Doctors have been quietly uploading thousands of videos of their most invasive procedures. And patients love it.
There's a bloody market for surgery videos on the internet. Most are a challenge even for the slightly squeamish and morbidly curious: hearts being lifted out of chests, up-close views of wisdom teeth extraction, knee replacements. Live-streamed surgeries are done on social media, often as a gory stunt.
Searching "educational surgery" or "real surgery" on YouTube returns millions of results. People have given birth and had skin lift procedures with a live internet audience. But many plastic surgeons use Snapchat to reach their future patients, like Dr. Matthew Schulman, who broadcasts from the operating room to millions of followers.
Then there's bariatric surgery, which has a following of curious patients all its own.
Dr. Thomas Brown, whose Colorado clinic posts videos of robotic bariatric procedures to YouTube, told me that the videos are up by patient demand. As far back as the 1990s, when he began doing laparoscopic surgeries, patients requested their procedures be filmed and that the doctor send them home with a copy on a VHS tape.
Now, it's part of standard patient consent to have their guts filmed for educational purposes.
"The average person is thinking about committing to surgery for at least a year, and spends about six months on the internet looking at different reports, studies—and yes, looking at videos," Brown said.
Researching and interviewing your surgeon is a big part of opting for bariatric surgery. Patients have asked Brown what kind of staples he uses and who manufactures them. "They're a very inquisitive crowd," he added.
Posting gnarly videos is also a way for surgeons to get new patients. You wouldn't shop around for someone to perform an emergency appendectomy, but for elective procedures, many patients choose their doctors based on internet research.
It's also a way for surgeons to trade notes. The company that makes Brown's surgical robots, Intuitive Surgical, has asked him for videos to help other surgeons learn how to use the tools. It took Brown about six months of training on simulators to operate the laparoscopic robot skillfully.
YouTube doesn't have specific policies around surgical videos, but it does outline rules around graphic images: Users must post descriptive titles so viewers knows what they're getting into, and gore for educational purposes—not intended primarily to shock or offend—is permitted.
For Dr. Steven Safran, a New Jersey based ophthalmologist and cornea specialist, teaching and learning with other doctors is one of the main benefits to posting his videos online. (And for freaking the rest of us out with eyeball horror.)
"I learn from both my successes and my less successful results how to do things better in the future," Safran said in an email. "The editing process really forces you to look at things much closer in great detail and helps you to better understand what happened and how to do things better or differently in the future. It's a part of a learning process that I'm still very much involved in."
For Brown as well, watching himself work is like a football coach reviewing game tapes. "You go back and look at 'em and say, jeez, I wonder if I could have put this stitch differently, or would it have helped to put the stitch in from this side or this side."
Will videos of surgeries someday become as commonplace as watching cooking tutorial videos or streaming video games? It's hard to say. Since Facebook is a very public domain, Brown doesn't foresee the same kind of patient educational activities will ever be employed there. It's more gore-shock than science class.
National meetings for medical professionals, however, often have sessions of three or four live surgeries at a time, with doctors available to ask questions in real time. Intuitive Surgical hosts virtual versions of these, where doctors tune in one-on-one for surgeries and can ask questions while the procedures play out. They're already on the frontier of virtual reality surgeries with remote, robotic tools in the operating room. It could someday be as simple as recording surgeries in 360-degree video, streaming them for VR, and letting the world tune in for a live look at a perfect stranger's insides.
Late last year, Schulman told Motherboard that while Snapchat is his platform of choice for now, he and a growing number of surgeons are trying to stay one step ahead of where their patients will watch.
"I provide essentially a show for them," he said. "It's an educational show, but it's still a show."