u/Kwerumrerum

I feel like it is so difficult to navigate a consult with a patient who has self diagnosed based on posts on TikTok, Instagram and Reddit. I'm a rheumatologist, so my experience is mostly with auto-immune diseases and there is so much misinformation on the internet, it frustrates me to no end.

People with a slight positive ANA who are certain they have lupus. People who make a post saying 'the have all the hallmarks of an auto-immune disease' and then list symptoms such as being tired, joint pain, dizziness, headaches, back pain... They never have any objective symptom like arthritis, fevers, cutaneous changes, serositis, proteinuria... All their tests come back negative or slightly elevated (but of low significance). Then they say their rheumatologist or immunologist were dismissive bc of their age or weight and all the comments recommend to go seek someone else.

Now, from experience I know that if you go to enough doctors, you will find someone who gives you a diagnosis and then you see a new post that bashes the first doctors and they are happy that they found someone who actually listened. These patients come back to the offices of the first doctors a couple of years later, because they have had every possible medication without any change in symptoms and then we have to tell them that their diagnosis was wrong. Now, this is also an ethical nightmare, because you do not want to discredit other doctors. I usually phrase it in way where I say that I cannot confirm a diagnosis or that their AI-disease is 'sleeping' and probably not the cause of their current symptoms.

How do you guys deal with these patients for a first consultation? I tend to be very thorough, even though I know from the first 5 minutes that it won't be auto-immune, so the patient at least knows every box has been checked. After thes etests, I try to explain my full reasoning on why I won't give them a diagnosis, but even then some of them will go and find someone else. It is exhausting, because it takes so much time and I rtaher put that time towards patients with real and complex diseases.

So, for context, I (F, 31) have been 'cycling' my entire life, living in a country where we use our bikes to go to school, work, going out... but it is always at a leisurely pace, because I do not want to start my day drenched in sweat. For exercise, I generally run and do fitness. Now, my sister happened to have a a racebike that she wants to sell and she lended it to me for a couple of months to see if cycling for exercise might be my thing too.

My question basically is: If I were to start once a week for 20-30 km, would that be a good way for me to make progress or is it simply not enough? I do have a job, 2 kids and already 2 other hobbies that take time, so at the moment I simply do not have space for more than once a week of road cycling. I do not want to buy a race bike and proper cycling attire if once a week is just not going to be enough.

So, I saw a new patient on my list next week of whom I clearly recognised the name. A guy I went to middle school with and was one of the instigators of my first year being bullied. Nothing physical, only words, laughing and shunning, but it was enough to make me suicidal at the age of 12. He was definitely not the only one and after 2 years he did not even go to my school anymore, but the bullying did cause my mental health to be quite bad and it took me until last year to finally feel like I am mentally stable again.

I never even thought of this guy anymore, but seeing his name rattled me a lot more than expected, whereas there is a high probability he does not even know who I am anymore.

Of course, if he is my patient, I will always treat him to the best of my abilities, but would it be wrong to maybe ask another doctor to see him? Is it overly dramatic? I have not seen this guy in maybe 18 years, I am happy with my friends, husband, kids and job. It should not bother me at all, but I just feel not at ease...

Extra info: In my country, you cannot just choose to not see a patient. I would have to write a formal letter to the patient and the order of medicine to decline him. Also, I am one of 3 rheumatologists in my area and the only one who is working next week. The others have waiting lists of 6 months.

Extra: I am working in this hospital for 6 months now, just graduated my residency in december, so I am also quite hesitant to talk to the chief or our director, bc I really do not want to stir any drama. I feel like I am just being quite dramatic and am hoping most of you will just tell me that there is nothing to worry about.

I (31, F) have always struggled with productivity, gettibg my ass of the couch, doing the things that needed to be done if there was no pressure of time.

It was not a big issue as a kid bc I was able to wing school and I had structured hobbies (specific training days and match days), but it got bad in uni. I just binge watched series every day for hours and hours, thinking I could wing it but I could not. I stopped volleyball bc of the distance to my team and wanted to do fitness and running, which I do like, but since there were no specific training days, I easily skipped them.

Then, when life got busy with a husband, kids and a difficult job, I just used the excuse of being tired to skip all other responsibilities. I did suffer from a burn-out too pr post-partum depression, but I also used it as an excuse imho.

Then, I got an ADHD diagnosis and tried some meds. They did not work, I felt like an imposter, untill I got 1 that did work. Everything calmed down. I did not feel the need to find a distraction all the time. I could focus and concentrate and now I am seeing all the work that needs to be done and am so motivated to do it, but it is huge. I do not know where to start. Do I start with the basic house chores? Do I start with the bigger projects such as painting walls and doing my garden, hanging lights...? Do I focus on running and exercising? Do I study more?

For all these years, I simply barely did anything and I never figured out how to know what priorities were since I always did the bare necessities and not more than that. Are we even supposed to be able to do it all?

We are on a holiday in Slovenia with my 2- and 4-year old and after some hikes we went to a lale with beautiful views of the mountains and a specific spot that is set up for taking photos (A wooden man on a bench with the lake an mountains in the background). I had seen the spot when we arrived and immediately said to my husband that I really want a pic there, but we first did some sightseeing around the lake.

When we got the specific spot, there were osme other people there taking pics, so obviously I went to the side and waited my turn. These other people were a group of 5 and they took every possible combination of their group for pics (all together to everyone alone to everything in between). They often redid combo's they already did before and then they just sat a bit on the bench without taking photo's or taking pics of just the background without the bench itself (which they could do after leaving that spot, because there is still about 15m of space before getting to the lake). I must have waiter for 15-20 minutes. Just by the time they are leaving, my 2- year old decided to poop his pants, so of course I had to step away and take care of that.

After we cleaned up our kid, another couple (German) was at the bench and I cannot complain about that, bc I left my waiting spot. So I stood to the side again. While waiting for the other couple to be done, 4 elderly Italians arrived, sat themselves next to the German couple and started taking pics of themselves. The German couple did not mind, they were done anyway. But I had been waiting there first and the Italians took over 15 minutes again to take pics and then just decided to sit on the bench ext to the wooden man and have some casual conversation without pictures.

I got very angry and left. Did not say anything bc I do not speak Italian and from experience most Italians of that age do not speak English. I did raise my voice and complained while walking away to my husband. He felt like it was a non-issue and it should not matter, but I felt like it was very selfish of the other people. If I see people waiting for the place I am taking pics, I always speed up and try to be out of their way asap.

So, my 3-year old daughter (almost 4 years old) has the worst attitude when she is a bit tired, which is about every day after school. The moment I go to pick her up, it starts. Nothing is good enough, not even the way I put her in her bike seat. At home, she terrorises the entire family, screaming yelling, throwing things. I feel like there is nothing I can do. I tried reasoning, I tried sitting next to her calmly, I tried to deviate from the subject, I tried yelling myself, I tried putting her in a corner, I tried taking away toys... She slams with the doors, breaks stuff on purpose and if I ignore her, she will soon become happy again for maybe 2 minutes before something else triggers her.

I really want to parent her and show her that this is not allowed, but it seems like she does not care for any punishment. I am afraid that I am raising an entitled kid and I do not know how to change that. Any advice is very much appreciated!