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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."
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.
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.
Well, Wikipedia can be suspect at times, but here's what it says (http://en.wikipedia.org/wiki/Crohn%27s_disease#Symptoms):
Really sounds to me like a combo of on-again off-again symptoms and symptoms that are fairly generic (i.e., shared w/ lots of conditions) than doctors and labs trying to squeeze ever last buck out of someone and their insurance. Now, if there is a problem if the first thing they do is run expensive tests for exotic diseases or something like that. I mean, a responsible physician would consider the a priori odds of each condition. And while I'm sure there are plenty of "quacks" out there, I'm not sure that's the first conclusion I would reach for in this particular case.
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.
Really sounds to me like a combo of on-again off-again symptoms and symptoms that are fairly generic (i.e., shared w/ lots of conditions) than doctors and labs trying to squeeze ever last buck out of someone and their insurance. Now, if there is a problem if the first thing they do is run expensive tests for exotic diseases or something like that. I mean, a responsible physician would consider the a priori odds of each condition. And while I'm sure there are plenty of "quacks" out there, I'm not sure that's the first conclusion I would reach for in this particular case.
Exactly! Her symptoms could have pointed to IBS, poor diet, allergies, repeated food poisoning or even hypochondria. I don't expect a doctor to run every patient with a headache through an MRI. If this poor student truly was visiting quacks, they would have run every test known to man on her just to pocket the CHIP money!
What I really want to know is how they got a sample of her intestinal tissue for a high school science class.
There is no "I disagree" mod for a reason. Flamebait, Troll, and Overrated are not substitutes.
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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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. :)