A PR PROBLEM or SOMETHING MORE? by Tricia Rae Pendergrast

A PR Problem, or Something More?

This year is not off to an auspicious start when it comes to public relations for the health professions. We ended 2019 with the #PatientsAreNotFaking movement, prompted by a viral TikTok video wherein nurse and social media personality “D Rose” insinuated patients fabricate pain for attention. Many people, Black women especially, shared personal accounts of their pain not being believed by health professionals and the resulting consequences. In what felt like rapid succession, the viral Tiktok was followed by a medical student chiding patients with chest pain for seeking care, an attending physician performing choreography while complaining about people coming to the emergency department, and a nurse who made a Tiktok that mocked manic patients in the Emergency Department. 

The Stakes are High for Physicians Online

Public trust in medical professionals has plummeted in recent years. This mistrust directly impacts health outcomes (ex. the anti-vaccine movement). When people don’t trust health professionals, they are less likely to engage in healthy behaviors or take medicines as prescribed, and it is evident that not all medical professionals consider these repercussions before posting on social media. 

Beyond using social media applications as a repository of patient mockery and shirtless photographs in white coats (do us a favor and at least pretend publicly to view what the coat represents as a privilege please), some take to social media applications to flaunt their wealth, and in doing so reinforce stereotypes that are already driving a massive wedge between the American public and their doctors. Others represent, in my opinion, the most pernicious strain of online medical professional: those whose posts lend legitimacy to the rapidly-expanding pseudoscientific nonsense that has crossed from unconventional to mainstream in recent years. Whether or not medical influencers receive compensation for this content is irrelevant, posts espousing the alleged benefits of cryogenic treatments, infrared saunas, and homeopathic medicines (not medicine, just lies) legitimize these practices.

Are Social Media Applications at Fault?

 The medical profession’s intimate relationship with racism, misogyny, and homophobia transcends generations. While social media applications are not the root of these evils, they are novel methods of sharing and reinforcing hateful beliefs to patients on a broader, more public, and permanent scale. Black Americans are consistently undertreated for pain relative to White Americans, women receive less aggressive treatments for heart attacks than men, and these videos serve to reinforce and confirm the biases patients already suspect health professionals have about them. The effect these videos have on normalizing biases and harmful behavior amongst medical professionals is unknown.

Is there a solution?

Steps have been taken in recent years to address implicit bias in medical trainees.  Many believe increased awareness of, and commitment to, addressing bias will make an impact on patient care, however stereotyping and prejudice experts have expressed concern that an emphasis on unconscious bias may result in less perceived culpability and accountability from others. Furthermore, not all bias is implicit. 

Unethical and biased conduct is a feature, not a bug, of the institution of medicine in the United States. Until 1965, the American Medical Association supported policies that excluded Black doctors, and allowed policies to exist until the mid-1990s because members felt the organization had no role in “race relations.” Explicit bias in health professionals has been quantified; in a prospective study, almost half of medical students reported believing Black skin is thicker than White skin. We know that bias manifests in clinical practice (Black patients are significantly less likely than White patients to receive analgesics) and traumatizes patients. 

 We punch down on patients because we can; because there are no professional consequences for doing so. The mockery of patients is so deeply rooted in the culture of medicine that it is written off as “dark humor,” and accepted as a reasonable coping mechanism. The recent rash of stereotype-ridden social media content represents a fundamental failure to screen for, and subsequently address and correct, any misconceptions about gender, sex, disability, race, or psuedoscience that are revealed throughout the course of training.

As more pre-health and health professionals take to social media to educate and entertain, resources must be devoted to identifying “red flag” behaviors both online and offline (overt patient mockery, racism, sexism) during transitions between levels of training and professional appointments. Institutions may also consider collaborating with science communication professionals to develop guidelines and guidance for health professionals who intend to use social media to network, educate, and collaborate. Organizations that reinforce and reward the use of social media for professional advancement and education may promote a more professional online community. 

This opinion piece written by @traependergrast

Ah yes it’s time to shame patients for seeking care o clock on the Tiktok I see pic.twitter.com/WTN6MUTOFg

— Tricia Rae Pendergrast (@traependergrast) January 14, 2020