Some Doctors Need Lessons in Civility
Now that I’m semi-retired and don’t have to answer to anyone other than myself and my family, I feel a certain freedom to speak up more than ever — and believe me, there’s plenty on my mind. I’m mostly concerned with the ill health of physicians — not “wellness,” because many physicians are actually unwell — and how practicing has exacted a terrible toll on the emotional health of physicians manifesting in burnout, depression, suicide, PTSD and substance use. Since my retirement, I’ve had more time on my hands, and I’ve been visiting several medical blogs on a regular basis. I’ve detected another malady that befits doctors — and it’s not pretty. It has to do with the way physicians attack each other online on social media platforms. Physicians, it seems, are just not civil to one another in many instances.
Using myself as an example, I wrote an opinion piece on Doximity, a.k.a., “LinkedIn for Doctors.” I explained why it took me 40 years to finally speak my mind without fear of reprisal from my employers. Most doctors resonated with the essay. For example, one physician wrote, “You have written in that article everything that we all who suffer the same conditions [fearing to speak out] would want to write. THANKS SO MUCH FOR BEING OUR VOICE.”
Another physician sent me a private message and said, “I just read your article about speaking out, Thank you. It came at a really good time for me. I’ve learned a lot about censorship recently and trying to figure out how to proceed.” Make no mistake about it. Doctors have been harshly censored, especially for speaking out about how their employers stumbled and bumbled through the initial phases of COVID-19 preparedness.
However, a few doctors took issue with my essay and had some really nasty things to say. One said, “I find it hard to believe that you can work for 40 years and ‘not speak up’ and feel that it is ok…I wonder how many patients were harmed by not speaking up for 40 years.” Another physician critiqued my essay for being “internally inconsistent” and suggested my motivation for writing it was less than altruistic. We argued back-and-forth online until one physician stepped in to defend me as “valiant,” and another physician interjected that the thread had become “contentious.”
An editor at Doximity who had been monitoring the exchange (perhaps alerted to it?) stepped in and apparently prevented one of the physicians from posting any more comments. (Doximity reserves the right to remove content it deems inappropriate.) It was reaffirming to receive a personal email from the Doximity editor informing me: “Your replies were, across the board, even-handed, professional, and respectful.”
In the spirit of full disclosure, I should mention that I am a Doximity Fellow — a select group of leaders in medical news curation, storytelling, and content creation. I am paid a nominal fee by Doximity to help them maintain their Community Guidelines — for example, by commenting and engaging with community members and, when necessary, identifying offensive, clearly inappropriate language and comments for possible removal. I’ve seen thousands of conversations exchanged online, and while the overwhelming majority of them are cordial and respectful, some of them are hostile, attacking and downright mean-spirited. To make matters worse, despite vigilant screening, Doximity and other medical web sites have allowed COVID disinformation to be published — by doctors of all people!
No one can ever guarantee that individuals who react to opinion pieces posted on a web site will be courteous or professional. Every author takes a risk by publishing — indeed, any author on any platform opens themselves up to backlash and criticism by amplifying their voice. But once again, I say that the amount of rancor that prevails on medically oriented social media web sites is disturbing and uncivil and possibly unethical at times. Modern versions of the Hippocratic Oath specifically recognize that physicians should respect the hard-won scientific gains of their colleagues and that physicians are members of society, with special obligations to all their fellow human beings.
Physicians as a group have become increasingly irritable and angry, and it shows not only in social media, but also in day-to-day interactions with patients. Stories of incivility abound. Your doctor was brusque because she couldn’t pinpoint your problem (leaving you to feel it’s all in your head). He rolls his eyes when you ask him for help (he’s incapable of providing assistance). She becomes intolerant of your questions, stating “we’ve covered this ground before.” He becomes petulant because you want a second opinion before surgery. She calls you “non-compliant” because you’ve stopped your medication (due to side effects). You’re terminated from the practice without cause or due process.
While roughly 10 per cent of all professions report disruptive behaviors, the number is higher in healthcare — about 30 per cent. I have researched what ails American healthcare workers, especially physicians, and I have read myriad explanations why their behavior is so ornery. Most explanations can be summed up under the headings of stress and loss of autonomy — more than 50 per cent of the physician workforce is now employed. Add to that a “cut-throat” culture that begins in college and carries through into medical school, where additional characteristics of the learning environment lead to loss of empathy, burnout and career regret by the time of graduation, and you have a recipe for producing some of the most damaged, unhappiest, and miserable people on the planet— and they take their frustrations out directly on patients and each other.
Some critics have suggested that social media platforms be shut down. I think this is too drastic. Instead, I propose that habitually offending physicians be banned on social media until they take a qualified course in civility and communication to ensure they conduct themselves in the same professional manner as they would — or should — offline in a professional medical setting. Civility and professional communication practices are instrumental in attaining greater meaning in work, reducing frustration, and counteracting feelings of burnout, which might go a long way toward toning down doctors’ online hubris and rhetoric.