Questions that sound like a medical issue

Question

This question is prompted by a couple of answers I've given recently.

• This one, which really sounds like a 5 year-old with OCD.

• This one, where one possible explanation is face-blindness.

In both cases the OP was not asking for medical advice; the questions were about worrying behaviour. In theory such questions might arise about physical conditions too, but with those its much more likely to be seen as a medical issue by the parents.

In the second case @Joe criticised the answer:

The "WebMD" syndrome, where people look at WebMD for "what is symptom X" and see "x cancer" or whatever and the other long list of bad things it could be, when it's probably just a stomach ache; thus causing lots of needless anxiety.

Joe is certainly right to be concerned about this (which is not a new problem incidentally; Three Men in a Boat from 1889 includes an anecdote about the narrator's encounter with a medical dictionary). The Internet is full of misinformation about medical matters and we should certainly be cautious about adding to it. However we should also beware of withholding information because we fear what the recipients might do with it. Despite the large amounts of idiocy in the world, I cling to a belief that more knowledge is better than less.

Hence I would argue that such answers should be acceptable as long as they:

• emphasise that this is not a medical diagnosis, rather it is a possibility that the parents might want to consider and research.

• say that if the parents are concerned then they should seek proper medical help.

This SE is meant to be a resource providing useful information to parents. The fact that a particular pattern of behaviour matches, or might match, the symptoms of a known psychological issue can be important information. In both of these cases I decided to make a suggestion on those grounds. In one case I got voted up, in the other case down.

I considered just saying "see a doctor". However that would not have been useful in the faceblindness case because even today many doctors have not heard of it. Personal anecdote here: I have mild dyspraxia, which my mother picked up on when I was at primary school. I remember very clearly the doctor's appointment; he walked me up and down a corridor and then told my mother there was nothing wrong with me. Dyspraxia, of course, was not recognised in those days. Even "clumsy child syndrome" was another decade or two in the future.

This leads to another issue with such questions: the frame "medical issue" is actually pretty fuzzy around the edges. There are an increasing number of issues which were once considered behavioural or moral, but which have now been shifted into psychology (e.g. ADHD, dyspraxia, overeating), and others which have been shifted out (e.g. homosexuality). If "medical issue" is in part a social construct then its probably not a solid ground for a rule here.

So my question is: how should one proceed when a question makes one think "That sounds awfully like X Syndrome"? How certain should one be (given zero medical qualifications) before posting such a reply?

Answer 1

Personal opinion as a physician-user: I believe Joe's comment is completely correct in the case of your face blindness answer. The child does not have symptoms - not even close! - for the diagnosis of prosopagnosia, and if your answer wasn't immediately dismissed by the OP, you might well have caused a lot of unfounded anxiety. The OCD answer is at least possibly in the ballpark, but seriously, everyone has irrational or antisocial thoughts from time to time. It's normal. The severity and degree to which this happens, along with other symptoms, matter for the diagnosis. Personally, I don't think you should post such answers.*

Everyone has familiarity with health and illness (their own and that of others). Throw in cultural influences, cognitive biases, hearsay and some reading, and it's remarkably common for people to think they know a fair amount of Medicine. The fact that it takes many years of dedicated study and practice to become decent at Medicine (which includes Psychiatry) and to interpret the literature doesn't seem to faze some people at all; they know what they "know". The real problem is that they don't know what they don't know, which is that we are ALL confident idiots** (<- A long but enlightening read.)

It's relatively harmless to be wrong about how often to change diapers, whether crying it out is a good practice or not, strategies for raising a bilingual child, potty training or effective bedtime rituals. But it's not harmless to dispense medical advice or diagnoses when you are not a medical professional, regardless of whether or not you were misdiagnosed by a physician as a child, that criteria for medical/psychiatric diagnoses change over decades or that a parent might not be looking for an answer about a medical issue where there might be one.

Sometimes it really is best to advise someone to see their primary care provider.

*_{I would never post an answer on Server Fault, Geographic Information Systems, German Language, Electrical Engineering, Information Security, Mathematica, Physics, Game development and an almost infinite number of subjects. The truth is that I know a lot about a little, a little about a lot, and nothing about a whole lot more.}

**_{This was a huge problem with Health.SE. It still is.}

_{There comes a point for a large majority of those in medicine when they realize how much they don't know and the gravity of being in such a precarious position. The anxiety accompanying the realization that one is/will be responsible for people's health/lives while not knowing so very, very much is paralyzing, and many students want to quit med school when it hits. Some do. Others learn to study harder/lean on colleagues/cope with the anxiety/get counseling (I did)/get good at searching the literature, etc. If you haven't gone through any anxious soul searching about your qualifications to diagnose, then don't diagnose. The bad docs are those who don't know what they don't know; let alone people handing out diagnoses who have no formal training in the medical field. Don't do it, just don't!}