You are what you click: Transform your social media experience [PODCAST]

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“Confidence and humility are strongly related, but one arises when we focus on self, and the other arises when we focus on others. However, each attribute can become unhealthy when it becomes too extreme, or when we lose the perspective of the other attribute. In the case of confidence, we focus on our worth as a remarkable human being—the fact that we have tremendous potential and deserve compassion and opportunity. But when we lose the perspective of the importance of others, confidence can veer into arrogance—the belief that our needs and value are somehow more important than everyone else’s.

In the case of humility, we recognize that we are just one person within a much bigger world and that all people have value and importance. But the risk here is that, if we lose the perspective of our own value and worth, healthy humility can devolve into self-loathing.

What does all this philosophizing have to do with social media?”

Brian A. Primack is a physician and author of You Are What You Click: How Being Selective, Positive, and Creative Can Transform Your Social Media Experience.

He shares his story and discusses his KevinMD article, “How to balance confidence and humility online.”

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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, 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 Brian Primack. He is a family physician, and he’s the author of the book You Are What You Click: How Being Selective, Positive, and Creative Can Transform Your Social Media Experience. There’s an excerpt from that book on KevinMD titled “How to balance confidence and humility online.” Brian, welcome to the show.

Brian A. Primack: Thank you. I really appreciate being here, Kevin.

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

Brian A. Primack: Sure. I actually started out as a junior high school teacher. That was my first job out of college. I started studying more about the kids that I had, became a dean of students of a school, and eventually decided to go into medicine, not sure if that would take me to pediatrics or psychiatry, and I ended up in family medicine. I did practice for 18 years, and during that time I also joined the faculty of the University of Pittsburgh School of Medicine and started doing more research. My research area has really focused on social media and other kinds of digital media and how they affect health in general. This was something that I came to very organically, as I was treating people and discovering what their major challenges were.

So that led to a whole public health and research career. I got the first R01 from NIH, and then the second, and then the third, and before you know it, I was doing more research than clinical work. Eventually I started to also integrate administration into the mix. I became the director of a research center on media technology, and I became the assistant vice chancellor across the health sciences at the University of Pittsburgh, and eventually the dean of the honors college. Then that led me to my current role, which is, I am dean of a very large R1 college at an R1 institution, the University of Arkansas at Fayetteville, which is the flagship campus of the University of Arkansas. I am the dean of the College of Education and Health Professions, so it combines some of my educational work from the beginning of my career, and we also have allied health and nursing and public health, so it integrates a lot of the other things from the rest of my clinical and research positions.

Kevin Pho: What are some of the challenges that face allied health today?

Brian A. Primack: Well, as you can imagine, everything has to do with COVID when we discuss that type of thing. We’ve got 1,600 nursing students, and it was very challenging to bring them in and out of clinical situations over the past couple of years. It was also very difficult to understand exactly the best balance, because in a lot of ways we wanted to keep everybody as safe as possible and keep as much distance between clinicians and patients, and so obviously there was a lot of pivoting to online. However, those kinds of pivots have costs as well, both monetary costs as well as emotional costs, because allied health and other health professions are so emotional and they’re so relational. So I think those have been the major challenges we’ve had while dealing with the pandemic.

Kevin Pho: During the pandemic, we’re of course hearing about the Great Resignation, and all I hear about are hospitals having severe nursing shortages. Are we training enough nurses and allied health professionals to meet these demands in the coming years?

Brian A. Primack: Yes, it’s a great question, and the short answer is we’re not. So for example, this past year my college’s freshman enrollment was up 39 from the prior year, and most of that was because of nursing. We have, for example, a particular LPN-to-BSN program to try to increase the value and function of the nursing workforce. We were expecting, when we created that program, to have about 80 students by now, and we have 500. So there is a huge shortage. We’re not really training enough people, but we are trying.

Kevin Pho: All right, so let’s transition into your book. It’s titled You Are What You Click: How Being Selective, Positive, and Creative Can Transform Your Social Media Experience. As you mentioned, a lot of your research experience has been on that intersection between social media and health, and we’re starting to see a lot of those implications in mainstream media. I’m seeing stories, of course, connecting mental health issues with Instagram, for instance. But tell me, what are some of the key points?

Brian A. Primack: Well, the book overall is called You Are What You Click, and it is about the interfaces you’re talking about between social media and mental health. But it’s also really trying to go the next step and say, what do we do about this? Because so far, a lot of the research that’s been done has really focused on identifying that there’s a problem, identifying that there are these significant associations between using a lot of social media and increased depression, increased anxiety, and increased social isolation. But then the question becomes, where do we go from here?

So the reason that I use this metaphor, You Are What You Click, that’s a little bit like you are what you eat, is that I think there are some lessons we can learn from the area of food and how we think about food medically. A few decades ago, there were a bunch of studies that came out about all of the different problems that were associated with eating too much of certain things. Too many carbs are a problem, too much fat is a problem, too much trans fat is definitely a problem. So we as clinicians obviously don’t then say to people, “Don’t eat.” We had to start developing and honing a food pyramid and telling people, “Hey, these are the things that are valuable. These are the things that are not as valuable. How can I help get you moving toward more fiber and less refined sugar? How can I help move you away from trans fats, less high-fructose corn syrup, etc., etc.?”

And so I think we need to do a similar process when it comes to social media, because we’re recognizing that it is almost like food. It isn’t very feasible in today’s world to just say, “Let’s get rid of this,” and I don’t really think that that’s the answer either. It can be very nourishing, just like food can. It can definitely enhance lives. And just because right now it’s not really living up to that promise of enhancing lives doesn’t mean we throw the baby out with the bathwater. It means we just think more carefully about it and how we can help people leverage social media to be a positive force in their lives as opposed to a negative one.

Kevin Pho: So give some examples, before you get into your solutions, of how exactly social media is a negative force in a lot of people’s lives.

Brian A. Primack: Yeah, it’s a great question, and I guess the segment that you picked to put on your website about balancing confidence and humility is a good example, and it’s easy for listeners to just go to your website and take a look. What I talk about in that segment is the fact that confidence and humility, we know, and especially those of us who work in mental health, are always a challenge for individuals. It’s important for people to be confident and think of themselves as wonderful, positive human beings. It’s important for people also to be humble, though, because we’ve seen confidence go too far when it comes into extreme self-centeredness and arrogance. But we’ve also seen humility go too far, where people become almost self-loathing. And I think the issue with social media is that it can exacerbate both of these problems.

So for example, confidence: As I said, it’s really good for people to be confident and to share stuff about them that makes them unique and important. But it’s very easy on social media for that to sort of become a game of who did the most and who has the best life, and it can really teeter over into arrogance pretty easily. We now have all of these celebrities online that we just try to be more and more like, and so overconfidence is definitely something that we see as a potential problem with the social media world.

But the humility side is also potentially a problem on social media, because it’s very, very easy to fall into social comparison when you are comparing yourself to your own peers. It’s very much wired in us that we compare ourselves. When I think about my athletic prowess, I don’t compare myself to Aaron Rodgers and think how disappointed I am that I don’t have Super Bowl rings. But I do compare myself to people in my own demographic groups, and those are exactly the people I’m friends with on social media. And so it’s very, very easy for me to see their curated posts about their 5K times or their athletic prowess that make me feel bad about myself.

And it’s not just athletics. I’m using that as one example, but it’s very, very easy, because on social media it’s very, very curated, but it doesn’t seem curated. It seems like real life, because we know that person. “That’s John. I know John. Wow, I guess I’m happy for John and that he’s having such a great life, but I just can’t measure up.” And I’m not thinking about the fact that John actually chose that factoid or that picture out of 200 factoids or 400 pictures.

Kevin Pho: So what kind of advice do you have for us to thread that needle between confidence and humility whenever we are either posting something on social media or digesting what comes on our social media?

Brian A. Primack: Well, that is exactly what the book is about. I actually present a social media pyramid, sort of analogous to the food pyramid, but it just has three levels, which are be selective, be positive, and be creative. I obviously won’t go into all of them right now, because each one is quite nuanced in terms of the specifics, but I try to have in there some very specific suggestions for people.

So when it comes to things like selectivity, I talk about a study that we did that demonstrated that, you know, people often ask me, “What’s the ideal amount of time I should spend on social media?” There are answers to that, and we have done studies on that, but we’ve also done some studies that have found some interesting tidbits that are also helpful. For example, regardless of the amount of time, we find that using fewer platforms is better. In other words, if you use seven platforms and I use two platforms, and we both use two hours of social media a day, in our study we actually found that you, with the seven platforms, are three times as likely to be depressed or to become depressed over the next six months. We don’t know exactly why this is the case, but what we need is some nuances like that, so that our message to people isn’t just “use less social media.” It’s “How do I really hone my social media use?”

At other points in the book, we talk about, for example, how it’s important to match your use of social media to your personality. That’s something that probably a lot of people haven’t really thought of. They’ve just sort of gone on instinct and joined certain platforms and used certain platforms in certain ways, but they never really sat down and took a personality test and then matched their social media use to that. And so in the book, we actually have a personality test related to the Big Five personality test that they can take, and then the following five chapters go through each of the different personality tendencies and help people match their use of social media to their personality.

Another example, the last example I’ll give, is the fact that it’s good to think about not just what social media you’re using but who you’re using it with. Again, this might seem sort of obvious, but I don’t think people really think about it. When you say to somebody, “What percent of the people that you interact with are close friends that you’ve met in person, and what percent are not?” they’ll often kind of scratch their head and think about it. But we actually have found in published studies that that’s an extremely important variable. People who say more than 30 percent of people are people that “I haven’t met in person, and I just know from online” are significantly more likely to be depressed, anxious, feel isolated, and that type of thing. So these are important considerations, and they belong in the food pyramid, or the social media pyramid, whatever you want to call it.

Kevin Pho: One of the things that’s come up over recent years is that social media has become increasingly tribal, especially on Facebook. We only interact with people who agree with us. We’re in our same ideological bubbles, and it’s very difficult to come across opinions that are different from what you already agree with. Some would say that would perpetuate a lot of the misinformation pandemic that social media is sometimes connected with. So what do you think about that?

Brian A. Primack: Kevin, this is a great question. I have a chapter on this specific issue in the book, because it’s another one of those needles that unfortunately we need to thread. It’s very easy to say to people, “You know what? It’s extremely important that you reach out to other neighborhoods,” because social media is a digital neighborhood. You wouldn’t just choose. I have a chapter in the book called “Love thy neighbor, but choose thy neighborhood,” because it’s very important for us to do both of those things.

And so it is important to reach out to others, like you’re saying, and be in neighborhoods that you’re maybe not as comfortable with, so that there is less information and there’s less of the echo chamber that we’re so concerned about. But on the other hand, we find in other studies that it’s really important, especially for people with certain tendencies or for people who have certain mental health conditions, to focus on areas where they’re more comfortable. And so we’re sort of giving people this dual message: Make sure to focus your neighborhood on things that make you more comfortable and ways of interacting with people that make you more comfortable. You’ll be less prone to some of the gaffes and some of the misunderstandings that can lead to depression, anxiety, and other problems. But at the same time, we need to also tell people to reach out of their comfort zone because of exactly the issues you’re talking about. So this becomes one of those areas, I think, that the only way to deal with is really good understanding of both sides, self-reflection, and then coming to a strategy that somehow threads that needle.

Kevin Pho: We’re talking to Brian Primack. He’s a family physician and is the author of the book You Are What You Click: How Being Selective, Positive, and Creative Can Transform Your Social Media Experience. Brian, I think physicians on social media have an added layer of responsibility, because the public in general looks to physicians for trusted medical and health information. Can you talk about some of the nuances physicians should consider whenever they engage on social?

Brian A. Primack: Yeah, absolutely. So I think that, just like we’ve been discussing, there’s very much a double-edged sword. There’s so much value in social and digital media for opportunities for engagement in education, and this podcast is a perfect example of that. You are leveraging this important medium for valuable entertainment, education, and information, and so I think that that’s something to be applauded for, and other physicians who are listening, similarly. I think it’s a very important and underutilized medium for us in terms of getting out positive health messages. We often shake our heads at the challenges where we see negative health messages getting perpetuated. And so I think one take-home for physicians is that there is a lot of potential positive that they can find if they are creative and if they are thinking about valuable ways to leverage the media.

However, there is that other side to the double-edged sword, which is that it is so easy for information on social media to get misunderstood. You don’t have all those other contextual features. You don’t have the in-person relationship and reading those physical cues and other social cues and understanding the full picture. And so it’s very easy for words and communications to get misunderstood, for there to be some kind of a gaffe, at worst, that really causes a problem. It’s very easy for that information, because now it’s public, to be sort of forever a potential challenge if somebody looks at that later on. So I think that, yet again, what we’re having as a theme here is the needle threading. It’s important for us to try to leverage this amazing technology and this amazing possibility for good, but we need to think of what all the challenges are.

I guess I’ll sort of close this section, or this response to this question, by mentioning that Mark Twain has some incredible quotes about this, where he was actually talking about the printing press. He said that the printing press, quote, unquote, I’m not going to get it exactly right, but he said that it’s given information a set of wings, isn’t that wonderful, but it’s given misinformation a double set of wings. And so in the era of social media, we’re seeing that same kind of thing, and we might even say it’s even five sets of wings. Maybe it’s given two sets of wings to positive information and 10 sets of wings to negative information. I don’t know. I wish that Mr. Clemens was here today to comment on this and to bring his wisdom to it. But I think that those things that we’ve been concerned about and learned a lot about with regard to other forms of communication over time are only getting magnified today in the era of social and other digital media.

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

Brian A. Primack: Well, I guess the take-home message is really just that social and digital media in today’s world are critical to understand for anybody, and I think especially for clinicians. People in the young adult age group, for example, are using these technologies and media three to five hours a day. And obviously I don’t want to have the message to already overworked physicians that they need to take a social media history, right? This would be one of the biggest messages that would be likely to fall flat, because I think that physicians are already overwhelmed with all the information they need to get. However, I think at least understanding how present they are in people’s lives, and how much information they are already getting from social and digital media, whether that’s positive and correct information or whether that’s misinformation, it’s just important for them to have that perspective. And then how they take that from there is up to them: how much they ask, how much they leverage. Some people are going to be very comfortable helping their patients find good information. Other people are just not going to be as inclined or as interested in that.

And then, even more generally, in terms of a take-home that’s more for everybody and not just physicians, there is such a strong relationship between social and digital media and mental and emotional health. And yes, I need people to understand that it isn’t looking good right now, that a lot of the studies that are coming out are very high quality and are demonstrating challenging associations. But I really don’t think that my takeaway message should be that we throw out the baby with the bathwater. It’s quite the opposite. I really think that it doesn’t have to be that way. I think that we just aren’t using it very well as a society right now. It’s the Wild West, and we’re just using social media in ways that marketers want and that aren’t necessarily the best ways for us. But if we start to look closely at this social media pyramid and think of more nuanced, empowered ways of using social media, then I don’t think it needs to be a negative for mental health, and it can actually improve our lives. We just have some work to do.

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

Brian A. Primack: Great, and thanks to you, Kevin. I really enjoyed it.

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