User:TenOfAllTrades/Why not?

Wikipedia's formal policies and guidelines related to the offering of medical advice can be found in several places. Worth reviewing are
 * General disclaimer
 * Medical disclaimer
 * The Reference Desk guidelines
 * Specific guidelines for medical advice requests on the Reference Desk

This informal essay isn't intended to be cited as policy or guideline. It serves only to summarize in a casual way some of the key reasoning behind the policies.


 * I have been told that I shouldn't give out 'medical advice' on Wikipedia. Why not?

We don't want to hurt anyone

 * See also No-win situation, confirmation bias

For most of us, this is the single most important issue. Poor medical advice – too optimistic, too pessimistic, too detailed, not detailed enough, incomplete, based on incorrect assumptions, just plain unlucky – can cause real physical and emotional harm. The harm can range from unwarranted fright all the way up to death.

Even in the absolute best-case scenario, where someone receives a correct diagnosis and recommendations from an adviser on Wikipedia's Reference Desk, we are left with a reader who has an uwarranted faith in the reliability and trustworthiness of our answers&mdash;a confidence that may betray them the next time they ask a question.

Sometimes even the best advice will go bad. Real doctors are sometimes unlucky, too. But we'd rather have a patient under a doctor's care and supervision when the unexpected arises. Mild symptoms (headache, sore arm) can be linked to serious underlying conditions (meningitis, heart attack).

Some people come to Wikipedia seeking to hear a particular answer. It may not be obvious what that is, but they will only listen to the part of the advice that confirms their own suspicions. Saying, "It may be harmless, but you should check with a doctor" will all too often be heard as "It's harmless".

And some editors of Wikipedia might just give bad advice. Most editors here aren't trained or certified physicians. Good intentions don't always mean good diagnoses. Even medically-inclined editors may have an off day. And the human ego can be a funny thing&mdash;there are some very smart people who still fall into the trap of assuming that their expertise in one particular area translates into expertise in other (or all) areas.

For those who are interested in causing potential physical harm to strangers, we recommend the sport of boxing.

For those who are interested in causing emotional trauma to strangers, we recommend auditioning for a reality television program.

Overdiagnosis is bad too

 * See also Type I and type II errors

Please don't try to 'scare' a reader into seeing a doctor by offering a particularly frightening diagnosis or prognosis. It's cruel to the reader, and it can lead false overconfidence the next time around. ("They didn't tell me it could be dangerous this time, so this new symptom must be harmless.")

You're not a doctor

 * See also Medical license, Medical malpractice

If you were a doctor, you'd already know that you shouldn't give advice to strangers on the internet.

Are you certain that you've considered all the possible causes for a symptom? Asked all the right questions about allergies, environmental exposures, medical history? If you are certain, then you're mistaken. If you aren't certain, then you're not in a good place to even begin thinking about giving medical advice.

People lie

 * See also House (TV series)

They lie about embarrassing things. They change details that they think aren't important. They omit valuable information without realizing it. They don't tell you about their drug use, their affair, the accident that they assume is unrelated. A doctor, in the room with them, taking a full medical history, has a fighting chance of figuring these sorts of things out. Here, you don't have a hope.

Is it their own fault if they get misdiagnosed based on their own dissembling? Well, maybe&mdash;but we still don't want to be playing a role in that process.

Think of the children

 * See also Age of consent, Age of majority, For The Children (politics)

An appreciable fraction of questions seeking medical advice comes from young people. Some identify themselves as minors when they first post a question; others don't mention it until a followup remark. Some probably don't tell us at all, while others may even lie about their ages (see above). We have no way of knowing, so we err on the side of caution.

Kids who don't have the maturity or experience of even an average adult shouldn't be making medical decisions on the basis of advice from random strangers on the internet. The fact that they're even willing to trust us here suggests that they need guidance about where to properly seek medical advice.

But the poster is a Wikipedia regular
He's someone who obviously knows the limits of Wikipedia's reliability, and he's said that he won't trust the answer he gets; he's just curious about his health in an idle sort of way.

Well, no. The risks of harm – caused by under- or over-diagnosis – still remain. Many Wikipedia 'regulars' (including ones with years of experience and thousands of edits) may still be minors.

Moreover, it sets a poor example. We don't (or shouldn't) look the other way on our policies and guidelines just because someone experienced is asking us to. We bend rules only where it would improve the encyclopedia for us to do so &mdash; not for the convenience or amusement of our on-wiki buddies. Responding to some medical advice requests while deleting others sends a very confusing message to new editors and new OPs. It gives the impression that it is okay to give medical advice, and that the Desks are in general an appropriate place to make requests for such advice.

New or inexperienced editors will wonder why their own questions get removed while initiated members of the cabal enjoy special privileges.

We don't want to hurt Wikipedia's reputation

 * See also Seigenthaler controversy, Russian roulette

In early 2005, few people on the street had heard of John Seigenthaler, Sr.. Most Wikipedia editors had never heard his name; fewer still had ever gone near his article. In May 2005, an anonymous editor – as a joke – added an entry to Seigenthaler's Wikipedia biography linking Seigenthaler to the Kennedy assassination. The biography was not corrected until September 2005; the offending revisions of the article were also deleted from the article history.

By December, the media were in full-blown outrage mode, leading to a firestorm of controversy on and off Wikipedia. (It was a slow news week, perhaps.) Jimmy Wales himself was appearing in print and televised media defending Wikipedia's battered reputation. Before Christmas, a new policy on biographies of living persons has been enacted granting Wikipedia editors and administrators broad power to remove and delete any poorly-sourced biographical material, and authority to enforce those decisions through page protection and blocks. At the time, it was seen as one of the most dramatic and draconian policy shifts Wikipedia had ever experienced.

We don't want to put Jimbo back on CNN to explain why Wikipedia scared/hurt/maimed/killed little Timmy and why our policies on medical advice were ignored. We don't want to taint the reputation of the entire project and all of its contributors (again) because of one editor's mistake. We don't want to see the Reference Desk shut down or sharply curtailed because the Foundation lost faith in our ability to regulate ourselves.

Each time medical advice is given out, it will carry with it a small (or sometimes not-so-small) risk of disaster. It is selfish for an individual editor to decide that he wishes to stake the entire project's reputation on his own amateur medical opinion. Play the odds enough times and we will lose&mdash;horribly and messily.

Won't we get bad publicity if we don't help a sick person?
Our standard response to a request for medical advice is to advise the person to speak to a qualified medical professional: their doctor or pharmacist. In general, telling sick people to seek the help of their physicians is a difficult practice for the press to demonize&mdash;and it has the side benefit of being the right thing to do. Imagine the following interview on television:
 * Interviewer: Today we are joined by Mary Smith, who is suing her local library. Welcome to the program, Mary.  Tell us about what happened to you.
 * Mary Smith: I kept having these awful headaches last spring. I was in at the library, and I stopped at the Reference Desk to ask what might be causing them.
 * Interviewer: Go on...
 * Mary Smith: The librarian at their Reference Desk told me that she couldn't tell me what was wrong with me, and that I should ask my doctor!
 * Interviewer: Then what did you do?
 * Mary Smith: I went home, drank some Scotch, and got so mad at that librarian!
 * Interviewer: Did you see your doctor?
 * Mary Smith: No.
 * Interviewer: Then what happened?
 * Mary Smith: A few days ago, I found out I had a brain tumour! The librarian never told me I could have a brain tumour, so now I'm suing the library for negligence.  Why didn't she tell me that I had a tumour?
 * Interviewer: [silence]

But the advice I'm giving doesn't count as practicing medicine
Is the information that you provided about a reader's condition something that he could find through a straightforward Google search?

Is your advice the sort of casual cocktail-party comment that doesn't approach being anything like the 'practice of medicine'? (You're not giving Medical Advice in a legal sense, are you? There's nothing happening that would create a doctor-patient obligation, is there?)

It doesn't really matter. If you answer here, it's Wikipedia – and your fellow editors – that get the black eye if anything goes wrong.

We don't want to get sued

 * See also Medical disclaimer

The Wikimedia Foundation's current legal counsel – Mike Godwin – seems to be a pretty good bloke. He's been in the legal world for a long time; he's done some valuable work; he's even got his own law. Since he's such an upstanding fellow, we don't really like to create more work for him.

Does Wikipedia's medical disclaimer protect the Wikimedia Foundation from lawsuits over bad medical advice? Oh, probably. The Foundation's former counsel Brad Patrick was of that opinion. Does the disclaimer protect the Foundation from the time-consuming hassle of dealing with baseless threats, claims, and filings? Nope. Since we like Mike, we try to limit the number of things we do that might get us sued, just because we don't want to stick him with more paperwork.

But surely we have disclaimers for a reason!
Yep. We do. That reason isn't so that editors can play doctor when the feeling strikes them. Wikipedia is an encyclopedia project. We've got the disclaimers because we know that any body of work of this size will contain occasional errors, and because our lawyers said we really ought to have disclaimers. Having disclaimers doesn't mean that we ought to abandon our sense of responsibility.

We don't want you to get sued, either

 * See also Legal disclaimer

Wikipedia's disclaimers are designed by Wikimedia Foundation counsel solely to cover the Wikimedia Foundation's ass. If you give some bad medical advice then you're on your own, legally speaking. We already told you not to, but you went and did it anyway.

Honestly, you seem to be a generous and helpful person. The kind of person we like to see on Wikipedia. Caring about others is a Good Thing. That's why we'd hate to see you get sued, baselessly or otherwise. Since you care about people, encourage them to seek professional, qualified care. It's the right thing to do.

But the poster promised not to sue in his question
That still doesn't protect him from coming to harm if he takes bad advice, and it doesn't protect Wikipedia's reputation if he is injured. You still don't know if the symptoms are reported accurately, and you have no guarantee that the poster is not a minor.