[tdrp]

Here is my story. A few years after coming to the US I started developing some neurological symptoms: confusion, dizziness, lightheadedness.

1. The GP first blamed it on dehydration and sent me home and told me to drink plenty of water. Went back a week later and she prescribed antibiotics thinking it was some kind of infection somewhere. "Let's just try the strongest antibiotics and see".

I did the full course despite some non-trivial side effects and was still not better, but at that point my heartbeat had gotten a bit faster from the whole situation so I was referred to a cardio.

2. Seeing a fast heartbeat, the cardiologist put me, a 24-year old at the time, on beta blockers. Two weeks later, still no improvement.

3. So I was referred to a neurologist. Did a brain MRI, did not find anything so he assumed it was some kind of epilepsy/migraine combo and put me on something called topamax. Mind you, all these prescriptions were given to me within 10-15 minutes of seeing those doctors. Topamax had its own side effects and my health at that point had spiraled out of control. Reported the side effects to the neuro and he thought he'd give me one more medication to counter the other medication's side effects.

When I went back to the GP they said the whole thing was probably caused by "stress".

4. I just stopped all medication, got sick leave from my job, and went back to my home country for a couple of months. I asked my old family doctor to just do a general check-up and see if anything was up. Within weeks my situation had magically started to improve.

Turned out my vitamin D levels were at 7 (forgot the unit, but the minimum was like 30).

None of the doctors thought about it, every doctor had arrogantly assumed that the problem could only be from their own field (neuro assumed it was neurological, cardio assumed it was cardiac), and literally none of them put the slightest amount of effort into looking at the whole picture. This was in one of the most affluent areas and those were supposedly some of the "good" doctors. I am still convinced that a machine trained model would have performed significantly better than these people since they were literally like bots following a rule book.

Side corollary, if you are from a sunny country and move to a state or country in Northern latitudes, keep in mind that vitamin D deficiency can slowly creep on you and basically turn you into a moron. This should be a PSA.

[phobosanomaly]

I think it's a great story, and provides a lot of points to think about. I only question the way you think of the physician's role. I think arrogance is not exactly what's going on here.

Confusion, dizziness, lightheadedness are tremendously vague symptoms, and the workup for dizziness alone is extensive.

Put yourself in the doctor's shoes. Here is an article from the American Academy of Family Physicians on how to work-up a patient who presents with dizziness.

https://www.aafp.org/afp/2017/0201/p154.html

It's not that simple, and there are lots, and lots of things that could be going on. How do you know for sure that your symptoms were caused by Vitamin D? I don't see any evidence that confusion, dizziness, lightheadedness are common presenting symptoms of vitamin D deficiency at all. According to the Cleveland Clinic, those aren't presenting symptoms of Vitamin D deficiency. Therefore, an AI wouldn't be any more likely to catch it than a real person.

https://my.clevelandclinic.org/health/articles/15050-vitamin...

There's nothing in your comment that makes me think your symptoms weren't caused by Carbon Monoxide poisoning from running a heater in your less-than-sunny place of residence. Or maybe it's eye-strain from sitting inside staring at a computer too long. Or neck issues from sitting at a computer for too long. Or maybe you really were dehydrated, and for some reason you drink more fluids in your home country. Maybe you're smoking too much weed. Or maybe you're depressed by being away from home. Or maybe you were doing a lot of cocaine and didn't mention it. Maybe you had a stroke. Or you have early-onset dementia, or sleep apnea, or a psychological problem, or an aneurysm, or any one of a million things.

Medicine is hard. There are a lot of variables. The human body and its environment isn't a perfectly-reducible system you can step-through in an IDE. The only point I'm trying to make is that doctors are trying to figure out exactly what is going on inside of an incredibly complex system that is heavily influenced by the external environment, and they can't always conjure up a precise answer immediately.

[tdrp]

Arrogance because the GP, neuro and cardio all made completely different diagnoses (conveniently from within their field of expertise) based on 15 minute visits and prescribed non-trivial medications. Putting a 24-year old on beta blockers, topamax, cipro and a couple more I had to stop on day 2, just to see if that fixes it, sends you down a spiral of side effects that make the original symptom far murkier.

Even if the algorithmic approach is accurate for 80% of cases, the suggestions it gives you for the 20% makes treatment extremely frustrating. If you are in those 20% then treatment by an experienced, more fluid doctor is night and day. Unfortunately, there seem to be fewer of those in the US than in other countries, probably because of litigation risk you mentioned before.

[phobosanomaly]

I think you have a really, valid point and part of that is also probably a consequence of the structure of the healthcare system itself:

"Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system."

National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington (DC): National Academies Press (US); 2013. 4, Public Health and Medical Care Systems. Available from: https://www.ncbi.nlm.nih.gov/books/NBK154484/

We're much better at moonshots, that just keeping most folks healthy.

[medntech]

How do you know it was low vitamin D causing your symptoms?

[tdrp]

I got back to normal after about a month of supplements and sunlight. It happened to me again a couple of years later to a much lesser degree since I had just forgotten about supplements and then once again was resolved the same way.

[bennyelv]

Don’t confuse correlation and causation. Maybe you were going to get better anyway and it just coincided with the supplements. Maybe the second time was something completely different.

I did X and now I feel better is completely meaningless without some quantitative supporting evidence providing a link between the two.

There’s a reason why the double blind trial is the gold standard of medical proof.

You may of course have this evidence, I’m just commenting on what’s written in this comment.

[medntech]

This was the point I was leading them to. Thanks!

A billion people are vitamin D deficiency. Many are asymptomatic.

Did you have a viral illness causing your symptoms and it got better? Was it the vitamin D? It is hard to say. Some supporting evidence would be you had a previously normal vitamin D level back at your old GP.