Patient Advocacy and AI for Improved Medical Diagnosis

Deep Dive

The discussion begins by addressing the frustration of individuals who feel unwell but are told by medical professionals that their labs are normal and they are fine. Dr. Erin Nance emphasizes trusting one's gut, stating that the absence of a diagnosis does not mean the absence of a problem. She notes that the medical system often prioritizes volume over accuracy, with short appointment times hindering thorough evaluation.

The conversation then shifts to the historical lack of research on women in medical studies, which has led to a pattern recognition failure in diagnosing conditions. Dr. Nance explains that many recognized symptoms for diseases are based on male presentations, causing women's symptoms, which can differ, to be overlooked or mislabeled as "atypical." This bias extends to conditions like heart attacks and ADHD, where symptoms in women are often less recognized.

Consequently, women are significantly more likely to experience a misdiagnosis. Dr. Nance highlights that the ideal scenario involves connecting with a "curious" doctor who is willing to investigate further and collaborate with colleagues. These "north star providers" act as guides, a role that is becoming increasingly difficult to find as primary care as an industry declines.

To aid in this process, patients are encouraged to track their symptoms and become informed. Dr. Nance suggests using social media, not for self-diagnosis, but to recognize patterns in others' experiences and stories. She acknowledges the risk of misinformation online but points to platforms like TikTok as places where individuals share their health journeys, leading to moments of recognition for those experiencing similar issues.

Dr. Nance also discusses the development of her platform, "Feel Better," which aims to provide a trusted source of medical information from vetted experts, addressing the need for credible resources when immediate doctor access is not possible. The conversation touches on the use of AI, with Dr. Nance explaining how she advises patients to use tools like ChatGPT for differential diagnoses to guide further research.

The discussion then explores the concept of "disease origin story" versus "root cause," with Dr. Nance preferring the former to avoid the overused term "root cause." She uses the example of a yellow fingernail, explaining that identifying the specific fungus causing it is crucial for effective treatment, rather than merely describing the symptom.

The challenges of healthcare reimbursement and the out-of-network status of some physicians are examined. Dr. Nance explains how insurance companies' low reimbursement rates can make it economically unfeasible for doctors to be in-network, forcing them to either subsidize patient care or operate out of network, which can be prohibitively expensive for patients. She recounts her own experience of being unable to join insurance networks due to her solo practice status.

The conversation addresses iatrogenic harm, or harm caused by medical care. Dr. Nance references studies indicating that medical errors are a significant cause of morbidity and mortality. She differentiates between individual medical errors and systemic issues, citing the example of central line infections and wrong-sided surgeries, which led to the implementation of universal timeouts and checklists to improve patient safety.

The evolution of cancer care is brought up, with Dr. Nance noting how treatment protocols, such as starting chemotherapy before surgery for some breast cancers, are changing. She also highlights advancements in orthopedic surgery, like limb-sparing surgery for osteosarcoma, which has replaced amputations for many patients. This underscores the importance of ongoing research and questioning existing practices.

The topic of early menarche in girls is discussed, with the observation that it is occurring earlier. This phenomenon is linked to the resolution of undernutrition and the subsequent rise in obesity, as adipose tissue can produce estrogen. The politicization of health discussions is lamented, with examples of how accurate health information can be distorted or used for political purposes, hindering productive conversations.

Dr. Nance expresses optimism about AI's potential to aid diagnostics but emphasizes that physicians remain crucial gatekeepers. She notes that while AI can analyze scans, it cannot perform physical examinations or procedures. The conversation also touches on the potential for AI to improve efficiency in healthcare systems, but expresses a desire for a systemic evolution that allows for more patient-centered care.

The benefits of female physicians are considered, with studies showing better outcomes for female surgeons. Dr. Nance suggests that female patients may feel more comfortable with female doctors, though she acknowledges that not all female doctors are perfect diagnosticians and that she herself has made misdiagnoses. She shares a personal story of a complex case involving Ehlers-Danlos Syndrome that she initially missed.

The discussion delves into rare conditions, with Dr. Nance sharing a story of "slipping rib syndrome" diagnosed via social media. She reiterates that rare conditions are often rarely diagnosed and that social media can help connect individuals with similar experiences, leading them to seek proper medical evaluation. Autoimmune syndrome, where the gut microbiome produces ethanol, is also mentioned as a peculiar condition.

The overprescription of medication is presented as a problem stemming from a desire for fast solutions. Dr. Nance emphasizes that every drug has side effects and that reliance solely on pharmaceuticals is not ideal. She highlights the positive impact of GLP-1 medications for weight loss, noting that they can help destigmatize weight issues by offering a medical intervention rather than framing it as a moral failing.

Lifestyle factors are discussed, with reference to a longitudinal study on Native Hawaiians showing reduced chronic illness due to traditional, active lifestyles. The impact of ultra-processed foods and the importance of individual food choices are explored, acknowledging that economic factors can limit access to healthier options. Dr. Nance advocates for making the best available choices, even when convenience or cost are factors.

The role of animal-source foods in a healthy diet is defended, arguing against their demonization, especially in an era of high ultra-processed food consumption. Dr. Nance suggests that conventionally produced protein is a better choice than processed alternatives like boxed mac and cheese. She encourages focusing on the beneficial components of food rather than solely on calorie counts or avoiding "bad" ingredients.

Dr. Nance shares the personal motivation behind her book, "Little MisDiagnosed," which was inspired by her brother's paralyzing diving accident on her first day of medical school. This experience shaped her empathy and approach to patient care. She also addresses the underrepresentation of women in orthopedic surgery and her desire to empower women in male-dominated fields.

Her specialization in hand surgery is attributed to a childhood experience where an orthopedic surgeon left an opera to treat her broken arm, inspiring her to pursue a similar dedication to her craft. She mentions her own journey navigating the male-dominated field and her decision to speak out against misogyny later in her career.

Finally, Dr. Nance outlines her platforms for connection: TikTok (@littlemissdiagnosed), her podcast "The Medical Detectives," and the health social media platform "Feel Better." She defines living a genius life as sharing one's expertise.