[Coolerbythelake]

So things that can look like anemia can be other things! Case in point, my wife was misdiagnosed for months with Anemia. What she really has is several tick Bourne diseases. For 5 months her doctors kept giving her blood transfusions as he hemoglobin reading was around 4-5 and it should be 12-13 for a normal person. Can't tell u how many specialists and emg room visits. Finally found a female md that listened to her and gave the approval to do a comprehensive tick panel. Sure enough rocky mountain spotted fever, erlicheaosis, recurring Lyme fever and regular old Lyme. The blood they were giving her was basically like throwing gas on a fire. Almost was ready to make funeral arrangements. Let me say tick diseases are going bonkers and a lot of people don't know they have it. Plus a lot of doctors won't believe or authorize tests. Advocate for yourself or you might die! Not kidding !

[danachow]

A hemoglobin for 4-5 is anemia - the definition of anemia is low hemoglobin concentration. If your wife had hemoglobin that low, then she was correctly diagnosed with anemia.

It is a bit odd though the apparent coinfection with multiple tick borne illnesses from different species of ticks - A lyme and ehrlichiosis coinfection is not surprising, but rocky mountain spotted fever is a very different illness, often more acute in presentation with distinctive signs and symptoms - but coinfection with the other two would be quite rare.

Also, those specific tick illnesses listed are unlikely to cause that profound of an anemia by themselves, so there's probably some other pathology going on - the tick borne infection may only be a trigger.

Any relatively young person that is otherwise healthy (no near end state kidney disease) should definitely get referral to a hematologist for hemoglobin of 4-5 if it isn't something blindingly obvious like blood loss.

[code_duck]

The difference is actually finding the root cause or just diagnosing what’s essentially a symptom as if it’s unexplained or isolated (idiopathic, I think is the term?).

My mother was diagnosed with anemia, and received many recommendations ranging from not drinking tea to getting a hysterectomy (which was done, in her mid 40s). It turned out she wasn’t absorbing iron due to Celiac disease. Treating the anemia as if it was an isolated condition wasn’t helpful at all since she needed to address the root cause, Celiac.

[haldujai]

“Anemia” isn’t really a diagnosis.

Your mother had a microcytic anemia (a broad class based on lab results), of which there are several types including iron deficiency anemia.

Next, there are multiple causes of iron deficiency anemia of which celiac disease is one of them.

You would never diagnose a patient with “anemia” and stop there. Further work up for the etiology is mandatory and endoscopy is commonly performed.

There is no such thing in modern medicine as “just treating anemia” unless you know the cause and the only treatment is transfusions.

[code_duck]

I would imagine that more details were available, but I’m recounting some thing that happened to someone else 30 years ago when I was a teenager. So I’m not really clear on the precise details. All I know is that they said she was low on iron and anemic, and the suggestions were to not drink tea and they gave her a hysterectomy. As noted, they failed to discern the actual cause at that time. She was diagnosed with celiac about 10 years later.

[danachow]

This is a good learning/discussion point: The post common cause of iron deficiency anemia in menstruating females is menorrhagia. Celiac disease is often an acquired disease in later adult hood.

This is not to comment or challenge directly your case but knowing the two above facts it is not uncommon (in fact I have personally seen this in practice) where your above outline is perfectly reasonable.

A woman may have multiple reasons or a sequence of reasons for IDA, developing celiac later in adulthood - it’s totally possible they had chronic blood loss anemia before that.

[DangitBobby]

> You would never diagnose a patient with “anemia” and stop there.

I kind of doubt that. In my experience, the treatment for chronic heartburn is to throw meds at it to stop the symptoms. After an upper endoscopy, no attempt at root cause was ever made.

[haldujai]

As much as you doubt that based on your anecdotal experience (addressed below), I’ve respectfully spent the past 9 years practicing medicine in 16 different hospitals across three countries and feel I am in a more appropriate position to comment on the medical standard of care.

I can say with absolute confidence at none of the places I’ve worked at would a doctor leave a patient with a diagnosis of anemia as this is malpractice. Are there physicians in some hospitals who practice negligently?

Sure, but there are also pilots who show up drunk to work and engineers who are negligent. That doesn’t mean the entire profession has a “problem”.

Anemia is not heartburn. Anemia can be life threatening.

As an analogy for the tech world. Anemia is a server crash. Heartburn is a warning in the server logs.

You may decide the warning is not worth fixing / may result in new bugs (aka complication).

When a server crashes step 1 is to get it back online (transfuse to a safe hemoglobin target).

Step 2 is find out why the server crashed (why is this patient anemic, which is a sign/symptom and not a diagnosis).

Just as a computer engineer would never say “I’m not sure why but let’s just keep restarting every time it crashes”, a doctor would not say “I’m not sure why you’re anemic” unless there was an extensive negative workup and the patient normalized therefore no longer requiring treatment.

There is no situation where a physician just keeps transfusing an anemic patient without figuring out why. This is not only expensive, but transfusions carry risks and with repeated transfusions some risks increase. This is not a medically accepted management plan anywhere and the hospital / blood bank would quickly intervene if a non-hematologist was serially transfusing a patient as this is outside their scope.

In your example:

Your negative endoscopy excluded H. pylori, gastric malignancy, peptic ulcer disease, and a hiatal hernia. Those are all of the easily treatable and life threatening conditions we should not miss.

Your next options for investigation would be a 24 hour pH study with consideration for fundoplication. This is a major surgery with risks and complications that are believed to be worse than PPI therapy.

Patients who fail PPI, are unable to be weaned, or have contraindications are the ideal candidates for such an invasive procedure. You don’t want to send every heartburn patient to fundoplication, we used to do that and made a lot of people worse.

[code_duck]

I feel that patients are qualified to comment on medical standards of care, also.

I am sure that you’re a good doctor, but to answer your question, yes, there are many doctors who operate negligently, to some extent. I had a long experience at one of the major hospitals in the US following drastic weight loss and months of pain. A major hospital did various tests, and ended up telling me I had “health anxiety”. It turned out that I was actually developing LADA, a form of type 1 diabetes. Since I had already been diagnosed with celiac and was having primarily digestive symptoms, the tests they did focused on the digestive tract and they never investigated other causes. I had to finally go into diabetic ketoacidosis before anyone figured it out.

[DantesKite]

> If your wife had hemoglobin that low, then she was correctly diagnosed with anemia.

That seems like a somewhat myopic perspective.

Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness.

A more accurate and helpful diagnosis would probably be something like "Babesiosis"——anemia caused by ticks infected with a microbe that destroys red blood cells especially considering the multiple cofactors at play. Or whatever it was that specifically caused the anemia; the parent comment didn't say.

[danachow]

Dude, I'm just addressing this: "So things that can look like anemia can be other things! Case in point, my wife was misdiagnosed for months with Anemia."

Which is a bit of a confused statement.

> Saying this patient was "correctly diagnosed with anemia" would be like diagnosing a cancer patient currently undergoing chemotherapy with male pattern baldness.

No, that's a pretty shit analogy and completely wrong. First, because chemotherapy doesn't cause "male pattern baldness" - the mechanisms aren't the same. So that's just wrong - while someone with a hemoglobin of 4 has anemia, whatever the underlying cause may be - it isn't a look alike - it is.

Second, diagnosing Alopecia (secondary to chemotherapy) is a perfectly reasonable diagnosis. Because it is something that doctors do manage with specific things separately from the chemotherapy and other cancer treatment, eg wigs, scalp cooling.

People can have more than one relevant diagnosis that they are treated for and are interrelated. For instance, if someone has anemia that is due to something like a GI bleed, they have both a GI bleed and anemia. If their hemoglobin is less than 7 you will likely treat that anemia with a blood transfusion independent of what you're doing to manage the GI bleed. GI bleed, iron deficiency, malabsorption, microcytic anemia are all diagnoses - they may be all interrelated.

> A more accurate and helpful diagnosis would probably be something like "Babesiosis"--anemia caused by ticks

But babesiosis is not anemia. It often occurs with it, but the diagnostic criteria for babesiosis is blood smear or PCR. If someone has a smear positive for babesia then they have babesiosis regardless of their Hgb/Hct.

And notably they listed a bunch of tick borne illnesses listed, babesiosis was not among them.

[medymed]

Right idea generally but in that scenario it would be like making a diagnosis of alopecia which just means hair loss. In any case some diagnoses don’t have clear explanations or subdivisions for decades or centuries until explanatory medical science catches up with the descriptive diagnoses like anemia or alopecia.

[vo2maxer]

I understand your family’s frustration but it’s hard for me to think that the only presentation (both by history and hematologically) was a Hgb of 4-5 and physicians just proceeded to transfused with no further questioning or consideration for the large number of diseases in the differential diagnosis. Did she have low platelets (thrombocytopenia)? Had she had a rash previously? Was she outdoors in areas where ehrlichiosis or rickettsia carrying tIcks are known to be endemic? I’m sorry but you provide minimal information and then dump on physicians. Yes, it’s possible that you dealt with dozens of careless physicians but what information did your wife provide to that one female physician, which triggered the battery of serologic tests, and that no other doctor could elicit in the flood of previous medical evaluations. It’s not as if your wife just shows up with vague malaise and fatigue but everything else is normal in her history and in the examination. She has a Hgb of 4-5. Was a hematologist called in? Was ID called in after she remembered that fever and rash she’d previously experienced, for example.

[cameronh90]

There are quite a few incompetent doctors, sadly, and they stick together and support each other. While I'm generally reluctant to bring up identity politics, it does appear that women and people of colour tend to experience this worse than others.

My mum had abdominal surgery, and one night following the surgery, she felt an extremely painful tear sensation in her lower abdomen and shortly afterwards noticed a big asymmetric lump in the intestinal area.

My partner is an ICU nurse and suspected a hernia so we took her to the local hospital and the doctor said it's just post-surgical swelling. It didn't go away, rather it got bigger, more painful and frequently gurgled, so we went to the GP. The GP said it's probably just because she's had kids 30 years ago (!?) and that my mum needs to get used to not looking attractive any more, and to lose weight.

What followed was months of doctors visits trying to get them to even accept there was even an issue. Bear in mind, this was a significant, painful gurgling lump, around the size of a tennis ball. Yet doctor after doctor said there was nothing wrong with her and she should consider therapy and antidepressants instead.

After a few more months, she began experiencing such bad pain that she couldn't walk, and finally a junior female doctor suggested she had a hernia. However, she got overruled by her senior and sent home with paracetamol. The junior doctor quietly told her to go to another hospital.

We managed to convince my mum this was ridiculous and brought her to London, where she got looked at by a hernia expert, who was very concerned about her treatment thus far and sent her for a CT and - obviously - found a large hernia. Due to the time it was left untreated, the repair was very challenging with many complications.

Back home again, while recovering, she was having the early warning signs of an infected surgical wound (hot swelling, pus, smell, chills etc.) and again the local hospital fobbed her off and said she's overreacting, didn't swab the wound or change the dressing and sent her home. That night, she called me incoherent and I called for an ambulance - turns out she had sepsis and nearly died.

I can promise you that we made sure everyone treating her had a full medical history at every point, but they still blatantly ignored what was right in front of them. There is actually a ton more to this too - the surgery in the first place which triggered all this was due to a medical error and wasn't necessary. It's been five years so far.

She's currently suing the local hospital and doctors.

[vo2maxer]

I’m sorry to hear this and of the incredible suffering your mother and her loved ones have had to go through. I am quite aware that there is a significant number of physicians who are careless, apathetic, rushed, eager to get home after long working hours. Many are incompetent but I would venture to say that a larger number is plenty competent. It’s just gotten to a point in their career where they are “burnt out” for whatever reason and they are aiming for speed. It becomes another consumer transaction and as the patient load increases during the night, the clinician just tries to simplify things as much as possible, taking shortcuts, working under weighty incorrect initial diagnoses. Once you’re seen by that first doctor who makes what should be a tentative diagnosis, that opinion carries a great deal of psychological force. Of course this depends on the docs seniority.

In your mom’s specific case, it is inconceivable to me that any trained physician would see her post-surgical history and subsequent development of an abdominal mass and not think immediately of a hernia and possible strangulation as it grew. A first-year medical student can palpate the abdomen and readily tell there is herniation through the abdominal wall. Is it reducible or not? An abdominal CT scan should be reflexive. It’s even more maddening when more than one physician misses the obvious or at least the way it sounds to me given the information you’ve provided.

Physician burnout is a real alarming phenomenon with emergency room doctors having one of the highest rates. This was already an issue pre-COVID-19. I can’t help but worry about how worse it may get.

[danachow]

From my reading of that story what was interesting was that shit hit the fan with a post-op infection after the hernia repair. A reducible hernia isn't an automatic indication for surgery these days - and post-op risks outweighing benefits is one of the reasons why. It's also weird why the "time left untreated" would have any bearing on the repair and risk of complications - people go through life with uncomplicated hernias for years - if they're complicated they declare themselves pretty rapidly. There are many other reasons I can think of that would increase risk though. When I hear a story like this it is very hard for me to believe the entire pertinent medical history is being conveyed.

[haldujai]

I concur. I often work as a radiologist in the ED setting, while this is anecdotal I can’t imagine that anyone with history of recent hernia repair, purulent discharge, and chills would not get a CT scan at an academic centre in the US (OP stated residents were present.

I can only speak to the centre I’ve worked/rotated at but this seems inconceivable based on the requisitions I get in my career. We do a lot more for a lot less.

The only point I would disagree on is that “time left untreated” can increase complication rate. If this a partially strangulated hernia and there was a microperforation (quite common and often missed) or bacterial translocation in the hernia sac mesh would almost certainly get infected. Even if not strangulated/perforated at time of surgery, if there are dense adhesions from recurrent/intermittent obstructions that may also increase operative complexity and a lysis of adhesions may contaminate the field. That said you could also just not use mesh.

[throwaway742]

In my experience US EDs tend to be very liberal with testing. At times it seems excessive. I have heard complaints from technicians who say they feel like sometimes the doctors just tick every box on their tablet. I think this might have to do with malpractice insurance. Perhaps, and I say this as a proponent single payer, the NHS prefers cost savings to risk reduction.

[vo2maxer]

Remember that in the chronology, the infection occurs after the second surgery, the hernia repair. The mass develops after the first surgery. I agree with you otherwise. Internal Medicine here.

[vo2maxer]

Well, the history is not clear. All we know is that post-first surgery, an abdominal mass develops which becomes painful over time. I assume the “hernia expert”, which is just another name for a general surgeon, followed a simple algorithm: Protruding painful abdominal mass -> Hernia? Incarcerated? With possible increasing risk of vascular compromise to bowels > CT Scan. Go from there. Period.

[haldujai]

To be fair and in defense of OP, I’m not sure why you are putting quotes around hernia expert.

I’m not sure what setting you practice in, I am personally in a ~1500 bed academic health sciences center.

At my institution, we have 3 general surgeons who are hernia experts (literally on their letter head). This is to say that their non ACS practice is heavily on hernia repair and they get the referrals for all complex hernia repairs from other general surgeons in the catchment area.

If you’re in a smaller setting you may not have a similar degree of sub-specialization amongst your general surgeons but hernia experts are definitely a real thing.

I appreciate your overall point and frustration, but I think you’re being a bit too dismissive here.

[cameronh90]

According to the surgeon who ultimately repaired the hernia, it was not an uncomplicated hernia. He said it was incarcerated and that there was an adhesion.

Ultimately, it could well have been the case that treating the hernia was not recommended, and that could have been discussed. But simply denying that there was even a hernia and refusing to perform any further investigation is clearly a failure.

[pixl97]

After seeing a relative go through hell for years of mistreatment and misidentification of Ehlers-Danlos syndrome that had not been identified earlier in life and went to specialists for a number of years with a ream of information, I just really have less faith in proper identification of anything that falls out of normal.

[haldujai]

I think you’re hitting the nail in the coffin.

As physicians were trained on the common and the deadly. We’re not that great at rare non-immediately life threatening conditions due to the nature of the discipline.

We’re trained that when you hear hooves, think horses not zebras. This does unfortunately mean that patients with zebras are often misdiagnosed for a while, but that’s because our approach isn’t intended to catch every zebra (which would be impossible).

The other element is to avoid unnecessary harm. Often the tests for zebras are nonspecific and overlap with other conditions (I.e. to be considered after exclusion of other aetiologies).

A late diagnosis of EDS fits in the zebra categories and probably wouldn’t have been picked up until you saw a rheumatologist or vascular specialist at a centre which deals with these.

[s1artibartfast]

The deficit of knowledge is bilateral. Sure clinicians don't know about patient risk factors, but people get things like rashes very commonly from a wide array of sources. Either way, the parent post was saying that people should inform and advocate for themselves. This is entirely consistent with your message.

I agree with your greater sentiment that people place unreal expectations on their doctors. The point is that doctors are fallible and not omniscient. This is just reality, patients need to be their own advocate.

Blame is beside the point.

[ClumsyPilot]

> Plus a lot of doctors won't believe or authorize tests. Advocate for yourself or you might die! Not kidding !

Experienced this myself. So mant doctors behave like JavaScript developer and I am another webpage

[pojzon]

At least in Eastern Europe thats because they dont really have the time needed to help the patient.

Its a business and you have 10m to do all paper work, check patient and prescript something.

Its horrible. Doesnt help that private doctors are super expensive, dont care about you and dont believe you.

Health became just another accommodity only super rich can pay for.

[Asooka]

The best approach remains to know the right people who can tell you about which doctors are good. Or as the kids call it,"networking". E.g. my dentist (an exceptionally good and professional woman) is someone I know because she's friends with the wife of a colleague of a girl I went to high school with. I hope that the new health platforms that are springing up will lead to knowledge of which doctors are worth their pay being easier to access and spread.

[Gatsky]

Small adjustment here... anemia is not a disease, it merely describes the state of having reduced hemoglobin concentration in the blood. It doesn't make sense to say things can 'look' like anemia. It has myriad causes. It is never benign, and should always be investigated thoroughly.

[cfcf14]

Hey, I noticed that you explicitly mentioned that you found a female md that was the one to ultimately make the correct diagnosis. Do you feel that the previous md's (males?) were unwilling to consider they should conduct a tick panel due to bias? I ask because my partner has had comparable resistance for a very different ailment and I'm interested in possible systemic errors occurring.

[areoform]

Yes, male doctors often don't listen to women. Speaking from both personal experience and the experience of almost every other woman I know.

Medicine is a horribly antiquated and biased field. It's one of the few fields that need to be automated.

[Auracle]

I’m sure that can happen, but please don’t just to that conclusion just because of sex differences. I’m a man and I’ve had plenty of male doctors not listen to me as well, along with one or two very dismissive female doctors.

It’s a profession that attracts know-it-alls along with those that actually want to help but are overworked.

[lamby]

Very true, but when there's literally 100s of years of women's legitimate medical complaints being dismissed (sometimes with fatal consequences), it is surely not too much of leap to speculate that this is part of the reason.

[robocat]

It is very rude to deny that areoform and Coolerbythelake have read their situations correctly.

Perhaps female doctor are more likely to listen better (to men or women).

Sexism is a well recognised problem in medicine - a little googling shows a lot of research into the problem. Here is one article referencing some research with how women are treated for heart attacks: https://www.salon.com/2018/12/14/new-research-reveals-how-se...

[Lammy]

I wonder if that type of bias could be some result of the way medical schools structure the courses training our doctors, or if medicine is just a universal enough human need that it exposes bias inherent in all areas of our society.

[haldujai]

Physician bias that women and people of colour are “tougher” is real. We are educated about it and are improving but as with bias against these classes of individuals everywhere else in life, we have come a long way but we are not perfect.

Most current medical schools (at least reputable ones) provides extensive training on this matter.

[formerkrogemp]

Different regions of the country have worse biases as well.

[joshgel]

Err it’s more that tick-borne diseases cause anemia.

There are lots of things that cause anemia! And someone with unexplained anemia deserves a complete work up (especially with hemoglobin levels in the 4-5 range), including for tick-borne illnesses, especially if they have been in an endemic area. But lots of other things worth checking too, many more dangerous than tick-borne illnesses.

[lloydatkinson]

> Plus a lot of doctors won't believe or authorize tests.

In the UK there is a silent but serious case of people dying from cancers because GP's are refusing to refer anyone to the hospital for checks. The whole situation is deteriorating. It's not just cancers either, it's other types of conditions and even diseases these borderline incompetent GP's are either missing or simple refusing to listen to the patients. You can google any type of combinations of phrases, eg replace cancer with X condition and you'll get countless examples of that too.

For example: https://www.google.com/search?q=people+dying+from+cancer+gp+...

People are literally dying because some GP's just don't give a shit.

[xdrone]

Yeah I just learned this from a video. https://youtu.be/HOK3NS2bD3M

Iron deficiency can be your body fighting off a disease, and adding iron is the wrong thing to do.

I also learned excessive iron is worse than low iron, your body can regulate the intake but not expend iron.

Iron is complex.

[xenocratus]

It took years for me to be diagnosed with thalassemia when my GP found some of my blood results suspicious. Got treated for anaemia a few times before, and was refused for blood donations as well without being able to explain what was wrong. My blood tests said "anaemia", but my life experience said "all seems ok to me...?" - luckily I have a mild form, I just need to watch my diet a bit.

My dad also found out through my diagnosis why he kept getting those same signs in his tests... :) Eastern European medical system at its finest.

[winter_blue]

You have good points, but how was transfusing blood to increase her hemoglobin levels like "throwing gas on a fire"? Maybe it didn't help, but it surely didn't hurt? And, isn't it sort of a good thing to raise hemoglobin levels, in any case?

[InCityDreams]

>Advocate for yourself or you might die! Not kidding !

Paid healthcare? As a europopulator i can choose to pay for my healthcare. Rest assured, that when i do pay, i insist on certain things. Like doing the tests i insist on...

"Plus a lot of doctors won't believe or authorize tests."

Surely, the money talks in a situation like this? I can pay for any test i like and no (socialist, here) doc would ever say no, nor would they actually give a crap.

[elif]

Unfortunately not in the USA. I assume lot of it comes down to the doctor's discretion because if the insurance company finds that the doctor is performing excessive treatment/tests, they will deny coverage, renegotiate rates with the provider, or even refuse to cover the provider outright.

I've been trying to get certain blood screenings through 3 doctors, and they were all more than happy to repeat the same basic blood panel 3 times, since it is incontrovertible, even though it would have cost less overall to get the specific blood screen I asked for.

And if I want to pay "out of pocket" it is impossible because the tests often require a doctor's prescription, and even if not, the non-insurance rate for the tests are 2-10x what providers negotiate with insurance companies.

[sleightofmind]

There is not, to my knowledge, any prohibition against you going to a doctor who only sees "fee for service" patients, to get your lab work done. That is, a physician who accepts no insurance whatsoever. These are not rare in the U.S. Get your test from such a doctor, send it back to your own physician/healthcare provider as a nudge.

For much of my 30s, 40s, and 50s I was strictly a fee for service patient in Southern California. This, of course, is no solution for someone with significant health problems. I've been blessed with good health, undeservedly so. I had cataract surgery on my left eye in 2011 for $2600 cash, up front, at the area's biggest hospital. No further charges materialized. I had no regular primary care physician at the time. To me, $2600 for a surgery, the result of which was so magically wonderful that I burst into happy laughter in the ophthalmologist's office when he removed the eye bandage, was worth far more than the $2600.

Don't overlook businesses like Everlywell or Private Labs MD that enable one to get tests performed outside your own network. I've used such a service to "nudge" my health care provider (with whom I am generally satisfied) to investigate some subject further. Admittedly, this is not much help for exotic tests.

If, like me, you are lucky enough to live reasonably near our southern border, labs in Mexico don't even require a doctor's order to perform tests. There may be exceptions to this -- I don't want to imply that I know more than I do.

I don't want to "wave away" the very real problems that exist for those who cannot afford any service outside their network, nor do I mean to ignore the very real problem of arrogant medical professionals who ignore a patient who tells them, "Listen, Doc, I've had this same test three times in the last three months." I only mean to suggest that sometimes, when it is possible, it helps to work around a stubborn physician, rather than attempting to bend said physician to your view.

[elif]

If only it were that simple!!

Because of digital record keeping and insurance laws, even if I go to a independent, fee-based doctor, the results of his test can mean that in 10 years, insurance can refuse to cover certain treatments.

It's really an inescapable web, that even my doctor is aware of and seems paralyzed to authorize a test for me because of not only the implications for my finances, but also her practice.

[elif]

Essentially, it's my opinion that US doctors are afraid of arbitrarily losing a chunk of their customers or having to negotiate with lawyers.

[9991]

Sounds like the insurance company is the customer, then.

[brewdad]

If insurance doesn't approve the test, it won't be paid for. Insurance also means US prices for tests are elevated to 10x what they "should" cost because providers expect insurance to knock the price back down to a reasonable cost. As a result, ordering a bunch of unapproved tests leads to huge out of pocket costs for patients so only the wealthiest will ever be willing to push for them.

Ironically, that same population also is the most likely to have insurance that will cover the tests in the first place. So it goes.

[smabie]

You actually can negotiate pretty easily with most hospitals / doctors. After getting the bill just say you can't pay and offer a fraction of the cost. Many times they will say yes (alternative for them is selling the debt for cents on the dollar anyways)

Source: have done this 2-3 times in the past when I was poor / used to not have self insurance.

[gtvwill]

On the other hand I have to travel 30 mins cus the 5 doctors in my town no longer bulk bill and I can't afford the cost to go see them.

The fact your ok with having to pay for a better standard of healthcare rather than just having a society which provides the best healthcare for all. Is legit cooked.

[pojzon]

Not everyone can pay. Health should not be gated behind a paywall. Life is not a microtransaction game.

[afterburner]

Lyme disease is spreading northward, areas that would have never thought about it 20 years ago need to exercise caution when hiking on uncleared paths (or when diagnosing patients), but the awareness isn't that huge right now.

[moneywoes]

How can we identify them! Also how to be safe?

[sdeframond]

Is Bourne disease when you can't remember your past and start being chased by secret services' killers?

[robonerd]

> Let me say tick diseases are going bonkers and a lot of people don't know they have it. Plus a lot of doctors won't believe or authorize tests.

The existence of Chronic Lyme disease is very controversial and diagnosing it can get doctors in trouble (depending on the jurisdiction.) Whether or not Chronic Lyme disease is real (I don't know), I think the general consensus of CLD diagnoses being quackery might bias doctors against diagnosing any sort of tick related disorders, particularly chronic ones.

[crooked-v]

The general medical consensus is that "chronic Lyme disease" doesn't exist and that symptoms attributed it often have to do with chronic fatigue syndrome or infection-triggered fibromyalgia.

[hmmokidk]

Doctors often don’t believe in fibromyalgia…

[cameronh90]

Doctors generally believe in fibromyalgia. What's more controversial is whether it's a disease, disorder, symptom or syndrome.

A patient experiencing fibromyalgia is very obviously unwell, but in many (not all!) cases it's comorbid with depression and treatment with antidepressants and therapy helps with both the depression and fibromyalgia.

As of right now, it's not especially clear what things like fibro and CFS are, and whether they might be mental disorders in some cases, but they're definitely real.

[lkrubner]

I had some illness for much of 20 years. Doctors were uncertain about what it was. They eventually called it Lyme disease because they weren't sure what else to call it. But I was stuck taking antibiotics for 20 years. I tried several times to quit the antibiotics, but I always got badly sick when I did. I eventually managed to achieve a complete cure, by fasting with only water for 2 weeks. I describe this whole saga in detail here:

http://www.smashcompany.com/philosophy/how-i-recovered-from-...

[temeritatis]

That is super interesting, thanks for sharing! Sometimes, less is more.