A recent Ask Metafilter thread has given me pause lately, partially because of my own involvement, and partially because of the outcome.

headspace posts this as her question:

You Are Not A Doctor: Three weeks ago, I got a nasty head cold that never quite went away. It’s now settled into my chest, and I have a chronic, slightly productive cough. Ordinarily, I would just wait it out, but I’m exhausted, can’t really get a full breath, and the stuff I’m coughing up tastes like bleach. I swear, I haven’t been inhaling or gargling bleach. I do have an appointment to see my doctor on Wednesday (the earliest I could get in,) but I was wondering if anyone else had had these symptoms and could tell me what caused them, so I can quit Googling medical conditions and diagnosing myself with lung abscesses and tuberculosis.

I hesitate to answer at first–I’m just a medical student, don’t know a whole, could be wrong and lead someone in the wrong direction–but I figure some information is better than none, and as long as I’m not definitive and make clear that I’m just a student, it should be okay. Having just finished pneumonias and respiratory infections, I remember that foul-smelling sputum is a sign of an anaerobic, gram-negative infection. The shortness of breath thing is concerning, but I don’t feel comfortable calling it a pneumonia. (“Can you still be walking around and be as sick as pneumonia?” I ask myself. All the pneumonia cases in class…people were really sick!) So, I post.

Later in the thread, a real live doctor posts in follow-up saying that I’m a bit off–he thinks it’s a fairly serious pneumonia, and that headspace needs to get to an ER before going septic (ie: get bacteria in your blood, and get really, really sick as your body freaks out in response). I feel a bit chided–this is the perfectionist in me–but it’s something I’ve got to get used to. I’m new at this, I don’t have experience, I don’t know all the answers, I’m learning. I will be wrong again. (This further makes me wonder if I should have posted in the first place.) I do , however, come away with a better understanding of mycoplasma pneumonia , also known as “walking pneumonia.”)

The whole post brings up issues of online diagnosing and malpractice that make me uncomfortable. Is it unethical to try to diagnose in the dark without all the data? Without actually seeing–that is, observing–the patient? Or is it unethical not to try to provide a diagnosis, or at least a recommendation that the patient go to their doctor or the ER? In this case, no one knew headspace’s age, exposure history, history of present illness, past medical history, social history, family history, sexual history.

But the more disturbing question, for me at least, comes from headspace’s follow-up :

Well, gram gets points for the diagnosis- I have bronchitis, and lots of lovely antibiotics and codeine cough syrup now, but ikkyu gets points for sending me to the doctor today. If I’d waited ’til Wednesday and felt any better, I probably wouldn’t have gotten the chest X-ray to rule out pneumonia, and they wouldn’t have found the mass that’s in my right lung. I’m a little shell-shocked, but better to find out now than when it’s too late.Thank you guys all for your good wishes and your suggestions, I really appreciate it.

It’s these freaky “what ifs” that have always bothered me. What if the doctor didn’t say headspace should have gone to the ER? What if she just took my advice, didn’t get the chest x-ray, and didn’t find out about the right lung mass until later? Is there something more to this than mere coincidence? Fate? Destiny? “Everything happens for a reason?” Or is this just random chance? The spiritual side of me prefers the former, while the medical side argues for the latter.

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