The St. Louis Transgender center hath hid serious medical issues faced by children transitioning, a front-page article on COVID-19 hath been debunked, and honor culture returns to America
Seriously though, if anyone else has been to one of the Unspeakable retreats, I would love to know what it was like. I'm even more of a loner and misanthrope than Katie, but might consider doing this if it comes highly recommended.
Another great one. But a kind of cruel thought crossed my mind about the cancer survivor comment; at best, it's a total non-sequitor to try and relate it to your long COVID episode. At worst, it's the hardest brand of narcissism to criticism because of the subject matter.
My most generous interpretation is that the LW meant that she had unexplained symptoms and the cancer diagnosis explained the symptoms. Similar to how long COVID might explain certain symptoms
Other than that. I was gonna make a similar comment - wasn't sure what the connection was . Very glad she was diagnosed in tine
Cancer can happen anywhere in the body, can have pretty much any symptom, and is not easy to test for. Even when we take patients seriously, it doesn't mean that we can find the answer every time.
This was not the first instance of an influencer whining that the public was insufficiently cooperative with her photoshoot, but it was probably the most egregious. Strangers have no obligation to participate in your content, which is exactly what they’re forced to do when someone parks a camera in from of them in public and starts filming.
The Babish thing is a good argument for the “ignore the screaming and it will stop” position, though I do think it helps that he has a generally normie audience. He’s obviously a huge HP fan & has done quite a few HP-themed episodes, which have gotten their own share of squawking in the comments, but he consistently ignores the issue and doesn’t seem to have suffered for it. Interestingly, I haven’t seen or heard a peep out of anyone on his crew, which suggests that he’s either a great boss or he’s hired some very sensible youngsters.
I strongly agree with you on strangers having no obligation to participate in someone's content.
I know it's a generational thing, but I am aghast at influencers. I can't believe that someone would try to film themselves like that and not expect to get shit on. Because it's just so conceited and self absorbed!
It's hard for people who were raised with cultural values of modesty and propriety to wrap their heads around this stuff.
It really annoys me when some idiot is recording or streaming in a public place - usually yelling at the mic, often in the way - while expecting everyone around them to act like extras (or NPCs…)
Of course the problem is that if you get annoyed you might wind up as content another way. I guess the trick is to look as unappealing as possible without rising to the level of noteworthiness.
I can't even stand people who talk at their phone holding it in front of their face in speaker mode in public. I have zero shits to give about people filming themselves. The sense of entitlement is grating.
I recently learned that Amtrak created some harry potter-themed trains that got a lot of 'trans-it' fans angry. Clearly an attempt to get normies who still like harry potter interested in riding the trains but online weirdos got mad about it.
Minor qualm: Katie complains about Jesse’s pronunciation of “written” because it sounds like “ridden” BUT when Katie pronounces the same word she says it like “wri’en” (can’t think of a way to write it out) dropping the “t” sound entirely. Which is more irritating??
"wri'en" sounds like Katie is a Victorian street urchin who is clever enough to learn her letters. "Where is it wri'en that I can't busk with me hurdy gurdy on this filthy stoop"
Being from the South I really don't like hearing anyone's speech get made fun of. Plus I understand Jesse just fine, I don't even register his accent or anything.
OMG! I was yelling in the car. Katie swallows “t”s. She would say “it is wri’en that I lost the bu’on to my coat on a hike up the moun’en this morning”. It’s a lot of her generation. My nieces in New England do it. I thought it was a Connecticut Valley thing but I heard a NPR person do it. I actually wrote to John McWhorter about it and he said the “t” changes over time. Also, although I am from northern New England I went to college in WV -heart of Appalachia. But still, she should lay off my New England homie.
I live in the Midwest now. I do not not notice much here, but it is new among the youngish in NEW England, particularly the Connecticut valley. It is very noticeable
This pod is the whitest thing I participate in besides listening to Phish so I was glad to hear Katie almost get the honor thing right.
I don't know where it comes from, but among lower class Black and Latinos that I've known, we'll joke about beating folks up for blatant disrespect but it's not serious. Well, sometimes it is as you see gang violence in those groups and stuff like that. But yeah, Cardi nor the twitter weirdo was being serious. In fact, when I saw the tik tok this morning I sent it to a friend with the caption 'sis softer than charmin' making fun of her for not getting in their face.
Oh, there are plenty of white teens and adults attending games at Fenway Park in Boston (near where Jessie grew up) or CitiField in Queens (near where he lives now) who would threaten him with violence and possibly follow through if his girlfriend gave their girlfriend the finger at a baseball game. That is if their girlfriends didn’t his stomp his girlfriend’s ass first.
Well of course, everybody got a ratchet wing on the team. I was just kinda amused that they took Cardi B and the twitter user literally though. Neither of those folks really were calling for actual violence nor would they have committed any.
ETA: I'm trying to get "folks" out of my vocab since SJWs took it from us good Southerners!
Yeah I think this is a class, not race thing. Rich people get freaked out by casual friendly violence (for good reason, they tend to have a lot more to lose with an assault charge)
Oh yeah, my people, working class Italian Americans, will also do the same.
The amount of times my dad has made threatening hand gestures to shitty drivers cutting him off? I was legit worried as a kid that he'd do the throat cut gesture to the wrong guy and then hit a stop light...
My BS alarms were ringing like crazy when the report said that "interviews with providers identified no patients who had adverse physical reactions to medications prescribed by center providers."
People have adverse physical reactions to medications and treatments all the time. Good doctors do try to use discretion, for example, considering interactions with other medications the patient takes or avoiding certain treatments if the patient is a bad candidate for such treatments, but it's often unpredictable or unavoidable. Any medication or treatment that affects your physiological functions has the potential to affect said functions negatively. There are plenty of cases of people having adverse reactions to (usually safe when used properly) OTC drugs like Advil and Benadryl. Antibiotics and chemotherapy have saved millions of lives, but they also have the potential for strong side effects. We still recognize that in certain circumstances the benefits outweigh the drawbacks.
Physicians are humans, they can make an educated attempt to mitigate risk when prescribing, but you can't always predict who's going to have side effects and who won't. It's an unavoidable fact of practicing medicine that some of your patients will have negative reactions to medications and treatments. It doesn't mean that someone's a bad doctor, it's just that the human body is complicated and medicine is a process of trial and error.
Unless they've never prescribed anything or attended to patients, it's completely dishonest for a clinic to imply that none of their patients have ever had adverse reactions to any prescriptions made by their staff.
Even placebos in drug trials have a significant adverse event rate.
I also regularly see people who self-describe as being “sensitive to medications” and report often extreme side effects to relatively banal medications. The idea that any substantial patient population has never had an adverse reaction to any intervention is ludicrous. I think the word “physicial” may be a bit of a weasel word here, but it’s BS regardless.
Another interesting phenomenon is the people who come into the emergency department with pain and claim to have allergies to everything but the strongest opioids (Dilaudid, typically).
On doctors: I think doctors have two responsibilities: to take it seriously when a patient says something is wrong, and to be willing to look things up and reconsider.
I mentioned on the last thread that I had glomerial nephritis as a child. I had to go to two different doctors to get diagnosed because the first didn’t take my symptoms--vomiting and intense exhaustion--seriously. And its not like it was a hard diagnosis that defies lab tests: a urine test would have screamed kidney problems (and given that my pee was brown before I got diagnosed, it’s possible the nurse collecting the sample would have screamed kidney problems before the dipstick did). (With the additional symptoms, my normal pediatrician back home had me effectively diagnosed before I came in.)
I am also close to someone who has terrible chronic illness A, which has a more common related syndrome with different treatments which I will call B. She was textbook for A, anyone who had looked up the general symptom on a medical website once should have recognized it. I did, because I have B and found websites that explained the difference. (There is a huge difference in when symptoms occur and how long symptoms last.) She had a huge struggle to get properly diagnosed and treated, even though she was 100% correct on her self-diagnosis and any reputable medical source would back her up.
Cancer woman’s doctor took her concerns seriously. That’s what I want for all patients. Even if it turns out to be psychosomatic, that’s something that needs treatment. It does suck for general symptoms with no easy lab tests, though.
Psychosomatic symptoms are real to the patient, yes, but what treatment do you think they need? I’m not aware that there’s any effective treatment outside of psychotherapy, which medical doctors don’t do. For those not in the profession, it’s hard to grasp that we’re trained to be oriented around things that are serious first and things that are common and medically treatable second. Illnesses that don’t fall into those categories just aren’t that well handled by our system.
We’re also just generally biased towards conditions we can actually treat. I diagnosed a patient with pancreatic cancer recently (after a long battle with chronic pain and precancerous pancreatic lesions following extensive surgery in that general area), and despite the patient having repeated specialist visits and scans, there just wasn’t much anyone could have done about it. It’s sad for the patient, but the underlying reality is that the pancreas is just a really bad location to get a cancer and only in very rare cases is any medical or surgical treatment effective for it.
Modern humans live a cushy lifestyle, but the reality is that we’re not as in control of our lives as we think we are sometimes.
But Psychiatry is a medical specialty isn’t it? I assume that is the treatment the prior poster was suggesting. A medical dr needs to be able to make that differential diagnosis and refer accordingly.
Yes, but this tends to be tough in practice, because many patients will not go and will get angry at you if you suggest this. Just getting access to mental health services is often a challenge even to those who do want them.
And it is tough for the primary care doctor because psychosomatic illness is basically a diagnosis of exclusion. So how much do you want to exclude? How many expensive, wasteful, harmful tests do you want to run? The answer is rarely straightforward.
I have a lot of second hand experience with this due to a family member's struggles with a variety of issues that may or may not be psychosomatic. I think all you can and should really do is to be straightforward, honest, and empathetic. Most patients can and will understand if you lay everything out and emphasize that while symptoms may not have a clear physical cause that does not make them any less real, And that patients often benefit if they do seek psychological care. In my experience with my family member he's fully cognizant that everything may be "in his head" AND/OR that there may be a physical cause for his maladies and he's open to both. Yes, he's probably getting some additional tests that are sort of unlikely physical causes, but those are helpful evidence to give confidence in an psychological cause.
I hear all that, and I do think it’s ideal to be straight with patients, but that is getting harder and harder in a world where a patient can file a complaint against you if they aren’t, in their own mind, “affirmed”.
On the other hand, I do see a physician mentality where if they don’t see a medical condition they recognize, they feel like their time is being wasted, and I think that’s a sad reflection of a culture and system that encourages them to be that way.
I suppose it depends on the person and how reasonable they are in general. I do know someone who is in this boat (no one knows what's causing his symptoms). He's open to the idea it could be psychosomatic or that it's physical. He just wants to be better.
I have a lot of experience with this, b/c I work in mental health with a large healthcare system, and the primary care doctors and specialists refer to MH a lot. I'm also somatic myself, but have good insight into it, and I've worked in medical and mental health for 30+ years as a social worker.
Most of the people I've seen who have psychosomatic symptoms have been through traumatic childhoods. I tell them sometimes (once I know them well) that our brains try to be helpful by getting us to focus on something physical rather than mental. And sometimes they see it for themselves. I had a man who was verbally abused in his marriage who noticed that his shoulder pain went away once he left his wife. The most difficult are the conversion disorders b/c they sometimes are so disconnected from their emotions that they will deny that they are under stress. They may not see their stressors as valid - something like they don't want to go into the family business but are afraid to tell their parents - often these take a lot of time and delving to uncover, and that's just the beginning.
Probably the most common "psychosomatic" scenario I get is a male who has been to the ER thinking he had a heart attack. The ER doc who clears them will tell them it might be anxiety and they will present with a mixture of relief and curiosity.
I'm sure this is maddening for primary care docs (and specialists). Y'all don't have time for this, quite literally.
I think Doctors should take their patients seriously but not literally. Even if it's just psychological, that's still a medical issue! Patients' views and autonomy should definitely be respected in all cases. Ed Yong I think is taking too many people literally and not just seriously if that makes sense. So when a patient self-diagnoses that self-diagnosis should be accounted for in how you treat that patient, doctors should not pretend like their patients' views are worthless.
Your next to last sentence is spot on. I wish it were better understood that psychosomatic symptoms are 100 percent real. My mom is going through this at the moment and it's really hard.
I read Labonita had a tripod set up. If someone turned a 3-hour baseball game into a photoshoot and I had the misfortune of sitting behind them, being distracted while they posed for fuck knows how long, I wouldn't be happy.
I cannot even imagine what I’d do if I found out my kid passed out at school and no one told me. Same school system probably sends kids home for suspected COVID if they cough twice.
Other than the internal investigation, nothing else.
The atmosphere around the hospital/campus is one very much supporting the clinic’s mission though, so I’d agree to take it with a grain of salt. Also since there really are no great standards around care, it makes me curious what they were using to measure correct/incorrect care?
On the other side of fence, a recent emergency order by Missouri is putting out some stifling rules around care. Imagine that in order to treat depression you’d first need to ensure the patient is aware of a government curated list of negative findings/negative outcomes in treating it -- and also requiring getting reaffirmation of that patient’s awareness of said articles quarterly. It has several other comments that just display a vapid understanding of mental health. It’s State government sticking its dick in healthcare like the teenager did to that pie in a certain 90’s comedy.
I have an MD family member in a specialty in which it's extremely important to take a good patient history, because it's a specialty in which you often can't rely on labwork. So this person is very committed to that, spending lots of time reviewing charts BEFORE seeing patients the next day. (If you've been a patient much or taken family members to the doctor, you know this is a rare characteristic!)
This MD has also told me many stories about patients (1) demanding a specific diagnosis that doesn't fit the symptoms/patient history but does look plausible based on WebMD; (2) malingering in an effort to get pain medication even though the doctor has repeatedly made it clear that they will not prescribe it; and (3) lying or making misleading statements about alcohol consumption, smoking, substance use, and so forth.
(Example from the hospital: "I quit smoking." "When did you quit smoking?" "When I got hospitalized last week.")
I'm not even getting into more tragic cases like a patient whose PARENTS attempted to smuggle opioids into the hospital so the patient could use during their hospital stay. As my MD relative commented, "A patient like that doesn't stand a chance."
So yes, doctors should listen to their patients, which includes taking good histories, reading charts, and trying to figure out the relevant truths behind complex medical-social situations. For people like me who are patients, it can feel very annoying to be questioned as if I might be lying, and it's extremely frustrating to encounter doctors who don't take good histories or think carefully.
But I also have to remember that my doctor doesn't know what kind of patient I am until we establish a relationship; vague symptoms can point to a lot of different things and have to be assessed in context; and it's even more important for the doctor to be careful if I'm walking in and asking for a diagnosis of an ill-defined, poorly studied condition than if I'm coming in with something like a simple earache.
Most non-physicians vastly underestimate how the minority of bad actors can really scar the physician psyche.
And I have a vaguely defined bizarre medical condition myself, so I’ve been on both sides of it. I have skin in the game. But when patients lie to you, you have to maintain a professional demeanor, which leaves a lot of pent up negative emotion.
My life was recently saved by medical intervention. I had a severe hiatal hernia and my stomach and intestines were in my chest, and twisted. It hurt like hell. Even dilauded and 2 doses of morphine wouldn’t touch it. I had professional, quick care at the local Kaiser hospital, with a surgery the next day. I’m grateful for modern medicine and the doctors that practice it. How my surgeon is able to focus that long on his feet is beyond me. I realize that the docs and nurses probably appreciate a straightforward case (I told them in the ER I thought it was the hiatal hernia). But I’m thankful every day. People expect too much of doctors. They probably won’t make you feel like your best day when you were 20, but they save lives, when they can.
American medicine is generally very good at diagnosing and treating acute, life-threatening problems which are amenable to medical or surgical intervention. When we look for those things and don't find them, we're not so good, which can leave many people with chronic illnesses that are less common or obvious with bad experiences.
It's great that you were one of the ones who was helped.
Adolescents who were born males who were placed on puberty blockers at Tanner stage 2 have no sexual function. This is despite the discussion that medications have no side effects reported. Dr. Marci Bowers has repeated this repeatedly and Dr. Joshua Safer, who wrote the Endocrine Society's guidelines on transgender affirmative health care, has backed her up. Here's her testifying to that fact on Mount Sinai Hospital's own YouTube channel with Katie Curry hosting. And she even says she doesn't think they gave true informed consent. https://youtu.be/PUxl50_X2i4?t=4104
There’s a fair amount of adults that also don’t have any sexual function after vagina plasty. without going through puberty appropriate to your sex this is a side effect. It’s unknown if they will ever get that function back doing so they would have to go back on androgen possibly
Shouldn’t it be Cardia of B? Or are we genderqueering Latin now?
"What is a Woman's Retreat?"
It's the opposite of a Woman's March!
Seriously though, if anyone else has been to one of the Unspeakable retreats, I would love to know what it was like. I'm even more of a loner and misanthrope than Katie, but might consider doing this if it comes highly recommended.
Have not been to a retreat, but have joined the online community, and it is a great place to interact with a whole bunch of "heterodox" women.
Not been to a retreat (yet) but would like to
I can’t afford it, but I volunteer as wine consultant if it comes back to NYS (and okay, I’ll cook too).
The offhand pronunciation of “la-tinks” followed by an offhand remark about calipers brought me so much joy.
I enjoy an different pronunciation of latinx which is "Latin equis".
"I don't usually butcher Spanish, but when I do, I say 'Latin Equis'"
I 100% laughed
Another great one. But a kind of cruel thought crossed my mind about the cancer survivor comment; at best, it's a total non-sequitor to try and relate it to your long COVID episode. At worst, it's the hardest brand of narcissism to criticism because of the subject matter.
Yeah, I wasn't quite sure what her point was, or why it was worth sharing. But then I'm notoriously cruel.
My most generous interpretation is that the LW meant that she had unexplained symptoms and the cancer diagnosis explained the symptoms. Similar to how long COVID might explain certain symptoms
Other than that. I was gonna make a similar comment - wasn't sure what the connection was . Very glad she was diagnosed in tine
Yeah, the point was her doctor didn't dismiss her symptoms.
Good thing the doctor didn't diagnose her with long covid though! Probably would have missed that cancer thing.
Cancer can happen anywhere in the body, can have pretty much any symptom, and is not easy to test for. Even when we take patients seriously, it doesn't mean that we can find the answer every time.
This was not the first instance of an influencer whining that the public was insufficiently cooperative with her photoshoot, but it was probably the most egregious. Strangers have no obligation to participate in your content, which is exactly what they’re forced to do when someone parks a camera in from of them in public and starts filming.
The Babish thing is a good argument for the “ignore the screaming and it will stop” position, though I do think it helps that he has a generally normie audience. He’s obviously a huge HP fan & has done quite a few HP-themed episodes, which have gotten their own share of squawking in the comments, but he consistently ignores the issue and doesn’t seem to have suffered for it. Interestingly, I haven’t seen or heard a peep out of anyone on his crew, which suggests that he’s either a great boss or he’s hired some very sensible youngsters.
I strongly agree with you on strangers having no obligation to participate in someone's content.
I know it's a generational thing, but I am aghast at influencers. I can't believe that someone would try to film themselves like that and not expect to get shit on. Because it's just so conceited and self absorbed!
It's hard for people who were raised with cultural values of modesty and propriety to wrap their heads around this stuff.
It really annoys me when some idiot is recording or streaming in a public place - usually yelling at the mic, often in the way - while expecting everyone around them to act like extras (or NPCs…)
Of course the problem is that if you get annoyed you might wind up as content another way. I guess the trick is to look as unappealing as possible without rising to the level of noteworthiness.
This is what I am enjoying about middle age.
I can't even stand people who talk at their phone holding it in front of their face in speaker mode in public. I have zero shits to give about people filming themselves. The sense of entitlement is grating.
Speaker phone use in public is going to be what eventually tips me over the edge.
I recently learned that Amtrak created some harry potter-themed trains that got a lot of 'trans-it' fans angry. Clearly an attempt to get normies who still like harry potter interested in riding the trains but online weirdos got mad about it.
this is why we can't have nice things
Minor qualm: Katie complains about Jesse’s pronunciation of “written” because it sounds like “ridden” BUT when Katie pronounces the same word she says it like “wri’en” (can’t think of a way to write it out) dropping the “t” sound entirely. Which is more irritating??
"wri'en" sounds like Katie is a Victorian street urchin who is clever enough to learn her letters. "Where is it wri'en that I can't busk with me hurdy gurdy on this filthy stoop"
Being from the South I really don't like hearing anyone's speech get made fun of. Plus I understand Jesse just fine, I don't even register his accent or anything.
I notice both accents but I think it's cool that traces of regional/cultural accents still remain in our society.
It’s called a “glottal stop” fyi.
Also, why would "written" NOT be pronounced like the "ritten" in Kyle Rittenhouse?
I love regional accents- all of them.
OMG! I was yelling in the car. Katie swallows “t”s. She would say “it is wri’en that I lost the bu’on to my coat on a hike up the moun’en this morning”. It’s a lot of her generation. My nieces in New England do it. I thought it was a Connecticut Valley thing but I heard a NPR person do it. I actually wrote to John McWhorter about it and he said the “t” changes over time. Also, although I am from northern New England I went to college in WV -heart of Appalachia. But still, she should lay off my New England homie.
I'm from the Upper Midwest and I don't know anyone who would pronounce the T in written.
There's literally no American anywhere that would pronounce the T in written or Martin. Only Brits do that.
I live in the Midwest now. I do not not notice much here, but it is new among the youngish in NEW England, particularly the Connecticut valley. It is very noticeable
Definitely 'ridden' is way worse than 'wri'en'.
This pod is the whitest thing I participate in besides listening to Phish so I was glad to hear Katie almost get the honor thing right.
I don't know where it comes from, but among lower class Black and Latinos that I've known, we'll joke about beating folks up for blatant disrespect but it's not serious. Well, sometimes it is as you see gang violence in those groups and stuff like that. But yeah, Cardi nor the twitter weirdo was being serious. In fact, when I saw the tik tok this morning I sent it to a friend with the caption 'sis softer than charmin' making fun of her for not getting in their face.
Also, I think it was fake kinda?
Oh, there are plenty of white teens and adults attending games at Fenway Park in Boston (near where Jessie grew up) or CitiField in Queens (near where he lives now) who would threaten him with violence and possibly follow through if his girlfriend gave their girlfriend the finger at a baseball game. That is if their girlfriends didn’t his stomp his girlfriend’s ass first.
Well of course, everybody got a ratchet wing on the team. I was just kinda amused that they took Cardi B and the twitter user literally though. Neither of those folks really were calling for actual violence nor would they have committed any.
ETA: I'm trying to get "folks" out of my vocab since SJWs took it from us good Southerners!
Ratchet wing： too true.
Yeah I think this is a class, not race thing. Rich people get freaked out by casual friendly violence (for good reason, they tend to have a lot more to lose with an assault charge)
Oh yeah, my people, working class Italian Americans, will also do the same.
The amount of times my dad has made threatening hand gestures to shitty drivers cutting him off? I was legit worried as a kid that he'd do the throat cut gesture to the wrong guy and then hit a stop light...
I am worried I am getting overly-cynical because I am questioning 'is this fake' on quite a lot of reddit comments as well as videos like this.
I think you should post this somewhere publicly, verbatim, as a review.
Or maybe add "3.5/5 stars"
My BS alarms were ringing like crazy when the report said that "interviews with providers identified no patients who had adverse physical reactions to medications prescribed by center providers."
People have adverse physical reactions to medications and treatments all the time. Good doctors do try to use discretion, for example, considering interactions with other medications the patient takes or avoiding certain treatments if the patient is a bad candidate for such treatments, but it's often unpredictable or unavoidable. Any medication or treatment that affects your physiological functions has the potential to affect said functions negatively. There are plenty of cases of people having adverse reactions to (usually safe when used properly) OTC drugs like Advil and Benadryl. Antibiotics and chemotherapy have saved millions of lives, but they also have the potential for strong side effects. We still recognize that in certain circumstances the benefits outweigh the drawbacks.
Physicians are humans, they can make an educated attempt to mitigate risk when prescribing, but you can't always predict who's going to have side effects and who won't. It's an unavoidable fact of practicing medicine that some of your patients will have negative reactions to medications and treatments. It doesn't mean that someone's a bad doctor, it's just that the human body is complicated and medicine is a process of trial and error.
Unless they've never prescribed anything or attended to patients, it's completely dishonest for a clinic to imply that none of their patients have ever had adverse reactions to any prescriptions made by their staff.
Even placebos in drug trials have a significant adverse event rate.
I also regularly see people who self-describe as being “sensitive to medications” and report often extreme side effects to relatively banal medications. The idea that any substantial patient population has never had an adverse reaction to any intervention is ludicrous. I think the word “physicial” may be a bit of a weasel word here, but it’s BS regardless.
A related phenomenon: people who claim to be "allergic" to a medication because they experienced a common side effect.
Another interesting phenomenon is the people who come into the emergency department with pain and claim to have allergies to everything but the strongest opioids (Dilaudid, typically).
Well my favorite are the very weird people who claim to be allergic to water:
https://nypost.com/2022/05/11/im-allergic-to-water-and-my-own-tears-feel-like-acid/
On doctors: I think doctors have two responsibilities: to take it seriously when a patient says something is wrong, and to be willing to look things up and reconsider.
I mentioned on the last thread that I had glomerial nephritis as a child. I had to go to two different doctors to get diagnosed because the first didn’t take my symptoms--vomiting and intense exhaustion--seriously. And its not like it was a hard diagnosis that defies lab tests: a urine test would have screamed kidney problems (and given that my pee was brown before I got diagnosed, it’s possible the nurse collecting the sample would have screamed kidney problems before the dipstick did). (With the additional symptoms, my normal pediatrician back home had me effectively diagnosed before I came in.)
I am also close to someone who has terrible chronic illness A, which has a more common related syndrome with different treatments which I will call B. She was textbook for A, anyone who had looked up the general symptom on a medical website once should have recognized it. I did, because I have B and found websites that explained the difference. (There is a huge difference in when symptoms occur and how long symptoms last.) She had a huge struggle to get properly diagnosed and treated, even though she was 100% correct on her self-diagnosis and any reputable medical source would back her up.
Cancer woman’s doctor took her concerns seriously. That’s what I want for all patients. Even if it turns out to be psychosomatic, that’s something that needs treatment. It does suck for general symptoms with no easy lab tests, though.
Psychosomatic symptoms are real to the patient, yes, but what treatment do you think they need? I’m not aware that there’s any effective treatment outside of psychotherapy, which medical doctors don’t do. For those not in the profession, it’s hard to grasp that we’re trained to be oriented around things that are serious first and things that are common and medically treatable second. Illnesses that don’t fall into those categories just aren’t that well handled by our system.
We’re also just generally biased towards conditions we can actually treat. I diagnosed a patient with pancreatic cancer recently (after a long battle with chronic pain and precancerous pancreatic lesions following extensive surgery in that general area), and despite the patient having repeated specialist visits and scans, there just wasn’t much anyone could have done about it. It’s sad for the patient, but the underlying reality is that the pancreas is just a really bad location to get a cancer and only in very rare cases is any medical or surgical treatment effective for it.
Modern humans live a cushy lifestyle, but the reality is that we’re not as in control of our lives as we think we are sometimes.
But Psychiatry is a medical specialty isn’t it? I assume that is the treatment the prior poster was suggesting. A medical dr needs to be able to make that differential diagnosis and refer accordingly.
Yes, but this tends to be tough in practice, because many patients will not go and will get angry at you if you suggest this. Just getting access to mental health services is often a challenge even to those who do want them.
And it is tough for the primary care doctor because psychosomatic illness is basically a diagnosis of exclusion. So how much do you want to exclude? How many expensive, wasteful, harmful tests do you want to run? The answer is rarely straightforward.
I have a lot of second hand experience with this due to a family member's struggles with a variety of issues that may or may not be psychosomatic. I think all you can and should really do is to be straightforward, honest, and empathetic. Most patients can and will understand if you lay everything out and emphasize that while symptoms may not have a clear physical cause that does not make them any less real, And that patients often benefit if they do seek psychological care. In my experience with my family member he's fully cognizant that everything may be "in his head" AND/OR that there may be a physical cause for his maladies and he's open to both. Yes, he's probably getting some additional tests that are sort of unlikely physical causes, but those are helpful evidence to give confidence in an psychological cause.
I hear all that, and I do think it’s ideal to be straight with patients, but that is getting harder and harder in a world where a patient can file a complaint against you if they aren’t, in their own mind, “affirmed”.
On the other hand, I do see a physician mentality where if they don’t see a medical condition they recognize, they feel like their time is being wasted, and I think that’s a sad reflection of a culture and system that encourages them to be that way.
Believe me, patients with psychosomatic illnesses do not take that news well, and do not believe it.
What they do is insist on useless test after useless test, specialist after specialist.
I suppose it depends on the person and how reasonable they are in general. I do know someone who is in this boat (no one knows what's causing his symptoms). He's open to the idea it could be psychosomatic or that it's physical. He just wants to be better.
I have a lot of experience with this, b/c I work in mental health with a large healthcare system, and the primary care doctors and specialists refer to MH a lot. I'm also somatic myself, but have good insight into it, and I've worked in medical and mental health for 30+ years as a social worker.
Most of the people I've seen who have psychosomatic symptoms have been through traumatic childhoods. I tell them sometimes (once I know them well) that our brains try to be helpful by getting us to focus on something physical rather than mental. And sometimes they see it for themselves. I had a man who was verbally abused in his marriage who noticed that his shoulder pain went away once he left his wife. The most difficult are the conversion disorders b/c they sometimes are so disconnected from their emotions that they will deny that they are under stress. They may not see their stressors as valid - something like they don't want to go into the family business but are afraid to tell their parents - often these take a lot of time and delving to uncover, and that's just the beginning.
Probably the most common "psychosomatic" scenario I get is a male who has been to the ER thinking he had a heart attack. The ER doc who clears them will tell them it might be anxiety and they will present with a mixture of relief and curiosity.
I'm sure this is maddening for primary care docs (and specialists). Y'all don't have time for this, quite literally.
I think Doctors should take their patients seriously but not literally. Even if it's just psychological, that's still a medical issue! Patients' views and autonomy should definitely be respected in all cases. Ed Yong I think is taking too many people literally and not just seriously if that makes sense. So when a patient self-diagnoses that self-diagnosis should be accounted for in how you treat that patient, doctors should not pretend like their patients' views are worthless.
Your next to last sentence is spot on. I wish it were better understood that psychosomatic symptoms are 100 percent real. My mom is going through this at the moment and it's really hard.
John Sarno, who was a retired rehab physician, wrote some good books on this, focused on back pain.
I've been following an audiologist who applies Sarno's work to chronic dizziness. The mind body connection is so powerful.
Anyone reading this who's dealing with dizziness related symptoms, go to the Steady Coach on YouTube.
I read Labonita had a tripod set up. If someone turned a 3-hour baseball game into a photoshoot and I had the misfortune of sitting behind them, being distracted while they posed for fuck knows how long, I wouldn't be happy.
I cannot even imagine what I’d do if I found out my kid passed out at school and no one told me. Same school system probably sends kids home for suspected COVID if they cough twice.
That the WashU clinic situation is now a totally opaque cluster fuck is probably the best take on it.
Any news? I looked but didn’t see anything.
Other than the internal investigation, nothing else.
The atmosphere around the hospital/campus is one very much supporting the clinic’s mission though, so I’d agree to take it with a grain of salt. Also since there really are no great standards around care, it makes me curious what they were using to measure correct/incorrect care?
On the other side of fence, a recent emergency order by Missouri is putting out some stifling rules around care. Imagine that in order to treat depression you’d first need to ensure the patient is aware of a government curated list of negative findings/negative outcomes in treating it -- and also requiring getting reaffirmation of that patient’s awareness of said articles quarterly. It has several other comments that just display a vapid understanding of mental health. It’s State government sticking its dick in healthcare like the teenager did to that pie in a certain 90’s comedy.
I don't know why people feel so comfortable openly filming strangers. I would also be rude to someone who was being rude by filming me.
"The reason why they feel uncomfortable is because they're not self assured."
I think being filmed by a stranger is enough reason to feel uncomfortable.
IT’S JOHN MULANEY NOT MULVANEY 😭
Katie needs to stop microaggressing a historically marginalized group (the Irish)
I have an MD family member in a specialty in which it's extremely important to take a good patient history, because it's a specialty in which you often can't rely on labwork. So this person is very committed to that, spending lots of time reviewing charts BEFORE seeing patients the next day. (If you've been a patient much or taken family members to the doctor, you know this is a rare characteristic!)
This MD has also told me many stories about patients (1) demanding a specific diagnosis that doesn't fit the symptoms/patient history but does look plausible based on WebMD; (2) malingering in an effort to get pain medication even though the doctor has repeatedly made it clear that they will not prescribe it; and (3) lying or making misleading statements about alcohol consumption, smoking, substance use, and so forth.
(Example from the hospital: "I quit smoking." "When did you quit smoking?" "When I got hospitalized last week.")
I'm not even getting into more tragic cases like a patient whose PARENTS attempted to smuggle opioids into the hospital so the patient could use during their hospital stay. As my MD relative commented, "A patient like that doesn't stand a chance."
So yes, doctors should listen to their patients, which includes taking good histories, reading charts, and trying to figure out the relevant truths behind complex medical-social situations. For people like me who are patients, it can feel very annoying to be questioned as if I might be lying, and it's extremely frustrating to encounter doctors who don't take good histories or think carefully.
But I also have to remember that my doctor doesn't know what kind of patient I am until we establish a relationship; vague symptoms can point to a lot of different things and have to be assessed in context; and it's even more important for the doctor to be careful if I'm walking in and asking for a diagnosis of an ill-defined, poorly studied condition than if I'm coming in with something like a simple earache.
Most non-physicians vastly underestimate how the minority of bad actors can really scar the physician psyche.
And I have a vaguely defined bizarre medical condition myself, so I’ve been on both sides of it. I have skin in the game. But when patients lie to you, you have to maintain a professional demeanor, which leaves a lot of pent up negative emotion.
My life was recently saved by medical intervention. I had a severe hiatal hernia and my stomach and intestines were in my chest, and twisted. It hurt like hell. Even dilauded and 2 doses of morphine wouldn’t touch it. I had professional, quick care at the local Kaiser hospital, with a surgery the next day. I’m grateful for modern medicine and the doctors that practice it. How my surgeon is able to focus that long on his feet is beyond me. I realize that the docs and nurses probably appreciate a straightforward case (I told them in the ER I thought it was the hiatal hernia). But I’m thankful every day. People expect too much of doctors. They probably won’t make you feel like your best day when you were 20, but they save lives, when they can.
American medicine is generally very good at diagnosing and treating acute, life-threatening problems which are amenable to medical or surgical intervention. When we look for those things and don't find them, we're not so good, which can leave many people with chronic illnesses that are less common or obvious with bad experiences.
It's great that you were one of the ones who was helped.
Adolescents who were born males who were placed on puberty blockers at Tanner stage 2 have no sexual function. This is despite the discussion that medications have no side effects reported. Dr. Marci Bowers has repeated this repeatedly and Dr. Joshua Safer, who wrote the Endocrine Society's guidelines on transgender affirmative health care, has backed her up. Here's her testifying to that fact on Mount Sinai Hospital's own YouTube channel with Katie Curry hosting. And she even says she doesn't think they gave true informed consent. https://youtu.be/PUxl50_X2i4?t=4104
When you say "have no sexual function" is that for life or for the duration of the medicine?
There’s a fair amount of adults that also don’t have any sexual function after vagina plasty. without going through puberty appropriate to your sex this is a side effect. It’s unknown if they will ever get that function back doing so they would have to go back on androgen possibly