through the nose) for their services. It's a crapshoot everywhere, ladies and gentlemen. You use your judgment and take your chances.
posted by languagehat at 6:53 AM on July 13, 2005


i really do think there should be some disclaimer about the range of commentary, to forestall any legal fears if you need a reason beyond the fact some people do have vaunted opinions of the caliber of the posters and compromised/subjective opinions. Mix that with the general fear of doctors/healthcare/hypochondria or lack of insurance and personal panic, any negative effects resulting from people misconstruing any advice given could be referred back to it when a comment is in question.
posted by philida at 12:29 PM on July 13, 2005


"--commentary on the question posting page,--"
posted by philida at 12:31 PM on July 13, 2005


To clarify:

a) It's not catgut. It's a strand of collagenous material prepared from the submucosal layers of the small intestine of healthy sheep, or from the serosal layers of the small intestine of healthy cattle.

b) The bit about Communism was a sarcastic cheap shot and was meant to be taken humorously. British medicine is justly famed worldwide; the hospital at Queen's Square is the birthplace of my own profession, at least in any sort of modern sense, and I hope to visit one day.

c) One of the most useful things I do, I think, is inject a jargon phrase into every answer that could then be used to make a fruitful google search. This is what medical jargon is for - referring to specific things without getting other connotations of the word that arise from usage.

d) When, rarely, I think that the only right thing to do is for someone to hang up and dial 911, I have said so.
posted by ikkyu2 at 8:26 AM on July 14, 2005


not to intrude, but i think roofus, besides not wanting to intrude via professional courtesy, didn't want to have this turn into a jargon off.
what is usual where any individual is doesn't make it the across the board standard, and if there are any surgeons who got burned by the batches of bad gut sutures, they may not be standard in their practice where they are.
blah blah blah
talk like this outside a medical forum just lets hypochondriacs flip out further and people who want a hook to hang a hat or suit on boggle eyed and drooly.
which is another reason i think a general disclaimer is a good idea.
thanks for trying roofus!
posted by philida at 2:32 AM on July 15, 2005


Most Londoners are quite proud of our left leaning mayor "Red Ken" and don't mind being called communists; I certainly didn't take it as an insult. Although I stand by the accuracy of what I wrote, I am sorry that I managed to involve Ikkyu and Docpops in a debate about wound closure.
I was vaguely aware that "catgut" wasn't made from cats anymore. It definitely isn't available in the UK at all. (Even from your fine Texas Prion-free cattle!). I checked with my very old-school boss, and learnt that although we never used it for abdominal closure, we did use it in gynae for hysterectomy pedicles, and even for perineums until this review and the BSE crisis. (The squeamish should not follow that link).
My last comment is that one of Britain's most prominent paediatricians was struck off today. One of his many errors was trying to diagnose a case of double infanticide, after watching a news report on TV about a mother whose two babies had suffered cot deaths. He probably felt ethically compelled to intervene, and it has (rightly) cost him his career.
PS Apologies to the hypochondriacs for any extra jargon in this post.
posted by roofus at 10:04 AM on July 15, 2005


Catgut has never signified cats. It's a distortion of "kit," which is an archaic word for "fiddle." It's always been made out of sheep, horses etc.
posted by abcde at 2:09 PM on July 16, 2005


As a physician, I have never hesitated to answer a question either here or in person if I feel I can give a helpful answer. This is for a number of reasons. First, I enjoy what I do and don't mind talking about it. Second, there are many reasons why people are reluctant to take their questions to a physician, ranging from inability to pay to fear to embarassment; by answering the question I might decrease their reluctance to go to a doctor. Third, many questions are asked simply out of curiosity, sometimes driven by a desire to find out more about an illness affecting the questioner or a loved one. Pointing such people to a good source of information can be genuinely helpful. As far as the question of liability goes, this forum is no different than any of a number of radio and television shows that answer medical questions. Giving an answer to a question is not synonymous with giving advice, and as long as the answer is thought through, it will help the signal to noise ratio.
posted by TedW at 9:15 AM on July 17, 2005


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