I am constantly amazed but often distressed by the rise of social media, particularly in terms of medical and surgical management of patients. I’ll give you an example:
The other week, a lady came to see me. She was booked for short scar facelift procedure under local anaesthetic. I sat her down, greeted her, made sure she was comfortable – all the usual pleasantries – and got the consent form out. I went through this consent form with her, in terms of risks, benefits and complications of the surgery, and as she was about to sign, she put the pen to one side and said, “I’ve looked on YouTube last night, and you need to tighten up a muscle that begins with ‘S’.”
At this point, I sat back in the chair and silently but carefully took a deep breath before I thought through my answer. I think that is important in itself – sitting back and not immediately answering, but taking four or five seconds to think about how you are going to answer a statement such as this. My response came back as:
“You’ve been watching YouTube, and you think I should tighten up a muscle that begins with ‘S’?”
She repeated again that she couldn’t remember the name of the muscle, but that it was essential that I tighten this muscle up. Again I took a five second pause, and asked her once more what she believed this muscle that begins with ‘S’ was called, but she could not remember.
I then stressed to her that my training is almost 40 years now in surgery, and I am a Royal College of Surgeons of Edinburgh examiner in anatomy, as well as general surgical MRCS training. I then proceeded to tell her the names of all the muscles in the face that are innervated by the facial nerve. And then, fully knowing what the muscle was that begins with ‘S’, I ended up by saying, “Could it be the superficial musculoaponeurotic system – or SMAS for short?” To this she beamed at me and said, “Yes that sounds absolutely right! You need to tighten up the SMAS muscle!”
At that point, I decided that I wasn’t going to operate on this lady. We had a conversation that followed where I stressed to her that I felt it was extremely disrespectful of her to actually imply that she felt after 40 years of training that I didn’t know what I was doing and would require a “YouTube tutorial”. She was quite surprised by the fact that I was refusing to do surgery on her, but the decades of training and experience that I’ve had have told me to listen to the ‘little voices’, and I think if anybody comes in with such a level of disrespect for what we do as practitioners then we’re on a hiding to nothing in terms of trying to operate on these people.
The problem, I think, is more deep-seated than just a lady coming in and citing online video. Nowadays there are people posting idealised pictures of themselves on Instagram and Facebook, and discussing every topic with friends through messenger systems, forums, blogs and patient care groups; and all of this means that the internet is rife with opinions about what to do and how you should look after your procedure. A friend of mine refers to this giving of unofficial opinions as: “John the forklift truck driver opinions.” Not meaning offence to any forklift truck driver named John of course, but let me explain. Quite often I get people coming in who have asked about the surgery they desire – usually they are concerned about a certain look. When I ask them why they are concerned about it, the comment comes back, for example: “Well my friend John says that…” When asked who ‘John’ is, they say, “Oh, well, my mate John is a forklift truck driver,” or some other profession essentially meaning that ‘John’ is not a qualified doctor or surgeon with decades of experience and training, and therefore the odds are not in his favour for being correct about our line of work. I would certainly not venture to advise anyone about the correct procedures of forklift truck driving, or any profession other than my own for fear of causing harm. This is typical of a number of patients who come through our doors these days, in that there is an external opinion about anything and everything from anybody and everybody. And unfortunately, the patients will believe “their mate John” over you as a practicing physician.
The question then is how to deal with situations such as this. You have to remember that in life-saving situations we have to treat patients; but if there is a situation where it is not life-threatening, you don’t actually have to treat a patient. If there is something that you are seeing them for that causes complications in terms of discussion and the way the conversation is going, you can elect to refer that patient on to another doctor. There are strict GMC guidelines on how to do this as you cannot leave a patient without the care of a doctor, but ultimately as long as there is no life-threatening condition you don’t actually have to treat anybody. This often comes as a surprise to patients but we are, at the end of the day, actioning free choice in terms of who we see and who we treat.
In summary, social media’s uninformed opinions aren’t going anywhere soon. Hopefully it will calm down with the growing awareness of misinformation, but as practitioners I think we have a duty to not just care for patients, but care for the information that is given to them. There is a movement afoot for practitioners to actually post legitimate medical facts on social media, and I fully support this. I think the more that we produce facts in the media rather than misinformation, we will help to support each other as a group.
Do I have Facebook? Twitter? Linkedin? Instagram? The answer is yes, purely from a business point of view. Do I know how they work? No, I don’t. All I know is that it is a lifestyle that is here to stay, at least for now. All we have to do is manage the misinformation that stems from it, and protect our professionalism along the way as well.