Q&A: Physicians often attacked on social media for public health messaging

A survey conducted before the COVID-19 pandemic showed that almost one in four physicians were attacked on social media. This number is expected to be even higher now, according to one of the study authors.

“If we were to do this study again now, I can almost guarantee that the numbers of people reporting harassment would be significantly higher because the last year has shown that many physicians and scientists are being attacked for disseminating public health messaging because of the polarized nature of our current climate in this country,” Shikha Jain, MD, FACP, assistant professor of medicine in the division of hematology and oncology and director of communication strategies in medicine at the University of Illinois at Chicago, and associate director of oncology communication and digital innovation at the University of Illinois Cancer Center, told Healio Primary Care.

Jain and colleagues administered the survey on Twitter in late 2019. Overall, 464 physicians responded to the survey. Among them, 42.2% were men, 57.8% were women or nonbinary, 76.9% were white, 15.7% were Asian and 2.6% were Black.

As previously reported, 23.3% of respondents said they were personally attacked on social media. Women were significantly more likely than men to report online sexual harassment (16.4% vs. 1.5%, P <. 001).

To learn more about the findings and the issue of online harassment, we asked Jain, who is also consulting medical editor of Healio’s Women in Oncology, chief operating officer and cofounder of IMPACT, and chair and founder of the Women in Medicine Summit, about how online harassment affects physicians, resources that are available to them and more.

What evidence — published or anecdotal — highlights the issue of online harassment among physicians?

Our paper is the first, I believe, to specifically look at online harassment of physicians engaging on social media. We found that one in six female physicians reported being sexually harassed, which hasn’t really been looked into in this setting prior. But it’s interesting in that our results are very consistent with the higher number of women physicians who also report higher levels of sexual harassment in person.

Anecdotally, there have been news articles and interviews from across the country of physicians being attacked, including newspaper articles where physicians have been getting death threats for encouraging things like masking, staying at home and risk-mitigation strategies during this pandemic. Many physicians who have been active on social media have been attacked either on social media or personally, to the point where people have showed up at their homes or workplaces.

Ashish K. Jha, MD, MPH, dean of Brown University’s School of Public Health, has been all over the news reporting on the pandemic. The Boston Globe recently reported a story on how he’s been attacked because of his voice and public health messaging, both on social media and in news media. Angela L. Rasmussen, PhD, a virologist who works at Georgetown University, has been criticized and attacked on social media. She talks about it quite openly. There was also a Forbes piece that came out talking about other physicians who had been attacked on social media, as well. So, anecdotally, there are probably hundreds of stories that I could share of physicians who have been targeted simply for promoting public health messaging in the social media space.

What are the most common themes of online harassment? Which do you find most concerning, and why?

In our study, one in six women was sexually harassed. That, to me, is unacceptable.

Promoting vaccines is one of the most common reasons physicians are attacked. The more common things in our study that people reported being harassed for were advocacy related to gun violence, smoking and abortion topics. Work-related attacks were mainly related to patient care and personal information. Personal attacks were largely related to race and religion, which was really concerning.

The types of harassment were awful. There was verbal abuse and death threats. Some people contacted physicians’ employers and certifying boards and shared their personal information on public forums. There were two doctors in our study who described threats of assault, including a Black woman who stated that she had been threatened with rape from a white supremacist due to her civil rights advocacy work.

How do personal attacks and online harassment affect physicians?

Women and underrepresented minorities and people with intersectionality really struggle in the hierarchal world of medicine in a variety of ways. Social media has provided people who don’t necessarily receive equitable treatment in the workplace with an opportunity to try to promote their careers and help them in positive ways, like with networking and mentoring. One of our really big concerns is that physicians and scientists who are women, people of color, LGBTQ individuals and underrepresented minorities are the ones who are more likely to be attacked on social media, and then they are the ones to leave social media more often. Those are voices that we need to promote information and to represent their communities. Not only are we losing their voices, but they are also losing the benefits that come with being on social media. Basically, this type of harassment is really hurtful for these people who are already at a disadvantage, especially women and people of color who are typically left out of the leadership positions in medicine.

This past year has been awful for many, many people. Our health care workers are being stretched to the brink. We already had an issue with physician burnout pre-pandemic, and then this marathon of a pandemic hit our nation and the world. When it comes to day-to-day work, physicians are working more hours than before, their pay is being cut, some are losing their jobs, some are losing their health and some are losing their lives. Patients are dying at rates that we have never seen before in this nation. We worry about getting our families sick, getting sick ourselves and bringing the virus home. It has been an exhausting year for clinicians who work in the clinical space, especially, but really for physicians across the nation.

The work that is done online — the social media advocacy work and public health messaging — is being done in the minimal amount of free time that physicians have. Physicians are trying to do the right thing by using what little time they have left in the day to spread information and try to save lives by creating public health messaging. Unfortunately, these attacks are leading to an even higher level of physician burnout. Seeing people who feel that the pandemic is a hoax, going out without wearing a mask, not social distancing and not taking basic public health measures — physicians are becoming disillusioned that their efforts are not making an impact.

It is also important to note that, during this pandemic, physicians have been asked to step up and promote information and, not only that, be a source of hope for the community. Physicians across the country are sharing pictures of getting their vaccines with the hashtag “#Igottheshot” to try to encourage others to get the vaccine as soon as it is available to them. Even those types of efforts are being attacked. So, we are sometimes asked to step out of our comfort zones and put this messaging out there for the greater good, and then you are penalized and attacked for doing what you think is helping the community.

How should physicians combat online harassment?

That is the million-dollar question.

We formed this group IMPACT at the beginning of the pandemic as a way to amplify public health messaging and advocate for evidence-based interventions. We have found that by creating a group of people who are led by the same mission, we are not only able to support each other, we are able to protect each other and help each other when these types of things happen. For example, I was recently targeted by a local radio station for promoting staying at home and other risk mitigation strategies. When that happened, the group from IMPACT was able to respond and bring a lot of other physicians from around the nation into the discussion. That is one strategy that we found very useful — creating a community of people who are able to help us combat the attacks. We have also created a social media toolkit for those who have faced harassment on social media. An organization called “Shots Heard Round the World” was created a couple of years ago to help physicians who are attacked for advocating for things like vaccinations. That’s another great group that helps with these types of challenges.

Sometimes it is necessary to get your employer involved, especially if somebody is attacking your professional identity or credibility or is doing something that might affect your professional status. In these situations, getting your employer involved might be the way to go. So, I think it is really important that employers and professional societies support physicians who have this type of harassment and find ways to help them because social media really does play a really big role in networking, medical education and research.

I want to really encourage people to continue to be on social media and to continue advocating and doing this type of work because it is so important and there really are a lot of benefits that can come out of it.

How can employers support physicians who are affected by online harassment?

It depends on the type of attack. There are certain cases where going to your media department might be helpful. One of my colleagues was doing advocacy work and an individual did not agree with the information she was putting out, so she went to her leadership team — another physician in her institution — and contacted them. It may be that HR needs to get involved because when you are posting things online, you will be posting things representing your institution, even if you state that you are not officially representing your institution. So, it really depends on the threat. Regardless, there needs to be some type of dialogue within the institution about how to protect employees when things like this happen. More and more, physicians are utilizing social media for a variety of things, whether it is for recruiting patients or networking or other advocacy work, so there needs to be protections in place. But as of now, the best thing to do would be to go to a supervisor to get their advice as to what the next steps should be.

What are your plans for future research on this topic?

One of the limitations of our recent survey is that we did not have as many people who belong to the groups that are typically targeted, like underrepresented minorities, for example. We would like to perform a similar study but do it in a way where we make sure we focus on the fact that there are people who suffer this harassment at even higher levels. So, as I mentioned, LGBTQ individuals, people who are underrepresented minorities and people of color. We want to make sure we are asking questions about sexuality, race, ethnicity and disabilities as well.

References:

IMPACT. Social media harassment toolkit. https://www.impact4hc.com/social-media-harassment-toolkit. Accessed Jan. 22, 2021.

Pendergrast TR, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2020.7235.