[Djvacto]

As a quick counter-point to *, there is another sub-problem with healthcare/doctors in the US, where often patients with chronic illnesses or not-easily-testable conditions have to fight hard for doctors to take them seriously. The why of this varies a lot from what I've seen, but includes:

- an attitude of "most patients are just trying to wring medications out of you" - an ego-hit of "if I didn't make the diagnosis, I don't want to help" (this applies to both patients coming in with a suspicion of what they have, or getting a diagnosis from another doctor) - burn-out/overworking, where doctors have a hard time managing all the different cases coming at them without dropping the ball here and there

It's not a simple, single-cause problem at all, but just want to provide an alternative point of view about patients who look things up or come in asking about a specific condition or diagnosis.

When I got my ADHD diagnosis after a quarter-century, I went in specifically asking about ADHD because I had seen some flags that made me think I might have ADHD. Contrast that with the people doctors screen out who are trying to get a stimulant prescription despite not needing it, and you have a situation where it's hard for doctors to tell who does or doesn't need meds, and where patients with actual conditions have to fight hard for those to be diagnosed.

Even in cases like POTS, which has no medication involved in treatment, just lifestyle changes, and yet people close to me who have POTS all had an uphill battle getting it recognized by anyone, especially doctors who could diagnose (disclaimer: sample size = 3).

[argc]

> When I got my ADHD diagnosis after a quarter-century, I went in specifically asking about ADHD because I had seen some flags that made me think I might have ADHD. Contrast that with the people doctors screen out who are trying to get a stimulant prescription despite not needing it, and you have a situation where it's hard for doctors to tell who does or doesn't need meds, and where patients with actual conditions have to fight hard for those to be diagnosed.

I told my doctor I had already been diagnosed with ADHD because I had a strong suspicion I had it and wanted to see for myself if the medication helped (it helped massively). I think medicine should be accessible for patients who need it but I don't know how to avoid large amounts of patients then taking medications for the wrong thing, which would probably happen if it was a free-for-all. It kinda comes down to the question of having the personal freedom to hurt yourself doing something stupid, which is a balance (a little of that freedom is good, too much probably bad). All-in-all I lean toward the current system of using on experts to make the final decision. Still, I would be really pissed if a doctor prevented me from getting stimulants for something I believe I need, so I am not 100% satisfied with the current system either.

[suchire]

Another wrinkle to the problem with that gatekeeping structure is that it is so prone to bias against women and people of color, who are much more likely to be undiagnosed and ignored or dismissed.

[tomrod]

I'm not sure why this is being downvoted. This is a legitimate issue, divorced from politics completely (politics usually result in downvotes).

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638275/

[1] https://www.medicalnewstoday.com/articles/gender-bias-in-hea...

[lostlogin]

Could someone explain what’s inaccurate here?

Edit: It originally appears to be getting heavily downvoted.

[clankyclanker]

Nothing is inaccurate. Here's a few primary and secondary sources.

https://www.health.harvard.edu/blog/women-and-pain-dispariti...

> a 2000 study[0] published in The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack.

0: http://www.nejm.org/doi/full/10.1056/NEJM200008243430809

https://www.independent.co.uk/life-style/health-and-families...

> women with chronic pain conditions are more likely to be wrongly diagnosed with mental health conditions than men and prescribed psychotropic drugs, as doctors dismiss their symptoms as hysterics [1].

1: https://psycnet.apa.org/record/1990-98104-000

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

> racial bias in pain perception is associated with racial bias in pain treatment recommendations... Black Americans are systematically undertreated for pain relative to white Americans.

[clankyclanker]

(To contextualize the votes: I think you were getting down voted for assuming that sexual and racial bias don’t exist. You assumed the statement mentioning that such biases existed was inaccurate and wanted explanation as to how. However, per my other comment, the biases exist and contribute to significant negative health outcomes for the disadvantaged groups.)

[lostlogin]

> I think you were getting down voted for assuming that sexual and racial bias don’t exist

I agree that they do exists and am aware of the research showing it. I work in healthcare.

I didn’t make the grandparent comment that got downvoted but was interested to know why it was happening.

[advael]

I view drug enforcement policy meant to prevent individuals from making decisions for themselves as always doing more harm than good. The place for regulation in this space is controlling what claims profit-motivated entities can make about drugs, enforcing quality and safety standards in manufacturing, and honestly tying the hands of insurance companies as much as possible, if not just gutting them altogether

[thewebcount]

Yeah, I've witnessed this first hand with my spouse. She's been told she just needs to exercise more (she was a professional dancer when it hit her), that it's all in her head (actual psychiatrist said otherwise), that it will resolve in 6-18 months (it didn't), etc., etc. It's pretty appalling.

Thanks for mentioning POTS, btw. Despite how many people have it, it's still fairly poorly known about even within the medical community.

[drc500free]

I'm more and more convinced that POTS/EDS/MCAS aren't rare diseases, they're just criminally under-diagnosed because they tend to affect women. FWIW, POTS is much more manageable with medication (e.g. Midodrine and Florinef).

[77pt77]

> criminally under-diagnosed because they tend to effect women

I just can't understand this argument. Women already live 5 years longer than men on average. You mean to tell me if the system didn't discriminate so strongly against their best interest they'd live even longer than men?

[Djvacto]

Responding to both you and the comment above/below you:

Women have a hard time getting symptoms, esp around pain, taken seriously. Oftentimes these symptoms are downplayed or ignored, regardless of the sex/gender of the medical professional.

[77pt77]

Again. If they are discriminated so strongly against, why do they live 5 years longer on average?

It's like you completely disregarded my comment and decided instead to just proselytize.

[kalleboo]

Because of biology? Other female primates (chimpanzees, gorillas, orangutans, etc) also live longer than males.

I don't understand your argument. Just because women live longer on average, they're supposed to live in pain without treatment?

[77pt77]

My argument is that if there was a significant bias against them then that gap would not exist or be much smaller.

In reality they get about 7 times the allocated health expenditure that males get.

[ejb999]

nurses are 91% female and doctors are about 37% female - are they also 'criminally under-diagnosing'? Seems there are quite a few more women in healthcare than men these days.

[Melatonic]

The counterpoint to your last thing is that there are also many ailments that we literally just do not have enough info about yet to have proper treatments. And if we are studying such things many doctors are not going to always be up on the latest research for that specific condition.

I have found it helpful to approach it in more of a teamwork-like mentality. Don't just read WebMD and try to diagnose yourself - journal your symptoms, observe the trends, record data. If it seems like it points to a specific condition hop on Google Scholar and look for some legitimate new research the average doctor may not have heard about. Print that out and then when you go in show them and ask questions without attempting to specifically diagnose yourself.

You could be totally wrong but with some background info your doctor is much more likely to accurately diagnose and take you seriously.