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Teen Diagnoses Her Own Disease In Science Class
18-year-old Jessica Terry suffered from stomach pain, diarrhea, vomiting and fever for eight years. She often missed school and her doctors were unable to figure out the cause of her sickness. Then one day in January someone was finally figured out what was wrong with Jessica. That person was her. While looking under a microscope at slides of her own intestinal tissue in her AP science class, Jessica noticed an area of inflamed tissue called a granuloma, which is an indication of Crohn's disease. "It's weird I had to solve my own medical problem," Terry told CNN affiliate KOMO in Seattle, Washington. "There were just no answers anywhere. ... I was always sick."
Crohn's disease is pretty common, so how come it wasn't diagnosed? The idiot medicos just pocketed the money for tests, hospital stays, appointments, medical certs etc for 8 years while the girl suffered? Hmmm. Come to think of it I'm not that surprised. There are far more quacks out there than decent doctors in my experience.
sudo mount --milk --sugar
For eight years her doctors were unable to diagnose Crohn's Disease? Shit, that's appalling. It's not exactly an obscure condition requiring House MD's staggering intellect, is it? It's been known about for at least a century, and while it's known to be difficult to diagnose with certainty, you'd think someone would have considered it...
Still, kudos to her.
Meta will eat itself
The original CNN story mentions that sometimes a fresh pair of eyes can spot something that the first pair didn't see. Coders and authors will be familiar with the idea. Sometimes you've looked over something and worked on it so much that you can no longer analyse it from the beginning, and it takes someone else to verify one's work. That's why nurses aren't allowed to dispense medicine unless they get another nurse to check that they have selected the right medicine and the right dose and the right patient. Also, the fact that this patient had a vested interest in making the diagnosis means that she would have examined the slide thoroughly. (Doctor) Richard Cavell
When my daughter first started school - many years ago - she caught impetigo. Now, I had had impetigo as a child myself, but I had completely forgotten the symptoms. All I knew was that my daughter had acquired some kind of skin disease, and that it was spreading.
I took her to our local GP who actually admitted that he didn't know what it was, BUT STIIL PRESCRIBED a topical steroidal cream (which did absolutely nothing to cure the problem). A week later, with even more spreading, I returned to the same doctor, and he again admitted he didn't know what it was, and this time prescribed some kind of internal anti-biotic. At that point I asked him, If you don't know what it is, WTF are you doing prescribing medication, and why don't you recommend a specialist. At which point I took my daughter by the hand and walked out the door.
The next morning I was sitting in another GPs office, waiting for him to arrive, and as he walked in the door, he took one look at my daughter, whom he had never met before, and said, "Oh, you poor little girl, you've got impetigo, well, let's get you looked at, and we get that cleared up in a jiffy."
Moral of the story: most diseases are actually well known - if you find a competent doctor. Unfortunately, most doctors are incompetent. Impetigo is an amazingly common problem especially for children of primary school age. For any GP to not have recognized the symptoms is simply an indictment of the complete lack of competence.
As long as the medical community continues to hide the fact that 90% of their job is to memorize symptoms, and accept payola from pharma companies for generating prescriptions , and prescribe medication unnecessarily I will continue to treat them like scum sucking lawyers, used car salesman.
This is not at all surprising to me, although most people would look at me funny for saying so.
If you are:
1. Smart (she is in AP science class)
2. Motivated (you are if you have an illness - it sucks; this is powerful and sustaining motivation)
3. Can spend as many hours of your spare time as it takes. This could be 10-1000+ hours.
4. Are willing to experiment.
5. Live in the internet age...
You can often diagnose and solve your own problems.
The key is to realize that:
1. The info is out there on the internet... somewhere. Probably on a forum, newsgroup post, whatever. (Chances are very high that someone has the exact same problem as you, and has written about it. You just have to figure out what combination of words are on that page and not on others.)
2. Although the signal to noise ratio is not great, if you are smart enough you will eventually learn to filter the noise and retain signal.
3. You may go down a wrong path, but since you are doing a type of extensive depth first search (but since you give up on non-promising leads by using your intelligence, you will eventually hit all the breadth), the search will start to approximate exhaustive.
4. In combination with 3, because you are experimenting, you learn when to curtail one of your search lines and try another.
5. Because you are smart, you will learn when one of your search lines fails but yields a clue to success, and because you are persistent you will get closer to a solution.
Thus, an exhaustive search will very often find the answer. The key enabler of all this, the "intelligence multiplier", is the internet.
Contrast this with a typical expert, such as a doctor. A doctor has 20 minutes to diagnose your problem, and has to remember something he studied for maybe half a day twenty years ago (if at all), in combination with the limited number of patients he has has both seen and successfully diagnosed in his life (compared to the vast collective experience of the internet). He can bill another N clients $$$ for another 20 minutes, or he can research your problem in his spare time. Guess what he usually does? He didn't make it through 90+ hours of internships etc. for the fun of it or to "help people" (maybe 1 in 100). He has student loans to pay off, a current model BMW, a trophy wife or girlfriend, a house in the best suburb, expensive wines to drink, classmates to impress at the reunion, and he has to start at age 30 or so.
And if you get a second opinion from someone who DOES diagnose your problem, does he get the feedback? Does he see your medical records from your new doctor? Usually not.
Another thing to realize with doctors is that many (of course, not all) of the people who go into medicine are not natural problem solvers. They are reasonably smart people who have good memories, good English skills, can cram well, and want the lifestyle that goes with being a doctor. A natural engineer by contrast, is better at diagnosis - figuring out what is wrong and fixing it. But often a good engineer will want to do engineering and not medicine. Note that I'm not saying that great doctors aren't out there. They are. But even the best doctors don't have expertise in all areas.
If I have seen further it is by stealing the Intellectual Property of giants.
It makes you realise what a waste of time most medical training is. We expect medical students to spend a massive amount of time and effort memorising lists of symptoms for particular diseases, when a relatively simple expert system could give them this information more accurately. Spending those seven years focussing more on their deductive reasoning and communication skills, rather than memorisation, would likely produce much better doctors.
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Yes, I've acknowledged that - as I said the pathologist will have been presented with many many samples, turned into slides, looking for a few, if any, granulomata, which are tiny in size. I even said "Now do you start to see why a pathologist may miss it?" It is very hard, if not impossible, to scan every single slide in its entirity, for a granuloma. Fortunately this girl found it, when the pathologist didn't. Props to her,
Absolutely. Agreed.
We must remember that, unlike computers that are often highly deterministic, biology is often non-deterministic, and any given test has a certain rate of accuracy that is rarely 100%. Any given test especially includes ones where there's a human who must interpret observations. Unlike with computers, false positive and negative rates on biological tests are rarely zero.
Jessica had a false negative on an intestinal biopsy for a test that has a poor false negative rate. Not a big deal.
Also, recall that Jessica is far more highly motivated to look for long times at her slides than a pathologist is. A pathologist cannot afford to spend hours gazing at slides, but a high school student can. Not surprising at all, then, that a difficult-to-detect granuloma would, at some point in modern human history, be detecetd by a student and not a pathologist.
This is an interesting story because of initiative shown by the student, but not a very provocative one because of implied medical ineptitude.
Put my fist through my alarm clock with its ding-dong death inside my ear. - The Blackjacks.
Well, experts make mistakes too, and they're different than tyro mistakes.
My primary care doctor is experienced and well known in the local medical community for his skills. One time I had an infection on the right side of my face; it was puffed up and rashy and I had a temperature of 103. He told me to get into his office right away; it sounded serious and he wanted to see me himself. He didn't want to leave this to some kid doing his residency at the emergency room. So he looks through my medical history, scrutinizes the rash, and in his best Sherlock Holmes manner announces that I have shingles. Shingles? Of course! I had chicken pox when I was baby, but the virus can stay dormant for decades, only to emerge as shingles.
So he sends me home with a prescription for Acyclovir ( which makes me sick to my stomach on top of having an infection), and instructions to call if anything changes at all. So I take my antivirals, and the next day I'm not any better. The day after that, my temperature goes as high as 104 and now the left side of my face is starting to swell. I call him up and as soon as he hears that he knows he was completely wrong. Shingles spreads along nerve paths; it doesn't cross the center of the body. He gives me an antibiotic prescription and by my second dose I felt great. I had a temperature of a 100, but after 104 that feels wonderful. After a full day on the antibiotic I was pretty much back to normal.
Every time I see my doctor now, he looks sheepish, because he made such a big point of not trusting my case to some kid straight out of medical school. The irony is that I'd have been better off with that kid just out of medical school. That kid wouldn't have been so certain based on his clinical experience of similar looking rashes. He'd have double checked, maybe done some kind of test, buy my doc had seen this situation before and dealt with is successfully. What I had was a staph infection, which can take on a wide variety of appearances. My rash apparently looked a bit like slightly atypical case of shingles. I must have been so satisfying when his memory dredged up my childhood chicken pox and made that connection. I'll bet that fact that it was a little atypical looking actually made the conviction more firm, because it made the deduction seem all that more clever.
I understand this, though. I've dealt with enough experts in my work to recognize that this is the kind of mistakes experts make. A conclusion that ties up all the details of a problem tidily, yet so unlikely to be arrived at by a less experienced professional is almost irresistible. You can't expect even an expert to avoid mistakes. However, you do expect him to be on the lookout for mistaks and to correct them. The fact that the kid in this article had the problem for years but they never went back to the start of the decision tree to see where they went says something bad about her doctors.
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Don't be crass. You obviously don't understand the level of investigation we're talking here. It is just not possible in a patient like this to examine every single piece of sampled tissue 100%, not unless you want to spend a day on every patient and reduce the wellbeing of the population, to eliminate an already very unlikely diagnosis. Do you know how small cells are? The sample's we're talking are many macroscopic lumps if tissue, cut in cross sections into many more slides, the granulomas we're talking about are groups of 30 or so cells. This could have been the only one. How long do you expect the doctors to look for it? It would be stupid to expect to look all over every sample.
And I find your example a bit hard to swallow - sorry the nurse shouldn't be TOLD the drugs, she should read them from the drug chart, to eliminate human error. Also, you imply that if he had used the right name then the nurse would have spotted the drug interaction? No, sorry, no nurse in the world will argue with a specialist about drug interactions - doctors and nurses are incredibly important in patient care, and they fulfil completely different roles - the nurses role is NOT to spot drug interactions, they are not taught about them, and the doctor knows best about these things. Similarly, I wouldn't expect the doctor to tell the nurse how to do aspects of her job.
So what percentage of those "self made" people had wealthy parents who could pay to put them through the best schools and connect them with those who could help them succeed?
Take Gates for example. His parents were well to do lawyers who sent him to Harvard and it was his mother who directed IBM to him for DOS. If he had been born to minimum wage parents would he be wealthy now? Maybe but much less likely.
I call him up and as soon as he hears that he knows he was completely wrong.
and
Every time I see my doctor now, he looks sheepish, because he made such a big point of not trusting my case to some kid straight out of medical school.
These two sentiments are why I'd trust your doctor. Everyone makes mistakes. Your doctor seems to be good at realizing when he did it, correcting his mistake quickly, and remembering it for a while (enough that he feels obviously guilty). That'd make me trust more that he'd care and do the right thing by me to the best of his ability.
This is why they call it 'practicing medicine'. Not many Doctors are that good at it yet.
Seriously. The most common form of practicing medicine is actually better phrased as 'statistical medicine'. If you have a complaint with a set of symptoms, the Doctor will look at your overall and family health history, your age and basically look at what is most likely to be the diagnosis. If your real issue is not blatantly obvious to see, or you just happen to be unfortunate enough not to fit this well oiled set of statistics. Then you are likely to go undiagnosed. Very few Doctors and specialist will take the time and effort with every patient to hit that few percent that fall outside. They almost always figure they will get a second shot at it at least without causing to much harm or risk to the patient.
The practice of practicing statistical medicine is well known in the profession. There is plenty of literature within the various disciplines about the situation and costs involved. What I don't understand is that the title should not have been this individual diagnosed herself. More appropriately. 'How many patients routinely find the cause of their illness' before the medical profession does, like this woman did. I would hazard a guess that a 'Specialist' level of failure is statistically related to the statistics they use, on your specific complaint. To put it another way. If we still deal with only the specialist level of care, then over one year period. If 10 patients of the same demographic come into the office with the same complaint and the actual disease has only a 1% chance of hitting that age group. But for argument sake all actually have this disease. He will either get only 1 wrong or he will get it wrong for all but one. Guess what really happens? Use statistics if you wish. :)