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Previously (Personal Diagnosis and Health.SE, Are differential diagnosis questions on topic? this has been discussed without a proper consensus building, as far as I understand it.

The first link is actually the newer post and concludes:

Should not be answered, Should be closed

The second, older post concludes in an upvoted answer that it is not so clear cut and may be judged into three categories:

Too broad, Too personal, and Probably OK

but the downvoted answer was unconditional in favour of such posts.

Since there was recently some controversy (regarding two questions) that revolved around the same topic, I think this needs a bit more of a better defined approach for this site.

The two posts in question were (a) Wishing to be dead without committing suicide and (b) Differential diagnosis for a facial lesion?.

Both suffered from being posed by a newbie, not being edited after being put on hold by the OP, and different types of ambiguities associated to them that gave the most reason to doubt any decision.

While (a) had some merits in its original form that might indicate a general desire to discuss the topic in its generic form, (b) was clearly a request for personalised medical advice and diagnosis.

Both questions were edited to "make them more generic" after being put on hold, (a) stayed closed, (b) was re-opened.

While it's natural to disagree on many points, comparing these two cases seems like we do not adhere to our own guidelines uniformly, or we might have too widely differing readings on them. In all help documents there is no mention of "differential diagnosis exemplified with actual, acute personal pictures" but multiple times "personalised medical advice is off-topic here"; for some reasons.

Now I am quite unsure on how to read and apply the guidelines. Since (b) was the reason for posting this, I'd like to concentrate the discussion primarily on this "case".

As far as I saw it: there was no edit from the OP, no real feedback, blurry pictures of unknown colour accuracy, no closeup view in person, no answer to questions and an ambivalent backstory. How can anyone differentiate with confidence from these pictures alone whether it is bacterial, viral or chemical (or other causes) and how seriously it will progress? In case my eyes are deteriorating: it's about the principle of looking at pictures with dubious quality

Since relevant parts of the community re-opened the question despite my concerns, I have to accept that, and I do. This is not about an appeal to this decision.

Nevertheless, I think a more properly defined guideline on different types of diagnosis is needed. Where do we stand on this and can we come up with a more uniform policy that is up-to-date to a current consensus on this issue?

  • Your second link doesn't work for me – Graham Chiu Feb 16 '18 at 21:49
  • @GrahamChiu Should be fixed now. – LаngLаngС Feb 16 '18 at 21:51
  • And I agree, it should be closed. – Graham Chiu Feb 16 '18 at 21:54
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    Is question a closed? I see an answer now. – Graham Chiu Feb 16 '18 at 22:30
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    @GrahamChiu I see. When I composed this Q I had to manually remove [on hold] from the title. Do not see any statistics on that. But I am sure it must have been reopened in the meantime. – LаngLаngС Feb 16 '18 at 22:32
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As the answerer, I'm obviously biased. In addition, I don't consider myself an involved member of the community any more, and when I was, I held very firm beliefs (like reliable sources *that actually support what you are stating, which was an actual problem). None of that matters any more.

If the community doesn't want to accept an edit from anyone other than the op, VTC/flag it for closing. It's your community, but AFAIK, this is not an SE requirement.

Also, Health is a rather unique site in the SE network. The only other site that comes close is Skeptics. So what the rest of SE does is not completely relevant here.

I answered because I am interested in doing good for people, which was the reason I signed on for this site. To my thinking, it was an opportunity to be nd do what Health was supposed to be and do. I practiced medicine to help people (not to make money; I made enough to support myself but not enough not to worry about college tuition for my kids or scramble when it started), I enjoyed that aspect of it more than anything else. It is a privilege to have someone put their health in your hands, and to actually fix something, leaving them better than they were (sometimes as good as new!)

That was what I was hoping to do with this answer. Facial herpes is on the rise because of the rise of genital herpes. It's a risk not a lot of people know about. Why not help the English-reading world just a little bit? If this answer prevents one person from contracting HSV, I will have done what I wanted to do.

In my decades of practice, I only saw one case of recurrant facial herpes, during residency. It was in a teenaged boy who had this very painful outbreak every year same time of year, and saw a doctor every year same time of year, and was misdiagnosed every year same time of year, until he saw me. And I only knew because I had just come off of a Dermatology rotation where I saw herpetic whitlow, and this looked the same, but on his cheek. I wasn't able to cure him, but I was able to give him a diagnosis and an explanation that finally made sense, and acyclovir had just hit the market, so there was potential to treat/prevent. That was why I loved medicine. (I did refer him to Dermatology though, because at that time, FM was a new field.)

  • I hope I did not offend you. I am not offended by all this, just in case. There is no need to apologise or justify. I just want some more clarity on the issue. –– It would be nice if things would matter much more… Your input is always valued. Edits: We just had the idea that bad Qs should be edited by the OP, so as to not stress ourself so much and more that a bad one-time OP shows the potential to become a better OP, i.e. a repeat customer expanding the dwindling user base.. If you spend your time editing: no objection. At all. I felt like you often enough: urged to write "that's X, do Y." – LаngLаngС Feb 17 '18 at 20:35
  • The facial lesion I feel is now appropriately asked and answered, because the q is more generic and the answer is a fairly broad differential diagnosis (not a specific diagnosis) with references. The quality of the image is less important as the differential is broad, though a better quality pic would make it higher quality. – DoctorWhom Feb 17 '18 at 21:20
  • @LangLangC - You didn't offend me at all. This is just the way I... write? approach things? I'm quite direct. If the community doesn't want anyone but the OP to edit, by all means, keep that policy; it does save the community work. I don't see an apology. I did, as I stated, what I wanted to do. :) – anongoodnurse Feb 17 '18 at 21:50
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    Good. I felt I might have started the conversation in chat a little brusque. Bad bedside manners. –– But one thing to repeat: My thought on edits (and we do not have a policy or consensus on that, at least yet) was just that an OP-edit is much preferred, since that is and shows effort on OP's side. That might be needed here to improve on our "awful questions" problem? Giving OPs more time to learn and fix things, ideally to hook them up in the process. As per original SE policy, even on HealthSE, everyone is still allowed and encouraged to edit everything ;) That never excludes you. :) – LаngLаngС Feb 17 '18 at 22:03
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    Health.se practice is just as bad as the practice of medicine. I had an edit rejected a couple of years ago which was just to add a citation to someone's answer. Took me a couple of years to chill. – Graham Chiu Feb 18 '18 at 1:08
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    @GrahamChiu - That's crazy. – anongoodnurse Feb 18 '18 at 2:17
  • I exaggerated. Less than a year. Why was my edit rejected? health.meta.stackexchange.com/q/585/3414 – Graham Chiu Feb 18 '18 at 3:53
  • @anon Itchy body all over with red spots health.stackexchange.com/q/15365/3414 looks like a rash of skin diagnoses coming your way – Graham Chiu Feb 18 '18 at 4:18
  • @GrahamChiu - lol! – anongoodnurse Feb 18 '18 at 16:01

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