Endos vs YouTube: Whom Do Your Patients Trust?

COVID-19 has made many of us indoor cats. As physicians and other healthcare workers rose to the challenge of battling critical illness, those of us who were not part of that effort suddenly had a lot of time on our hands. And much of that time connected our eyes with our screens.

With most of the public's face-to-face access to their healthcare team gone, where were they getting their information? I thought I'd give myself an endocrinology tour of a likely place, often-used but untrustworthy: YouTube.

Starting With the Obvious

Starting with the obvious search word "endocrinology" took my computer chip to its Boolean destination, which, as I expected, really had no theme. It is the place where healthcare systems showcased their endocrinology staff physicians. There was surprisingly little variation among the dozens of professional colleagues who underwent similar mini-interviews — nearly all had about five "likes" and zero "dislikes."

In addition to meeting your next endocrinologist, you can also get an overview of the scope of endocrinology and endocrine disorders. What you don't get is anything suggesting sophistication: no lab mavens, no hint that we often delve beyond the immediate clinical needs of our patients to the molecular basis of those disorders, and no items that dominate our symposia, training programs, and journals.

Changing the search from "endocrinology" to "endocrine" redirected the focus from people to physiologic systems, although some endocrine surgeons eventually got captured by the search engine for a few minutes to inform people of what made their skills special. To my surprise, endocrine-disrupting chemicals did not appear until the screen scrolled quite a few times.

Where It Gets Interesting

Having established what we do and who does it, I moved on to some of the diseases about which our patients may want to directly access information: "diabetes," "thyroid," "adrenal," and "testosterone."

I might have expected diabetes presentations to be about physiology, diet, and medicines. They were certainly amply represented, but so were oodles of people, including some physicians, who claimed that they had answers that mainstream medical communities rejected. It is these people claiming that their methods are better than anyone else's whose viewership exceeded a million.

I might have predicted more of these people on a "thyroid" search, but I was pleasantly surprised to find that the YouTube algorithm selected nearly all mainstream presentations of thyroid nodules, some brief talks on thyroid hormone synthesis, discussions of common symptoms, and a few overviews of thyroid cancer. There were some folks on the fringe who claimed that patients could reduce their number of prescriptions by rubbing walnut oil on their thyroid bed and who pooh-poohed lab results in favor of symptom control. Some claimed that chiropractic care would address Hashimoto thyroiditis, which they categorized as global systemic inflammation. But much of the content would actually make good educational resource material for a lot of office patients.

Perspectives changed considerably on accessing content on "adrenal" and "testosterone." Although a certain amount of mini-physiology reviews appeared, so did testimonials and pitches for improving adrenal fatigue and "low T." These presentations could be divided into those from institutions I've heard of and those from sources that were never part of my training or professional curriculum.

Some people access these videos for education; others are searching for easier treatment options that might help them feel better than with what their doctors provided at office visits. Needless to say, Alpha M and Real Men Real Style, two popular YouTube channels dedicated to making men more masculine and stylish, had a lot more viewers of their testosterone advice than did the Mayo Clinic.

What Can We Do About It?

Amid this colossal jumble of laudable information, misinformation, and even some disinformation, the best arbiter of reliability remains probably what it has been for the last 100 years — the endocrinologist.

Much of the misinformation seems to be addressing things we wish we could do better but which may fall outside the capabilities of our individual and collective skills. Any experienced practitioner can adjust a TSH level to normal. Not everybody can effectively change the malaise many people notice when T4 from a bottle replaces the thyroid hormones that used to come from their ablated thyroid gland, of blessed memory.

But these patients are seeing folks on YouTube who claim to offer them (without having evaluated them) what we cannot offer to those we have evaluated. A patient may very well conclude that the person must be a world-class expert, having a million views, whereas videos of the young staff endocrinologists only have about 500.

By the time patients arrive in our exam room, particularly if they get there by referral and especially if we are opinion number four, they've already tapped the resources of the World Wide Web. Perhaps we are remiss in not proactively asking our patients what information they already sought for themselves. These YouTube pitches could also alert us better to the things that frustrate patients and help us assure them that their concerns are shared by many people.

This was my first exploration of this medium, taken more out of pandemic-generated boredom than any need to serve patients. But perhaps we should be more professionally assertive in seeing what patients seek out on their own, and maybe even use this as a teaching exercise for house staff. One idea would be to create a list of videos or sites that we recommend, rather than have patients scour the web out of curiosity about what they might not be getting from us.

Richard M. Plotzker, MD, is a retired endocrinologist with 40 years of experience treating patients in both the private practice and hospital settings. He has been a Medscape contributor since 2012.

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