Physicians in Social Media, the digital frontline

We interview physicians whose daily work, activism, and social media presence, have sparked solidarity, harassment, and threats. The human stories behind the controversies are the focus of this interview series.

Physician stories from around the world, beyond the media buzz

The esanum Global Series is a collection of articles that brings together esanum's German, Italian, English and French-language editorial teams to provide a global perspective on the contemporary issues and stories impacting physicians' lives. In our first series, "Physicians in Social Media, the digital frontline", we interview physicians whose daily work, activism, or social media presence, have sparked a full array of responses from within their own professional communities, media platforms, and beyond. Solidarity, harassment, fame and threats, and the human stories behind the controversies, are the focus of this interview series.

The digital era

We live in times of disruption. The digital era has created a new economy, profound shifts in the creation, access and diffusion of information, and an ongoing change in all sorts of human relations and roles: the private and the public, experts and laypeople, citizens and states. As most of the world’s population becomes connected to the digital world through an ever-increasing amount of electronic consumer goods, there are opportunities and benefits to all, but also the unintended, unforeseen, or undesired effects of such a time of rapid change in humanity.

Digital health

At present, no single economic sector, human activity or profession has escaped the shift to a more intense reliance on information technologies, the internet, and digital products or services. The health sector, and the medical profession, has seen its share of transformation. The application of software in medical devices, health information technology, wearable devices, telehealth, telemedicine,and social media has opened new horizons for professional collaboration, improved research & development, and beyond. The impact is felt across physicians’ training, practical work, the patient-physician relation, and the medical professional’s role in society.

The Empowered Physician

With the rise of digital health, and the transformation of the physician-patient relationship, it has been argued that the medical profession itself would transform from one where the “physician-as-idol could shift from self-confident to curious, from rule follower to creative, and from lone hero to team worker.”2  In such a context, the digital era would also give rise to empowered physicians, whose use of digital technologies can support and expand their capabilities, improve their knowledge, the accuracy of their treatments, and even empower their patients.

The Rise of Social Media

With the digital age, the use of social media has consolidated over the past ten years globally. It has become “an important driver for acquiring and spreading information in different domains, such as business, entertainment, science, crisis management, and politics”3 to the extent that, for example, in the USA, “emerging adults spend approximately 6 hours using social media every day, and frequently use multiple platforms simultaneously”4. The popularity of social media has become crucial for the creation and sharing of public messages at a low cost.5

Physicians in Social Media

As the digital era unfolds, digital health transforms not only the medical workplace. The profession itself is readjusting the codes that had historically guided physician and patient relations, the interactions amongst medical colleagues, and the divide between a physicians’ personal or professional opinions.

Such is this reshuffling, that we see attempts within the medical profession to build new rules of engagement in social media.6 But it is undeniable that social media provides physicians with opportunities to build a brand, expand their skills, educate patients and the public, attract new patients and diffuse their research.7 And as physicians engage, a new ecology develops, in which some physicians become renowned commentators, passionate advocates, influencers, and digital superstars. 

Different to the physician TV personalities that developed predominantly in the English-speaking world during the boom of cable TV during the 1980s and 1990s, social media have given physicians an opportunity not only to promote their medical practice, interact with colleagues, or advance their skills. Many physicians in social media have taken a central role to “combat misinformation by making responsible medicine sound almost as exciting as the scores of medical conspiracy theories, exaggerated claims, and snake oil promises that spread rapidly online."8

As social networks develop, the downside of the 'digital ecosystem' also comes to light as societies worldwide confront so called fake news, alternative facts, echo chambers, disinformation, and anti-science groups that battle to gain visibility, to shift public policy, monopolize public opinion and storm the 24-hour news cycle to propagate their messages. In this context, the medical profession finds itself in a new frontline, where attacks and harassment increases,9 as a new cybernetic battleground between science and beliefs develops. 

The digital world, with all its positive opportunities for knowledge, collaboration, and exchange, has also shown its ugly side. And social media has become one of the spheres in which physicians have become targets and key players in conflicts over science, politics, policy, faith, facts or fear. One study “found one in four physicians report being personally attacked on social media, including being barraged by negative reviews, receiving coordinated harassment and threats at work, and having their personal information shared publicly. Some attacks were particularly disturbing, such as threats of rape and death” according to the authors.10

Physicians in the frontlines

But the attacks against physicians are not new. The confluence of intimidation, scapegoating, violence, or threat against medical professionals, is unfortunately an extension of the “real world” into the nascent digital world. The COVID-19 pandemic shed light on the physical and digital harassment of physicians but “sadly, violence against health-care personnel is not a new phenomenon. Before the COVID-19 pandemic, such attacks were increasingly documented in clinics and hospitals worldwide.

Attacks on health-care workers and health-care facilities also occur as a deplorable tactic of war that defies international humanitarian and human rights laws.”11 In that article, McKay and co-authors explain that “the reasons people attack and abuse health-care personnel during health emergencies are many, and local contexts vary. In some settings during the COVID-19 pandemic, fear, panic, misinformation about how SARS-CoV-2 can spread, and misplaced anger are likely drivers.” And indeed, we find reports, already in the second half of the 20th century, of trends in which physicians would become the scapegoats of political confrontation,12 and targets at times of social upheaval13, military warfare, or health-related catastrophes.

The esanum Global Series

In such a context, the esanum editorial teams brought together four stories from Germany, Italy, France, and the United States, to provide our readers with a small yet diverse and eye-opening pool of interviews with physicians whose daily work, activism, or social media presence, have sparked a full array of responses from within their own professional communities, media platforms, and beyond. Solidarity, harassment, fame and threats, and the human stories behind the controversies, are the focus of this interview series.

From Germany, we interview Dr. Kristina Hänel, one of the best-known physicians in the country. Her unequivocal stance on abortion and her fight against the ban on pro-choice advertising in the German Civil Code (which regulates the publication of information on abortion) have brought her not only notoriety but also hostility. She was, and still is, opposed by anti-abortion activists, harassed, and even receives death threats. She talks about who her enemies and supporters are, how she has learned to deal with stress, and what advice she would give to young physicians that may find themselves in similar situations to the ones that she has encountered over her years of work as a physician-activist.

Our second interview is with Italy's Dr. Salvo Di Grazia known on the web under his nickname 'MedBunker'. His blog ("MedBunker - Le scomode verità", in English: The Inconvenient Truths) and his presence on various social networks have made him an authoritative bulwark in defence of medicine and the scientific method against the attacks of so-called alternative medicine, pseudo-medical practices, and fake news. Dr. Di Grazia is a gynaecologist and for over a decade he has been writing a blog focused on debunking so-called alternative medicines, pseudo-medical practices and myths related to health, with recurrent themes being issues related to homeopathy and vaccinations.

We share the story of France’s Dr. Mathias Wargon, an emergency physician and an outspoken media personality in France, who takes to the Twitter arena several times a day. Ever since he received a bullet cartridge case, his secretary has been reluctant to open his mail. Because his wife (Emmanuelle Wargon) is a minister in the current French government, the extreme left sees him as a supporter of ‘Macronism’ while the extreme-right have their own reasons for abhorring him: he is Jewish, he does not criticise Muslims, and works daily with people of immigrant origin in his hospital in the Seine-Saint-Denis department, north-east of Paris, and the poorest in France. The conspiracy theorists hate him as a physician and a scientist, while his stance against homeopathy has also garnered more detractors around him.

And our final article in the series is with Dr. David Gorski from the USA, a professor of surgical oncology, specializing in breast cancer. A strong advocate of evidence-based medicine, he is known for his criticism of 'alternative medicine', his staunch opposition to the anti-vaccine movement and his digital engagement to counteract disinformation targeted at medical and scientific topics. And this work, has attracted attacks from embattled anti-science groups and a spectrum that covers anti-vaxxers, “quacks”, neo-Nazis and beyond.

We hope to inform, inspire, and encourage our readers with these interviews, and we look forward to sharing more fascinating stories from physicians around the world in the next instalments of our esanum Global Series, a joint editorial effort by the teams from esanum.de, esanum.fr, esanum.it and esanum.com.

References

1. FDA. 09/22/2020. Digital healthcare: What is digital health? https://www.fda.gov/medical-devices/digital-health-center-excellence/what-digital-health
2. Mesko B, Győrffy Z. The Rise of the Empowered Physician in the Digital Health Era: Viewpoint. J Med Internet Res. 2019;21(3):e12490. Published 2019 Mar 26. doi:10.2196/12490 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454334/
3. Stieglitz, S.; Mirbabaie, M.; Ross, B.; Neuberger, C. Social media analytics–Challenges in topic discovery, data collection, and data preparation. Int. J. Inf. Manag. 2018, 39, 156–168.
4. Vannucci, A.; Ohannessian, C.M.; Gagnon, S. Use of Multiple Social Media Platforms in Relation to Psychological Functioning in Emerging Adults. Emerg. Adulthood 2019, 7, 501–506.
5. 
Hruska, J.; Maresova, P. Use of Social Media Platforms among Adults in the United States—Behavior on Social Media. Societies 2020, 10, 27. https://doi.org/10.3390/soc10010027
6. The General Medical Council. Doctors' use of social media. https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/doctors-use-of-social-media/doctors-use-of-social-media
7. Kevin B. O'Reilly (News editor). APR 17, 2019. American Medical Association. 5 reasons why physicians should use social media professionally. https://www.ama-assn.org/practice-management/career-development/5-reasons-why-physicians-should-use-social-media
8. Abby Ohlheiserarchive. April 26, 2020. MIT Technology Review. Doctors are now social-media influencers. They aren’t all ready for it. https://www.technologyreview.com/2020/04/26/1000602/covid-coronavirus-doctors-tiktok-youtube-misinformation-pandemic/
9. Pendergrast TR, Jain S, Trueger NS, Gottlieb M, Woitowich NC, Arora VM. Prevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media. JAMA Intern Med. 2021;181(4):550–552. doi:10.1001/jamainternmed.2020.7235
10. Kristin Samuelson. January 04, 2021. NORTHWESTERN NOW. One in four doctors attacked, harassed on social media. https://news.northwestern.edu/stories/2021/01/doctors-attacked-on-social-media/
11. McKay D, Heisler M, Mishori R, Catton H, Kloiber O. Attacks against health-care personnel must stop, especially as the world fights COVID-19. Lancet. 2020;395(10239):1743-1745. doi:10.1016/S0140-6736(20)31191-0 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239629/
12. A Gordon. Why doctors are becoming society's scapegoats . Physicians Manage. 1978 Feb;18(2):23-5, 29-30.
13. Nancy Y. Hoffman, PhD. April 3, 1972. The Doctor as Scapegoat. A Study in Ambivalence. JAMA. 1972;220(1):58-61. doi:10.1001/jama.1972.03200010044007