The Not-So-Private Lives of Young Doctors

Why is it so important to scrutinize the social activities of young doctors when so many of them are sacrificing themselves and their loved ones to treat patients with COVID-19? Doesn’t that say enough about their character?

Well apparently several physicians affiliated with Boston University felt otherwise. After collecting data between 2016 and 2018 about the prevalence of unprofessional social medical content among young vascular surgeons, they felt it necessary to publish their findings in the August (2020) Journal of Vascular Surgery.

Worse yet, the journal’s editorial board, representative of the white male dominated medical establishment, saw nothing wrong with the study, which was inherently biased and blatantly sexist, causing a backlash that prompted Thomas Cheng (medical student) and Jeffrey Siracuse (associate professor), two of the study authors, to tweet identical apologies, saying in part:

“Our intent was to empower surgeons to be aware and then personally decide what may be easily available for patients and colleagues to see about us. However, this was not the result. We realize that the definition of professionalism is rapidly changing in medicine and that we need to support trainees and surgeons as our society changes. We are sorry that we made the young surgeons feel targeted and that we were judgmental.”

In this “research” paper, social snapshots of surgical trainees were gleaned from their Facebook, Twitter, and Instagram accounts. Approximately one-quarter of 235 doctors had either clearly unprofessional or potentially unprofessional content, such as profanity, HIPAA violations (discussing patients without their permission), controversial religious, political, or social comments (e.g., abortion), inappropriate attire (OMG, women in bikinis!), and depictions of drug paraphernalia and intoxication. The young surgeons were chided for their inappropriate behavior and warned to exercise caution when posting to public websites. Is this the example they want to set for their peers, patients, and current and future employers?

Several other articles of this sort have previously been published, apparently trying to hold physicians-in-training accountable for their actions. But in the wake of #MeToo Movement and other recent attempts to stamp out racism, sexism, and disparagement of minority groups — LGBTQIA+ people, immigrants, indigenous peoples, people with disabilities — the present study really hit a raw nerve. Reactions to it were swift and overwhelmingly negative.

Medical professionals flooded social media with pictures of themselves in bikinis with the hashtag #MedBikini, accompanied by sharp rebukes calling the article misogynistic, among other things.

The firestorm on Twitter forced the journal editors to retract the article, ironically in a statement posted to Twitter:

Editor’s Statement Regarding “Prevalence of unprofessional social media content among young vascular surgeons” J Vasc Surg 2020;72:667–71

“A publication in the Journal of Vascular Surgery, first presented as a paper at the 2019 annual meeting of the Society for Clinical Vascular Surgery and posted in the December 2019 issue of the Journal of Vascular Surgery has been criticized for its methodology and the implicit bias found in its analysis. Many who have read the article expressed great concerns about the method of data collection, lack of diversity of the authors collecting the data, as well as potential bias in the evaluation and the conclusion. Although the editors of the JVS believe that the authors of this paper were attempting to advise young vascular surgeons about the risks of social media, the review process failed to identify the errors in the design of the study with regards to conscious and unconscious bias and thus the published paper was interpreted as broadening inequities in surgery. It also became apparent that the authors did not receive the approval of the Association of Program Directors in Vascular Surgery (APDVS) to use its database in identifying the vascular surgeons in training who were evaluated for their participation in social media. The Editors therefore decided there was sufficient rationale to retract the article. Our decision was in line with the feedback we received from many of our readers, from members of the Society for Vascular Surgery and its leadership, and the APDVS. The authors of the manuscript agreed with our decision and they are fully committed to perform more informed research on these issues in the future with a diverse team.

Finally, we offer an apology to every person who has communicated the sadness, anger, and disappointment caused by this article. We have received an outpouring of constructive commentary on this matter, and we intend to take each point seriously and take resolute steps to improve our review process and increase diversity of our editorial boards.” (Peter Gloviczki, MD and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery).

Following the retraction, retweets and comments came fast and furious:

· “I’m a journal assistant at an academic publication. This would not have gotten past my desk to even be sent out for review. After me would’ve been an associate editor, several reviewers, and an editor-in-chief. This wasn’t an oversight, this is reflective of values.”

· “They have more men named Peter than women on their editorial team.”

· “Well it’s literally two dudes called Peter running the joint. Who could’ve predicted a massive blind spot in that scenario?”

· “Consider adding more women to your editorial team. Where are the women? #MedBikini #WomenInMedicine #MedEd.”

· “I hope the authors decide not to continue research that provides little value to patients, society, or the field of vascular surgery. Their methods were flawed, unethical, and, frankly, useless.”

· “This was cyber stalking/harassment based in ageism and sexism published under the guise of research. Why was this published in the first place?”

· “That’s what I found most disturbing! Creating fake accounts and then stalking their personal social media accounts. It’s creepy and unethical.”

· Hope we learn from this mistake and stay away from “gotcha” and “sensational” articles and focus on real science and research that advance our field.

· “Didn’t get approval to use the database. Why wasn’t that caught in peer review?”

· “This is also surely an issue for the authors’ universities to pick up and investigate. Clear research misconduct.”

· “Maybe, instead of apologizing to those offended, you should apologize to the research subjects that you helped exploit. The trainees (in your own field!) that you have an obligation to mentor and support.”

If one’s interest in the private lives of young physicians is to “empower” them, I can think of a half-dozen topics worthy of medical attention deserving further research. None of them involve residents in swimsuits or appearing intoxicated — well, almost none — because although the use of drugs by surgery residents is relatively low when compared to drug use by other types of physicians, alcohol abuse may be a problem, and alcohol is the substance of choice of most residents.

One in five Americans live with a mental illness. Amid the coronavirus pandemic there exists an epidemic of psychiatric disorders afflicting many physicians, not only attending physicians, but medical students and residents as well. Substance use disorders, PTSD, burnout, and depression and suicide lead the list. Approximately one physician per day completes suicide in the United States. The fact is the mental health of American medical trainees and the physicians who train them is a real concern.

Surgical residents have an alarmingly high rate of burnout, and medical students begin to lose empathy as early as the third year of medical school, precisely when they are thrust into the clinical arena and begin to interact with patients. Clinical training appears to have a negative impact on empathy and morale; perhaps the erosion of empathy is a precursor for burnout. We cannot afford to let medical students and residents succumb to apathy and indifference when caring for patients.

Improving the mental health of the next generation of physicians should be the real call to action. Medical trainees are often the front-line healthcare heroes, whether during a pandemic or not. But sometimes heroes need help too. For all we know, social media provides a therapeutic outlet for their pain and woe. The study in question did not even assess whether the social media profiles of doctors had an effect on patients.

It’s time for academic faculty members to stop pimping up-and-coming doctors and shaking their trees. The voyeuristic behavior of medical school professors should be harshly condemned.