#MedBikini and medical professionalism [PODCAST]

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“While our bodies have been a bastion of the heart and soul of medicine, a group of our peers thought it was acceptable to diminish the capabilities of our bodies to pictures on social media. They thought our ability to be exceptional physicians was inversely proportional to the number of pictures that showed us holding a drink or wearing a bikini.

Our bodies do so much more than just practice medicine. What we choose to do with our bodies in our own free time should not become part of an investigation that is packaged as peer-reviewed research.

Our bodies may have tattoos, ride motorcycles, or compete in pole fitness competitions for sport. None of that impacts our practice of medicine negatively. It’s past time we start celebrating the strength of our bodies and hold accountable those who try to negate our accomplishments with an ill-perceived attitude of sexism and misogyny.”

Jessica Pearce is an obstetrician-gynecologist.

She shares her story and discusses her KevinMD article, “Let us talk about the underlying situation of #medbikini.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Jessica Pearce. She’s an obstetrician-gynecologist, and she wrote the KevinMD article “Let us talk about the underlying situation of #medbikini.” Jessica, welcome to the show.

Jessica Pearce: Thanks, Kevin, so much. I’m really excited to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and your journey to where you are today?

Jessica Pearce: Yeah, so I am a board-certified OB/GYN physician based out of Texas, but I actually left clinic about three months ago, and I’m starting a project of my own, a passion project. It’s called the Ludicrous Uterus, and it’s a community for women, or anybody that identifies as women, to come in and have a safe space to talk about their mental health, physical health, and sexual health, just in a capacity where we’re not able to do that conventionally in a clinic setting.

Kevin Pho: Excellent. And how’s the project been going over the last few months?

Jessica Pearce: It’s been really interesting. So I launched everything officially a week ago, but I have had so many women, even prior to the launch, just come out and reach out to me about some of the things that they really wanted to make sure we talk about and we explore. And so some of the topics are things, like I said, that we don’t really get a chance to talk about, such as, you know, what is it like to be intimate after a cancer diagnosis or after hysterectomy, just things that we don’t talk about, and removing the shame when it comes to talking about our own bodies and the pleasures and desires and things that we want to explore in our own life.

Kevin Pho: Wonderful. Best wishes to the community.

Jessica Pearce: Thank you.

Kevin Pho: So let’s talk about your KevinMD article, “Let us talk about the underlying situation of #medbikini.” Now, this was an issue that occurred during the summer. Now, for those who aren’t acquainted with that issue, can you tell us about the circumstances surrounding #medbikini?

Jessica Pearce: Yes, so the response, #medbikini, was a response by female physicians to an article that was published in the Journal of Vascular Surgery. And this article basically looked at, the setup for it was, they had six men and one woman as part of the authorship of this project, and they basically created these neutral accounts on social media to evaluate over 400 graduating either vascular surgery residents or fellows. And what they did is they looked at their social media and kind of categorized them into the content of: Was their content professional or not professional? And so it really just sparked this, obviously, outrage from the female physicians, because it was really just interpreted as almost an invasion of privacy. And so the response was to kind of show people that, you know, women physicians are also people, and we have personal lives, and those things don’t represent in any way, shape, or form our ability to be professional individuals within the health care system.

But what was really interesting is that this was not the first article to do this. There are actually multiple other articles that were published in the past. In 2017, there was an article that looked at the professional content of social media of urology residents. There was one in 2016 that looked at the social media professional content of general surgery residents, and then there was even one that looked at the professional social media perspective of general surgery attendings. So this is not something that was new, and one of the things that they highlighted in this article was that they replicated the same exact outline and questions and categories that were already outlined when this was done in 2016 and 2017. So fortunately, this article got retracted. As far as I’ve seen, to this date the other two have not been retracted. So it’s a really interesting position that we’re in at this moment.

Kevin Pho: So tell me about the outcry itself. So what happened on Twitter? What happened on Facebook after this article was published?

Jessica Pearce: Yeah, so what happened is the movement was basically #medbikini. So women professionals all across medicine came out and basically were just posting pictures of themselves enjoying themselves at the beach with their family, in bikinis or in bathing suits, to show that this is a normal thing and that that shouldn’t be viewed in any way, shape, or form as anything that’s unprofessional, because it doesn’t impact negatively any of the work that we do. It doesn’t impact our ability to take care of patients, to do surgeries, to do any sort of patient care. And so that’s where that backlash kind of came.

Kevin Pho: So other than the retraction, did you hear from the authors themselves?

Jessica Pearce: I have not. But interestingly, I actually thought the retraction letter was a really interesting perspective, when they had the actual article retraction printed. And so they actually highlighted some really key points that I think were really important to bring up. And they said that the methodology, this is straight from their retraction, that “the methodology of this article was predicated on subjective assessments of professionalism.” So they kind of acknowledged that it’s based on antiquated norms. So while they were trying to be subjective, it’s based on norms that are really created in this, and again, they said this, male authorship, and looking from a white heterosexual male perspective. And so these sorts of constructs that they used in judging what was professional and unprofessional don’t really speak to the diversity of what we see in medicine. And I thought that they highlighted that really beautifully, because that was a big, huge issue.

The other issue is that their project, or this study, none of the people, the professionals that they were looking at on social media, had provided any consent to this. So that brings up a really big issue that I’m really passionate about, which is talking about consent and how do we teach consent from every aspect of our lives. And I thought that that was just a really brutal, almost like an abusive, invasion of privacy, because you’re creating these accounts and you’re looking at people’s intimate moments.

And yes, I get that side of the argument where people say, “Well, then they shouldn’t post it on Facebook if they don’t want it on there.” But physicians are people too, and yes, there are certain things that I think we all know we are not going to put online, but there’s no harm in showing how you enjoy your life, how you celebrate your life, whether that’s what you wear for a Halloween costume or what you are doing on your time off. And so the fact that consent was completely disregarded in this just highlights another issue with what we all experience, and I think, for women specifically, what we experience in health care.

Kevin Pho: So one of the things that you mentioned was that the standards of what professional is are antiquated, from this paper. So this goes to speak about the evolution of professionalism in health care. Could you comment on how professionalism has evolved over the years?

Jessica Pearce: I think that it has evolved in the aspect that a lot more female voices are coming up and helping to make policies that are making our role in health care a little bit easier, because what essentially happens is, you know, a lot of times our voices and our perspectives are kind of muted, and I don’t know that’s necessarily always intentional. I think part of it is there exists this gender gap, and it exists in every aspect. It exists in health care. It exists in the way that communities are set up. So you just have this mentality of, like, you have a design of how things should be, but you’re not taking into account the people that are affected by these designs and these policies. And so I think you’ve had a lot more women leadership come up, and they have helped create these policies that are more malleable for professional women to take leadership roles and still have time for their family, but there is still a lot more work to do in that regard.

Kevin Pho: So in your opinion, if physicians are just new to social media and they’re not quite sure what to post, what is your definition of professionalism, and where do you draw the line when you advise these new physicians coming to social media?

Jessica Pearce: Yeah, I think, interestingly, in the article they kind of made these two categories. So one category was absolutely unprofessional, and that was talking about, you know, HIPAA violations, so putting patient information, which I think is just wild, and they found that nobody really actually did that. And then the other category was could be considered unprofessional, and that was where you had people who were holding a glass of wine or holding a beer or in their bathing suit. So again, there’s this really weird line.

But I think what we can all agree on when it comes to social media is, one, obviously never post anything that’s specific about a patient, an identifying part of a patient or their care, because you never know who you’re friends with and to what degree they’re going to know this particular person that you’re talking about. So I think that is at the basis for something that we should never post online.

When it comes to, you know, your stance on politics and things like that, I think we should be able to talk about those things, but you have to be really careful and make sure that you are not saying things that are considered, or would be considered, racist or misogynistic, because those are things that you are going to be held accountable for. And we’ve seen it. We’ve seen, I don’t know her name, but she was applying for residency, and she had put a significant amount of comments on her Facebook where she was just absolutely talking terribly about the Jewish population, and she got her residency applications pulled, and she didn’t get anything whatsoever in terms of residency.

And so there are extremes for free speech, and I think we all have to acknowledge that we’re allowed our opinions, but when it comes to slandering other groups of people or slandering people’s religion or slandering people’s sexuality, that, I think we can all agree on, is not safe for social media. But in terms of, you know, putting pictures of you in a bathing suit, or you just kind of enjoying whatever things you consider pleasurable and desirable, that should never be intertwined with or representative of what you’re capable of as a physician.

Kevin Pho: Now, there was a huge outcry from clinicians to this article, but did you hear anything from the patient standpoint?

Jessica Pearce: You know, interestingly, I haven’t heard anything from the patient standpoint, but one thing that I find really interesting is that just in our day-to-day, there are so many patients that will friend their physicians on social media, and I think a lot of us are aware of what sort of things can come out of that. So there are many physicians that have a hard no. There are many physicians who will have just a public profile for their work.

But I’ve had a few patients personally myself, also especially as I’m going into this new passion of mine, who have reached out and wanted to be friends on Facebook. And so I think that there is a safe way to do that, but if you’re going to do that, you have to make sure that you are very conscious of what you’re doing, and maybe having two separate accounts is fine. But I haven’t had any patients specifically say anything to me about that article.

Kevin Pho: We’re talking to Jessica Pearce. She’s an obstetrician-gynecologist, and she wrote the KevinMD article “Let us talk about the underlying situation of #medbikini.” Jessica, for future researchers who want to study medical professionalism on social media online, what kind of tips do you have for them?

Jessica Pearce: Gosh, you know, I think that probably the best thing to do is maybe not make it a study where people aren’t aware that they’re part of it. I think the biggest issue is not looking at what’s going on on social media, but talking about the underlying issues, which are: How do we do education? How do we do sexual education? How do we talk about consent? How do we talk about the ways in which women specifically are being held to different standards than men when it comes to, in this particular case, a professional setting?

So I don’t think that we actually need any more research on this, because even these three research articles, so looking at the urology residents and the surgery residents and then the vascular surgery residents, they found that really only between, I think, 7 percent and 13 were deemed unprofessional. So there’s not a whole bunch of that out there. So I don’t think we need research from that standpoint.

I think what we need is we need to start looking at how do we change the way that we’re viewing women in medicine, and how do we change the way that our policies are reflective of ways that allow them to have a seat at the table regardless of what’s going on in their personal life, but also allowing for flexibility for women in health care to have the ability to have a personal life, take care of their family, and still come to the table as female leaders in medicine. That’s where I think the biggest issue is, and that’s where research should be focused.

Kevin Pho: And my final question, Jessica: What is your take-home message that you want to share with the KevinMD audience?

Jessica Pearce: So, you know, I think my take-home message is really, it kind of ties together some of the things that I’m really passionate about that this article touches on, and what it comes down to is this: Medicine is hard work. There are always going to be people that have certain expectations of you, and we’re always going to want to give and give and give to please everybody else, but there comes a point where you’re going to have nothing left to give.

So my biggest thing is, you always focus on what is important to you. Practice self-love, self-health, self-care, self-pleasure, anything that you need to do to make sure that you are constantly in tune with yourself, because what that does is it allows you to be a voice and to stand up for yourself when you see issues that need to be taken care of. So whether that’s, you know, negotiating a contract or coming up with policies that are going to be helpful for you and your patients, once you have that strength within yourself and that clarity within yourself, then these things are not going to just be enraging; they’re going to inspire you to make specific changes so that we don’t have to deal with these things again in the future.

Kevin Pho: Jessica, thank you so much for sharing your insight, and thanks again for being on the show.

Jessica Pearce: Thanks, Kevin.

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