“Your doctor doesn’t want to spill the secret, so I will.”
Words scroll across the screen as a woman in a kaftan gyrates to the latest Lizzo song. My recently diagnosed 14-year-old patient, Bonnie, excitedly showed me the TikTok video with 2 million views. She described how this “Hashimoto’s coach” inspired her to stop taking levothyroxine and start rubbing essential oils onto her thyroid instead to cure her hypothyroidism. Bonnie had also been on an “anti-inflammatory diet”: no dairy, no fish, only Himalayan pink salt (in summary, nothing that contains iodine).
“Can we get the full panel of thyroid tests this time?” asked her mother. Their “research” showed that a reverse T3 level was critical for diagnosis, which I had apparently completely missed out on.
I told them I appreciated and encouraged their trying to learn more about the condition. And that dance was, as the kids say, “fire”! However, I wondered whether their eagerness to grasp at so many alternative solutions was stemming from underlying anxiety about being diagnosed with a potentially lifelong medical condition, and if they were feeling like they needed more control over what was happening. They both burst into tears. I told them I understood. While I was confident in my diagnosis, I was here to support them, and answer all their questions. I busted out my trusted thyroid model and got ready to deliver my animated spiel on the pathophysiology of Hashimoto’s hypothyroidism. But just as I was about to begin, I got a Teams message —I had three other patients triaged and waiting to be seen.
Eighty percent of Americans use social media. According to a Forrester Consumer survey, in 2021, 63% of Americans aged 12 to 17 years used TikTok on a weekly basis, and 57% used Instagram. While seeking medical information is likely not the primary motivation for individuals to access social media platforms, we are clearly seeing its impact on health-related decision-making in our patients.
I applaud the fact that influencers are now spreading awareness on health care issues. My patients can see other individuals dealing with the same issues as them and feel less alone in doing so. I secretly admire the persuasion skills of content creators. They seem to so effortlessly compel thousands of followers to drink a chemical in fish tank cleaner, and here I am, struggling to convince a patient with Type 1 diabetes to take their life-sustaining insulin injections. I also worry about the amount of misinformation and pervasive distrust against the medical community that is propagated and getting millions of views from impressionable youth every day. As my pragmatic brain enters problem-solving mode, I begin to consider potential solutions.
As they say, if you can’t beat them, join them. The best antidote to misinformation is accurate evidence-based medical knowledge. There are so many of us on #MedTwitter, interacting with one another through a plethora of entertaining and educational commentaries about cutting-edge medical research. So, why aren't there more medical professionals posting engaging videos with verified medical facts on community-facing platforms like TikTok and Instagram?
Despite mounting evidence of social media's impact on patient perceptions, most health care organizations do not encourage personnel to engage with the patient-community through personal profiles. In fact, in most cases, it is actively discouraged out of concern for misrepresentation, alleged ethical transgressions, and patient-privacy breach.
Even if our hospital systems and administrators encouraged us, the truth is that health care professionals are busy. It’s not that we are above some mindless scrolling at the end of the day or posting witty remarks on our friends’ latest vacation pictures. But it is possible that we are too burnt out to devote even more of our lives and time to the seemingly thankless world of health care. With rising productivity demands, we can’t even afford to develop social connections with our patients within the confines of a clinic visit, let alone reach out to the larger community via social media. With all the information exchange and documentation that needs to be squeezed into a 15-minute appointment, how do we make time for open and substantial conversation? No wonder some of our patients leave feeling unheard and seek alternatives outside of allopathic medicine. It’s hardly surprising that they are easily captivated by health care gurus online who claim to have gone through the same ordeal as them and have magical cures for symptoms their doctors don’t even acknowledge, all while being immensely entertaining.
Even if we had all the time in the world, most medical professionals would think twice before deciding to partake. “Social media” has been a “dirty” phrase in medicine for the longest time. We have loved to hate it. The spotlight has shone brightly on the detrimental effects of digital media on physical and mental health of youth. It has emerged as a top villain responsible for our current state of societal unrest, psychosocial distress, and metabolic decline. Despite the notoriety, most of our social interactions have now moved online. The trending platforms may change, but social media is clearly here to stay. It is fervently influencing our behaviors, as well as our patients’. This makes it imperative for health care organizations to embrace its power, especially for engaging our younger, “tough-to-motivate” patients. By virtue of appropriate training, no one else besides licensed health care professionals can bear the onus of disseminating factual medical information in a way that is contemporary, relevant, and accessible to our patients. The academic medical community needs to open its arms and incentivize community outreach through these platforms as measurable credits that can be used toward promotion. Physician burnout needs to be addressed promptly so that more of us can find ourselves inclined to be vigilant participants in the social media revolution. Patient advocates need to train themselves to reach out and meet the patients where they are at: online.
As we gradually become more receptive to the crazy notion of using social media for health care, some of our colleagues are already starting to blaze trails in this uncharted territory. While TikTok trends and song-and-dance sequences may not be everyone’s cup of tea, we can all use social media strategies in our everyday practice. If influencers can project solidarity with our patients through 30-second snippets, perhaps we can learn to do that as well. During clinic visits, we will always need to prioritize gathering and providing information, but maybe we can be more intentional about being relatable. Maybe we can take a few extra minutes every now and then to understand and acknowledge where our patients are coming from. If nothing else, maybe we can try to bond with our next teenage patient over the latest Instagram trend.
Don’t get me wrong: it won’t make us “cool” in their eyes. But they might appreciate the effort, and it may lead to them actually paying attention to what we say. Like Bonnie. Sweet Bonnie, whose eyes rolled all the way up (and stayed there for a surprisingly long time) when I tried to copy the Lizzo choreography in clinic while talking about the wonders of levothyroxine. But next visit, she reported taking it every single day, because “how could she not after all that.” Take that, Hashimoto guru.
How do you talk to patients about medical opinions they get from social media? Share in the comments.
Dr. Priyanka Bakhtiani is a pediatric endocrinologist at the Children’s Hospital Los Angeles, CA, specializing in the endocrine care of children after cancer therapy. She manages social media and networking for the Southern California Organization of Pediatric Endocrinology and the Pediatric Endocrine Society. She is passionate about medical education and currently pursuing a Masters in Academic Medicine. She loves to go hiking with her husband and foster dogs. Dr. Bakhtiani is a 2022–2023 Doximity Op-Med Fellow.
All names and identifying information have been modified to protect patient privacy.
Illustration by Jennifer Bogartz