Thread by @Nicole_Lee_Sch

When people critique self-diagnosis as a valid practice they misunderstand the relationship between medicine, diagnostics, and medical training. As a historian of medicine this is endlessly frustrating to me. So here's a thread on the history of diagnostics. 1/22

Until the early 19th century turn to empirical training, which took off in France, diagnostics didn't actually matter all that much. Doctors generally claimed that their patients were sick from imbalanced humors (black bike, yellow bile, blood, and phlegm). 2/22

Some claimed that patients were sick bc of an imbalance between the body's liquid and solid parts (known as solidism), others claimed imbalances from nervous excitement, but on the whole the idea was that an imbalance was happening and needed to be remedied. 3/22

Regardless of the theory the dr believed in the treatment was the same - bleed, purge, give an easy to digest diet, and slowly restore the body to stasis. It didn't matter what disease or medical condition you had, so coming to a particular diagnosis didn't really matter. 4/22

This changed in the early 19th century with the rise of statistics and empiricism. There was an assumption that doctors could gather enough facts about patient habit, lifestyle, and background to define what exactly sparked the imbalance. 5/22

And so in the early 1800s you see all these new criteria for diagnostics and medical terminology popping up in medical textbooks and student lessons. But the majority of it is based purely on observation and is, quite frankly, wrong. 6/22

And so medical professionals begin writing about all of these specific medical conditions, with specific signs and symptoms, with specific therapeutic interventions, and with specific prognoses (aka expected outcomes). 7/22

But at best these diagnostics are guesses. Because medical professionals have yet to figure out germ theory, they've yet to understand genetic inheritance, and they've yet to acknowledge the impacts of dangerous living and working conditions. 8/22

But the process of arriving at a diagnosis looks eerily similar to that of today. Drs are instructed to gather data on patient life, to investigate personal habits, to ask about work and family life, and they're explicitly trained to view patient testimony with disbelief. 9/22

In fact doctors are expected to interview family members and household laborers to try to uncover secret details that the patient refuses to disclose. And somehow then the professional is able to piece all of these facts together into a clear diagnosis and prognosis. 10/22

Keep in mind this is happening less than 200 years ago. All of those diagnostic categories are essentially thrown out or revised about a hundred years later. And since then they've been thrown out, revised, and recycled countless times. 11/22

For two hundred years doctors have been making guesses, often bad ones, that nonetheless make sense when you consider the scientific theories and tech available to them. And so it is incredibly narrow minded to believe that we are not still doing the exact same thing. 12/22

Diagnoses are not perfect. They are not stable. They change every time we find a new marker or test or develop better tools for testing. Diagnoses change frequently as new professionals lay out updated criteria based on the newest available information. 13/22

But in the end, doctors today are still fumbling with diagnostic categories in the same way that doctors did in the past. The medical profession absolutely is uncovering new conditions, disorders, and diseases all the time. 14/22

And as our environment changes and we face new challenges, of course this challenge will be endless. And as we develop new tech and tests all of our criteria will change as well. And so it's ridiculous to me that some people think that medical dx is proper science. 15/22

Getting a diagnosis from a doctor gives a snapshot at a moment in medical history. It doesn't tell the embodied experience of a patient. It doesn't convey what the patient might need, or the resources they could secure, or the knowledge they have about their own bodies. 16/22

When people self-diagnosis they are doing the exact same process as medical doctors - gathering data, looking over tests and biomarkers, soliciting interviews from patients with the suspected condition. In fact they're doing more science than most doctors. 17/22

And they're often doing better science. They're looking at huge patient communities. They're collecting and reading targeted information and going through up to date literature. And they're claiming knowledge about their own bodies that doctors cannot and will never hold. 18/22

Self diagnosis is just as valid as medical diagnosis. The only difference is the criteria by which we judge our cases. There are plenty of "rare" diseases defined by clinical assessments alone, that have no real tests, the only difference is who is doing the assessment. 19/22

The medical community does not have a monopoly over the ability to make empirical observations, to gather data, to research patterns, to speak to patient communities, and to come to conclusions. The science is flawed, no matter who is doing it. 20/22

The real question is: why are patients seeking answers treated as if they are incapable of practicing these basic approaches to science? And why is formal medical training treated as the only way of truly knowing the body? 21/22

Self dx is valid, it's understandable, and it literally saves lives. To treat patients as if they're incapable of this work or uninformed is to stake a claim that power and privilege over care and knowledge belong to medical professionals alone. 22/22 #DisabilityTwitter #HistMed