Why is my question closed as "off-topic" for this site?

Question

Why is my question closed as off-topic, really? (Right now it has 4 close votes, I'm sure by the time you read this it would have been closed already).

First let me introduce a bit about myself. You may observe my rep point on this site is low, that's because I'm using the "hidden community" feature of Stack Exchange. I have 36k reputation across all sites, with 26k+ on a major site which I participate on.

I had a peek on Health Meta and was surprised that this site gets so little traffic that it is near closure. I am perhaps guilty as being one of the users who supported this site through its private beta (along with another site with controversial topic - Law.SE). I left shortly after it went public, and only returned yesterday.

After asking my question and getting my response from the community here, I'm no longer surprised that this site is nearly closure. In fact it makes perfect sense. More on that later.

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First let's go through my question:

• The GIST of the question is to identify some likely cause given the described symptoms.
• It's not asking for medical advise. The patient (me in this case) have already fully recovered.
• Thus there is no point in me going to a doctor asking for an explanation.

Here is what I expected as an answer:

When we wake up or sit up, we are using ______ muscles located in the chest. These muscles, together with _______ muscles in our arms, are linked together. During the sudden deceleration, your chest likely pressed against the seat belt and caused injury in them. The doctor used an x-ray scan to diagnose that you did not have any broken ribs, so released you from hospital.

In fact, I nearly get an answer in one of the comments:

On the other hand, a temporary pressure of the spine on the spinal column or spinal nerves could cause the symptoms described in the question.

This is what I'm looking for! This is why I posted. I wish to learn medical knowledge, and this post inspired me how to research further in related areas.

I'm not looking for a conclusive diagnosis. On the internet, it is impossible. Even if I were to go back to the doctor, it would be impossible as well as I have already fully recovered, and the medical report simply stated "xxx injury" (xxx being a medical term I do not understand).

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Let's consider another made-up example:

I had been consuming alcohol quite frequently lately. Three weeks ago it hurts when I urinate. My urine is also reddish in color. I went to the doctor and he prescribed me drug A and drug B. I reduced my alcohol consumption and now it is getting much better.

What is my condition and how does alcohol caused my urinating pain?

Here's is an example answer I would expect (I lack medical knowledge, so please forgive me if the content does not make sense to you):

You likely suffered a rare condition known as ABC Disease. Typical symptoms include Symptom X, Symptom Y. Some patients, especially female, also suffer from Symptom Z.

ABC Disease is typically treated with Drug A, which side effects include a reduction in the desire to hammer. This side effect can be countered with Drug B.

I can't see why this post is not beneficial to Stack Exchange:

1. It addresses the OP's question.
2. We are not applying diagnosis here. And even if we are, we are not giving prescriptions. There is a similar concept on Law.SE and Money.SE, where we do not give individual legal advise / financial advise, but nevertheless provide an analysis of the OP's situation. Sometimes we explain why the professionals chose their actions, which the OP may need a more laymen explanation. Other times the OP needs advise on whether to go to a professional, since it can be expensive.
3. The knowledge in this post is interesting and broadens the reader's knowledge.
4. It is applicable to a wide audience. Even if the condition cannot be conclusively drawn from the OP's information, we can state the possibilities:

Your described symptoms match Condition A, Condition B and Condition C. Condition A is far more common as virus spread more easily. Condition B is rare, but serious. A blood test may be used to identify or rule out Condition B. Condition C is usually accompanied with other symptoms.

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If you're here (after this long post), thank you. So this meta question is not really asking why my question is off-topic. My question is, what are we doing here?

I returned to a community which was very different than when I left. If this site is dedicated to medical professionals only, how is it going to find active users? Do doctors and nurses go on Stack Exchange and ask each other treatment advise? It is no wonder that no expert stay to share their knowledge.

We need to broaden the audience. General users (like me) wish to learn medical knowledge. We are not asking personal medical advise; nor are we asking you to diagnose exactly what condition we have. We wish someone to explain to us medical terms and the doctor's decisions, which can be hard to obtain during the 3~5 minutes we see the doctor.

If this site continue on its current direction, I'd say vote to close the site (is there such a thing?). There is no point putting in more effort. I mean...I don't see how this site is going to get out of it. We need a change in direction.

Thoughts?

Answer 1

I'll give you a different example:

During a large festival, a patient's face turns pale, they start to sweat a lot, they have a difficulty breathing, and they don't feel so well.

What could this be?

• any acute coronary syndrome (heart attack or myocardial infarct)
• potentially stroke
• foreign body aspiration
• asthma or COPD exacerbation
• pulmonary embolism
• food or other poisoning
• CHF exacerbation
• heat exhaustion/ heat stroke
• hypoglycemia or DKA/HHS
• panic attack/hyperventilation
• vaso-vagal reaction
• mild circulatory issues
• exsiccosis/dehydration

By reading this, I can't tell you which of these it is. I doubt that DoctorWhom could, or any other veteran user here. Some of these are more likely, some are less likely, but likelihood doesn't help you, you need the diagnosis. And no, I'm not going to write a huge post laying out all these potential problems, explaining them and so on, because if I do, I might have overlooked something.

But being there, you could probably get a good gist of how severe the condition is. An infarct can only be diagnosed in the hospital, same with a stroke, and needs immediate care, a mild circulatory issue can be resolved by monitoring, laying down, and more or less waiting while eventually administering fluids etc. if blood pressure was too low.

This is one example, but because of this we don't give a medical diagnosis in general. There never is only one likely cause given a bunch of symptoms.

Answer 2

Good answers here. Interesting to see a rehash of this discussion on hot meta questions. The @DoctorWhom answer to the related question is excellent, but I thought I'd add my understanding of the disconnect between the OPs expectations and the way medicine is actually practiced.

The OP expects the following:

To identify some likely cause given the described symptoms.

As illustrated by the hypothetical:

Your described symptoms match Condition A, Condition B and Condition C.

The idea that we could do this is the primary misunderstanding here. Diagnosis is not a symptom matching algorithm. Even when we don't do a proper physical exam, we look at the patient, listen to their voice, and integrate a good deal of additional information. Then we're left with process A-G, not condition A-C, which we narrow down with follow up questions, and an option for further testing.

You'll see this on medical dramas where there's some montage of a resident digging through textbooks trying to figure out what might cause a rash, bloody nose, and no fever, but this is not how it works. We don't sit around trying to match up a list of symptoms to a list of conditions. We integrate other types of data, clarify specific aspects about the quality and time course of the spontaneously reported symptoms, and then run through a whole series of important follow up questions that often can seem like we weren't listening (why are you asking me about urination and sexual history... the pain is in my shoulder?). We can usually do this pretty quickly, but it involves much more back and forth than occurs in a SE post. The end result here is usually a provisional diagnosis, many other possible but less likely diagnoses, and a prudent course of action to narrow it down further (often accompanied by treatment recommendations in the meantime).

None of this matches the expectation that a brief paragraph containing the spontaneous symptom report (even including a description of a visit to a doctor) of an internet person could be responded to with any certainty by another internet person using an answer: "these symptoms match A, B, and C". This isn't (just) a legal or license issue. We just can't make a diagnosis from that information.

Answer 3

I appreciate the extensive explanation. And welcome back. Same to anyone else who returns to HealthSE and wonders "wtf is happening here?" We would love to have more active users.

Those of us who stuck around to keep this site afloat have tried multiple ways to fix the near-fatal problems we've struggled with for the past 2+ years. The fact that we're in agreement on what the problems are and how to try to solve it should indicate that you're missing a piece of the puzzle to understand why the site name/scope must change. Also, why we want to try this rather than just closing it.

It would help to read some of the meta posts by our most active users to learn more about the reasons we have decided the need to change name/scope, like this or this. And the reasons why we can't give medical advice (which also helps illuminate why many questions that don't seem like medical advice really still are). And the attempt to foster a separate community of medical experts to contribute to answering/voting on this site (which didn't work).

Medical professionals know not to give individual medical advice or diagnosis outside of a clinical relationship or specific other situations. When the vast majority of HealthSE questions have become medical advice & diagnosis requests, or questions without the effort to even google it, or "is this wild claim right?" questions... medical professionals tend to not stick around due to frustration.

I understand you want to learn. I did too, that's why I studied it, and why I like to teach. But on HealthSE there are guidelines, and there are ways to ask your question to get close to the answer that you want.

Your question gives a rather specific scenario and asks for the names of the possible causes. It's not "what are the non-cardiac etiologies of chest pain?" but instead is a set of specific circumstances and symptoms asking what could it be. That is diagnosis - without the full picture of HPI ROS PMH PSH FH SH M/A... (history of present illness, review of systems, past medical history, past surgical history, family history, social history, medications, allergies...)

Even the "answers" you gave above as examples are very diagnosis-like. I understand that it might not be crystal clear why, but read the meta on why we don't give medical advice and it may clarify some of it.

I understand that you also wonder why didn't we just edit your question, or reshape it, or teach you how to ask it in a way that doesn't violate our guidelines? That would be ideal! We'd like to - in fact, for hundreds and hundreds of questions we did just that.

Yes, some of us who stayed here DID spend countless hours trying to teach, edit, guide, and help people whose questions were problematic - in the hopes they would learn, edit, join in and contribute. The vast majority of the time, it was to no avail, and the repeated futility of it has largely burned us out. Many of our experts quit. We decided we no longer have the manpower to edit all questions, so we are closing off-topic questions rather than editing them most of the time now. You're experiencing the result of that.

Right now, we're just trying to keep it afloat until we can change the scope and try to see if we can breathe new life into it.