Sir, recently a 50-year-old lady attended the clinic suffering with spasmodic torticollis of the neck. She has been suffering with the condition for over 20 years and continues to undergo prescribed treatment of Botox injections to her sternocleidomastoid muscles. These injections have proven ineffective, leading the patient to search the Internet for alternative treatments. The reason for her referral from her GP pertained to a video she had seen on YouTube from an American dentist. The long video revealed a lady of similar age, suffering with full body dystonia who was then fitted with an intra-oral splint by her dentist as a new and innovative therapy. Following the placement of the splint there was near instant cessation of symptoms.

During the consultation, the patient replayed the video and wished to discuss at length the treatment provided in the video. She then requested that a similar such device be constructed for her. She also reported that she had contacted the patient in the video, and they were now in regular correspondence. The patient was advised that a search in the medical literature would be carried out to ascertain whether or not this treatment could be substantiated. No convincing evidence/research relating to the use of splints in treating this condition could be found.

This case highlights potential difficulties in the future provision of treatment and management of patient expectations in the NHS. The rise of social media platforms such as YouTube, Facebook, Twitter and Instagram has had an inherently positive impact. As patients become better connected and less isolated, they will seek and gain greater support. There are, however, negative consequences as patients searching for treatments have greater access to information and 'cures' for which research may not be of the highest merit. This gives patients false hopes and expectations regarding possible treatments for their conditions, pressurising clinicians to provide care without sound scientific evidence. The increasing frequency of such cases opens up new challenges for the NHS in the twenty-first century. It may become more difficult to provide treatments based on sound evidence and clinical research, whilst endeavouring to meet patient expectation. Social media is becoming a direct challenge to a clinician's ability to manage patient's expectations of their treatment and its outcome. Whilst the rise of social media is undoubtedly a positive development, it could cause significant difficulties for continued provision of evidence based practice, leading to fracturing and breakdown of the patient/clinician relationship.

1. Kettering General Hospital

https://www.youtube.com/watch?v=MoD37BbVeNM_