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Is Seeing a Specialist Always Best?

When people ask me about finding a doctor, I almost invariably tell them to see a headache specialist. Seeing someone with headache-specific knowledge is important because headache disorder education isn’t widespread. But is seeing a specialist always the best idea?

Dr. Aniruddha Malpani of The Patient’s Doctor writes:

Most patients want to go to the doctor who has special expertise in handling their particular problem. They will spend a lot of time and energy tracking down the “biggest name in the field” – and then leave everything up to the doctor. This can often be a short-sighted approach, because specialists are biased, and it’s important to be aware of this bias.

While it’s true that an expert has a lot of experience in dealing with a particular problem, this extensive experience also introduces all sorts of bias in the way he handles this particular problem. There are many reasons for this.

Because he is used to seeing complex cases which have been referred to him, he often cannot deal with simple bread and butter problems ! He also sees life through a distorted lens, and may not be able to see the big picture. Because he cannot afford to make mistakes, he often overtests and overtreats. He often asks for esoteric and expensive (and painful) tests, to differentiate himself from the other ordinary doctors. He also usually bad-mouths alternative options of dealing with the problem – after all, this is his competition! He is reluctant to refer cases which he cannot handle, because this would damage his aura of omnipotence and omniscience.

Often, in the pursuit of narrow goals, he loses objectivity; and is more interested in doing research rather than treating patients. Many experts are so used to seeing only sick patients, that they often cannot recognize a normal variant!

What do you think? Let us know in the comments below or on the online support group and forum.

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Credibility of Medical Blogs (including The Daily Headache)

Can you trust medical blogs? Clinical Cases and Images describes an initiative among medical bloggers to establish the credibility of their blogs. Using a variation of the National Center for Complementary and Alternative Medicine‘s 10 questions to ask when evaluating online medical sources.

Although I’ve never thought of myself as a medical blogger, I suppose I am. So here’s my disclosure.

1. Who runs this site?
Me, a patient

2. Who pays for the site?
Me, with a little help from Google ads and Amazon sales

3. What is the purpose of the site?
To create a supportive community of people with headache; and to help people with headache know that they aren’t alone, be informed on current headache- and pain-related news, and be more involved in their own medical care

4. Where does the information come from?
News sources like the New York Times, Medical News Today and Reuters; other medical blogs; research and articles from headache organizations, like ACHE and the National Headache Foundation

5. What is the basis of the information?
I’m a long-time migraine and CDH patient with a background in writing, teaching and social science, which helps me evaluate, understand and share information

6. How is the information selected?
What’s in the news, on blogs or a hot topic on a forum; headache books and articles; my own experiences

7. How current is the information?
I try to post every weekday, usually in relation to topics that are typically no more than a week old. When I find old articles that are interesting, I check for updated information on the topic.

8. How does the site choose links to other sites?
I share the source of inspiration or information, typically other blogs and only link to sites that I’ve evaluated as credible. The only time I link to sites that I don’t know much about, it is to link to a news story that’s no longer available in a wider arena, like Google or Yahoo news or Reuters.

9. What information about [visitors] does the site collect, and why?
I collect site statistics through Site Meter and StatCounter. My primary goal is to see how many people visit the site and what sites refer visitors to me. I also look at what search terms people use to find the site and what other sites their search pulled up — I use this information to make sure I’m covering topics that are relevant to readers.

Through the statistic sites, I’m able to access IP addresses of readers and locations of visitors. I sometimes look at IP addresses to see if major companies visit the site (like drug companies) and where visitors come from so I can be sure the information is geographically relevant.

But, honestly, I rarely look beyond the visitor numbers, referral sites and search terms.

10. How does the site manage interactions with visitors?
I respond to e-mail in as timely of a manner as I can manage. I respond to comments unless they don’t need a reply. Sometimes I reply via e-mail, sometimes directly in the comments. I delete comments that are obviously irrelevant spam.