Where do we draw the line between personal diagnosis request and "made generic" "differential diagnosis"

Question

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?

Answer 1

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.)}