Dr. Youtube Will See You Now

news-apr5_Layout 1 16/03/11 10:48 AM Page 647

CMAJ News

Dr. YouTube will see you now

ee one, do one, teach one: that’s the philosophy behind a new S brand of how-to video showcas- ing self-surgery and other “do it yourself” fixes to medical problems that’s gaining traction on the social Web. Motivated by financial hardship, frustration with lengthy wait times and a desire for a more active role in health care decision-making, an increasing number of people are heading to video- sharing websites such as YouTube to study and share at-home solutions to a range of health complaints. The procedures, performed for the most part by amateurs without such niceties as local anesthetic or sterilized tools, range from the mundane (how to remove stitches) to the dangerously mis- guided (how to perform makeshift cryosurgery on skin cancer using dry ice). Despite the inherent risks associated with “backyard medicine,” self-treatment often poses less of a “hassle” to patients

fed up with navigating costly and compli- Galbraith Reuters/Robert cated medical systems, says Orin Jencks, The adage that a doctor who treats himself has a fool for a patient can apply equally to a Louisiana-based YouTube user whose patients who think they hold an MD. at-home toenail removal video (one of several hundred on the site) has attracted to, and I’m not saying it’s the best option, Today’s “informed patient” is also almost 15 000 views (www.youtube.com but I’ve been doing this for years and more confident in their own medical /watch?v =YRpqJgbpmKM). never had any problem.” abilities, she says. “It wasn’t so long “I’ve seen a lot of people’s videos The number of people in the United ago you couldn’t do a pregnancy test of their toenail removals,” he says. States without health insurance increased without going to the doctor. Now, “I’ve had my own removed twice by to 50.7 million (16.7% of the population) nobody bats an eye about buying a kit the doctor, but they kept coming back in 2009 from 46.3 million (15.4%) in at the store. … I choose to do almost wrong. I don’t have insurance, so I 2008. Even those patients with insurance everything at home, and I’d say half of started taking them off myself every are projected to each cough up $US4386 my medical knowledge I got at medical couple of months with a pair of pliers in 2011 to cover health insurance premi- school and the other half I got online.” or tweezers.” ums and out-of-pocket costs such as Some 78% of American patients While Jencks plans to have a doctor copayments and deductibles (www.cmaj believe they can learn helpful informa- permanently remove the nails some .ca /cgi/doi /10.1503 /cmaj.109-3713). tion about their conditions by communi- day, for now, “it’s just so expensive When money isn’t an object, wait cating with other patients over the Inter- and takes so much time and paperwork times often are, says Misty Zaugg, a net, according to a Jan. 31, 2010, to get anything done, it’s really more Michigan-based blogger and unlicensed survey by the Markle Foundation, a of a headache than it’s worth to go to physician whose how-to video on New York City, New York-based not- the doctor.” removing stitches got 47 672 hits on for-profit organization that promotes the Medical care isn’t an option for every- YouTube (www.youtube .com /watch?v use of information technology to one, he explains in response to queries =P7S _y34HUHo). “A lot of people resolve health care and national security over whether the videos might encourage don’t want the inconvenience of going needs (www.markle .org/publications some to forgo necessary medical atten- to the emergency room. Plus, any time /1446-public -and-doctors -surveyed -use tion. “I wouldn’t tell just anybody to go you enter a hospital you run the risk of -social-media-comparable-proportions). out and do what I do if they didn’t want getting a nosocomial infection.” While it can be difficult to separate

News

the wheat from the chaff when it comes “everything that seems simple may not Safety Commission’s National Electronic to online advice, videos give people be to everybody.” Injury Surveillance System reveals a who are considering self-treatment a While Canadians are less likely than litany of botched attempts to remove leg better sense of what they’re getting their American counterparts to “rifle casts with paint thinner, moles with nail into, says Zaugg. “You don’t need a lot their own medicine cabinets” rather clippers, dry skin with razors and teeth of medical knowledge to perform cer- than see a doctor for financial reasons, with screwdrivers, among other do-it- tain procedures. In almost all cases, the Goldman says wait times in Canada are yourself medicine failures (www.cpsc main risks you run are infection or cut- motivation enough for some people to .gov /cgibin/NEISSQuery /ExportFile .aspx ting into something you shouldn’t, but shirk professional care. ?FileName=/download/nss20027.tsv). that doesn’t mean the knowledge “A woman I know was scheduled Most common are the “people who should be inaccessible for anyone who for an appointment at an orthopedic have a lump on their skin and are certain wants to put the time and effort into clinic to have surgical pins removed they have an abscess, so they squeeze learning. I think everything a doctor from her foot. She arrived on time for it,” putting themselves at risk of “partic- learns, your average intelligent person her appointment at eight in the morn- ularly serious” blood-borne infections, can learn without a degree.” ing, and was kept waiting until four in says Goldman. Another category of do- It may be “quite reasonable” to train the afternoon. At one point, she decided it-yourself enthusiast that Goldman fre- patients, particularly in remote loca- she couldn’t wait any longer, so she quently comes across in emergency tions, to remove their own stitches, but pulled the pins out right there in the rooms is “the patient who is convinced one should “never underestimate the clinic and walked away. This is a smart they have a foreign body, like a sliver, a ability of people to misinterpret rules or person, and she was willing to do that.” metallic shard or a piece of glass or get them wrong,” says Dr. Brian Gold- A dearth of research tracking compli- wood, which they’ve attempted to man, an emergency room physician at cations among patients who choose to remove themselves. … Sometimes I can Mount Sinai Hospital in Toronto, skip the line and treat themselves at remove it, sometimes I can’t and some- Ontario. “The first thing I’d want home makes it difficult to assess the times there’s nothing there at all.” someone to tell me is how many health impact of open forum access to While such cases are nothing new, stitches they had, because if they pulled videos such as those featured in the the proliferation of medical how-to out eight and are satisfied, when in fact “YouTube Medical School” series. Cre- videos may lend a sense of false security there were nine, they could end up with ated by an orthopedic surgeon to provide to people who might otherwise have an infection.” practical examples of procedures to been on the fence about attempting a The popularity of medical how-to medical students “or anyone else who procedure at home, Goldman fears. videos speaks to the “tremendous wants to study to be a doctor,” the near “Suffice it to say, it happens in Canada, potential” that exists to teach patients to 600 videos in the series have attracted it happens in the United States, and I’d use health care services more appropri- some 1 136 850 views (www.youtube be very surprised if it doesn’t happen in ately, he adds. But in their current .com /user/surgicalgown). other countries, both developed and form, such videos typically fail to men- However, a cursory search of patient developing.” — Lauren Vogel, CMAJ tion “anything about the potential com- narratives accompanying 2009 data com- plications” or take into account that piled by the US Consumer Product CMAJ 2011. DOI:10.1503/cmaj.109-3812

“Do it yourself” births prompt alarm

growing number of women Some 33%, or 8708 out of 26 667 guides and home videos dedicated to are choosing to give birth homebirths in the United States in 2007 freebirth. Popular parenting website A without the assistance of doc- were not attended by a physician or Mothering.com, for example, currently tors or midwives, provoked by dissat- midwife, up from 30% in 2005 and hosts more than 15 000 active discus- isfaction with modern obstetric care, 31% in 2006, according to the US Cen- sions on unassisted childbirth, or what fear of unnecessary medical interven- ters for Disease Control and Prevention members call “UC” (www.mothering tion and a desire to reclaim birth as a (www.cdc .gov/nchs/data/nvsr/nvsr58 .com /community). private, natural act. /nvsr 58 _24.pdf). Two-thirds of those It’s a difficult trend to track with any It’s a choice the professionals say is deliveries attended by someone other certainty, not least because advocates fraught with peril. They fear the fledgling than a physician or midwife in 2006 were of unassisted childbirth aim to avoid “freebirth” movement may undo gains in reported as “planned” (www.cdc .gov interaction with the medical system mother-infant mortality. The women, /nchs /data/nvsr/nvsr58 /nvsr58_11 .pdf). wherever possible. however, believe unassisted childbirth is Canada lacks similar statistics, but a While some women forgo prenatal emotionally and physically the safest cursory search online turns up a surfeit care entirely, others orchestrate a option for themselves and their babies. of websites, forums, chat groups, “planned oops” or “accidental” unas-