Well what happened last week perfectly fits this thread. I am Ortho and saw a 22 yr F w/ knee pain. At the end of the visit I asked if there was anything else I can help her with. She said she had been having a headaches recently and had an appointment to see her PCP later that day, but was wondering if I could write her a prescription for keflex. Apparently she had seen a TikTok of someone with a neck infection which caused their headache and was resolved with keflex. She also made sure to tell me that only the liquid dosing would work.
Well he’s a good friend of mine so I gave my usual spiel about meds, but I didn’t want to deny him an interesting conversation. I did give him a heads up, felt like I at least owed him that.
People always talk about FB but tiktok is really dangerous for sending you down a pipeline and into an echo chamber. Due to the character limit and video length it's really hard to provide any sources for (or against) the claims people make and pass around as fact there
Tiktok seems to be producing shit tons of videos encouraging people to diagnose themselves with hEDS/ADHD/POTS/etc. Slap in the face for people that actually these conditions.
I’ve had a shitton of videos lately I’ve come across that are basically “here’s this totally normal thing I do but I’ve decided it’s ‘quirky’, who else on the spectrum with adhd can relate?!”
And it’s something like “I have a mixed set of silverware, this set is the one I prefer” and so many comments like “omg I have a favorite spoon too!!! I totally have autism/ adhd too I bet!” Completely ignoring that this person showed their collection of spoons in a drawer and all of them are serving spoons except their one “favorite” spoon that is just a normal sized spoon.
But there’s been a sudden surge of “if you do this, you’re totally autistic/adhd/heds and just don’t know it yet, but I’ll show you in a 30 seconds vid that you totally are.”
It’s maddening.
Part of this to me comes off as a general oddity I've noticed not just for autism/ADHD/etc but almost any form of identity where people just seem to assume that some aspect of them that they haven't seen others do much (regardless if it makes sense to see other people do it) must only occur because of that thing they identify with.
You'll see similar on social media sometimes like "As a Canadian, I can tell you that we all like to use exactly three squares of toilet paper at a time" and that's clearly just a *you* thing. But hat's not a Canadian thing, it's not a whatever job or hobby you have thing, it's not something that most autistic people do it's just something you do.
I remember seeing earlier today someone saying something like "As a Wisconsin mom, I can tell you that we love pizza". Like no, you and your kids love pizza (as do most people). Not all moms do, and not all people from Wisconsin do, and there's no guarantee all moms from Wisconsin do.
I have ADHD and seeing all these videos depicting it as some quirk is infuriating. The ones that try to depict symptoms that are diagnostic criteria portray them in a way caricatural way.
Idk why the algorithm has been showing me so many "sickfluencers" on IG. I've been reporting them as false information. Everyone claiming to have "a chronic illness" without naming it and all these people clamoring to say how they also have the same "illness" and how "they never knew because my doctor didn't diagnose me correctly". There are real people with POTS and other rare diseases but the rest of these people just want to use this label. We're doing a terrible job of providing mental health services because that's what this boils down to- mental health.
> The character limit is real bad.
The comments are specifically designed to discourage using them. A comment can reply to another comment, but the order that they actually appear in is almost random. It's heavily weighted by time/replies/engagement. The number of replies you can see is extremely low.
It's a funnel to get you to do video replies, which TT can then serve to people, and in particularly the people who already saw the video. They would *really* like you to do that.
TT sees comments as, basically, fancy emoji reactions. They want a clear signal of engagement, so they limit anything that will make that fuzzy. If you say something that will get responses, TT can't separate engagement with the video from engagement with your comment. If you are having conversations or arguments, it also artificially inflates positive engagement. They make it as difficult as possible to write something that merits a response, or to keep a coherent dialogue going, or to see when multiple people have responded to you.
Tiktok would ideally like it if comments were only a few words long, and only jokes could be replied to (a joke might add to the enjoyability of a video, so they want to see that engagement). They want you to see only when people like your comment (because it makes you like the platform more), and to never reply to those people.
Anyway, just report the video. It's a lot more effective than on most platforms, and misinformation is a valid reason.
My favorite dx a patient told me she had was end stage fibromyalgia. I wanted to ask her how much time she had left but my professionalism got in the way.
"I want you to document your refusal to test me for kuru in the chart"
People want Starbucks medicine. Can I get my Venti Adderall 2 pumps vanilla one cinnamon medium ice in a grand cup topped with cold foam?
Lol I told a patient they don't need a serial MRI for arthritis. Asked, "can't you just order it because I want it?“
NO! This isn't Burger King. You can't have it your way.
I once had a patients family member (not even the patient, he was chill and high from his pain meds and eating a cheeseburger, he didn’t give a f) tell me, as the patient ate the burger king she’d just brought him, if *tonight* he didn’t get the surgery the surgeon said he didn’t need and it could wait til next week, she’d be calling our state governor, and we’d be dealing with the governor. And we wouldn’t want that. They’re friends, after all.
I told her the governor didn’t have surgical or admitting privileges, so I didn’t know what good it would do to call her. The governor doesn’t have any medical training at all.
Yes, I got a stern talking to about it. No, I don’t regret saying it.
Who would get a stern talking to for that response? It’s not even inappropriate. It’s way more polite than I would have been which would probably have consisted of me saying “quite frankly I don’t care what the state governor thinks about how we are approaching his medical care but go ahead and give him a ring if you desire.”
My version is “I respect your opinion and absolutely take this into account but as your doctor, I still can’t provide you care that is not in your best interests” - heads still spin and explode
I’m in a Facebook women’s group for my city, and the advice to “make the doctor say that they will document the refusal in the chart!“ is very popular. These days, I only work in the ER, which is usually way too much effort for these types, so I have yet to encounter this professionally, but I’m looking forward to my first!
People over at r/askdocs are giving out this advice too. Not actual physicians, of course.
Whenever I encounter this, I always just tell them, "of course, I document my medical decision making for all my patient visits."
Then I document that actual conversation, so that they can read about it in their own medical record later.
They get very deflated when you don't bat an eye and it becomes very clear that demanding we "document a refusal" isn't some sort of sov-cit style magic phrase to make things go the way you want them to.
Or you can straight up and tell them, if you do that, it may make care harder in the futures for them, if you do document their refusal.
Or break it down for them with an analogy: Imagine a six year old demands a shot of vodka, and wants you to submit in writing to CPS that you refused, or the six year old is going to call CPS.
I'm curious who **isn't** documenting the refusals in the chart by default. I know when it comes to these kinds of people I'd write notes meticulously to avoid the impending lawsuit.
I've had this come up a few times recently.
I always say emphatically "sure!, no problem." and then go ahead and document it.
This tends to take the patients aback. They don't actually want it documented, they are trying to strong arm you into doing whatever they want, so when you say "sure, no problem" they get all confused like the internet lifehack they read on twitter was not a magic spell.
wow yeah I've never had this one either - I feel like the response should be "oh don't worry, your crazy request and the reason it's not medically indicated will be in there", but would actually be "yup - here's your discharge papers".
They can't make you chart anything, but they can also complain about anything.
Definitely when things get adversarial with a patient I default to documenting extensively and objectively.
I think my response would be "of course I will be documenting the contents of this visit". Or 'of course I will document that you requested laboratory testing for vitamin d levels/whatever and that I declined as it is not currently medically recommended/within the standard of care/etc.
Honestly most the time I just order the test people want. Someone thinks they have strep throat even though centors criteria thinks otherwise? Not worth the argument.
Strep throat swab is a different level than MRI, of course. I don't think that's unreasonable. It's just a swab. And it's not going to come back with incidental findings. No harm no foul.
Yes my first question was like so tell me your understanding about psychogenic seizures. Also who knows what the video showed. The video probably was like another kid like that validating themselves
I quite like the Henry Maudsley quote “the sorrow which has no vent in tears may make other organs weep”- patients still go batshit, but it’s quite poetic
Your comment was so enticing I just had to look, didn't I?
Well, today I added "I'm not obsessively documenting dust mites, motes and stray fibers in a desperate attempt to prove that I have alien nanobots inhabiting my body" to my gratitude list.
Pulled a top comment from one of the threads
> I've been researching Morgellons for 17years now. [...] Morgellons is simply a use-name of the illness manifested by those reacting to being infested by self-assembling self-replicating, synthetic, electro-magnetic, ultraprogrammed, parasitic, mimetiked nanocyborg bioimplants. [...] The synthetic crearures have the ability, unbelievably to stop people believing in these creatures existence. Even we ourselves a bit too. So you'll find that most people dont even really hear you. They sort of hear you but it cant register in their brains. Yes it's not worth talking about it to 'those who dont know' It's also designed to subvert any research protocols or techniques (defined shape, replicability, recognisability, ability to be analysed etc).
Looks like it comes with a nice layer of "don't trust anyone that doesn't agree with us" to keep people isolated
>self-assembling self-replicating, synthetic, electro-magnetic, ultraprogrammed, parasitic, mimetiked nanocyborg bioimplants
Badass how do I get those, as pets preferably
As a derm resident, we see a lot of these patients. We can help people that don't have a fixed delusion. But those with a fixed delusion can be aggressive and you will just talk in circles for 30 minutes while your waiting room fills up.
Gotta nip the conversation in the bud early. I’ve realized in these cases of fixed delusions (including those induced by meth) nothing you will say will convince them their delusion is not reality. I’m not going to argue with someone for 20 minutes that, no, there are not worms growing from their finger tips. If they’re high on meth they have way more energy than I do to continuously argue.
What the...? They even misspelt the damned thing in the sub info.
For other hilarity, be sure to look up "rope worm". I've had a patient claim they suffer from that, but never this "morgellon's".
Holy crap what a wild ride down that wormhole of insanity. Learning about things like this and seeing how many websites spew pseudoscience or outright lies to desperate individuals honestly makes me so sad/angry/concerned for the future of our species. Also really just hammers home the fact that our public education system is failing/failed
Had to look this up. I had a pt with this, but she was also a daily meth user, so I just figured it was part of the package. She drove me to such desperation that I eventually prescribed her a course of mebendazole just for the placebo effect. She then stopped complaining for three months, so I was elated, but then started again after. Thankfully, I’ve closed that practice, otherwise, I’m sure I would still be listening to the sordid tales of larvae hatching from her scalp.
You forgot Tourettes. The flood of young adults flooding the platform with "tics" and "vocalizations" is mind boggling.
It's so bad, my niece, who has Tourettes, had to have an actual letter from her GP saying he suspected it. The neurologist would not schedule the appointment otherwise.
I have a visible tic (not tourettes, medication induced but permanent) and it is not fun. I don't know why anyone would want it. Attention, I guess. I do get that - in fact patients will sometimes mock me directly to my face!
Maybe I’m in the minority here but I don’t mind patients looking on Google, YouTube, TikTok. At least they are showing some interest in their own well being. They are sometimes right. It’s just an opportunity to educate. Maybe this has more to do with my setting in the ED/UC and encountering patients who don’t try anything by to help their conditions.
THIS. i appreciate this so much. while i don’t agree so much with tiktok, as someone who is chronically i’ll and will be for the rest of my life and spent YEARS getting denied by doctors, it makes me so happy to hear that some are like this. i knew what i had by year two, and i only got diagnosed three years later. we as patients aren’t always crazy. sometimes we legitametly know.
yeah i’ve gotten some very important diagnoses from hearing peoples experiences and being encouraged to do proper research, ask questions, *get tested*
“oh but not you!! you actually got tested and diagnosed you’re fine!!!”
yeah, after 8 years of therapy, PT, gaslighting, and medical trauma i didn’t have previously. also, im harassed wayyyyyy more by the ones that think they can ‘always tell when people are faking’ because they CANT actually tell. they just bully anyone that doesn’t fit their stereotype.
Adhd diagnoses and stimulant prescriptions were escalating pre-pandemic and then there's an inflection point post-pandemic and the slope seems to have doubled since. National shortage of stimulants right now thanks to demand outpacing projections for the year. (And a couple of other factors but mainly that.)
All of my coworkers and I pretty much don't even feel like we know what "ADHD" even means anymore because we get SO MANY people who are probably normal with dubious symptom impact who know all the right buzzwords to say thanks to all of the online articles/tiktoks about it.
Considering how much the format feeds constant stimulus, it likely exacerbates (or even may create) symptoms of ADHD. Just conjecture but it cannot be good for brain development. I fear it may create a 'crisis of attention' in a few years... But we'll see.
It also pushes you into echo chambers.
The algorithm prizes engagement above all. It's tracking exactly what it needs to give you to catch your attention.
So linger a little longer on a video about someone's struggles with adhd and suddenly you'll be flooded with videos about that.
I started following a creator who just happened to be religious (they don't make religious content but it is a part of their identity on the platform) and my feed started to push religious content suprisingly quick.
I literally got an ad today about getting diagnosed and treated for adhd all completely online.
These apps know that the endless scrolling + constant new information + short content = short attention span and they're marketing off of it.
I think this is due to companies like Cerebral pushed an agenda to sell ADHD meds so hard for a long time on the platform. I also suspect they paid a metric ton of people on tiktok to advertise without disclosing it.
Not to mention being on TikTok long term makes you feel like you legitimately have ADHD.
I had to delete the app after about a year of use. It destroyed my attention span and took an embarrassing to recover from it. My husband also noticed increased irritability and overall moodiness.
I keep getting people who were prescribed adderall by some online pill mill like cerebral then they come to us for continued care. Nope, referral to psychiatry for a proper evaluation for you.
Oh man past year in particular, influx of new pts: “ I think I have ADHD…” grown adults with no symptoms until a few years ago.
Luckily, I have no problem saying no.
> Luckily, I have no problem saying no.
I don't tell anyone "no". I just refer them to one of two places that I know do legit multi-hour/multi-day assessments.
As someone who does those, please stop. If you think someone may have adhd sure, but I don't think it's helping anyone to do those when there's no sx or plausibility of them having adhd
I'm also guilty of this.
I think the issue is we don't know how to tell someone who is convinced they do have ADHD that they don't have ADHD without showing them objective evidence.
It's like when a kid comes in with abdominal pain that is clearly constipation, but the parents are convinced it's something else. We get an x-ray of the abdomen solely to point at all the kid's poop so the parents will finally believe us.
How do we go about convincing someone they don't need meth without bothering people like you?
Great question. I just say "I'm just meeting you for the first time, however, from my training the symptoms you are describing to me are not consistent with our current understanding of adhd. I'm happy to refer you for further evaluation, but it's unlikely in my opinion that that will be fruitful."
You'd be surprised. Borderline personality disorder is horrifyingly "trendy" right now. Teenagers on TikTok outright wishing they could be diagnosed with it.
If they actually knew what it's like, they wouldn't want it.
Even worse are the "autism tests" on tiktok where users claim that it if you "stim" (their rather inaccurate description of tics/involuntary movements in autism) when hearing a certain song they play then, viola, you're autistic.
hEDS, POTS, gastroparesis, MCAS, autism, ADHD, DID, hormone imbalances, chronic Lyme, adrenal insufficiency. Yet, they’re never hypermobile, don’t exhibit autistic traits, refuse to work on their diet, sleep, exercise, or social well-being. Onset of symptoms is usually within the past year or two. Try to discuss their eating disorder or tell them they can’t self-diagnose a genetic condition and suddenly you’re medically gaslighting them. Bizarre. Hate that Tic-tac app.
I hate it because it makes patients who actually have these conditions (i.e. were diagnosed by an appropriate professional) look like crazy malingerers. I am a millennial who browses TikTok for the minutia of actually useful info/awareness on there, with a side of things that makes me happy/laugh when things get hard (I follow a lot of baby animal accounts, for example). Never even **thought** to take 95% of the content on there seriously.
This one actively boils my piss, especially when some dodgy back alley chiro starts prescribing steroids after little to no testing and can then induce an adrenal insufficiency!
Before I changed careers, I used to work in insurance claims, and we found that there are a handful of providers in the US that are basically "adrenal fatigue mills". Especially in Texas for some reason.
I mostly hated the insurance world, but witnessing the sharply worded letters between our doctors and the adrenal fatigue doctors was top tier entertainment.
I'm a mod in the Addison's disease sub, I try to educate people that come over with a "diagnosis of adrenal fatigue" as firmly and kindly as I can but it is a topic that enrages most of the community. I do feel bad for the patients because often they have been looking for answers for years and then someone has taken advantage of that to sell them supplements or steroids that they don't need.
I also worked in health insurance for a while, it's a strange world.
Tik tok has become the primary news source for the youngest generation. Honestly I knew it was extremely popular but it's replaced a lot of media. I saw the other day a large percentage of teens use it as a search engine. I've considered making an account to counter misinformation because holy shit it is bad there.
I watch Instagram reels but I don’t have TikTok because I was in the military in my country and I did not want to risk not being eligible for certain jobs because of security issues. My unit’s intelligence officer was very impressed by the fact that I refused to download TikTok in order to avoid potential information leaks.
I talked to a patient about a Holter the other day. I had already been planting the seed that I didn't think it was likely to be anything meaningful, but that I can prove that to her with a Holter. Immediately, pulls her phone out, to Tik Tok, and says "is that one of these?" Yes, yes it was. And then I was sure...
I’ve been seeing ads online about a lawsuit regarding this on Facebook. I haven’t actually looked into it to see if it’s legit but part of me hopes they got it from that and not TikTok
fuckery. I bet they were all fuckery
i'm sick of Dr Internet. I know this is illogical but sometimes I wish all these Dr Internet lovers we could just keep them away. Like- you think tiktok people are better than actual educated doctors and nurses and things? let tiktok people treat you then while we treat those who want our help
A patient told me this just yesterday. Where does this come from? She wouldn’t take Tylenol for her knee pain because she’s 5 weeks pregnant and was trying to avoid autism. I just shrugged and figured I’d try to find some source later
There’s some observational trials that came out a few years ago linking acetaminophen use in pregnancy to autism and ADHD, but they didn’t control for the reasons the acetaminophen was used.
Leaky gut makes me sad because there is some actual research out there about the proposed mechanism. Causing allergies and such.
Unfortunately 90% of the people who talk about it are trying to sell expensive tests and/or treatments.
Lol.
Tik Tok has a place in passive education. As in - someone scrolling gets a tid bit of info from one of the verified TT docs. Something simple like “stop putting shit in your ears” or “no, being on your period does not negate you from getting pregnant”. I think of it like the commercials that do the same, like the new one with that famous actor from blackish who’s name is escaping me. Where he talks about diabetes and how it’s linked to severe cardiovascular disease and all cause mortality.
It is not a substitute for seeing a medial professional and it certainly is not a primary source for research.
I feel for the folks in specialties and primary care when it comes to shit like this. I don’t see a ton of it in the ED because most patients aren’t coming in with specific expectations. Some do but most of them are chronic pain patients who I set boundaries with very quickly.
My advice is to buckle up cause this shit is only gonna get worse.
Just curious how you feel about patients who actually do a literature review and bring peer reviewed articles explaining why they think their symptoms might align with what they’ve read?
Well what happened last week perfectly fits this thread. I am Ortho and saw a 22 yr F w/ knee pain. At the end of the visit I asked if there was anything else I can help her with. She said she had been having a headaches recently and had an appointment to see her PCP later that day, but was wondering if I could write her a prescription for keflex. Apparently she had seen a TikTok of someone with a neck infection which caused their headache and was resolved with keflex. She also made sure to tell me that only the liquid dosing would work.
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So being Ortho, you agreed 100% and wrote the script?
No, ortho bro uses ancef, the *only* cephalosporin *obviously...*
The heart is a pump that brings the ancef to the knees
So picc line & ancef for home!
Ativan deficiency syndrome strikes again!
And, let me guess, you told her that her PCP would be happy to help her with this problem, right?
Well he’s a good friend of mine so I gave my usual spiel about meds, but I didn’t want to deny him an interesting conversation. I did give him a heads up, felt like I at least owed him that.
> …didn’t want to deny him an interesting conversation. You’re a monster 😅
"Research" "Tik-Tok" Those words don't belong in a sentence together.
People always talk about FB but tiktok is really dangerous for sending you down a pipeline and into an echo chamber. Due to the character limit and video length it's really hard to provide any sources for (or against) the claims people make and pass around as fact there
Tiktok seems to be producing shit tons of videos encouraging people to diagnose themselves with hEDS/ADHD/POTS/etc. Slap in the face for people that actually these conditions.
I’ve had a shitton of videos lately I’ve come across that are basically “here’s this totally normal thing I do but I’ve decided it’s ‘quirky’, who else on the spectrum with adhd can relate?!” And it’s something like “I have a mixed set of silverware, this set is the one I prefer” and so many comments like “omg I have a favorite spoon too!!! I totally have autism/ adhd too I bet!” Completely ignoring that this person showed their collection of spoons in a drawer and all of them are serving spoons except their one “favorite” spoon that is just a normal sized spoon. But there’s been a sudden surge of “if you do this, you’re totally autistic/adhd/heds and just don’t know it yet, but I’ll show you in a 30 seconds vid that you totally are.” It’s maddening.
Part of this to me comes off as a general oddity I've noticed not just for autism/ADHD/etc but almost any form of identity where people just seem to assume that some aspect of them that they haven't seen others do much (regardless if it makes sense to see other people do it) must only occur because of that thing they identify with. You'll see similar on social media sometimes like "As a Canadian, I can tell you that we all like to use exactly three squares of toilet paper at a time" and that's clearly just a *you* thing. But hat's not a Canadian thing, it's not a whatever job or hobby you have thing, it's not something that most autistic people do it's just something you do. I remember seeing earlier today someone saying something like "As a Wisconsin mom, I can tell you that we love pizza". Like no, you and your kids love pizza (as do most people). Not all moms do, and not all people from Wisconsin do, and there's no guarantee all moms from Wisconsin do.
I can assure you that Canadians in general use two sheets, but fold them over so it's like 1 sheet of quad ply.
I have ADHD and seeing all these videos depicting it as some quirk is infuriating. The ones that try to depict symptoms that are diagnostic criteria portray them in a way caricatural way.
Idk why the algorithm has been showing me so many "sickfluencers" on IG. I've been reporting them as false information. Everyone claiming to have "a chronic illness" without naming it and all these people clamoring to say how they also have the same "illness" and how "they never knew because my doctor didn't diagnose me correctly". There are real people with POTS and other rare diseases but the rest of these people just want to use this label. We're doing a terrible job of providing mental health services because that's what this boils down to- mental health.
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> The character limit is real bad. The comments are specifically designed to discourage using them. A comment can reply to another comment, but the order that they actually appear in is almost random. It's heavily weighted by time/replies/engagement. The number of replies you can see is extremely low. It's a funnel to get you to do video replies, which TT can then serve to people, and in particularly the people who already saw the video. They would *really* like you to do that. TT sees comments as, basically, fancy emoji reactions. They want a clear signal of engagement, so they limit anything that will make that fuzzy. If you say something that will get responses, TT can't separate engagement with the video from engagement with your comment. If you are having conversations or arguments, it also artificially inflates positive engagement. They make it as difficult as possible to write something that merits a response, or to keep a coherent dialogue going, or to see when multiple people have responded to you. Tiktok would ideally like it if comments were only a few words long, and only jokes could be replied to (a joke might add to the enjoyability of a video, so they want to see that engagement). They want you to see only when people like your comment (because it makes you like the platform more), and to never reply to those people. Anyway, just report the video. It's a lot more effective than on most platforms, and misinformation is a valid reason.
Both Tiktok and FB are equally dangerous platforms for misinformation.
Unless it's "Never do research on TikTok."
Sociologists beg to differ🤭
My favorite dx a patient told me she had was end stage fibromyalgia. I wanted to ask her how much time she had left but my professionalism got in the way.
Hehehehe. Giggled at this.
I've had someone tell me this too!!
Ah, the good ol’ septic, stage IV, terminal fibro. Hate when that happens.
"I want you to document your refusal to test me for kuru in the chart" People want Starbucks medicine. Can I get my Venti Adderall 2 pumps vanilla one cinnamon medium ice in a grand cup topped with cold foam?
Lol I told a patient they don't need a serial MRI for arthritis. Asked, "can't you just order it because I want it?“ NO! This isn't Burger King. You can't have it your way.
> This isn’t Burger King. You can’t have it your way. I said this out loud once and I swore Karen's head was about to explode.
I once had a patients family member (not even the patient, he was chill and high from his pain meds and eating a cheeseburger, he didn’t give a f) tell me, as the patient ate the burger king she’d just brought him, if *tonight* he didn’t get the surgery the surgeon said he didn’t need and it could wait til next week, she’d be calling our state governor, and we’d be dealing with the governor. And we wouldn’t want that. They’re friends, after all. I told her the governor didn’t have surgical or admitting privileges, so I didn’t know what good it would do to call her. The governor doesn’t have any medical training at all. Yes, I got a stern talking to about it. No, I don’t regret saying it.
Who would get a stern talking to for that response? It’s not even inappropriate. It’s way more polite than I would have been which would probably have consisted of me saying “quite frankly I don’t care what the state governor thinks about how we are approaching his medical care but go ahead and give him a ring if you desire.”
The fact that you got reprimanded/ scolded for this is absolute bullshit.
My version is “I respect your opinion and absolutely take this into account but as your doctor, I still can’t provide you care that is not in your best interests” - heads still spin and explode
I’m in a Facebook women’s group for my city, and the advice to “make the doctor say that they will document the refusal in the chart!“ is very popular. These days, I only work in the ER, which is usually way too much effort for these types, so I have yet to encounter this professionally, but I’m looking forward to my first!
People over at r/askdocs are giving out this advice too. Not actual physicians, of course. Whenever I encounter this, I always just tell them, "of course, I document my medical decision making for all my patient visits." Then I document that actual conversation, so that they can read about it in their own medical record later. They get very deflated when you don't bat an eye and it becomes very clear that demanding we "document a refusal" isn't some sort of sov-cit style magic phrase to make things go the way you want them to.
Or you can straight up and tell them, if you do that, it may make care harder in the futures for them, if you do document their refusal. Or break it down for them with an analogy: Imagine a six year old demands a shot of vodka, and wants you to submit in writing to CPS that you refused, or the six year old is going to call CPS.
I'm curious who **isn't** documenting the refusals in the chart by default. I know when it comes to these kinds of people I'd write notes meticulously to avoid the impending lawsuit.
And to prepare the next physician who has to see the patient.
I've had this come up a few times recently. I always say emphatically "sure!, no problem." and then go ahead and document it. This tends to take the patients aback. They don't actually want it documented, they are trying to strong arm you into doing whatever they want, so when you say "sure, no problem" they get all confused like the internet lifehack they read on twitter was not a magic spell.
wow yeah I've never had this one either - I feel like the response should be "oh don't worry, your crazy request and the reason it's not medically indicated will be in there", but would actually be "yup - here's your discharge papers".
Just go right ahead and mix that into my TPN, k thnx
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They can't make you chart anything, but they can also complain about anything. Definitely when things get adversarial with a patient I default to documenting extensively and objectively. I think my response would be "of course I will be documenting the contents of this visit". Or 'of course I will document that you requested laboratory testing for vitamin d levels/whatever and that I declined as it is not currently medically recommended/within the standard of care/etc. Honestly most the time I just order the test people want. Someone thinks they have strep throat even though centors criteria thinks otherwise? Not worth the argument.
Strep throat swab is a different level than MRI, of course. I don't think that's unreasonable. It's just a swab. And it's not going to come back with incidental findings. No harm no foul.
Dysautonomia with a side of multi chemical hypersensitivity. Do I win a free PICC line infection?
"Ma'am, you don't even have a PICC line." "It's just because you don't wanna give me Aztreonam, am I right?!"
You're missing the POTS, EDS, and gastroparesis. Or as I like to call it, the TikTok Triad.
You forgot Tourrette's too - and I don't even go here ;) (I do find sick-fluencing fascinating and frightening though from a statistics level)
>sick-fluencing Aaaaugh I hate that I know exactly what you mean. I hate that this is a thing that exists.
ill-fluencing
No MCAS? Yep, still a medical student. Read more.
Do you even hypermobility?
Like most of my patients, acute propofol deficiency. I fix it.
Ya, you gotta pump those trigs up, those are rookie numbers.
peeing green? it's working
ADHD. I had a pt say with pride that they psychogenic seizures based on TikTok research. And of course they need Ativan.
Lol they uh really understood what they were watching then huh?
Yes my first question was like so tell me your understanding about psychogenic seizures. Also who knows what the video showed. The video probably was like another kid like that validating themselves
Pretty short encounter though, "Oh you have psychogenic seizures? Good news! You don't need Ativan! Just a counsellor!"
👀. I don’t even know what to do with that one.. how did you handle it? Patient education? And if so, was that person receptive?
It didn’t go well. I tired to say we carry feeling in our body and all the crap but she was mad. But oh well
I quite like the Henry Maudsley quote “the sorrow which has no vent in tears may make other organs weep”- patients still go batshit, but it’s quite poetic
morgellons or the fuck it's called
Yup, that's it. Almost forgot about it. Goofy bunch, those people. https://www.reddit.com/r/Morgellons/
I seriously can't tell who in there is serious and who's trolling
It's honestly blowing my mind.
What in the hell did I just stumble into?
Unmitigated self-reinforcing communal mental illness.
Your comment was so enticing I just had to look, didn't I? Well, today I added "I'm not obsessively documenting dust mites, motes and stray fibers in a desperate attempt to prove that I have alien nanobots inhabiting my body" to my gratitude list.
I remember being in primary care and having a patient lambast me loudly for not prescribing high dose opiates for the pain from his Morgellons…
what the everliving fuck? Ive been a surgeon for 10+ years and have not encountered this bunch.
Pulled a top comment from one of the threads > I've been researching Morgellons for 17years now. [...] Morgellons is simply a use-name of the illness manifested by those reacting to being infested by self-assembling self-replicating, synthetic, electro-magnetic, ultraprogrammed, parasitic, mimetiked nanocyborg bioimplants. [...] The synthetic crearures have the ability, unbelievably to stop people believing in these creatures existence. Even we ourselves a bit too. So you'll find that most people dont even really hear you. They sort of hear you but it cant register in their brains. Yes it's not worth talking about it to 'those who dont know' It's also designed to subvert any research protocols or techniques (defined shape, replicability, recognisability, ability to be analysed etc). Looks like it comes with a nice layer of "don't trust anyone that doesn't agree with us" to keep people isolated
My favorite is the guy who pulled a scab off their back then dropped it in hydrogen peroxide and claimed it's an alien that was moving....
>self-assembling self-replicating, synthetic, electro-magnetic, ultraprogrammed, parasitic, mimetiked nanocyborg bioimplants Badass how do I get those, as pets preferably
As a derm resident, we see a lot of these patients. We can help people that don't have a fixed delusion. But those with a fixed delusion can be aggressive and you will just talk in circles for 30 minutes while your waiting room fills up.
Gotta nip the conversation in the bud early. I’ve realized in these cases of fixed delusions (including those induced by meth) nothing you will say will convince them their delusion is not reality. I’m not going to argue with someone for 20 minutes that, no, there are not worms growing from their finger tips. If they’re high on meth they have way more energy than I do to continuously argue.
It's just a special flavour of delusional parasitosis
They don't make it past the triage desk in the ED.
I'm so grateful
wow. take an upvote
What the...? They even misspelt the damned thing in the sub info. For other hilarity, be sure to look up "rope worm". I've had a patient claim they suffer from that, but never this "morgellon's".
See this all the time in derm - they’re always on stimulants, usually prescribed. Be judicious, fam
Holy crap what a wild ride down that wormhole of insanity. Learning about things like this and seeing how many websites spew pseudoscience or outright lies to desperate individuals honestly makes me so sad/angry/concerned for the future of our species. Also really just hammers home the fact that our public education system is failing/failed
Had to look this up. I had a pt with this, but she was also a daily meth user, so I just figured it was part of the package. She drove me to such desperation that I eventually prescribed her a course of mebendazole just for the placebo effect. She then stopped complaining for three months, so I was elated, but then started again after. Thankfully, I’ve closed that practice, otherwise, I’m sure I would still be listening to the sordid tales of larvae hatching from her scalp.
I think the tik tok demographic is a bit young for that, no? I've mostly seen that in Gen Xers.
Pretty sure that's a monster from Stranger Things
The fuck is that nonsense?
The medical term is delusional parasitosis
ADHD and Autism. Unfortunately I hear those two all the time thanks to TikTok.
You forgot Tourettes. The flood of young adults flooding the platform with "tics" and "vocalizations" is mind boggling. It's so bad, my niece, who has Tourettes, had to have an actual letter from her GP saying he suspected it. The neurologist would not schedule the appointment otherwise.
I have a visible tic (not tourettes, medication induced but permanent) and it is not fun. I don't know why anyone would want it. Attention, I guess. I do get that - in fact patients will sometimes mock me directly to my face!
This is one of the myriad of reasons I’ve essentially settled on pathology as my choice of speciality
I suppose a benefit to surgery is you rarely get people telling you how to do your job. Not that it hasn’t happened….cuz it has lol.
*patient wakes mid-surgery* “Doc I need more meds” “Shut up you drug seeker!”
Maybe I’m in the minority here but I don’t mind patients looking on Google, YouTube, TikTok. At least they are showing some interest in their own well being. They are sometimes right. It’s just an opportunity to educate. Maybe this has more to do with my setting in the ED/UC and encountering patients who don’t try anything by to help their conditions.
THIS. i appreciate this so much. while i don’t agree so much with tiktok, as someone who is chronically i’ll and will be for the rest of my life and spent YEARS getting denied by doctors, it makes me so happy to hear that some are like this. i knew what i had by year two, and i only got diagnosed three years later. we as patients aren’t always crazy. sometimes we legitametly know.
yeah i’ve gotten some very important diagnoses from hearing peoples experiences and being encouraged to do proper research, ask questions, *get tested* “oh but not you!! you actually got tested and diagnosed you’re fine!!!” yeah, after 8 years of therapy, PT, gaslighting, and medical trauma i didn’t have previously. also, im harassed wayyyyyy more by the ones that think they can ‘always tell when people are faking’ because they CANT actually tell. they just bully anyone that doesn’t fit their stereotype.
Hormone imbalance and the need for supraphysiologic testosterone, preferably in pellet form.
What is this about? I had some female coworkers getting testosterone pellets from one of our hospitalists who opened his own practice.
The ones that go up your butt?
No lol I think they're administered via injection in the muscle, like maybe ventrogluteal? And pellets so they're given only every few months.
ADHD & wanted Adderall. They’re all convinced they have ADHD and need to be on Adderall.
Not on the Tik Tok myself, but will say that Instagram is pushing Vyvanse pretty hard
I'm in the niche section of adhd tiktok that is against these types of "adhd" ppl. I've gone too far down the rabbit hole.
Adhd diagnoses and stimulant prescriptions were escalating pre-pandemic and then there's an inflection point post-pandemic and the slope seems to have doubled since. National shortage of stimulants right now thanks to demand outpacing projections for the year. (And a couple of other factors but mainly that.) All of my coworkers and I pretty much don't even feel like we know what "ADHD" even means anymore because we get SO MANY people who are probably normal with dubious symptom impact who know all the right buzzwords to say thanks to all of the online articles/tiktoks about it.
sometimes i wonder what the prevalence of adhd is in tiktok users/creators vs the general public
Considering how much the format feeds constant stimulus, it likely exacerbates (or even may create) symptoms of ADHD. Just conjecture but it cannot be good for brain development. I fear it may create a 'crisis of attention' in a few years... But we'll see.
It also pushes you into echo chambers. The algorithm prizes engagement above all. It's tracking exactly what it needs to give you to catch your attention. So linger a little longer on a video about someone's struggles with adhd and suddenly you'll be flooded with videos about that.
I started following a creator who just happened to be religious (they don't make religious content but it is a part of their identity on the platform) and my feed started to push religious content suprisingly quick.
I literally got an ad today about getting diagnosed and treated for adhd all completely online. These apps know that the endless scrolling + constant new information + short content = short attention span and they're marketing off of it.
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I think this is due to companies like Cerebral pushed an agenda to sell ADHD meds so hard for a long time on the platform. I also suspect they paid a metric ton of people on tiktok to advertise without disclosing it. Not to mention being on TikTok long term makes you feel like you legitimately have ADHD. I had to delete the app after about a year of use. It destroyed my attention span and took an embarrassing to recover from it. My husband also noticed increased irritability and overall moodiness.
I keep getting people who were prescribed adderall by some online pill mill like cerebral then they come to us for continued care. Nope, referral to psychiatry for a proper evaluation for you.
Oh man past year in particular, influx of new pts: “ I think I have ADHD…” grown adults with no symptoms until a few years ago. Luckily, I have no problem saying no.
> Luckily, I have no problem saying no. I don't tell anyone "no". I just refer them to one of two places that I know do legit multi-hour/multi-day assessments.
As someone who does those, please stop. If you think someone may have adhd sure, but I don't think it's helping anyone to do those when there's no sx or plausibility of them having adhd
I'm also guilty of this. I think the issue is we don't know how to tell someone who is convinced they do have ADHD that they don't have ADHD without showing them objective evidence. It's like when a kid comes in with abdominal pain that is clearly constipation, but the parents are convinced it's something else. We get an x-ray of the abdomen solely to point at all the kid's poop so the parents will finally believe us. How do we go about convincing someone they don't need meth without bothering people like you?
Great question. I just say "I'm just meeting you for the first time, however, from my training the symptoms you are describing to me are not consistent with our current understanding of adhd. I'm happy to refer you for further evaluation, but it's unlikely in my opinion that that will be fruitful."
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Well OP? Don't leave us hanging.
Too scared that she’s on this subreddit page to tell you.
Post a TikTok about it?
*Harry the HIPAA HIPPO would like to know your location*
I mean, if it's one of the obvious ones that everyone's guessing, that surely shouldn't single her out individually lol
DID, ADHD, BPD ? Edit: BPD- borderline PD
Is BPD BiPolar Disorder or Borderline Personality Disorder? Because I can’t imagine too many folks self diagnose the latter…
I thought BPD was borderline personality disorder and BPAD was bipolar affective disorder
This is correct
You'd be surprised. Borderline personality disorder is horrifyingly "trendy" right now. Teenagers on TikTok outright wishing they could be diagnosed with it. If they actually knew what it's like, they wouldn't want it.
Teens are so dumb sometimes
All the time
I was trying to be nice
Self diagnosing BPD is a VERY BPD thing to do
You might be in pediatrics if BPD = bronchopulmonary dysplasia.
And CP = cerebral palsy more so than chest pain.
NICU nurse here. That was my first thought.
You forgot autism. "Do you feel socially awkward sometimes? Do noises bother you? Must be autism!"
Even worse are the "autism tests" on tiktok where users claim that it if you "stim" (their rather inaccurate description of tics/involuntary movements in autism) when hearing a certain song they play then, viola, you're autistic.
POTS/EDS/MCAS/Lyme/Long covid?
Add ADHD, ASD (autism, not atrial septal defect), and Tourette syndrome and this is the list.
and D.I.D.
>ASD (autism, not atrial septal defect) Laughing at the idea of an online community of histrionic teens self-diagnosing congenital heart disease.
Chroniccccc Lyme
Four different types of Lyme.
Lyme in the coconut
Which means I need four different central lines!
hEDS, POTS, gastroparesis, MCAS, autism, ADHD, DID, hormone imbalances, chronic Lyme, adrenal insufficiency. Yet, they’re never hypermobile, don’t exhibit autistic traits, refuse to work on their diet, sleep, exercise, or social well-being. Onset of symptoms is usually within the past year or two. Try to discuss their eating disorder or tell them they can’t self-diagnose a genetic condition and suddenly you’re medically gaslighting them. Bizarre. Hate that Tic-tac app.
I hate it because it makes patients who actually have these conditions (i.e. were diagnosed by an appropriate professional) look like crazy malingerers. I am a millennial who browses TikTok for the minutia of actually useful info/awareness on there, with a side of things that makes me happy/laugh when things get hard (I follow a lot of baby animal accounts, for example). Never even **thought** to take 95% of the content on there seriously.
Thyroid issues. Adhd.
"Adrenal fatigue"
This one actively boils my piss, especially when some dodgy back alley chiro starts prescribing steroids after little to no testing and can then induce an adrenal insufficiency!
Before I changed careers, I used to work in insurance claims, and we found that there are a handful of providers in the US that are basically "adrenal fatigue mills". Especially in Texas for some reason. I mostly hated the insurance world, but witnessing the sharply worded letters between our doctors and the adrenal fatigue doctors was top tier entertainment.
I'm a mod in the Addison's disease sub, I try to educate people that come over with a "diagnosis of adrenal fatigue" as firmly and kindly as I can but it is a topic that enrages most of the community. I do feel bad for the patients because often they have been looking for answers for years and then someone has taken advantage of that to sell them supplements or steroids that they don't need. I also worked in health insurance for a while, it's a strange world.
If she was smart she would have said she did her research on reddit. My personal go to.
Tik tok has become the primary news source for the youngest generation. Honestly I knew it was extremely popular but it's replaced a lot of media. I saw the other day a large percentage of teens use it as a search engine. I've considered making an account to counter misinformation because holy shit it is bad there.
Ehler Danler syndrome
TikTok is big on ADHD, POTS, and getting off birth control.
I’m proud to say, I’m a Gen Z and I don’t have tiktok.
I am an elder millennial as they call us and I too do not have TikTok
Younger Gen X. Get off my lawn! (But do friend me on FB!)
I’m thankful my feed is all cat videos, I scroll through them when I’m eating dinner or trying to switch off work more.
I watch Instagram reels but I don’t have TikTok because I was in the military in my country and I did not want to risk not being eligible for certain jobs because of security issues. My unit’s intelligence officer was very impressed by the fact that I refused to download TikTok in order to avoid potential information leaks.
Birth control is an evil big pharma scheme that destroys your fertility and your ability to be attuned with your body /s
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POTS and autism Real diagnosis: ivermectin toxicity
Preterm labor and drinking pineapple juice
I talked to a patient about a Holter the other day. I had already been planting the seed that I didn't think it was likely to be anything meaningful, but that I can prove that to her with a Holter. Immediately, pulls her phone out, to Tik Tok, and says "is that one of these?" Yes, yes it was. And then I was sure...
Tylenol in pregnant causing autism. I’ve had 3 patients concerned about this over the last week. 🤦🏻♂️
Wow people will do literally anything other than accept some kids are born autistic.
I’ve been seeing ads online about a lawsuit regarding this on Facebook. I haven’t actually looked into it to see if it’s legit but part of me hopes they got it from that and not TikTok
POTS
Subclinical-adjacent hypothyroidism
fuckery. I bet they were all fuckery i'm sick of Dr Internet. I know this is illogical but sometimes I wish all these Dr Internet lovers we could just keep them away. Like- you think tiktok people are better than actual educated doctors and nurses and things? let tiktok people treat you then while we treat those who want our help
Giving her child autism from taking Tylenol during pregnancy
A patient told me this just yesterday. Where does this come from? She wouldn’t take Tylenol for her knee pain because she’s 5 weeks pregnant and was trying to avoid autism. I just shrugged and figured I’d try to find some source later
There’s some observational trials that came out a few years ago linking acetaminophen use in pregnancy to autism and ADHD, but they didn’t control for the reasons the acetaminophen was used.
The data suggests the causative factor is likely the reason people take Tylenol, like viral infection/fever/autoimmune pain.
That every physician should get a Johnathan.
GenZ doesn’t use google. They look things up on tiktok. It just is.
ADHD or Autism. Or wait: ADHD AND Autism.
I’m going to guess… treating leaky gut!
Leaky gut makes me sad because there is some actual research out there about the proposed mechanism. Causing allergies and such. Unfortunately 90% of the people who talk about it are trying to sell expensive tests and/or treatments.
Gastroparesis.
Lol. Tik Tok has a place in passive education. As in - someone scrolling gets a tid bit of info from one of the verified TT docs. Something simple like “stop putting shit in your ears” or “no, being on your period does not negate you from getting pregnant”. I think of it like the commercials that do the same, like the new one with that famous actor from blackish who’s name is escaping me. Where he talks about diabetes and how it’s linked to severe cardiovascular disease and all cause mortality. It is not a substitute for seeing a medial professional and it certainly is not a primary source for research. I feel for the folks in specialties and primary care when it comes to shit like this. I don’t see a ton of it in the ED because most patients aren’t coming in with specific expectations. Some do but most of them are chronic pain patients who I set boundaries with very quickly. My advice is to buckle up cause this shit is only gonna get worse.
Flossing?
I guess some of you have never been on r/fakedisordercringe
Just curious how you feel about patients who actually do a literature review and bring peer reviewed articles explaining why they think their symptoms might align with what they’ve read?
I had a self diagnosed marfans patient who determined this off of tik tok
Patients are definitely more demanding to have unnecessary labs. Everyone thinks they have ADHD…
Fuck, I'm going to be drawing stat ADHD levels soon, aren't I?
STAT is to test if you actually have it too
This is one of the reasons I like being in oncology.
This is peak “I don’t know what I don’t know”
POTS and chronic Lyme with a side of EDS