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True Story — For thousands of years, the world's professional societies and religions have disseminated its teachings in arcane languages understood by few. It was believed that such knowledge in the hands of the the unwashed masses would be dangerous without the proper tutelage to wield it wisely. Specialists were ordained to disseminate solutions in "plain English" on a need-to-know basis to assure its wisdom was not applied haphazardly. I am grossly paraphrasing history, but it illustrates an important point —

On a site like this, folks are allowed to talk about this strange and mysterious world of "medical health." Folks will be discussing how we can live longer, stay healthy, fix problems, and how all this stuff works. Our hope in creating a Stack Exchange site like this is that we can separate the good information from the mis-information.

but… That doesn't mean that anything goes.

When General Advice Become Personalized Medical Consultation

If someone asks if they should heed their doctor's guidance... or continue taking their medication... or if this mole is cancerous... or is this sharp pain is cause for concern? — those are very difficult questions that can only be answered by an expert privy to all the medical history and information regarding your specific case.

Your. Specific. Case. That's an important phrase we should all remember. We are not your doctor and we do not dispense PERSONALIZED medical advice here. But I've been watching this self-inflicted moratorium on legal and medical advice permeating this network for years, and it's just not prudent to freak out over someone asking how to remove a splinter… followed by all the grave concerns that such "medical advice" could cause infection or cause the loss of the entire arm... or worse.

That's just nonsense.

We're allowed to talk about this stuff. Nobody is suing Stack Exchange for hosting illicit talks about how to treat your athletes' foot or discussing if vitamin C really does help stave off a cold. If you reach that point where you innermost self is just screaming… "Man, you really need to see a doctor!", you have all the tools to moderate your site for content. But until that point comes, just assume that anything said here is to be taken with a grain of salt. We are not purporting to replace your medical doctor, nor should the site be used like that.

And this doesn't just apply to questions. Every time you see an answer that says, "I did {X} and I turned out just fine."for criminy sake, please do not up-vote it! We can't have a "sounds good" motif here. If you "heard" something, tell us where you heard it. There IS potential for poor advice to be passed on here, and folks simply up-voting the best-sounding answer is going to get this site shut down fast. We can't have the blind leading the blind in a subject like this.

Then again, that doesn't mean we shouldn't be allowed to talk about this stuff at all.

Confused? I don't blame you. I'm just posting this so (hopefully) we can all just relax a bit. Let's just see what type of "problems" become widespread before condemning this site for issues that are few and far between. I'm sure we'll be talking a lot more about this going forward. For the time being, just relax, be mindful, and… enjoy.

  • 4
    If we shouldn't upvote the "sounds good" answers, should we downvote them? – Ooker Apr 1 '15 at 6:41
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    I believe professional answers should include a reference or resources. Otherwise it should be taken inseriously. – Shimmy Apr 1 '15 at 21:56
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    +1 for a new word - criminy! – Tim Apr 2 '15 at 20:08
  • Agreed. These are some helpful points, these will come in handy when building rules for the help center and handling content disputes for the site. – Pobrecita Apr 3 '15 at 7:03
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    Perhaps we should encourage non-experts to avoid voting on answers, and stick to voting on questions. Since this probably has relevance to all SE site, I posted a question on Meta SE. – Garrett Apr 4 '15 at 5:57
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Regarding personal advice, some other sites have close reasons for this.
Judaism.SE has a close reason for "ask your rabbi". Christianity.SE has a close reason for "ask your pastor".

I think that when Health moves out of private beta we could also have a close reason for "ask your doctor".

  • 4
    Absolutely. See this question as an example of one that would fit that: health.stackexchange.com/questions/144/… – JohnP Apr 1 '15 at 15:15
  • Agreed. As a addition, it could be ask your medical professional or something. Doctor is pretty specific, so we should just point them to their physician or a hospital. – Pobrecita Apr 3 '15 at 7:05
  • CogSci has a similar close reason. – Shokhet Apr 3 '15 at 16:19
  • @JohnP, the example question you link to does not seem to be a problem of overly personalized advice. It was too broad, but it was not very personalized. It was a question about renal problems. An overly personalized question would be like some of the ones I've seen on Academia SE where someone describes their very unique situation (which is unapplicable to anyone else) and then asks for advice. – Garrett Apr 4 '15 at 6:02
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    @Garrett - It was asking for a specific diet for renal problems. That to me falls into medical advice, as many of us won't know the specific problems that various foods can cause, especially combined with unspecified medications and previous history. If I have to get a case history before I can create a good answer, then it's probably OT medical advice. – JohnP Apr 7 '15 at 15:14
  • I think the trouble with "ask your doctor" is that it will get overused to shut down a ton of perfectly answerable questions. There need to be very specific criteria on when to use this close reason, and a bias against using it. – Jez Apr 11 '15 at 19:29
  • @Shokhet Hi! I don't want to be a pest, just want to let you that the link you referred to from CogSci is a Page Not Found. Thanks for the great job all of you are doing! – Sue Apr 21 '15 at 1:07
  • @Sue Thanks. I think that it was a closed question with a "self-help" close reason. This probably would have been the better page to link to. – Shokhet Apr 22 '15 at 18:38
  • @JohnP: I've just joined the site minutes ago and am trying to learn about the rules. The question you mentioned as an example has been deleted. 1) I'm sad to see that the deletion policy (instead of closing) permeates here from SO; 2) Since you're a mod, can you maybe update your answer to include the relevant part of that question, that presumably got it deleted? – Dan Dascalescu Jun 18 '15 at 2:12
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    @DanDascalescu - The entire question was: "I would like to know is what sports, activities and foods to avoid/include that are specifically good/bad for kidneys ?", which was closed as too broad. – JohnP Jun 18 '15 at 14:18
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    @DanDascalescu - The original question that was edited gave a specific disease state and asked for diet and sport recommendations, which for me, put it a little too far into personalized medical advice. – JohnP Jun 18 '15 at 14:25
22

I will be a dissenting voice here.

There IS potential for poor advice to be passed on here, and folks simply up-voting the best-sounding answer is going to get this site shut down fast. We can't have the blind leading the blind in a subject like this.

I've been here all of two days. However I've been a doctor for decades, and I've already seen bad answers and advice up-voted here. How do you propose to avoid your scenario?

It was believed that such knowledge in the hands of the the unwashed masses would be dangerous without the proper tutelage to wield it wisely.

That represents a reality of the situation. Ask any physician how often patients have insisted on an antibiotic which was completely unnecessary, or believed Tylenol in mega-doses was safe because the government wouldn't allow it to be sold over the counter if it wasn't. (And this while Paracetamol was the suicide drug of choice in the UK.)

One needn't be well above average to practice medicine, but one does need to study hard for a long time; the average (after college) is seven years - 4 of medical school, 3 of residency - and that is the minimum for a competent primary physician. (It takes less time to become versed in only a wide variety of the most common problems; that's what physician's assistants do.) Add to that the fact that you learn more medicine your first year out on your own than you learned in any of the previous 7 years. Year by year, the learning falls in quantity, but always continues. How can the average SE user compete with that?

The voting on this question puzzles me. There are equal up and down votes for both answers. How are people making their decisions? I can only guess that the first answer, before the edits, was not acceptably written even though it is basically correct. This is exactly the scenario you describe:

We can't have a "sounds good" motif here.

I don't have any problem with all the free advice in the world given freely by non-members of my secret society as long as it's correct. Or bad advice about athlete's foot, splinters, or Vitamin C because it will mostly be innocuous. I have a concern about users that have and will continue to up-vote well-written, authoritative sounding answers that are simply wrong. This can only be discouraged by requiring answers to have decent references. Without them, it's no better than what you might get from your brother-in-law's cousin or the guy sitting next to you on the bus.

I like SE. I'm active on a number of sites. I want Health.SE to succeed, so I have an interest in being here. But how will you get the professionals you want to come here unless it's more professional?

Your decision.

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    I agree with almost all of this (+1). The trouble is, I can’t figure out how the community could make a decision to improve the quality. It’s so easy to take sources out of context and cite decent (or better!) references yet still be wrong if perspective (generally achieved through training) is lacking. This is also a field where there are plenty of people eager to pretend they are experts. With that eagerness + decent writing skills, selling nonsense is easy. The solution, I think, would be an educated audience willing to give critical feedback, but....? – Susan Apr 4 '15 at 6:19
  • @Susan - if critical feedback were honestly welcome, it would be forthcoming, but on many SE sites, it mainly results in unpleasant comment wars. Most people don't want to feel even the minor sting of a gentle correction in spite of the fact that it may improve their answers. I agree with you, though. That would help a lot. – anongoodnurse Apr 4 '15 at 6:53
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    It was actually the “educated audience” (rather than the “critical feedback”) part that I wasn’t confident the community could muster.... ;-) The feedback issue is something the community could decide to change. The other, I’m not so sure. – Susan Apr 5 '15 at 17:22
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Nobody is suing Stack Exchange for hosting illicit talks about how to treat your athletes' foot or discussing if vitamin C really does help stave off a cold.

I appreciate this point, and I recognize that it reflects the consistent, sensible approach that SE has taken to such issues. I think there is one aspect of this that often flies under the radar, though. Although there may be no real threat of a lawsuit anywhere in the vicinity, the perception of such a threat is an issue for .

The tag apparently has zero meta discussion as of yet, but it should, and will. Along these lines:

But, in these earliest days, we are DESIGNING a site for experts. To attract experts, you need a site where people are asking very interesting and challenging questions, not the basic questions found on every other Q&A site. Remember, the pro sites WILL attract the enthusiasts, but not the other way around!

What does this have to do with lawsuits? One group of people with the appropriate background to serve as “experts” for many of questions on this site will be those with medical training. Doctors (in the US) are (frequently) paranoid. Most are sued at some point in their career, nearly everybody knows somebody who has been sued, and the hype around the trauma of lawsuits is incessant.

What percentage of these lawsuits involved circumstances that are anything like the health.SE site? I have no idea; probably fleetingly few, perhaps none. That doesn’t matter. The prevailing impression (among a bunch of people who know almost nothing about law and make it their life’s aim to stay as far away from it as possible) is that an MD who provides medical advice — however loosely construed — can be sued if it’s bad advice.

How is this related to health.SE?

One question asked: Should the site have a clear disclaimer along the top?

One of the answers:

A disclaimer doesn't solve the actual issue. Any reasonable person should know that they shouldn't trust the internet for medical advice. And anyone else won't read the disclaimer anyway.

This strikes me as completely reasonable. However, as in so many areas, I’m not sure that we can assume that reason governs behavior.

So there is no actual issue. So a disclaimer doesn’t actually negate said nonexistent issue. What’s the point? The point is that it may make (at least some) of the experts you’re interested in attracting more comfortable. It may make the difference between a decision to offer an answer and a decision to click away because “it isn’t worth it” due to a perceived possibility of legal liability for practicing something that we all know isn’t proper medicine.

There has been a lot of pooh-poohing concerns about lawsuits. I happen to believe you when you say that y’all have looked into it and this isn’t an issue.* I do think, though, that a willingness to cater to the (baseless, inane, delusional, whatever) apprehensions shared by many MD-types would go a long way to allowing this site to attract the experts that will help it succeed.

I don’t know what that should entail. A disclaimer shown to people asking questions, or an item in the Q&A that explains how the legal responsibilities (or lack thereof) in this area work, or a notation in the tour that nothing here should be construed as personal medical advice? I also agree with an idea raised in another answer about a related close reason. I just don’t want to see us refuse to engage in a discussion of such measures because smart, objective people tell us that it’s silly. When it comes to , that’s not the point.


*Although I note that you say that “nobody is suing Stack Exchange.” The concerns I relay here are not about Stack Exchange’s legal accountability….

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    "This strikes me as completely reasonable. However, as in so many areas, I’m not sure that we can assume that reason governs behavior." +1. Also, though I've never been sued, I'm not paranoid about bad advice. I dislike it because we're taught to "first do no harm" and because most of us are genuinely passionate about helping people get better. Bad advice doesn't help anyone get better. I'm not worried about good advice. The more, the better! – anongoodnurse Apr 4 '15 at 3:19
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    @medica Thank you, and agreed (though I think you and I may not be the most representative sample considering that...we’re here). My concern about “bad advice” isn’t because I think any of us is incompetent or has ill intent, but rather even the best of us are limited here by the question, which provides only whatever bits of pertinent info the OP happens to feel like providing, and we have no opportunity for a proper interview, exam, or whatever else. This is necessarily suboptimal. – Susan Apr 4 '15 at 4:05
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    (cont.) Of course, these aren’t supposed to be personal questions, and one can be careful to provide only general info, but probably many of them actually are thinly veiled personal questions, and if the OP isn’t forthcoming about where they’re coming from, I think it’s probably easy to be misled into offering something that isn’t actually appropriate. I understand that we can’t be sued for that. I just think it’s a concern that’s out there. – Susan Apr 4 '15 at 4:11
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I think some of this should be added to https://health.stackexchange.com/help/how-to-answer and https://health.stackexchange.com/help/on-topic.

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The purpose of the whole SE (which Health is a member) is providing knowledge. It can be in the form of advises, methods, or cures, but it must tell why it works. There is no clear cut what question is not potentially dangerous, but if it clearly requires a doctor, then it should be closed. In a good form answer, it will have a reference to back it up. In an Utopia, where anyone can reach a doctor, I definitely dis-support this site. But there are places in the world where the patients can't have good condition (can't find a doctor, can only talk to them under five minutes, or worst, doctor who are only care for making money), then this site will help both the patients and the doctors.

Check out:

  • any reason for a downvote? – Ooker Jun 16 '15 at 5:50
  • I suspect because you're advocating that health.se replace a doc where there isn't one. And of course most respondents aren't qualified. – Graham Chiu Jan 1 '17 at 1:10

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