As women in medicine who use social media to advocate for public health and social justice, we know firsthand what it’s like to be personally attacked and sexually harassed online.
These attacks have taken many forms. Some are more of a nuisance, like online trolling after advocating for mask wearing during the pandemic. Others are downright egregious and scary, such as an anonymous call to our hospital leadership “reporting” online advocacy efforts, or having our personal information published online, also known as doxxing.
We also know we are not alone. Over the course of 2020, many physicians vocal on social media have been attacked for simply asking others to wear a mask or highlighting the challenges they face caring for patients in hospitals that are strained. Some have even received death threats.
While it’s easy to believe that this is a byproduct of the expanded roles many physicians have assumed on social media to champion public health initiatives during the pandemic, the truth is that this form of harassment is not new.
With several colleagues, we published a research letter in JAMA Internal Medicine this week that uses data on online harassment collected in 2019, before the pandemic started. Our study demonstrates that 1 in 4 physicians who use social media reported being personally attacked. The most common reason reported for these attacks was engaging in advocacy, especially promoting vaccinations. Other reasons included advocacy related to reducing gun violence, as well as personal attacks on one’s race or religion.
Another disheartening aspect of the study was that 1 in 6 women physicians faced the additional threat of being sexually harassed online, often in the form of being sent sexually explicit messages or pornographic images. Threats of rape were also reported.
While we performed this study before the pandemic, it is worth considering the implications for physicians on social media today.
First, it’s likely that the rates of being attacked and harassed online are higher for physicians than other professionals, and this has become even more evident as we navigate Covid-19. One major reason for this is the politicization of mask wearing and other public health measures by President Trump. His false allegation that doctors are profiting off the virus further emboldened those who support him to attack physicians online.
Second, as physicians willingly engage on social media — or are being asked to — to promote risk mitigation strategies, vaccinations, and other public health measures during the pandemic, they should be aware there is a risk of being attacked or harassed. This could be especially disconcerting and stressful for those who are engaging in social media for the first time, or for trainees who are just establishing their professional social media presences.
Third, women and physicians of color face the additional risk of attacks that are grounded in sexism, racism, or the intersection of the two. For example, as health care advocacy efforts intersected with racial equity and justice, online attacks manifested in more overt ways, as we described in a recent New England Journal of Medicine article when a virtual #WhiteCoatsForBlackLives march was “Zoom bombed.”
Given the risks, it is tempting for many physicians to avoid social media altogether. This silence, however, would allow rampant medical misinformation online to go unchecked, leaving a void that is hard to fill. It is even more important today to ensure that the voices of credible physicians and scientists are not only heard but also protected and amplified online.
To ensure that physicians and scientists continue their advocacy and online presence, health care institutions and professional societies can advise physicians, scientists, and trainees on how to advocate on social media in the safest way possible.
One potential mechanism is to advocate in a group, either informally or formally. With several other colleagues, we started the Illinois Medical Professionals Action Collaborative Team (IMPACT) to bring together health professionals who were advocating on social media to amplify their voices for greater reach and to help influence local and state policy and public behavior.
Groups such as the international Center for Countering Digital Hate have created playbooks for how to “disrupt the architecture of online hate and misinformation.” While attacks do and will occur, the group approach allows individuals to come to each other’s aid and provide moral support to continue.
In addition to advocating together, it is also essential that the medical community join the fight to advocate for stronger laws to safeguard against cyberstalking online. Although it is widely recognized that cyberbullying and online sexual harassment are harmful, federal law addressing these situations is lacking, often leaving it up to individual states. To make matters worse, the line between free speech and a credible threat to a victim is often vague, and thus inconsistently enforced by local law enforcement. Finally, social media companies should be held accountable and take more decisive action to remove users who violate terms of service.
As our nation faces the challenge of promoting a widespread mass vaccination effort in the face of vaccine hesitancy, it is imperative that doctors, scientists, and others are able to freely use social media to promote positive messaging without fear of retribution, retaliation, and harassment.
Vineet Arora is a physician, professor of medicine, assistant dean for scholarship and discovery, and associate chief medical officer for the clinical learning environment, all at the University of Chicago, and a founding member of Time’s Up Healthcare. Tricia Pendergrast is a second-year medical student at Northwestern University Feinberg School of Medicine and co-founder of GetMePPEChicago. Shikha Jain is a medical oncologist, assistant professor of medicine in the Division of Hematology and Oncology at the University of Illinois in Chicago, director of communications strategies in medicine and associate director of oncology communication and digital innovation for the University of Illinois Cancer Center, and the founder and chair of the Women in Medicine Summit.