The earliest adopters of social media were the technologically minded, including, I’m sure, some health care professionals. Then came physicians who knew how to engage with and communicate to a larger non-health-care audience. Now social media has become part of regular life and physicians, who heretofore would at most publish only to medical journals, are joining in. There are problems.
Traditionally, physicians were seen as gods. One did not brook their authority. Over time, this view softened, but the sense of ultimate authority and knowledge resting with the physician acting as a silo, or perhaps as a member of a trusted, carefully curated team, remains. In addition, physician vocabulary towards patient care hasn’t changed much and includes words like "difficult" and "compliance." "Evidence-based" and other such new jargon words connotes superior knowledge and power, as well. Although patients have mostly shed the view that physicians know all and aren’t to be confronted and although patient empowerment is growing, patients’ traditional place of being below the physician in power continues to be enforced by many.
As a side note, nobody outside the United States cares about "board-certified" when physicians use that on social media as a measure of their authority. Physicians need to either first check the profile of the person they’re replying to — always a good idea, anyway — for geographic information before they use that term or assume the person is outside the US and just not trumpet board certification so as to avoid the mental eye roll of followers.
Unfortunately, the hierarchical view of physician above patient creates unpleasant situations on social media. I recently witnessed quite the telling off by a physician toward a lay person on Twitter. The contretemps began when the physician tweeted out about a treatment. A random person, who’d been at the receiving end of a not-well-managed similar treatment, replied critically. The person had a point; the physician also had had a point. The physician could’ve acknowledged the person’s point, been self-deprecating, perhaps restated or expanded on their point in a non-authoritarian way, and moved on, although if I’d been the physician and checking up on the person’s profile, I might not have expanded on the point but kept the reply to a brief acknowledgement. Instead, the physician began lecturing the person as if the person was a dimwit who knew nothing, who had quite the chutzpah in criticizing them, and who was insulting because the person used a well-known Twitter jargon as a shortcut reply to their lecturing tone. The physician seemed to find it intolerable that some random Twitter user would challenge their language. I wondered about the fragility of their ego and if they didn’t want to admit to having a bad day, didn’t want to expose their humanity. And then fellow physicians piled on in support of their colleague. The physicians couldn’t understand why this person didn’t bend to their will nor admit they were infallible, I mean, correct. In other words, they treated this person as a particularly "difficult, non-compliant" patient. It was fascinating, instructive, anger-inducing, and avoidable if this physician, as all physicians in adopting social media should, had taken lessons on how to communicate as a regular person towards other regular people. I wonder if the physicians involved understood others were observing silently like I was, as happens on social media?
After several exchanges, in which the person explained their point of view a bit and expressed confusion at being piled on, the person finally responded with the virtual version of the raspberry and prudently left, while other members of the public became angered or worried and one physician denigrated a non-physician trying to smooth things over and then blocked them while still arguing with them. I found the denigration immature and the blocking reason strange. This sort of thing is not an isolated incident. Nor is blocking based merely on disagreement. It also reminded me of a recent argument I had with my neurodoc who at one point said, outraged, "Why are you arguing with me. Stop arguing with me." Well, if he’s going to lecture me based on the assumption he knows more about my physical health than I do when he knows only the barest minimum of my long, complicated history, what does he expect? As a person with a brain injury, I’ve been more subjected to this idea of physician knows all and one-way communication of physician-to-patient than in any other health care area.
And therein lies the crux of the problem: one-way, hierarchical communication and lack of openness to patients’ expertise.
Too many physicians don’t seem to know how to hear well or have the time to do so, listen with humility, ensure they have all the facts before they opine, respect and incorporate differing views including those based solely on experience by people with no medical credentials, and use humour to understand the other person, themselves, and how to diffuse a situation. They by and large have no idea how to de-escalate. I believe training in de-escalation techniques is essential because this skill makes everyone’s life easier — and safer for those with mental health issues and brain injury.
In an age when insurance companies in the US and government insurance in Canada are drowning physicians in paperwork and, as well, portraying them as sucking on the teat of scarce tax dollars, physicians feel under siege and unable to focus on patient care. Physicians — and patients! — would like nothing more than to focus 100 percent of their energy on caring for their patients, not on jumping through administrative hoops, fighting with poorly designed electronic health records, justifying to expert panels who have no expertise in the management of individualized medicine of patients with complicated chronic health issues the use of various medications, and other sundry administrative time wasters and energy suckage. And so more and more they are being urged to join Twitter, or other social media, to share expertise with each other, support each other, promulgate research findings, inform the public on good medicine to counter the rising amount of pseudo-science, and interact with the public so as to show the public they’re not the bad guy.
Unfortunately, not enough physicians seem to have realized that the ability to communicate well and with respect is essential.
Not having the time to listen well, is bad for patient care. Rushing on social media and/or not reading replies or tweets with diligence, is bad for constructive conversations and the aim of showing the public that physicians care.
Physicians must shed the idea that because of their education, credentials, and medical expertise, they are superior to any member of the public and therefore what they say in their tweets is superior and cannot be challenged. Unless and until they shed that idea, there are going to be bust-ups between them and the people who reply to their tweets. Physicians would be prudent to adopt the habit of checking the person’s profile, reread and think about what the person actually said when their reply outrages them, add in humility and humour, remind themselves that on Twitter all are equal in humanity, including themselves, and only then reply. They also need to understand the milieu of Twitter and that Twitter is a public conversation in which anyone may decide to chime in. This is the beauty of Twitter, but also takes some experience in handling. Seeing themselves as a student as they learn, not as a teacher with ultimate authority, and using humility and humour on social media, would go a long way towards harmonious communication and collegial debates with the public. Then the public would be more likely listen to them, as well.
Copyright ©2019 Shireen Anne Jeejeebhoy. May not be reprinted or reposted without permission.