Social Media Is a Drug. Should Doctors Act Accordingly?

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Social media has exploded as the dominant marketing avenue for cosmetic procedures. Thanks to controversial boundary-pushers like Dr. Michael Salzhauer (AKA “Dr. Miami”), what was once an occasional post has morphed into a high-stakes arms race with 40-part Instagram stories, “trademarked” hashtags, and graphic one-upmanship. Social media’s inherent image-centricity, combined with its micro-targeting marketing capabilities, naturally lends itself to cosmetic medicine. But other traditional, disease-related specialties are following suit by increasingly leveraging these platforms for promotional purposes.

We’ve reached a point where Plastic and Reconstructive Surgery, the leading journal for plastic surgeons, felt compelled to propose ethical guidelines for social media video posting. These guidelines came on the heels of an Aesthetic Surgery Journal study demonstrating that the majority of plastic surgery-related hashtags are attached to posts by non-board certified doctors, nurses, and other under-credentialed practitioners.

None of this is to suggest that medicine and social media shouldn’t mix. Each physician has the prerogative to use social media in a way that dovetails with her personal and professional goals. But patient safety and privacy issues, along with the maintenance of medicine’s integrity, rightfully places social media within the crosshairs of board-mandated, and potentially even government, regulation.

Yet, while this important debate intensifies, there is arguably a more consequential issue being overlooked: how social media is impacting the quality of our medical work, as well as our Hippocratic mandate to prioritize overall patient well-being.

Toxicity and Negative Side Effects

Since the dawn of the smartphone era, with advertising and data collection as the dominant monetization strategies, product design goals have subtly shifted from maximizing contentment to maximizing attention. In this race to the dystopian bottom, social media has been particularly effective in leveraging addiction science to manufacture dependence. This has recently taken center stage in the lay press, where experts are sounding the alarm regarding the rapidly shifting mindscape of young adults, ostensibly linked to smartphone and social media adoption. The data shows that this cultural overhaul has led to unprecedented epidemics of anxiety, depression, loneliness, and suicidality.

So, with a spotlight squarely focused on social media’s negative impact, why highlight the physician? For several important reasons.

Doctoring involves drawing from years of intensive experience to achieve diagnoses or navigate complex surgical anatomy. Decades of passive and active exposure to patients and disease leads to this much-touted “art of medicine”: pattern recognition, nuanced intuition, and the vital subtleties of bedside manner. To do justice to this process, “Deep Work” is required — a term coined by Cal Newport’s book of the same name — which describes mindful and undistracted attention.

The disruptive nature of social media is putting a dangerous damper on this delicate and finely-tuned ability. When we go back-and-forth from the intensity of operating to Facebook Live narration, or spend regenerative time between consults mindlessly scrolling through Instagram, we are suffering an expensive switching cost, ultimately upending the vital flow of focused thought. Absent this flow, I fear we are practicing medicine beneath our potential. A recent New England Journal of Medicine Perspective piece put it succinctly: “It’s ironic that just when clinicians feel that there’s no time in their daily routines for thinking, the need for deep thinking is more urgent than ever.”

Beyond diagnostician and care taker, a physician is also a scientist. And a cornerstone of scientific insight is recognizing unforeseen connections between disparate observations. As elegantly detailed by Manoush Zamarodi in Bored and Brilliant, unfocused “boredom” is a vital ingredient for inspiration.

Not long ago, natural, “in-between” moments existed throughout the day: standing in an elevator, using the restroom and — yes — walking between consult rooms. But hyper-connectedness, typically via social media, has consumed nearly all of this fruitful boredom. This drastic shift has the potential to subtly impact serendipitous medical discovery.

There is also the touchy issue of envy and self-worth. Millennia ago there was a survival advantage in observing others and comparing their techniques to our own. Yet, by providing on-demand access to a cultivated stream of polished photos and carefully-edited narration, this once-vital trait has been hacked and exploited. It’s no wonder a recent, longitudinal study demonstrated that the more you use Facebook, the worse you feel — despite a sometimes-obsessive need to engage.

This habitual comparison is particularly toxic for physicians. We are continuously bombarded with the supposedly perfect lives of our intellectual peers, who pursued “easier” careers that seemingly facilitate endless leisure time or fancier lifestyles. Yet while these posts highlight (or exaggerate) merely the positive, they fail to remind us why we initially made certain trade-offs. Perhaps to perform more meaningful work. Or maybe for increased independence and job security. Without this comprehensive recognition we may question our paths, foment resentment, and grow increasingly disconnected from the potential joy of practice. This does not bode well for already epidemic levels of physician burnout, no doubt at the hands of other unrelated factors like overwhelming paperwork and plummeting reimbursement.

Physicians also have a duty to examine the impact of social media on our patients. We are the ultimate guardians of health and well-being, yet social media is undisputedly a product engineered for addiction that can lead to mental illness, including the exacerbation of body dysmorphic disorder. If social media is the new smoking, do we have a responsibility to discourage patient use (as opposed to fueling it)? Are we the modern-day versions of those doctors in cigarette ads?

Powerful Tools, Used Responsibly

But we must also recognize how social media’s power has been harnessed to benefit medicine. I am fortunate to work amongst physicians who use social media to reach patients who may otherwise never receive education about a particular disease or treatment option. And I’ve personally improved my own practice by reviewing shared videos from other thoughtful and generous physicians. Perhaps most tangibly, social media has efficiently connected physicians around the globe who can leverage collective experience to arrive at difficult diagnoses. Patients also use these networks to benefit population health by stemming epidemics and collaborating in rare disease support groups.

So what can physicians do to harness the benefits of social media, while avoiding its pitfalls?

The first step is an honest reckoning of one’s relationship with these networks. Is the expenditure of time and energy intentional, or is it compulsive or obligatory? Which practices have a positive impact on ourselves and our quality of work, and where are the sources of negativity? How are current habits affecting patient care and one’s general disposition? Does patient-targeting via a purely addictive product jive with one’s own moral compass?

Systems and boundaries are then needed to leverage the positive benefits, while minimizing detriment. Advice abounds for reigning in and positively constraining social media (and smartphone) use. Notification tailoring, app deletion or even opting out are viable techniques to loosen the grip. Post planning, batching and scheduling, unfollowing or even outsourcing account management can also positively transform use.

No matter the techniques used, authenticity is the key ingredient. In a misguided attempt to compete, emulating other physicians in use-patterns or content is a losing battle, and at the very least could backfire by attracting patients who are not a good fit for your practice. No matter the medium, promoting elements of your authentic self and practice will lead to a happier, more harmonious personal and professional life.

“Create more, consume less,” a maxim popularized by the Minimalists, elegantly summarizes another recommendation. With more time spent composing meaningful content than judging, digesting, and counting the posts, comments and likes of others, you will start to naturally feel greater harmony in your social media consumption. You will also generate more value for yourself.

As social media evolves, there will be new challenges for physicians in meaningful use and boundary setting. This is already occurring with the recent explosion of time-stamped video stories and live streaming. It will take persistence, courage, and honesty to maintain an intentional and unobtrusive relationship with this medium, and to promote this same healthy relationship to our equally vulnerable patients.

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