Personal attacks and sexual harassment of physicians on social media [PODCAST]

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“This survey study examines the self-reports of personal attacks and sexual harassment of physicians through social media outlets. A total of 108 physicians (23.3%) reported being personally attacked on social media, with no significant difference between female and male physicians. In contrast, women were significantly more likely than men to report online sexual harassment.”

Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain.  She can be reached on Twitter @ShikhaJainMD.

She shares her story and discusses the article, “Prevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media.”

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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, we welcome back to the show Shikha Jain. She’s a hematology-oncology physician, and she co-wrote a JAMA Internal Medicine research letter, “Prevalence of personal attacks and sexual harassment of physicians on social media.” Shikha, welcome back to the show.

Shikha Jain: Thanks so much for having me, Kevin. I really appreciate it.

Kevin Pho: So for those who didn’t get a chance to listen to our first episode, can you just briefly share your story and your journey to where you are today?

Shikha Jain: Absolutely. As you mentioned, I’m a hematology-oncology physician. I’m also the founder of the nonprofit Women in Medicine and the founder and chair of the Women in Medicine Summit. I’m also the CEO and one of the founders of an organization called IMPACT, which is all about amplifying the voices of health care workers and advocating for good public health messaging, and that started during this pandemic. And then, as I mentioned, I’m an assistant professor of medicine at the University of Illinois and the director of communication strategies of our cancer center, where I also see patients in oncology.

Kevin Pho: So, especially during the pandemic, why is it so important to amplify health care voices?

Shikha Jain: Well, as I’m sure you’ve seen, on social media especially, and then also in some traditional media, we see a lot of fake information, misinformation, and disinformation that is being put out there, which has made it very confusing and complicated for the general public to really know how to sift the truth from the falsehoods. People are making decisions on their own health, whether it’s getting a vaccine, or wearing a mask, or how serious the pandemic is, and a lot of the information people are seeing is often inaccurate.

So it’s really important that the voices of health care workers, and the people who are really doing the research, who are studying the topics that need to be discussed, and who are seeing the impact of this pandemic in real time on the front lines, really need to be amplified. We need to be listening to what they’re saying, and we need to be trusting the science and the evidence, as opposed to these conspiracy theories and the things that have really led to the deaths of thousands, probably hundreds of thousands, of people because of this really horrible pandemic of misinformation, or, as the WHO calls it, an infodemic.

Kevin Pho: So as more health care workers are more prominent online, on mainstream media and on social media, we’re getting some pushback because, as you know, everything about the pandemic and misinformation is so highly politicized. So you co-wrote this JAMA Internal Medicine research letter. It’s titled “Prevalence of personal attacks and sexual harassment of physicians on social media.” So for those of you who didn’t get a chance to read this research letter, can you just briefly share the story and summarize it for my audience?

Shikha Jain: Yeah, so the interesting thing is this study was actually done before the pandemic. What we did was we sent out a survey through social media that was responded to by about 464 people who self-identified as physicians. And again, this survey was sent out before the pandemic. What we found was that one in four physicians on social media reported having some form of attack on social media, personal attacks or attacks on their profession or their professionalism. And one in six women physicians, so people who self-identified as female physicians, reported actually being sexually harassed.

That was very concerning, and I can imagine that those numbers would be even higher if we did this study again today. There actually was a paper, I believe, that came out in Nature relatively recently that did indeed show that the amount of attacks on social media among health care workers is pretty bad right now, in the middle of this pandemic.

Kevin Pho: So can you give us some examples and case studies of some of these personal attacks against physicians that you uncovered during the study?

Shikha Jain: The four main kinds of topics that we saw, that we categorized these attacks into, were attacks related to advocacy work, personal attacks, and work-related attacks. In the advocacy space, and again, I want to remind everyone, this is pre-pandemic, there were a lot of attacks on vaccines and attacks from the anti-vaccine movement, on gun control, on abortion, and on smoking. There were personal attacks related to race and religion. In many of these comments, the physicians who reported these attacks said that some of these were death threats. In some situations, their employers and certifying boards were actually contacted. There was also some personal identification and personal information that was shared on public forums.

Kevin Pho: Now, which social media platforms did you guys look at?

Shikha Jain: We predominantly looked at Twitter. That was our main goal, because a lot of public health messaging goes out through Twitter. So the purpose of this study was predominantly to assess the impact of social media engagement on Twitter, which is where we sent out the survey.

Kevin Pho: Now, this survey, of course, you mentioned, was focused on Twitter. Are you noticing personal attacks on other social media platforms, like YouTube and Facebook, as well?

Shikha Jain: Yes, we absolutely have. I will say that even now, what we’re seeing is that people who write op-eds and people who post things online are often told not to read the comments section, because that’s where a lot of these attacks are happening. The really concerning thing is when these attacks go beyond just comments on Facebook or YouTube or Twitter, and they actually go into contacting people’s employers or contacting people’s boards for really just harassment purposes.

Kevin Pho: And how often does that happen? Of the attacks that you categorized, what percentage of these actually go on and look up physicians’ workplaces and complain to their employers?

Shikha Jain: You know, the interesting thing is, it’s really hard to actually quantify that, because there are probably a lot of times where that happens and we aren’t even aware. The only times we become aware are when someone is contacted by the medical board or by their employer. There are many instances, I’m sure, where it happens and people aren’t even notified. There are things like Yelp reviews that are put out there. I know of many physicians who have had instances where their clinics have been downvoted on multiple platforms.

So actually, the really interesting thing, and actually the really positive thing, that’s come out of these types of negative interactions on social media is that there are groups out there like Shots Heard Round the World, This Is Our Shot, and IMPACT, the group that I co-founded, that actually have strategies and toolkits to help address these types of attacks. Shots Heard Round the World actually helps a lot of physicians who are targeted, especially relating to the anti-vaccine movement, and they actually have strategies and teams in place to help counteract some of these attacks that happen.

Kevin Pho: So let’s go to some of these tools. If I’m a physician and I wrote something provocative, or even something that’s medically and scientifically sound, on Twitter, and I start getting attacks and death threats on Twitter, what can I do?

Shikha Jain: So I think the first thing is you need to speak to your employer. That’s number one, first and foremost. You need to tell them what’s happening, because that is something that your employer needs to be aware of. The second question is going to be, when you talk about death threats, or people getting really doxed online, where their personal information is being shared, sometimes it’s necessary to go to the police. In some cases, I’ve heard of people actually even going through the FBI. The reason for that would be because you don’t want a threat online to become a threat in real life as well.

You can also, like I mentioned, go to Shots Heard Round the World. They actually have a way that you can report if you’re being attacked by anti-science or anti-vaccine individuals, or if your practice is being attacked. They actually have a button you can click on their website that will help you get in touch with them. And then, again, they have a toolkit on their website. We also have a toolkit on our website, and then there are organizations like Hollaback that also help with that type of, I want to say, protection, and help you strategize a way to protect yourself online.

Kevin Pho: Has there been any success in terms of the pushback against people who harass physicians online, if these people are reported? Have you heard of cases where there were repercussions for them?

Shikha Jain: Well, we know that our former president was banned from Twitter for a variety of reasons. I think some of it included harassment and misinformation and inciting others to do that type of work online as well. So I have seen, and I’m hopeful, that the social media platforms will take a little bit more responsibility for this type of thing moving forward, and we’re starting to see the ability on Twitter to report anti-COVID or anti-vaccine or anti-science tweets. So that gives me some hope that maybe we will be able to do something.

There is an organization that was founded by a group of physicians called No License for Disinformation, and they’re actually working on getting physicians who are putting out this misinformation to be reprimanded, or potentially have their licenses taken away by medical boards. So there’s an organization that’s working toward that.

And then I think that really the most powerful part of social media is when these types of things happen, when someone is getting attacked. I’ve seen a lot of other health care workers, physicians, nurses, and people who are on social media actually come to the defense of the individual and drown the threads out with more information. The challenge often becomes that these anti-science movements often have a very targeted way and a very strategic way of disseminating their information. But I think now people who have the tools on the science side are starting to learn how to kind of fight back, so to speak. So we’re seeing people come to each other’s aid and help drown out the negative as much as possible, and I’m seeing some positive events, where we see people who are basically really drowned out by the science and by the evidence that’s being posted online.

Kevin Pho: We’re talking to Shikha Jain. She’s a hematology-oncology physician, and she co-wrote a JAMA Internal Medicine research letter, “Prevalence of personal attacks and sexual harassment of physicians on social media.” Shikha, on one hand, it’s very important for physicians to speak out on social media, but on the other, they read research letters like this, and they may not want to risk personal attacks and deal with the sexual harassment online that goes along with that territory. So how do you reconcile that? And what do you advise physicians who do want to speak out?

Shikha Jain: That’s such a great question. I will tell you, I struggle with that on a regular basis, because there are weeks or days where I’m feeling like I don’t want to do this anymore, because it can get overwhelming. But I also want to remind people there is so much positive that you can have come out of your engagement on social media. I have found friends. I’ve found collaborators. I’ve found other people who feel the same way as I do.

Most importantly, if all of us leave, if we are not there providing that information, if we are not there providing that evidence and that science to help people make informed decisions, then that gap is going to be filled by the people who are touting unscientific, unresearched, not evidence-based information, and it’s going to be really dangerous to the public, and it’s going to be really dangerous to public health.

I always encourage people to take social media breaks. I also tell people not to engage with the trolls. So, for example, if somebody posts something negative or argumentative on something that I post, I typically respond with one comment, and usually that comment will be, “Thank you so much for reading my tweet,” or “reading my article. Here’s actually a paper that supports what I was talking about. I hope that you stay safe and healthy.” I usually end it with a positive.

Honestly, I’m not putting that response out there for the person who’s attacking me, because social media is not the place to change people’s hearts and minds if they are very set in their ways and set in the way they’re thinking, especially if they’re a bot, for example. But my purpose in putting that tweet out there is all of those people who are on the fence, who aren’t really sure if what I’m saying is right or if this person who’s attacking me is right. I put this out there for them to read, so that the people who aren’t in the conversation, but are seeing the conversation, get more data and evidence.

So I’ve seen a lot of positives come out of social media. I’ve seen people who were sitting on the fence change their minds. I’ve seen amazing, engaging discussions on social media. So I recommend that people drown out the negative, ignore the people who are attacking you, and just focus on the positive and keep putting out good science-based information, because really, it’s up to all of us to educate our communities. Unlike 50 years ago, our communities are not just the people who we live next to. Our communities are really global. We really need to be providing them with the best and most up-to-date information we can, in order for us to help make the country and the world as healthy as they can be, making decisions based on evidence and science.

Kevin Pho: And my final question: What are some of the take-home messages you want to leave with the KevinMD audience?

Shikha Jain: I think the most important thing to remember is that even though we have studies coming out showing that physicians and health care workers are getting harassed online, know that there is an incredibly powerful medical community online as well that will be there to support you. There are so many good things you can do by engaging in this space. If you’re nervous about it, just look at Twitter, follow people, and don’t tweet anything until you get a little more comfortable. But try really hard to engage, at least in some capacity, if you can, because all of our voices are really important, especially in this time, where the spread of misinformation and disinformation is so rampant. It’s literally costing people’s lives.

I’m a physician who cares deeply about helping as many people as I can. So for me, engaging online is a part of the responsibility that I took on when I decided to go into this profession. Everyone does not feel that way, and that’s also fine. If you don’t feel comfortable engaging on social media, that doesn’t mean that you need to. But I encourage everyone to at least dip their toe in and see what it’s like, because I can promise you, you’re going to do more good than you even believe you’re going to be able to when you get started.

Kevin Pho: Shikha, thank you so much for sharing your time and insight. Thanks again for coming back on the show.

Shikha Jain: Thanks for having me, Kevin.

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