Nearly one quarter of physicians who responded to an online survey reported that they had been harassed on social media, according to a study published online January 4 in JAMA Internal Medicine. Women were more likely than men to be attacked online, and were twice as likely to experience online sexual harassment, the researchers report.
The coauthors of the study include Vineet Arora, MD, a professor of medicine and associate chief medical officer at the University of Chicago Pritzker School of Medicine; Tricia Pendergrast, a second-year medical student at Northwestern University Feinberg School of Medicine; Shikha Jain, MD, of the University of Illinois Chicago; N. Seth Trueger, MD, of the Feinberg School of Medicine and digital media editor of JAMA Network Open; Michael Gottlieb, MD, of Rush University Medical Center, Chicago; and Nicole C. Woitowich, PhD, of the Women's Health Research Institute of the Feinberg School of Medicine.
A total of 464 participants who self-identified as US physicians completed the online survey. Of those respondents, 196 (42.2%) identify as male, 357 (76.9%) are White, 73 (15.7%) are Asian, and 12 (2.6%) are Black.
Overall, 108 (23.3%) reported that they'd been personally attacked on social media, with harassment slightly more common among women than men (24.2% vs 21.9%). Forty-four women (16.4%) and three men (1.5%) reported online sexual harassment, report the authors.
Forty-six respondents contributed information about the nature of the harassment they encountered on social media. Most of the personal attacks fell into one of four domains: advocacy (21), personal (7), work-related (5,) and other (13). Advocacy-related attacks included responses to physicians' online comments about vaccines (10), guns (3), abortion (2), smoking (2) and other issues (4). Work-related attacks were related to patient care (4) and personal information (1). Some personal attacks referred to the physician's race (4) or religion (3).
Physicians reported verbal abuse, death threats, threats to contact employers and certifying boards, and the sharing of personally identifying information on public forums.
Respondents shared 18 comments about sexual harassment. Of those, 12 women reported receiving sexually explicit messages, including several who received pornographic images. Two physicians described threats of assault, including a Black doctor who reported that White supremacists threatened her with rape because of her civil rights advocacy.
The researchers said that their study was not representative of the physician workforce because so few minority physicians were included. In addition, the median age of respondents was 39, which is lower than the median age of US doctors in general.
In an interview with Medscape Medical News, Arora noted that physician users of social media tend to be younger than doctors overall. However, she said, this study was of social media users, not the entire physician population.
The survey respondents, she said, mainly used Twitter and other social media sites as physicians, not as anonymous individuals. However, many of the people attacking them online used anonymous accounts, she said.
Asked whether physicians were attacked on their personal or professional social media accounts, she said it's difficult to distinguish between the two on media like Twitter and Instagram, although some doctors may have personal and professional Facebook pages. She said this was a bigger issue when social media was a new concept.
Turned Off by Social Media
Some physicians still feel strongly about keeping their personal and professional social media identities separate. Medhavi Jogi, MD, a Houston endocrinologist, told Medscape Medical News that he advises the other physicians in his group not to "put anything out there that represents you as a physician, because you're representing the group and putting us all at risk."
At one time, he noted, he posted on behalf of his practice on a variety of social media sites. But it didn't help build the practice, he said, and it resulted in some people making inappropriate requests on Facebook or Twitter. "They said bizarre things like 'Help me please, I'm dying,' or 'You're the most horrible person for not responding to me.' "
Jogi, who has been active on social media since 2010, said he stopped using most of these sites a couple of years ago, "because I was receiving strange responses, and you couldn't talk about anything really useful. And if you do, once you express an opinion that doesn't appeal to certain people, you've alienated two thirds of your clientele."
The endocrinologist said he has been harassed online, but not because he's a doctor. "Say I was posting about the drugs for hyperthyroidism, for example. Just saying I don't prescribe a certain type of drug creates this problem. There's no discussion anymore and I can't really tell them why. That was part of it. Also, everything seemed to invite some kind of response that you had to respond to, and you had to really think about what to say because it might be taken out of context."
Because of this experience, Jogi has decided he's better off not expressing his opinions as a doctor on social media, except on sites such as LinkedIn that are mainly used by professionals and are geared toward business.
Should Doctors Advocate Online?
Arora, in contrast, believes that physicians have a duty to take positions on issues related to public health, especially in the midst of the COVID-19 pandemic. But they have to be prepared to take criticism online.
"Physicians often go on social media to advocate for public health measures," she said. "They're concerned about women's health, gun violence, and masking during the pandemic, for example. And they're doing that as an extension of who they are in the professional sphere, and they're getting attacked for it."
She added that "professional societies and policy makers and healthcare organizations are encouraging physicians to go out there and advocate for the vaccine and public health measures. So we need to prepare and empower people to overcome the negative side of social media. Any physician who's going to venture into advocacy online needs to know this is a potential issue."
In a recent STAT article, Arora, Pendergrast, and Jain said that doctors can be empowered to persevere in their social media advocacy, despite these assaults, if they come together in formal or informal groups "to amplify their voices for greater reach and to help influence local and state policy and public behavior."
The study authors said they started the Illinois Medical Professionals Action Collaborative Team (IMPACT) specifically for this purpose. In addition, they write, the medical community should join the fight to advocate for stronger laws to safeguard against cyberstalking and online sexual harassment.
Harassment Is Part of the Deal
Esther Choo, MD, MPH, a professor of emergency medicine at Oregon Health & Science University in Portland, told Medscape Medical News that the online harassment described in the new study "seemed really accurate. That's been the experience of me, my peers, and many women whom I've talked to who aren't in medicine."
However, she didn't have much faith in the ability of institutions or medical societies to do anything about it. "Sometimes the people who harass doctors have anonymous accounts, and how do you even find them? That's why they're emboldened to do it."
Having used Twitter since 2013, Choo said she barely even notices the negative aspects of the social media environment anymore. "At the beginning, it was quite traumatizing, and I took it very personally. Now, I think, oh yeah, it's still there, I forgot. It's like I've gotten used to it. It's the saddest thing that it has become normal. It's like the air that I breathe online, like the cost of admission. If I want to be part of that conversation, here's the cost of admission: a nice steady stream of harassment."
Although there has been a big surge in physician use of social media during the pandemic, she noted, "COVID has been very polarizing, and people feel very strongly about how much health professionals should direct the pandemic response. It sounds ridiculous, but because of certain messaging, people feel angry at health professionals about comments that might lead to policies that restrict their freedom. And President Trump has said things like physicians are overstating COVID for monetary benefit. So there are pockets of the internet where people think physicians and other providers are not trustworthy, and that leads to harassment."
Nevertheless, Choo agreed with Arora that physicians should continue to express their views online, despite the attacks against them. "In general, if we avoid controversy, we avoid a huge chunk of things that affect health," she pointed out, whether that's vaccination against COVID-19, gun violence, or smoking.
"So I don't think we should gauge what's controversial before we decide to speak out. We should gauge what's relevant to the health of the population."
Coauthor Trueger reports receiving salary support for his role as digital media editor at JAMA Network Open, a stipend for his role as social media editor of Emergency Physicians Monthly, and a stipend for consulting from Level Ex. Arora receives funding from the Journal of Hospital Medicine as a social media editor, the American Board of Internal Medicine, and the Joint Commission, and is a founding member of TIME'S UP Healthcare. No other disclosures were reported.
JAMA Intern Med. Published online January 4, 2021. Full text
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