Diagnosis: What’s Wrong With Me
August 26, 2019 8:40 AM - Season 1 (Full Season) - Subscribe
Based on the New York Times column of the same name, this medical docuseries focuses on patients with unique illnesses and their journeys to find a diagnosis and cure.
Came in to say the exact same thing. This is easily a 20 minute show. Ain’t got time for filler! I’ll just look up the summaries online.
posted by St. Peepsburg at 2:26 AM on August 28, 2019 [2 favorites]
posted by St. Peepsburg at 2:26 AM on August 28, 2019 [2 favorites]
I am kind of conflicted about this show. On one hand, I used to read Lisa Sanders' NYT column regularly, so I was pretty excited to see this. On the other hand, the way this show is framed is frustrating. The crowdsourcing idea is cool, but they don't provide enough information for viewers to make an educated guess (this is a fundamental rule of mysteries!), and on reveal, the diagnoses are not really that mysterious. They are like, second-year med student cases. The real story, which isn't clearly told but is hinted at, is the total failure of the US healthcare system to meet the needs of patients.
[Spoilers below, and a little bit of neuro-nerding.]
Episode 1 is a young woman with a "mysterious" episodic weakness that makes her urine turn dark brown. Except it's not mysterious at all! Dr. Sanders even says, in the first Skype interview, that this sounds like a metabolic myopathy -- and surprise, that's what it ended up being. Metabolic myopathies are not well-known in the general population, but are bread and butter neurology. If the woman had seen a neurologist at any point, she probably would have gotten tested upfront, but without the drama and the Italian heroes saving the day. The show hints that the woman is uninsured or underinsured -- she seems to go to the ED or urgent care when she is in rhabdomyolysis (potentially life-threatening muscle breakdown), gets fluids and glucose so that she doesn't out-and-die, and then goes home. There's a dramatic argument with Dad about healthcare costs (PS I was really kind of worried for the Mom in this show, she seemed terrified of her husband's uncontrolled rage), and then tears of joy when she learns that the Italian healthcare system will cover her testing for free. I really wish they had explicitly said that her diagnosis was delayed for years because she lives in a country with tiered and restricted access to healthcare. (Alternatively, she likely could have gotten free or reduced-cost care at UCLA -- world-class neurology department -- not clear from the show if she had tried that route and been denied, or what.)
Episode 2 is more about deciding between treatment options: little girl with Rasmussen encephalitis, parents are told she needs a hemispherectomy (one side of her brain removed) which is a really scary thing to do to a cute 6-year-old. So they start looking for other options. This one reminded me of Anne Fadiman's brilliant book The Spirit Catches You and You Fall Down. There was less of a cultural divide between the doctors and the family in this episode than in Spirit, but the same information divide. The crowdsourcing in this one suggests Lyme (sigh) so the desperate family wastes 6 weeks at the hands of a quack whose antibiotics not only fails to improve Sadie but also expose her to harm. (Doxycycline is contraindicted in kids under 8 as it can cause defects in new permanent teeth.) The device she ends up with as an alternative to hemispherectomy (Neuropace) is pretty cool and I think will revolutionize the treatment of epilepsy -- but it's not approved for under-18, which should have been made clear. Using in a 16-year-old's brain is probably fine; using it in a 6-year-old's brain is definitely experimental.
I haven't seen the other episodes, but apparently they are all also neurological or psychiatric, which -- either no other specialty has mystery diagnoses, or other specialties don't understand neurology/psychiatry. Given that I once got a consult question of "you guys deal with the weird stuff, right?" I'm inclined to think the latter.
posted by basalganglia at 6:54 AM on September 1, 2019 [2 favorites]
[Spoilers below, and a little bit of neuro-nerding.]
Episode 1 is a young woman with a "mysterious" episodic weakness that makes her urine turn dark brown. Except it's not mysterious at all! Dr. Sanders even says, in the first Skype interview, that this sounds like a metabolic myopathy -- and surprise, that's what it ended up being. Metabolic myopathies are not well-known in the general population, but are bread and butter neurology. If the woman had seen a neurologist at any point, she probably would have gotten tested upfront, but without the drama and the Italian heroes saving the day. The show hints that the woman is uninsured or underinsured -- she seems to go to the ED or urgent care when she is in rhabdomyolysis (potentially life-threatening muscle breakdown), gets fluids and glucose so that she doesn't out-and-die, and then goes home. There's a dramatic argument with Dad about healthcare costs (PS I was really kind of worried for the Mom in this show, she seemed terrified of her husband's uncontrolled rage), and then tears of joy when she learns that the Italian healthcare system will cover her testing for free. I really wish they had explicitly said that her diagnosis was delayed for years because she lives in a country with tiered and restricted access to healthcare. (Alternatively, she likely could have gotten free or reduced-cost care at UCLA -- world-class neurology department -- not clear from the show if she had tried that route and been denied, or what.)
Episode 2 is more about deciding between treatment options: little girl with Rasmussen encephalitis, parents are told she needs a hemispherectomy (one side of her brain removed) which is a really scary thing to do to a cute 6-year-old. So they start looking for other options. This one reminded me of Anne Fadiman's brilliant book The Spirit Catches You and You Fall Down. There was less of a cultural divide between the doctors and the family in this episode than in Spirit, but the same information divide. The crowdsourcing in this one suggests Lyme (sigh) so the desperate family wastes 6 weeks at the hands of a quack whose antibiotics not only fails to improve Sadie but also expose her to harm. (Doxycycline is contraindicted in kids under 8 as it can cause defects in new permanent teeth.) The device she ends up with as an alternative to hemispherectomy (Neuropace) is pretty cool and I think will revolutionize the treatment of epilepsy -- but it's not approved for under-18, which should have been made clear. Using in a 16-year-old's brain is probably fine; using it in a 6-year-old's brain is definitely experimental.
I haven't seen the other episodes, but apparently they are all also neurological or psychiatric, which -- either no other specialty has mystery diagnoses, or other specialties don't understand neurology/psychiatry. Given that I once got a consult question of "you guys deal with the weird stuff, right?" I'm inclined to think the latter.
posted by basalganglia at 6:54 AM on September 1, 2019 [2 favorites]
basalganglia, I also felt like this show (and column) could only exist in the US!
posted by ellieBOA at 8:19 AM on September 1, 2019
posted by ellieBOA at 8:19 AM on September 1, 2019
ellieBOA, the column was really good, actually, and featured complex or unusual "zebras" and also included clinical documentation, labs, radiology reports, and spend a good bit of time showing its work, as it were, demystifying the way doctors come to a diagnosis. I think that would apply anywhere in the world.
The Netflix show, however -- too much drama and filler. And yes, very tied to the current state of health care access in the US.
posted by basalganglia at 9:59 AM on September 1, 2019 [2 favorites]
The Netflix show, however -- too much drama and filler. And yes, very tied to the current state of health care access in the US.
posted by basalganglia at 9:59 AM on September 1, 2019 [2 favorites]
The column today has a story where the patient has the same case as the girl in episode 2 who was having seizures, and is worth a read.
posted by ellieBOA at 6:17 AM on June 3, 2020
posted by ellieBOA at 6:17 AM on June 3, 2020
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posted by Rock Steady at 12:23 PM on August 26, 2019 [2 favorites]