Fearmongering Youtube video du jour
I can tell which health videos are viral based on the chief complaints
Based on what anxiety brings patients in, I can almost tell which Youtube videos are viral at the moment. As context, most of my patients are seniors over 65 years old.
Not that long ago, there must have been a doctor proselytizing the benefits of vitamin D. I had asked the patients, why are you interested in vitamin D? They reply, “It’s all over the radio and youtube about how important it is!” So for a while, everyone was coming in asking me about vitamin D. Funny enough, the public service announcement seems to be working. Now in this community, I check vitamin D levels not as much to screen for deficiency, but more so to screen for toxicity.
Following the vitamin D craze, it was foamy urine. I’ve had several patients come to me, actually rush to me, because they had 1-2 episodes of foamy urine. Foamy urine is a non specific symptom, indicating no health problems most of the time especially in the general public. But there must have been a physician on Youtube that instilled urgency in patients to go see their primary doctor if their urine has bubbles, in case it’s a symptom of kidney disease and imminent need for dialysis.
Most recently, videos on constipation are gaining traction. One patient presented as a walk-in requesting medications for constipation. Constipation means different things to different people, so I asked more about it. His constipation is not bothersome. But he doesn’t have a bowel movement (BM) everyday, instead maybe every other day or so. This is not new and there are no associated pains or symptoms. This patient who is 75 years old, came into the clinic because he saw a video informing him about the potential dangers of non daily BMs. So I told him I also don’t have daily BMs and though it would be nice, I’m not reaching for a pharmaceutical grade colon cleanse because I’m 1-2 days late. He laughed, agreed, and left.
These scenarios have me reflect on the role of medical communication to the lay public. More information is not always better, and can be detrimental. This reminds of health fairs in the days before social media, the most salient being prostate cancer screenings and peripheral artery disease screening. Both practices appear well intentioned at a glance. We now know these health fairs were marketing ploys that led to overdiagnosis and overtreatment, and was likely a net harm for the patients.
Whereas reassurance was the best medicine back in the day, now it’s about hypervigilance for any new symptom, no matter how small. At times I find it difficult to ignore cynical explanations of how stoking anxiety in people leads to more office visits and thus more payments. Not to mention how content designed for outrage and anxiety is favorable for social media algorithms. There is fierce competition to bring patients into the clinic by any means, and to maximize billable hours. Because unfortunately for healthcare, patients who are well stay at home, and patients who stay home can’t be billed.
Do you think, despite the imperfections of these videos etc., that these can be good opportunities to build trust with patients? Further, could it be a sign of an engaged patient?