Because as a society we can't spend ten million dollars on every patient with a hard-to-diagnose chronic condition that may just be stress. It just isn't practical.

Stress can show up as chronic cortisol elevation which is not an expensive test. Instead we get the cheapest cure of all: gaslighting.

That's just false, and pretty insulting to the medical establishment.

It’s false that cortisol can be easily tested? Or it’s false that many doctors tell patients that their unexplained symptoms are probably just psychosomatic and they should try to reduce stress, as a way of getting them to go away and stop asking for diagnostic efforts beyond the doctor’s current level of expertise?

I’ve experienced the latter first hand, and know many other people who have also, none of whom were chronically stressed in any kind of unusual way, as far as I could tell.

Maybe “gaslighting” is a slightly unfair name. I would describe it more along the lines of “patronizing indifference”.

As insulting as this may be to some doctors, perhaps the ones who care, it is exactly what most patients of hard to diagnose problems experience most of the time. I've seen many doctors with my girlfriend who suffers from CFS.

Patronizing indifference describes it quite well. They may run a few tests, then come up with nothing and insult you with the dumbest things.. Its especially bad when you go back multiple times and know more about the disease than they do, and the state of the research (this without spending an obsessive amount of time looking into things).

People's lives are totally ruined by this condition. Other diseases where you may experience pain, or discomfort, or reduced mobility, you may still be able to fight through the pain and achieve life goals. With CFS, the harder you fight, the harder you lose. You can go from being an extremely high achiever who works 3 times as hard as everyone else to get there to then being powerless over your own life, career, etc. The harder you try, the harder you fall. You have to learn to do little every day and hope that you're lucky enough that it'll lead you somewhere, or that some day, something will be discovered and it may help your condition.

The worse part is in many places, you get no help.. You may `appear` fine on the day you go in to the doctor, because it was the only thing you did that day and took it easy the day before because you wanted to at least make it to the doctor. Then they don't get it. Or they'll suggest you exercise, as if that makes your CFS better. Nope.. Because if you go at it a bit (10-15 minutes of light cardio) then you're out of commission for a few days, leaving you feeling pathetic and useless as your loved ones pick up the slack and try to provide you with everything you need and not make you feel guilty, while all you wish to do is get up and do chores or your part, or work, or anything productive, to feel alive, to feel like you're useful at something, have a purpose.

But nope. While there is research happening, the general medical community doesn't recognize CFS for what it is and the systems around it which should offer support don't exactly recognize it either. You're more likely to be referred to a therapist to go do some damn CBT than you are to get help. Telling that to someone who has a degree in psych who's done CBT and has CFS and knows the whole thing inside out is pretty demeaning and discouraging.

Anyway.. rant over.. but yeah, patronizing indifference. Hit it on the nail.

Not op but cortisol is elevated in "just stress" as well as critical illness. An elevated cortisol is not a diagnostic test that can deferentiate between a serious medical problem and stress.

Also, cortisol isn't always elevated when stress is the problem. So a negative test result doesn't really tell you anything, and a positive test result tells you something, but you don't know what that something is without a lot more testing, which may or may not tell you anything.

I find it hard to look at American medicine and conclude that reasoned, careful rationing of costs is actually a factor.

You don't maximize profit by spending more than 15 minutes on each patient. That is how American medicine is reasoned. Time is money and medical mysteries are a waste of time.

You can certainly bill for running a lot of tests.

Nah, it's because a doctor can't spend ten minutes thinking about what's going on with a patient, much less a couple of hours. This is what we got from our lame attempt to shoehorn health care into the commodity business model we use to manage fast food joints.

That sure does leave a lot of middle ground with doing nothing.

There is. They don't do nothing. They run some basic metabolic tests. If there's something specific (like you have pain in a particular place) they'll run more tests.

But when your complaint is something like "I don't have any energy", there are just too many branches in the decision tree. They need more to go on.

How did you get there from my comment?

What incentive do they have besides being a heroic, indefatigable person? If anything, they're increasing their attack surface for being blamed or sued.

Curious about this. I often find engineers motivated purely by the desire to solve the problem. Was just at defcon - witnessed many people vaguely wandering around the tables of teams trying to hack devices, then getting sucked in as they offered solutions and inevitably got involved with trying to solve the problem. Did it myself a couple times, even though I had planned on attending more talks.

They hate solving problems when someone comes up to them with a strange and incomplete description and says "can you fix my problem"? The made a whole show about this called the IT Crowd where they play a tape that says "Have you tried turning it on and off again" instead of legitimately answering phones.

https://en.wikipedia.org/wiki/The_IT_Crowd

Here's a subreddit where people complain about the problems that people bring them: https://www.reddit.com/r/talesfromtechsupport/

Here's a subreddit for which the tagline starts with "Tired of stupid customers?": https://www.reddit.com/r/iiiiiiitttttttttttt/

There are many problems in the tech field which are exceedingly difficult yet uninteresting. There are many problems that people bring that are vague descriptions that eventually turn out to be user error. It would not be surprising for the same phenomenon to exist in the medical field as well.

Huh, I had never thought of that - the daily issues that patients bring a doctor I can see as a parallel to an engineer being presented with "can you fix my email?" - complete with user stupidity - "My heart don't feel good" "Did you quit smoking and start exercising like I told you to?" "No."

The human body apparently has pretty terrible UI/UX.

It's not bad for something we found in a cave.

I've wondered the same thing myself pretty much every time I've come into contact with a doctor. The fundamental lack of curiosity for someone in a field related to science (seemingly based on science) is astonishing.

That has never been my experience with any doctor, and I have met many doctors of many different specialties.

Perhaps the problem here is not doctors, but the way you are communicating (or not) with them. Your sotto-voce "seemingly based on science" is exceedingly derisive; perhaps that is carrying across. I too tend to minimise the length of conversations with people that treat me with contempt.

Yes, you could potentially "solve the problem." Unless there is a test or a treatment that is easy and effictive enough to use empirically it is much harder to diagnose that person. Physicians have to balance quality of life improvement for patients along with treatment. There may be a trade-off between efficacy rate of treatments and the likelihood of adequate compliance. People may not change their diets or take their meds appropriately to improve their health for example.

If you can't rely on the patient you might never find the solution. You may just be better off at improving their quality of life even if it doesn't ultimately solve their underlying condition.

So are programmers by and large incredibly non-curious about learning completely new stuff they will probably not even use so much, and for which they could make solutions with the tools they have.

It's a job like any other. Some people don't want to go the extra mile because they have other priorities in life.

I found seeking treatment for RSI pretty frustrating until I went to an occupational therapist.