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Social Media and the Weight of Professionalism

Op-Med is a collection of original articles contributed by Doximity members.

It was a bit jarring to hear the hospital affiliate of my alma mater come out of a content creator’s mouth. I was listening to Philip DeFranco report on a now-retracted article from the Journal of Vascular Surgery, in which three men created fake accounts and followed the public posts of young vascular surgeons on Instagram, Twitter, and Facebook to determine if they were posting “unprofessional content.” The methodology and analysis of the study was later described as riddled with “significant conscious and unconscious biases,” labeling certain behaviors as unprofessional without setting any reasoning for why they would be classified as such. This included alcohol use, socio-political commentary, and attire such as Halloween costumes and swimwear. The resulting backlash from the online medical professional community over this published article and its subsequent retraction emphasized that the concept of professionalism is changing, in part due to the ubiquity of social media. With the increased usage of such online platforms, health care professionals now have the ability to reach and impact a wider pool of people. Those that have done so are known as “medical influencers.”  

There is no universally agreed upon definition for the term “influencer,” and the criteria to become one may be different for different platforms. However, my preferred definition of influencer is “someone who creates content that is posted to social media, where its intention is to be engaged with by a followership outside of the influencer’s immediate social network, a title that is given credibility by their followers who trust in their authority based on a belief in an influencer’s expertise.” I would also add that a key criteria to become an influencer is the ability to mobilize their audience for financial, social, or political gain.

The concept of medical influencers, or influencers with expertise in the medical field, is an even more underresearched topic in academic literature. Three broad categories encompass most of the content in the “medfluencing” community: the pre-medical journey, student experiences, and the licensed professional. I first engaged with this content in college, furiously looking up MCAT studying tips on YouTube or scrolling through Instagram posts of almost calligraphic handwritten notes for a physiology or physics course. The social media algorithm had locked onto my demographic details and churned out relatable content faster than I could peruse. At that time, medical influencing content was niche — relegated to its corner of the internet for current clinicians and the neurotic, aspiring medical student (such as myself) to find. 

However, TikTok and the COVID-19 pandemic skyrocketed the promotion of such content. From skits and dances to commentary and reaction videos, health care workers not only debunked myths or misinformation about the virus and vaccines, but also provided a look into hospital culture, clinicians’ perspectives of  patients, certain pathologies, and the challenges and rewards of working in the medical field. Content can be satirical, educational, comedic, ironic, or serious. Creators are wide and vast, but my “For You” pages have often recommended influencers like Dr. Glaucomflecken, Mama Doctor Jones, drkaranrajan, HealthyGamerGG, Dr. Mike, NurseJohnn, vickichanmd, doctormo16, and thepsychdoctormd. For such influencers, their profession is the centerpoint of their brand. However, trust for medfluencers can be tenuous, depending on the platform, content, and audience garnered. Before a professional medical association steps in, it is usually the viewers and commenters who collectively decide what crosses the line into unprofessional behavior. 

Rather than getting called out for wearing certain types of clothing or consuming alcohol in appropriate settings, health care workers are mainly called out for behavior that potentially or actively puts people in unnecessary harm. From hypocrisy over COVID-19 guidelines to actively livestreaming patients’ surgeries, medfluencers can lose a significant portion of their online following or even their license, depending on the severity of their actions. To prioritize one’s own self-interest over the health of others contradicts the so-called expertise and authority that many followers initially subscribed for. 

Complaining about patients on social media can have repercussions as well, with four Emory nurses disciplined after posting a TikTok about their “icks” with labor and delivery patients. No patients were recorded in the video, no identifiable information given when describing the “icks,” no harm seemingly done — and yet, four health care professionals were called out online and received real-life consequences. Perhaps they were fired for representing the profession and medical field in a negative light, or because people began to question how their opinions and attitudes would affect patient care. According to a post by Emory Healthcare on Twitter, “This video ... falls short of the values and standards we expect every member of our team to hold and demonstrate.” I am sure this would be the case for any hospital. Publicly, that is. 

I have heard many health care workers complain about patients and their family members behind the scenes in hospitals, calling them “stupid,” “annoying,” and even using racist remarks. And the day goes on. While venting to colleagues is a natural and sometimes therapeutic process, problematizing the patient — not their diagnosis, but rather their basic needs and personality — just seems plain mean. To then do so on a public platform for a viral trend feels cruel, a characteristic no one would want in their clinician. 

So what is the purpose of a medical influencer? Is it to provide education and a professional opinion on topics within an area of expertise? Or is it to peel back the veneer of professionalism and provide an inside look at the health care industry? And how does the professional identity of being a physician impact those who want to create content related to non-medical subjects? While I am by no means an influencer, as a medical student in the midst of residency interviews, I am acutely aware of what I post on the internet, including this article itself. Indeed, even Doximity, an online social networking service for health care professionals, is a form of social media. So while the American Medical Association’s Code of Medical Ethics section regarding professionalism in the use of social media does not specify "professional norms" beyond maintaining patient privacy and confidentiality, it does clearly state that “physicians must recognize that actions online and content posted may negatively affect their reputations among patients and colleagues, may have consequences for their medical careers (particularly for physicians-in-training and medical students), and can undermine public trust in the medical profession.” 

I spent my childhood before the advent of social media and grew up with it as a pre-teen — young enough to know the positive outcomes of connecting with others online and old enough to understand that what is posted on the internet could stay on the internet forever. Individual lifestyle choices that are shared publicly may not reflect a person’s capacity to be a proficient clinician, and yet we still live in a time where such behaviors are scrutinized as such. So while the concept of professionalism continues to evolve with social media and the Med-Tok-Twitter-Tube communities expand, perhaps we can all agree with at least one code of ethics: If you are not going to say it to your alert and oriented (AO) x 3 patient’s face, maybe think twice before posting it online.

How can clinicians maintain professionalism on social media? Share your recommendations below.

Soubhana Asif is a medical anthropologist and fourth-year medical student at New York Institute of Technology College of Osteopathic Medicine (NYITCOM). Her interests include community psychiatry, cross-cultural practice, and racial justice. She is a 2023–2024 Doximity Op-Med Fellow.

Image by Varijanta / Getty

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