Abstract
Digital evolution has undoubtedly reshaped modern medicine, collapsing the boundaries between experts and laypersons. This review highlights the increasing prevalence of Do-It-Yourself (DIY) surgeries driven by the widespread accessibility of unregulated health information. We consider the causes driving dangerous DIY surgery and explore what potential essential reforms are required to eliminate this silent contributor to avoidable mortality and morbidity. Debates around telemedicine, digital health, patient autonomy and the dissemination of sensitive medical procedures to the general public are considered. This review demonstrates that most cases involving self-surgery are not mere medical failures but were driven by social pressure and the widespread availability of online medical material. How much online transparency of professional data constitutes too much for the good of the general public? Is too little information even more dangerous when combined with misinformation and apparent online peer validation.
Background
Surgery has been around for thousands of years and, through gruesome trial and error, is now recognised as a cornerstone of life-saving healthcare and it continues to develop and evolve. However, surgery remains one of the most technically demanding medical specialities that requires extensive theoretical knowledge, prolonged supervised training and strict adherence to safety standards. 1 The term self-surgery can be defined as when a person performs a surgical procedure on his/her own body. In the digital era, with widespread internet access and readily available information on pretty much everything and anything, a vast array of topics can be retrieved from different commercial social media platforms including YouTube, Instagram, Facebook, TikTok and so on. Although these platforms are used by aspiring students as an additional learning resource and tool, there has been an alarming rise in cases of the misuse of critically sensitive medical content by lay persons. This can range from practising self-surgery after ‘learning’ from a YouTube video to unqualified practitioners endangering innocent lives by attempting to carry out self-taught surgical procedures on their naïve and vulnerable victims. Many fail to recognise that the educational content available via social media is there to supplement the formal training required and not to replace it. Such ignorance leads to unqualified individuals attempting to perform complex surgical interventions without the necessary expertise and further without doing so in a proper sterile environment all of which multiplies the risk of fatal complications. Surgical procedures, whether minor or major, require adherence to standard guidelines such as those provided by the World Health Organization (WHO). The WHO Surgical Safety Checklist was developed to decrease errors and adverse events and develop teamwork and communication. 2 Lack of necessary academic, theoretical and practical knowledge along with inexperience leads to misguided attempts, which can cause permanent injury and damage or even death.
Self-surgeries by doctors
There are instances where self-surgeries are carried out by surgeons, but they are performed out of necessity under a controlled environment (Table 1).3–5 These cases highlight invasive surgical procedures in controlled hospital settings or sterile make-shift operating rooms, which were performed by medical personnel on their own body under local anaesthesia with or without medical support. Most self-surgery is prompted by a last-ditch and desperate attempt to save oneself when in a dire situation; other instances of self-surgery may be motivated by altruism, for example, to initiate innovations in procedures, but all will have been carried out by professionally skilled people who will have taken steps to prepare appropriately in advance. One such example of self-surgery was performed by Dr. Werner Theodor Otto Forssman, who is regarded as the father of cardiac catheterisation. After his requests for human experimentation of his newly developed technique were denied he performed it on himself, with the assistance of an operating room nurse. 3 While self-surgery by surgeons in such cases can be justified as the medical condition posed an imminent danger to life, this does not hold true in cases where lay people rely on social media videos to perform surgery on themselves or others.
Examples of self-surgeries by doctors.
Quack surgeries by non-medical men
In contrast to self-surgery performed by experts in a controlled environment, there are a few recent developments of contemporary Do-It-Yourself (DIY) surgeries conducted by unqualified individuals. These attempts were facilitated by online educational videos which were inadvertently misused with catastrophic results. Most of these cases caused severe complications and/or even death. Predictably, the general availability of these videos on the internet have the potential to transform educational content into harmful tools which can inspire YouTube-guided surgeries. Some examples of such cases that made headlines are tabulated in Table 2.6–9
Examples of quack surgery performed by unqualified men that killed the victim.
Recent Do-It-Yourself self-surgery by non-medical professionals
In addition to sham surgeries performed by unqualified quacks for easy money, self surgery by a lay person may be driven by a desperate attempt to get rid of pain or to treat a condition that is considered a stigma. We highlight two such cases of self-surgery (Table 3).10,11 In the first case a 32-year-old man attempted abdominal surgery on himself to get rid of recurrent abdominal pain; he followed YouTube tutorials to this end. 10 In the other case, a 16-year-old boy desperately attempted to hack off his genitals with a scalpel to achieve gender rassignment. 11
Examples of self-surgery by non-medical professionals.
The case from China is representative of many other similar cases, that demonstrate a desperate attempt at gender reassignment by mentally distressed people who are petrified of being ostracised or disowned, as most of them need legal consent from their guardians. 11 Similarly, instances of injury have also been attributed to unlicensed individuals performing cosmetic surgery. 12 The search for cosmetic surgery on the black market is prevalent, with tempting low prices attributed to low-quality instruments, prostheses and medical services. The widespread use of online platforms such as Instagram, where every influencer looks polished, drives consumer desire for perfection as they take the edited photos at face value and do not know that every photo released has been heavily edited/filtered. This causes ‘body dissatisfaction’ and ‘self-objectification’, amplifying the consumers’ desire to pursue cosmetic intervention that meets ‘unrealistic beauty standards’.13,14 A study in the United States revealed 50% hospitalisations, 25% deaths and 6.3% amputations caused by cosmetic services procured from dodgy providers at locations such as salons, spas, offices, hotels, motels and homes. 12
Socio-legal implications
The practice of medicine by quacks presenting as physicians is widespread in rural South Asia. Although many prescribe basic medications such as anti-pyretic, analgesic, antibiotics and supplements such as vitamins and minerals, daring to perform surgery by watching a social media video goes a dangerous step further. The cases we describe highlight the flaws in the current abundance of unregulated information and the social problems it drives. The incidents also demand further reforms in medical and ethical control to censor/restrict procedural content without hindering beneficial knowledge sharing. With social media platforms providing a wealth of content on surgical practice, a greater emphasis on public health literacy is essential. The public should be encouraged to seek health care from licensed providers with proper training and simulations. Legitimate procedural videos for educational purposes should include clear warnings and disclaimers stating that such procedures are only for trained professionals. Without regulation, accessible tutorials can foster false confidence, especially when driven by financial constraints, limited healthcare access.
A study conducted in Nepal reports 57% of patients who required surgery did not accept it due to accessibility (including distance/transportation), affordability and/or fear or distrust in the medical system. Frequently, they turned instead to quack interventions that place cost and quality above safety. 15 It also calls for an immediate response to eliminate exacerbating health disparities in resource-limited regions to rekindle the eroded trust in legitimate healthcare.
Doctors uphold ‘Primum non nocere’ which translates as ‘first do no harm’ and must gain informed consent from their patients by clarifying the purpose, necessity, dangers, alternatives, prognosis and rights to decline treatment to which they are legally entitled. Reliance on YouTube videos by lay people violates the core principles of medicine. After gaining the patient’s confidence, unsafe surgical practices performed by unskilled people in uncontrolled settings can follow along with a higher risk of sepsis, bleeding, organ damage and death.
Social media platforms, when used appropriately, empower informed decision-making. Telemedicine revolutionised healthcare by providing access to basic health services to marginalised populations. It has established global health awareness and promoted self-management of minor ailments, which is especially helpful in under-served areas. However, algorithms favour sensational, unvetted content, amplifying the spread of misinformation. Since social networks are run on clicks and views, misleading viewers into making uneducated choices ultimately endangers lives. This was evident during the COVID-19 lockdown, when people resorted to traditional folk remedies to cure their aliments amid restricted healthcare.16,17
In the context of surgery, the availability of in-depth surgical procedures causes more harm than good. Most of the content does not provide patient education and spreads blatant misinformation, while only a handful of videos provide more considered answers. 18 This is too structured for medical students to learn from, not for the general public to follow. When freedom to practice simplified click-baits is exploited, fatal complications or death may result.
Urgent regulatory measures and disclaimers are needed across all platforms that host medical videos. Spread of misinformation must be banned. The right to disclose potentially explicit medical knowledge should be restricted to certified licensed medical practitioners. Age restrictions must be implemented and access to sensitive content must comply with strict regulation protocols. The content must be rigorously verified before being uploaded to the public. Regular surveillance and flagging of hazardous content are also equally important but should be done with caution to prevent censorship of valuable information.
Conclusions
Widespread internet access has provided general access to unlimited high-quality medical literature and has promoted public health literacy, providing the most desirable opportunity for informed decision-making. However, it also poses a public health threat when applied without extensive surgical knowledge and expertise. Critical ethical lapses have occurred due to gaps in public healthcare systems that place profit over quality service. The unequal distribution of health services has especially compromised disadvantaged low-income groups, triggering the search for detrimental cheaper alternatives. These shortcomings have been taken advantage of by opportunistic quack doctors. Unqualified practitioners seen participating in such activities should be met with strict multidisciplinary interventions. Overall collaboration with health authorities could help spread the needed awareness of quackery and simultaneously reinforce public health infrastructure. Currently, initiating reforms should be prioritised to curb abuses and harness technological benefits.
Footnotes
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
