Not infrequently people raise medical matters on this forum. The threads generally go along the lines of "I've got this problem, has anyone else had it and what did you do about it?"

To my mind, there's nothing wrong with finding out more about the condition and what remedies have worked for other people - provided that one doesn't assume that the same remedy will work for oneself. In my opinion, discussing medical conditions on here is not much different from discussing such issues with real life friends. In real life, you talk about anything and everything with your friends and workmates, and are likely to get opinions which are just as diverse as anything you read on here. If anything, in my opinion, there are advantages to talking about it on here because if somebody says something really inappropriate, they would get shot down in flames and that doesn't happen if you're talking the problem over with someone in real life.

On the other hand, I know there are a number of people who who don't think medical matters should be discussed. Some of them are doctors themselves, and I appreciate that it must be very hard to watch what might be professionally regarded as inappropriate treatments being put forward as suitable.

To my mind, discussing medical matters provides food for thought and maybe the impetus to go to a doctor with the problem. Trying to quash discussion, in my opinion, is more likely to lead to the person doing nothing about it. Surely it's not crediting an OP with any sense to make out that because XYZ remedies have been used by other people, the OP is going to go and try them all - isn't that treating us a bit like children?

What do other people think? Since the issue crops up fairly regularly, I thought it might be useful to have a discussion on it...

I think putting the feelers out to see if other people have had the same experiences isn't an issue... It's when they act on bad advice given on a forum that it can be problematic (eg: "Eye of newt and toe of frog worked for me!"). It's nice to see that there are options out there and it might as you say, give them the nudge required to see a GP/specialist.

Some fora on t'interweb ban all discussion of medical issues to avoid any legal complications.

Well I have to say that I agree with you Skylark, I don't see any reason why someone can't ask peoples opinions about a health condition. I am sure that we are all sensible enough to realise that if we want a proper diagnosis then we should go to a doctor.

ET

I've got too much time today

I don't think it's trying to stop a discussion, it's just rather trying to prevent arguments - when the word 'insult' starts getting used, that should clearly be allowed.

Apart from that, I think it is more helpful to suggest where people can get professional advice than to confuse them further. Or people offering advice who have neither experience with the drug (at least that should be the case IMO) nor work in a healthcare job, but I wouldn't say they are not entitled to have an opinion (just the question if it helps to discuss this on a rather abstract level that is neither down to personal nor professional experience - one could argue).

That's just my opinion, down to previous discussions. I might have seen it differently some while back ...

If you want a proper answer to a medical problem, then two things are required of the person you ask:
1) they need to be qualified
2) they need to be in the same room as you (in only a few cases is this not applicable, e.g. telephone CBT!)

There's nothing to stop you asking / discussing such things on a forum, especially with sharing experiences of things. I don't mind people talking medical, and may contribute where I can. But the 'asker' needs to be aware that nobody on a forum is going to be able to deal with the specifics of you and your health.

But, having all your forum friends say 'you really should go and visit your GP' could lead to someone actually going and getting the help they need and might otherwise avoid, so it's no bad thing

The main troublesome issue with the discussion of medical matters isn't when someone is told there are options available and encouraged to go to seek appropriate professional advice; but rather potentially useful treatments are discredited based on a poster's personal experience or biases, and hence someone is thereby discouraged from seeking advice.

It's natural to consider ourselves a little knowledgable about things with which we have some experience - having taken a beta-blocker, or a painkiller, or found some physiotherapy exercises that help with our gammy knee. However, it's the extrapolation from a negative personal experience to the general case and posting against an option that causes problems. The perennial example is 'beta blockers are a waste of time, they did nothing for me and/or make you play boringly and/or are addictive'. Or even without experience, an opinionated person might write 'don't go to your GP with depression, they'll just stick you on anti-depressants - you need to pull yourself together, get a hobby, go out to see people, and do more exercise' (and yes, I've seen this on fora all over the 'net). Both of these are just the poster's opinion, but if someone is considering seeking medical advice, both of these would deter them from doing so.

Our individual experience does not change which licensed treatments are more or less appropriate, in theory, for a given condition. With reference to my own experience, I have chronic upper back pain and swear by a daily combination of morphine, served with extra morphine as needed. But I won't go bad-mouthing physiotherapy, ibuprofen, paracetamol, diclofenac, baclofen, diazepam, chlordiazepoxide, codeine, tramadol, meptazinol, gabapentin, and lidocaine patches - I'm in the fraction of patients who don't respond to each one of these respective treatments, but it doesn't mean they don't work better than placebo in a double-blind study.

I do think there are some issues that could be considered medical, but also can be appropriate to ask some of the teachers on here, such as pain arising from bad posture or technique on the various instruments. In this instance I certainly think that the questions are worth asking, but always on the understanding that we can't see exactly what happens and most of us are musicians not doctors.

Well, this actually happens every day when we talk about music or when lawyers talk about law.. or whatever.

When a doctor, teacher, policeman, accountant etc become qualified, they don't suddenly acquire divine knowledge and a halo! Though I know some of them still do!

You'd be surprised how much in the scientific world is governed by what and isn't fashionable at that moment or by whatever perks the drug companies are giving or who is funding so called scientific studies.

This is not to denigrate for one second the hard work that all professionals do, but merely to blow away the mystique that certain professions like to give the impression they have.

The phrase "Trust me, I'm a professional" has been used since time began. Look at the old adverts for cocaine and opium or the teachers that forced left handed kids to write with their right hand.

I'm sorry if I come across as ranting, but with the way things are going in the UK, I'm determined to fight for freedom of speech as long as I can!

At least till the knock at 3am!

Steve

As much as that might be the case, one has to weigh up a medical professional who is with the patient, and in possession whatever training and experience they have; against people playing doctors and nurses on the Internet. They might be human, and thus imperfect, but are still in a better position.

I can understand why doctors may be loath to give opinions when readers know they are doctors, and might therefore take their comments more seriously than comments from those who are only giving opinions based on two-dimensional personal experience. Doctors have a professional obligation to look at the whole picture before giving advice to a patient, and that whole picture may not always be what they get here. They don't have a full case history to look at, have no idea whether the poster is even asking on their own behalf or somebody else's, and therefore need to be very careful in qualifying their response to medical issues.

However this often leaves us with the blind leading the blind. All we can really talk about is our own experiences, but I don't see the harm in that, as long as, as YetAnotherPianist said, people are not dissuaded from seeking proper medical advice about something that might be the only solution to their problem[b]. Certainly, no one should feel that they are morally lacking because they need help with something when a doctor may be able to provide that help. It's not wasting a doctor's time to ask about aching joints; if there is potential help out there, the doctor will refer the patient accordingly to a specialist - whether the specialist is in the public or private sector, as appropriate. If panic attack in performance is an issue, it is not wasting the doctor's time to be asked for a solution any more than it is wasting his time to be asked for help with panic attacks at social gatherings. Neither is life threatening, but neither, too, are the vast majority of things that people do see the doctor about!

I think the specific problem with the "nerves and beta blockers" issue is that many people who encounter normal nervous states before and during a performance have really no idea of the extent to which some others suffer. There is a point beyond which it should be termed simple 'nerves', and at which it becomes 'panic attack' - a simple question of semantics - but this is not always taken on board in the course of discussions on how to deal with the issue. Neither by those who discount beta blockers nor by those who recommend them to all. I think sometimes a doctor's input can clear up misunderstandings on any subject when posters clearly get the wrong end of the stick about a medical matter, but I can understand why they would be wary of giving too much input.

I totally agree but the original post was about whether we should discuss medical issues on the forum, not necessarily diagnose and prescribe drugs! Over the years I have got a lot of advice and help from both the internet and colleagues at work about medical conditions but of course it would never take the place of an informed diagnosis by a doctor.

Given the generally high intelligence of the posters on this forum, I'm sure that most people will always receive the correct advice...i.e. see your doctor.

The original post - I think - was sparked by the question of when these discussions become too heated and lead to insults being exchanged. But that's a totally different issue! If we were to ban discussions because they may lead to arguments then we'd never discuss anything!


Steve

I think depression is a good example of a medical condition which it is actually beneficial for someone to talk about on a forum, particularly this forum where the vast majority of people are level-headed and intelligent. Depression or any other mental health problem is something which many people would be concerned about mentioning in real life because it could affect the way they are perceived at work or in some of their relationships. Broaching it within the anonymity of a forum might be the first step towards getting treatment for it. I believe most people here would qualify their response with the caveat "it's best to see a doctor or parent". The OP of such a thread would probably know that deep down, but hasn't yet got the confidence to take that first step. Being encouraged to do so by others might help.



Yes it's an internet forum, which is supposed to be for discussion, information and support and there are all sorts of benefits to that. Exchanging experiences can provide comfort - ie thank goodness I'm not the only one that's had this problem. It can put people in a better position to talk more meaningfully with their doctor and ask appropriate questions. It can encourage people to go to see a doctor. It can provide information which the OP may not have thought of or known about. An example from the Nerves thread is someone giving the link to Bapam (British Association for Performing Arts Medicine). If the thread hadn't been started, many people would have remained ignorant of the existence of Bapam.

In my opinion the benefits of medical threads far outweigh any negative outcome, which from what you've said, is a concern that people could in fact be deterred from seeking medical treatment because of somebody dissing it. If the welter of opinion was against a particular treatment, yes the OP might be deterred, but it's unlikely that the majority would diss a recognised medical treatment.



It wasn't the direction of that discussion which prompted this thread, it just happened to be yet another thread discussing medical issues where the inevitable happened and somebody said something along the lines that such threads were a bad idea, albeit fairly softly (not getting at anyone here!) It's more the freedom of speech aspect as you mentioned earlier which prompted this thread - some people are against medical threads, some against threads which air other personal problems, some against discussions where strong views are held, some against trivial threads etc etc. The forum would end up being very bland! As long as it's within the rules, in my opinion people should be able to feel free to post what they like and I think it would be a shame if people stopped posting about medical issues or anything else in case they thought they would be jumped on and told they shouldn't be posting about that particular thing.

As someone with a very rare medical condition I find the internet a wealth of ideas and possibilities, but the system is to find out what other people have tried and then take any such evidence as you have to your doctor, and give them time to research the idea. If I left it to my GP's limited experience with rare conditions (not his fault, you just don't come across someone like me more than once in a lifetime of general practice) then I would never have tried anything at all. When I get a chance to discuss with other people I can find out that drug x actually exists, or that treatment y is available to someone else in my NHS area when I have been told it's not.

We do have to be treated as sensible enough to process any information we receive via a reliable expert, however that reliable expert is not always your GP. There is more expertise in many rare conditions can be collected from patients than from doctors. Some patients are critical academics with the same sort of experience as GPs in reading academic texts and deciding what is and is not reliable evidence that something works. Once you have a diagnosis from someone experienced in anatomy, physiology, chemistry, etc. - the skills of the GP - then any other experienced academic is not doing a different thing from a GP if he goes away and studies articles in the Lancet and a meta-analysis of worldwide data. In fact, GPs are often those with the least time to do that sort of thing, especially for rare conditions. GPs are a wealth of expertise on new treatments for diabetes, angina, asthma, all the things in the "General Practitioner" magazine. They are not as likely to know of a cutting edge new treatment for Ehlers-Danlos Syndrome. In fact, for cutting edge treatments the consultant is usually taking almost as much of a leap in the dark as the patient. It appears from early studies that this treatment is safe and effective, shall we give it a whirl?

And what do statistics really mean anyway? If 97% of people found treatment x effective there is no higher likelihood in pure mathematical terms that I will fall in the 97% group than the 3% group. From many perspectives I really don't care what works for most people, only what works for me. I have to beat off the desire for me to try the same treatment all over again because "it works for most people". I myself have tried it 26 times and each and every time it did not work and made me worse - what's to try a 27th time? Or the "have you ever tried..." No, I never tried the safest, most routine, cheapest first line treatment, my consultant and I decided to go straight to dangerous and radical surgery just for the heck of it! I suppose there is a risk that the uninformed person does hear that a tertiary choice helped someone else so they try that first rather than a much safer simple cream or change of diet.

I think it is rather patronising to put people into little boxes of Doctor=God who knows everything about everything, Patient=Total Moron. I suppose I have a different perspective from many, it's not as simple as I have the occasional small problem, go to the doctor, he/she says oh yes we know what that is and this tablet will make it go away. My GP is more of a stepping stone to the national specialist hospitals that have enough experience to work with me, or a source of legal prescribing for the treatments I have researched and sent the research to his secretary. He trusts my judgement, and for the most part signs off whatever I want to try because he knows I have looked into it properly, not just Googled it and gone ooh, I've never tried yak urine, perhaps that will cure me.

I also need to be a partner in my own risk-taking, and I dislike doctors who say we can't do that because it's too risky - the risk is mine to take too, and your role is to explain the risks so I can choose whether or not I want to take them. Then if you personally do not want to put yourself on the line to be complicit in that risk I can look for someone who does, but it's back to the "good patient pat on the head" to just tell me that for you personally risk A is preferable to risk B, you are not in my pain. Apparently they say you should never perform an operation you would not want to have done yourself, but that's kinda nonsense because some people would just never, ever have a foot amputated unless it were going to kill them. Others get fed up with a neuropathic foot getting infected and dragging and cramping their lifestyle in a way that the person who hasn't had one will never truly understand, and just want it off. Why does a doctor assume to decide for a patient what suits his personal lifestyle?

And finally, since I am on my soapbox, I think some people need to be able to fully get their heads around incurable. Many times I have told someone I have an incurable genetic condition and been told they hope I find a doctor who can cure me soon, like the answer always has to be out there. I think one of the reasons my GP trusts my judgement so much is he knows I fully understand I shall not find a cure and just want to ameliorate the symptoms. When one gets really desperate for a cure for an incurable illness that's when the most usuary charlatans come out, and when people start to go down the most extreme routes.

*can of worms now open*

Since there is a possibility that this thread, somewhat catch-all in its scope as it is, might have been triggered by my protests about requests for medical information: I'll try to explain where I come from on these matters.

I qualified more than twenty years ago now, and remember well that first, scared day, venturing out into the beginning of my eighty-four-hours-per-week first job, unable to believe that the people saying, "doctor" actually meant me...I started that job aware that I really didn't know anything much, but ironically, my ignorance meant that I was only about a fifth as frightened about just how much responsibility I was carrying as I would have been if I had known then what I do now. That is why I react as I do when medical advice is doled out on the forum - spells of breathlessness may be anxiety, or they may be asthma, or indeed something else entirely, but the nonmedical contributions to questions on symptoms on the fora tend to be skewed, depending of course on contributors' personal experiences, and that can end up being falsely reassuring, or falsely frightening.

So much then for the aura of mystique we're supposed to be cultivating - we've got the experience and knowledge base we have by dint of hard work and unending self re-education, over years and years. Sure there are fads and trends in medical thinking as in any other part of society - but we practise our craft with reference to protocols, and we all have to justify our work as evidence-based.

As far as the sorts of discussion which might be helpful to have online go - I really don't know the answer to that one. The voluntary sector, self-help groups, support groups etc, will probably have more information than a random forum of musicians might. Sure, if a particular grip on a violin neck is causing hand pain, another violinist might be able to give advice on how to alter the grip. Performance anxiety, the question asked which bugged me recently, does have other approaches, but the question had been about medication, and my own view is that given that it is a practitioner who has to provide that, asking a forum of musicians about it is not going to be that helpful.

My final beef with talk on medical issues is that it's not just forum members, who may well be more intelligent than average, who can access this information - it's open to anyone who knows how to type a question into a search engine and can read English. You cannot assume that the information will be well used by others, even if we assume that it probably will be by those who requested it. If I give medical advice at work, it's tailored to the individual, and relies on proper history-taking as a minimum, and examination as an ideal - on a forum that is impossible.

Given that success rate it would be 97/3 times more likely that treatment x will work for any given random person. This is no guarantee, but it is most certainly a higher likelihood. Of course, if you're in the 3% then it will probably be no consolation to know about the other 97% - for you it doesn't work 100%. Maybe I've misunderstood what you meant, bearing in mind what follows:

It's the only thing that counts!


That attitude irritates me enormously too: Some of my colleagues (some branches of the profession are notoriously worse than others on this) have a God complex that is simply astonishing even though I've spent my entire adult life exposed to variations on it. On the other side, in my experience patients who are total morons are such a rarity as to be almost (but alas not quite) mythical: Very, very few people are completely stupid.


Call me odd but I wish more of my patients took this attitude. Without it intelligent discussion and properly informed consent are almost impossible.


I don't see a problem in hoping that a cure eventually can be found for in incurable condition: Without that hope there is no research. However I fully agree that there is a difference between the hope that drives research (building on existing knowledge and realistic expectations of improved knowledge in the hope that one day this might help lead to improved outcomes and even, eventually, perhaps a cure) and the sort of desperate hope that the quacks and snake-oil salesmen feed on (building on fear, fantasy, lies and the realistic expectation of a quick buck).

Best wishes! I hope research into your currently incurable condition yields results in time to be of benefit to you: Will that be OK?



. . . to which you can add appropriate investigation.

As doctors the most we can offer on a forum is general advice about conditions, symptoms or signs: Specific advice on a specific problem in a specific patient is highly likely to be flawed, so we try not to do it and try to discourage others from doing it.

*Debate, not argument*


I do understand that medically qualified practitioners on here may find it frustrating to see replies which they believe are flawed. The same must go for professional accountants, lawyers etc, although I appreciate that the stakes may be higher where health matters are concerned.

Where would you draw the line though? For instance I've recently started doing more walking in order to get fitter, and I've got various aches and pains as a result. Not that I'm planning to, but I can't see a problem in posting about that and asking if anyone else gets pain in a particular joint/muscle when walking. I'm not asking for a diagnosis or advice - it's just conversational, a sharing of experiences. The notion that I would see my GP because of this is out of the question at this stage - I expect the aches and pains to subside as my limbs/joints acclimatise to unaccustomed exercise, and in the meantime I'm trying not to overdo it, and if I thought I was doing myself serious harm, well of course I'd see my GP. Would it be so wrong to talk about this on a forum? This isn't just a forum of musicians - it's a community of people from all walks of life, and people are people, as likely to suffer a similar range of ailments as the next person.

I don't think there's any doubt about the sincerity and the concern of the doctors on here, and I'm sure most people appreciate it. But on the other hand, I do think people should be allowed to be responsible for their own decisions, whether that's to see a doctor or not, to ask on here for shared experiences or not, and to take notice of any responses or not. Even teenagers who are technically not adults, are capable of taking that responsibility. If someone is not yet at the stage where they feel a doctor's visit is necessary, then talking about it on here with trusted members of a well-established community is surely preferable to going to alternative sources of information which may not be as sensible. People will only go to a doctor when they are ready, and talking about it on here may be the pre-cursor to taking that step.

So does anyone know a sure-fire cure for Morton's Neuroma (probably caused by too much running while over-pronating and or numerous injuries sustained playing soccer).

Apart from not being able to run very far these days, it even gets painful doing the shopping. I am certainly not going to be hiking up Kilimanjaro (at least - not without pain-killers) until it is fixed.

Neither cortisone injections nor custom orthotics has made any difference.


I will of course immediately try out whatever is suggested with no further thought, consideration, or application of intelligence.

Try rubbing mustard all over yourself liberally, and strap a toad on your head for a week!

I thought that was the other way round for that condition?

Ouch, aaargh, croak. croak, bloop. ... ah ,, ah, whoah, ...

Paula Radcliffe had surgery for this
http://sport.scotsman.com/paularadcliffe/R...t-be.2777061.jp

Thanks. The problem is real, despite the superficially flippant last sentence in my post above, and my jokey reply to Solari.

I can accept that I may never run again - I can still swim and cycle enough to stay fit, but to be able to walk without pain would be wonderful. I didn't know Paula Radcliffe had the same condition, and had surgery for it. But from the article you linked to, it seems that surgery is far from being a certain cure. And as I should have had it done 5 or more years ago, I'd be in for a long recovery.

Can you please die quietly, some of us are trying to have a discussion?

It seems the intelligent debate has gone out the window! Shame, I was enjoying reading it!

But Mad Tom's point was quite intelligently illustrated. Humour and ridicule can say in a very few words what serious debate would take a whole page to say.

Well, it's well known that the cure for water retention is a tap on the knee!


I'll get my coat.



Steve

You've just inadvertently demonstrated above one of the reasons why I'm so against any form of censorship on this forum provided posts stay within the rules. Who knows what will come out of a discussion on any topic? Maybe the information about Paula Radcliffe will mean that you or others with Morton's Neuroma will pay close attention to articles about her in future in case she finds successful treatment, who knows? As I mentioned earlier, a link to Bapam came out of the Nerves discussion. Whatever information comes out of a thread, it's our own personal responsibility to do what we choose with it and to seek to remove that responsibility is to treat us as children. In my opinion!




As I understand it, doctors are becoming less and less willing to take on risky procedures or operations because if they're not successful, it affects their performance charts and could have other far-reaching ramifications. I can't say I blame them - it's another aspect of the "tick-box" society which our politicians have created.

I don't know anything about performance charts, but I do know from personal experience that fear of litigation is too big factor in doctors' decisions. For this reason I think it is in our interests to be as well informed as possible, to be able to weigh up from our own subjective angle, and to be prepared to take responsibility. It is all too easy to assume that the doctor has a black and white reason for a decision that is purely in the best interests of the patient. This is not the fault of the doctors, but the fault of society. Doctors also take advice from other doctors, and the nature of specialism means that the whole picture can be clouded or erased altogether. It is our responsibility as individuals to see the doctor in a consultative role, but the buck stops here. "Doctor's orders" is an expression of the past. They do not have crystal balls, and it is wrong in this age of so-called enlightenment for us to expect them to. It's all too easy to allow a doctor to take a unilateral decision and then blame the doctor. Had I not been aware of the extent to which the fear of litigation affects doctors' responses to any given situation, I would have had fewer children, too many Caesarians - and my mother would be in a locked EMI unit. Having made my own decisions, I have to say that in the aftermath, the doctors in question have been hugely supportive and done all in their power for me, and I could not have done without that, but it took me to go against their 'advice' in the first instance and it was clear that any risk involved was mine.

So my point is that we always have to assess advice from whatever source within the context of the source. Knowledge is essential, and opinion is essential, professional and otherwise, but we cannot blame doctors for not knowing everything, and the ultimate decisions are always our own. If discussion of these things became taboo on public forums I think that would be wrong.

Strange enough that exactly the same person who gave the BAPAM link was the one who was a bit wary of the whole discussion (in case anyone wonders - if we are talking about the same thread, it was me). One does not have to exclude the other.

To put it in a nutshell: I am not against these discussions as such - I think they are an integral part of staying informed and make the (hopefully) best possible choice. What I am against though is the bickering and arguing. Of course not everyone does this, don't get me wrong here. It started to get into that direction though.

The problem with controversial treatments or medications (if they are stamped this rightfully or wrongly doesn't even matter) is that we have a very personal viewpoint, down to own positive or negative experience. Again, this is not right or wrong, just personal.
The problem arises though where this personal opinion, all the more when it has been asked for (or do we just want to hear that our own ideas were right?), gets pulled apart. It doesn't matter if the majority or minority is of the same opinion, it doesn't make one right and the other wrong. Of course someone who has been successfully treated with e.g. a certain type of drug will not like it if someone else says that they would never do this, also down to personal reasons. Especially when a psychological background is involved, like it is the case with the mentioned 'nerves', the tolerance level of what is regarded not insulting (again a very personal feeling) or hurtful is sometimes very low, which can lead to all sorts of interpretive problems and misunderstandings.

This is the part I am not comfortable with, not the discussion itself. The reason I mentioned it is that there were really tons of threads about this in the past, and they all seem to end in a similar way. Considering the deeply personal root of the problem, I don't think it is really a surprise.

I think most people here, albeit not all, are always careful enough to explain why they have a certain viewpoint. I would also think that most people are intelligent enough to just see this as a bit of brainstorming. We had the problem in the past that people thought things were rightly or wrongly discouraging people of getting proper medical advice. Of course this would be a problem I wouldn't like to be responsible for, but I also think this is a bit of a thought-terminating cliche. Still, I can see why someone e.g. working in a medical profession is wary of these types of discussions, and I can also see why people with personal experience would like to share them.

We should all have the right to say: "I don't like this or I don't, I would do it or I wouldn't", no matter on what we base our opinion (even if it is the toad-and-mustard approach ), as long as we explain it, so the reader can make an informed choice.
Strangely this sometimes doesn't seem to be possible without getting personal.

It is right however: Not a problem of medical disussions, but of debate culture ...

I have reason to believe that a decision as to appropriate treatment is not even necessarily the doctor's to make. For instance, if the official body decrees that X drug is the best treatment for a particular ailment, but the doctor believes that because of certain other factors in the patient's medical condition, a different - and more expensive - treatment is appropriate, that doctor may find themselves answerable to the Trust's administrators to justify the extra cost. Far easier to prescribe the normal treatment than go out on a limb and come into conflict with your paymasters, even if you believe it's not the best treatment for that particular patient. I'm certainly not blaming the doctor for this state of affairs - it's another insidious example of responsibility being taken from the individual and put into the control of the state.

I hope my selective quoting doesn't place your comments "out of context", but these few points above are the basis of many a 'problem' on the forums, if not all.

Indeed. I find sometimes that the best approach when I have a strong reaction to a post is to go away and sit with those feelings for a few hours or even a day or two, then return to readdress the subject with a fresh mind. Misinterpretations, reading more into a comment than the writer intended, based on my own previous experiences, the sort of day I have had and the number of people who have trodden metaphorically on my toes can really influence how I respond to something I read. I'm sure the same is true for others. Taking time to think and respond calmly and sympathetically while stating one's own opinion clearly are the important skills here.

I have no problem with a wide range of opinions being expressed on whatever subject is being discussed - medical subjects included. We can all learn from each others' experiences and this is one of the real strengths of a forum such as this. I would always go away and do my own research as well before trying something out that I had read about - and we are all free to do this. Giving specific medical advice over the internet is a dangerous game, as others have said - general medical information is different, but should always be qualified with the rider that you need to discuss your own specific situation with your health provider (notice I am not saying doctor, as I recognise that we don't all choose to see doctors and I respect this, even though I would feel that a naturopath would be less likely to have a thorough understanding of pharmaceutical medication, just as I would be less expert in the use of herbal and naturopathic medications, not having been specifically trained in this area). I'd actually argue that the same is true of other things - for example, teaching is just as much a skill and area of expertise as medicine and I would imagine that specifics are equally important when giving advice to other teachers (it certainly seems so from reading the posts here and from my experience with growing up with two teachers - my parents!). General advice is safe enough, but infering too much about the specific situation from a small vignette can lead to all sorts of potentially harmful advice (I don't mean that the person giving the advice intends it to be harmful, just that they don't know enough about the situation to know if it is appropriate). Sure, the majority of us will hopefully have the experience and maturity to recognise this and disregard those comments which are neither relevant or useful (comments can of course be irrelevant but still useful or vice versa!). And certainly others reading the thread will benefit from learning about approaches which they may not have encountered but which may be helpful for them. I think, though, that we all need to be careful about being too black and white in how we express our opinions, not only to avoid giving offence but also to highlight to others who may not be as experienced that advice in an internet forum is a great resource but has to be used wisely and in a questioning sort of way. Children and adolescents are two groups that spring immediately to mind as examples of folk who may not have developed their critical skills sufficiently yet to successfully filter information of this sort and certainly can have very open access to the internet (I supervise my daughter pretty closely as she is only 12 and has training wheels on, so I can speak from experience here - she talks to me about what she reads and I monitor the sites that she visits but I know for a fact that she is in the minority in her peer group and others are doing much more wide ranging things without their parents having any idea what they are up to - I see it at work too, as I do a fair bit of adolescent mental health).

To give an example of potential harm done by giving medical advice over the net - I also work as a lactation consultant (I do shared obstetric care as a GP and decided I needed some extra training in this area, so have done my International Board exams twice now). One of the most common presentations I see is breast and nipple pain while breastfeeding - there are a host of potential causes, none of which can be accurately diagnosed without watching mother and baby interacting during a feed. I frequently see mothers who have tried treating themselves and the baby for thrush (not arguing that it doesn't exist, just that it is a much less common cause than you might think) on the basis of advice over the net from other mothers - that's fine, but when we actually take a history and watch what is going on (and ask the mother how it is feeling while she is feeding the baby), nine times out of ten the problem turns out to be a positioning issue and actually pretty readily fixable with some small tweaking (which reminds me strongly of playing the cello - so often I just need to do something differently in a subtle sort of way and problem is solved - thank you teacher!!!). I recognise and respect the autonomy of those women to try things themselves before seeing me. I welcome the mother to mother support that you can get over the internet or in mothers' groups - goodness knows I benefit from it on an ongoing basis myself! I just wish that someone along the way had said to them that there are limitations to this sort of advice, as by the time they get to see me they have been through a fair bit of pain and suffering (always assuming they haven't given up in disgust, then blamed themselves for not persisting) which was really fairly avoidable. Sigh. On the other hand, perhaps they heard over the net that a lactation consultant (or even an experienced mother who has had this issue herself and knows what to do to fix it - but who can see what is going on and knows to refer when her approach isn't working) can help - and so were encouraged to seek help. And that can only be a good thing - and so we have come full circle to the argument that there are benefits to having these sorts of discussions over the net.

I think the key is respect - thinking about what you write, reading over what you have written before you press the add reply button and being careful about very strong comments, which can more easily be misinterpreted. Some of us do this beautifully (and I have learnt a lot from reading their posts - thank you!), others could benefit from the above strategies but no doubt mean nothing but the best in what they contribute, and I thank them too for their generosity in taking time to add to the general pool of wisdom. I also appreciate the patience of many of you as new folk like me find their way around the forum and learn the general courtesies of this rather unfamiliar environment.

Wolfnotes

Yes, that's sort of where I was coming from, statistics only apply to quantities of people. If you actually have 100 people then it's 97/3 that a random person will fall into the majority group, but when you have only one person the odds are actually no greater that they will fall into either category no matter how much more likely it would be for one state of affairs to apply in a group. Statistics only work on groups of random selection, and they don't remember that the previous person fell into group A. I have had so many doctors say to me I can't possibly have a particular condition because it's really rare. So that means I can't have it then? Granted it's pretty unlikely, but it's not an internet diagnosis, it's something I have been sent to London to see the world expert for! It gets to me when others with my condition welcome all new-comers to the forum who say "might I have x" by saying it sounds like they do - the chances are tiny.



Exactly, I was more meaning those people who think that if I am not better yet it's becuase I just haven't tried the right combination of special diets and alternative therapies. They believe that a cure for everything must exist and it must be out there right now, and it must be one of the things that we know about, so it's all down to the fact I haven't read the correct clipping from the daily paper yet. Plus I haven't got time to try all the cures, I'd honestly rather be ill but getting on with my life than constantly pinning hopes on unlikely cures with little to no science behind them.

Why on earth should we do that. Is it to avoid being sued? Have we finally become American?

You should accept NOTHING uncritically. That includes " advice " from the internet, on any subject. It can vary from the best any expert could give you to (rather more common) the most complete codswallop. And there is plenty of that (codswallop) on this forum - even on the subject of music!


To me to include such a rider would be equivalent to telling the reader "I think you are stupid".

The "American" litigation culture has indeed contributed to personal idiocy on the part of the individual. Pragmatism has been replaced by a childlike attitude to right and wrong. Yesterday I was a passenger in a car in which the driver did something daft, and potentially dangerous, but within the law. Her response when I said "What the **** are you doing? That was really dangerous!" was "But I have the right of way; the other car shouldn't have been there." Not a lot of use as an argument if we'd been beyond the grave having to summons a medium in order to claim damages...

Have we all become so stupid that we can't temper our response to a situation according to the individual circumstances - or can't place in context the advice that we get on a forum? Considering personal freedom is at the root of the 'American dream', it's a bit of a travesty if freedom of speech is only possible with a disclaimer attached - which implies idiocy on the part of the reader or listener (and which can become a self-fulfilling prophecy), and which renders the writer or listener more and more unlikely to speak at all.

Deep breath. OK. Badly expressed. I'm not worried about being sued in this context (although it is a reality for me in my job that at some point it may occur - I hope it never does, but I live with the possibility on a daily basis and I find it somewhat hard to be flippant about it). My primary motivation here is to do no harm. And perhaps that simply isn't possible in this situation - in which case it is better that I avoid contributing in a medical sense to any discussion.

I agree that nothing should be accepted uncritically - I spend much of my time talking about this with patients. Do you really believe that everyone who uses the internet is able to sift fact from fiction? I myself would not have the training or expertise to judge a site devoted to the ins and outs of computer software. Perhaps that makes me stupid? Or perhaps it means that I need to be more careful when I am reading through information which relates to an area with which I am unfamiliar. Perhaps I may even need to check such information with someone else like my husband, who is an expert in this area and can guide me through the codswallop to the pearls.

I don't think people are stupid. I don't wish to insult anyone's intelligence. I don't envisage you attaching a written disclaimer to any medical information which you choose to post (and, as I said, this was badly expressed on my part - I just meant that I would wish people to be aware in a general sense that general medical information is best used when applied to their specific situation). It's not a question of being sued, but I do believe that people are more likely to be uncritical of something when they see it in print. You are perfectly at liberty to disagree - and I will defend your right to do so - but my experience in my working life is that not all of us remember to be critical of what we read. Including on the internet.

I will admit to being quite distressed by your post. I'm not sure if you meant it to come across as abrupt? Perhaps this is just my reading of what you have written. I did take my own advice and went away to think for a while (reading a chapter of Swallows and Amazons to small son made for a good interlude). There is always the option of checking with someone about what they have written and asking if this is what they meant, before responding so strongly - and this is what I was referring to in the rest of my previous post.

Wolfnotes (feeling rather bruised, but recognising that this is a risk of using the internet too - perhaps if I can't stand the heat, it is time to get out of the kitchen!)

Don't take it personally, Wolfnotes! (Though I'm sure Mad Tom will correct me if he actually meant it personally, but I doubt it!) My own post that followed that one certainly wasn't meant to be personal towards anybody, although it expressed something similar. It's more of an indictment on society that we can't give an opinion without all sorts of disclaimer clauses and qualifications. It means that opinions are likely to be witheld, and the very sort of vulnerable person that you are thinking about will only be left with the politically correct options - which can be wrong! And wrong precisely because everyone jumps on the bandwagon of so-called accepted correctness without wanting to dare to stick their neck out.

Does anyone remember the film "Twelve Angry Men", starring Henry Fonda? The course that that film took is actually very similar to the course that many forum discussions take! And rightly so, for obvious reasons.

So please stay on in the kitchen, Wolfnotes!

Could anyone describe (in laymans' terms please!) what an "MRI IAM with Gadolinium" is please? The MRI scan is on the brain.

Thanks.

Do stick around - but try not to stew! Posts often appear harsher than the poster intended. I've often been surprised at what I've considered a 'benign' post generating a good degree of vitriol.

I think we've all been there - the nature of forums is such that it is very easy to misinterpret posters' intentions, get the wrong end of the stick and end up in a heated debate. Even the use of particular smileys can be misconstrued...

In response to this thread: I'm a medic myself and have learned that it is best to stay out of medical discussions. Giving personal advice in a post is not, in my opinion, wise. There may be other symptoms that the OP may have withheld, which could suggest a more serious underlying condition. Without a detailed medical history and examination, it's just not possible to make a diagnosis.

In response to the medical skeptics: a doctor provides an opinion. That opinion is based on medical knowledge and experience. It is possible therefore that another doctor will give a different opinion from a different knowledge and experiential base. In addition, everyone is unique, symptoms for the same condition may be different from patient to patient, and treatment that works for one patient may not work for another. By all means research on the internet but the answer may not be as straightforward as it appears.

Logging off now before I get sucked in deeper myself...


An MRI of the inner ear with intravenous contrast - that's the gad.

(edit: gad is a specific dye that you use for MRI)

Thank you.

Medically related... Homeopathic A&E

http://www.youtube.com/watch?v=HMGIbOGu8q0

I see wolfnotes has gone - what a pity.

Must indeed have been bruised by an encounter on here - I wish things didn't have to get so heated.

What?

Why do people just disappear without contacting the mods? It's not right

A pity : I think wolfnotes had a lot to offer...

I think in these situations we should also try to remember that not everyone has the luxury of abundant free medical care. Many of the working poor in the USA are earning too much for state aid but aren't covered by a luxurious company health plan, and often they need to know is this situation something that really means I have to go without food and heat for my family this week to pay a bill for a doctor to say gosh it would be nice if you could afford tests and drugs but if you can't then I can't help you, that will be $150 please.

Even in the UK some areas have more NHS services than others. I often talk to people on other forums who say why don't you see a dietician/podiatrist/orthotist/physiotherapist, the whole "ask your GP for a referral to..." and usually you've tried that and you've been driven to your own research in despair at the lack of services. It wasn't very helpful when I was asking for help on disability sites that my wheelchair services didn't do vouchers and the chair they were offering I couldn't push (not one of the issuing criteria, you are meant to have a minder!) and people said my wheelchair service should give me a chair so I shouldn't need their help. What should be the case didn't help me one bit!

And I am afraid there are still a lot of doctors who like to "cure" a problem by avoiding the situation that causes it. Got eczema on your hands? We don't care if you are a trained hairdresser and that is all you ever wanted to do and you own your own salon, the only cure we can offer you is to stop handling hairdressing chemicals. Suggestions range from "don't pick up your baby" - yes really! - and "you shouldn't use a computer" - all very modern and practical suggestions!!

In an ideal world of course we'd all seek the right kind of advice, but I can't afford Alexander Technique or other non-free therapies and if I see my doctor about anything it's a 15-day wait for an appointment (for which there is no point informing me that's not allowed, because that doesn't make it not the case) followed by being told if it hurts when you get up then stop getting up or the alternative "you shouldn't let the pain get in the way of anything". Is it any wonder some of us wind up looking for help anywhere we might find it?

I'm sorry to see that Wolfnotes has left and that she was upset by a reaction to something she said. Sadly I don't think she'd been around long enough to recognise styles of writing, and to also recognise that expressing strongly held views doesn't necessarily constitute a personal attack. I was probably one of several people who tried and obviously failed to convince her of that, and I'm sorry she has deregistered instead of just giving the forum a miss for a while

Oh dear...I owed Wolfnotes a PM and regret that she has deregistered ...I wanted to collect my thoughts in the hope of writing a halfway sane response to her very interesting message. I enjoyed reading her posts.

This isn't particularly in response to you, RoseRodent, but what you've said brought to mind something which a friend told me many years ago and it's always stuck in my mind. She was disabled through a chronic and very painful condition, and attended a two-week residential chronic pain management course. One of the things she learnt was that she was stuck with the pain for the rest of her life and nothing could alter that, so she could either try and do things and have the pain; or not do things and have the pain. Either way, she would have the pain. I'm recounting this not because I think it might be relevant to you, RoseRodent, because I'm sure you know this if you've had your condition for a long time, but the thought has been helpful to me not just in the medical sense but because it translates to so many different situations as well so I thought I'd share it.