You may recall, a recently published (now retracted) article named “Prevalence of unprofessional social media content among young vascular surgeons” sparked outrage among doctors, medical students, and medical providers alike. The paper highlights the regularity of “unprofessional” behaviors on publicly available social media accounts of vascular surgeons. While the writers acknowledged the subjectivity between the parameters of “strictly” and “potentially” unprofessional, the subjectivity of what is considered “provocative attire” and “controversial” language is not lost on readers. This scrutiny comes from the fact that the searches on social media using “neutral accounts” were done by males of the ages 28, 33, 37 years old. Already, a clear bias in this method is found. If one is using subjective measures to determine “inappropriate” or “provocative” attire, the observers need to include an even mix of males and females.
This issue with attire is two pronged.
First, the purpose of this study completely negates the fact that physicians and all medical professionals have lives outside of work.
With physicians being one of the top professions with the highest rates of suicide, I would hope they have a life outside the clinic. Please go to the beach. Please go to a club. Rewind. Refresh. Come back to the hospital a new like.
Most distain towards the article comes from the mention of Bikinis as an “inappropriate attire”, hence the hashtag handle #medbikini when referencing this article. What else am I suppose to wear to swim? I know roughly half the population wear swim shorts. But many women don’t want to be peeling a one piece off their body every time they have to relieve themselves. If the expectation is to wear a one piece or be considered “provocative”, where is the equality? Men aren’t urged to wear body suits. Acknowledging that, after Thomas Cheng had issued his apology over the article, it became clear that researchers were considering both bikinis and swim shorts without a shirt as under the same category of “unprofessional”.
This also doesn’t negate the fact that “inappropriate”, “provocative”, or “sexual” attire (as stated in a referenced article) is subjective and misogynistic in nature, which is the second issue with this article.
Sexualizing The Female Body
This reminds me of the days I was in High School where I couldn’t wear spaghetti straps in one-hundred degree heat. The only shorts and skirts that I owned that followed the dress code were the ones I had found in the mature womens section at Macys, because the Juniors section always had ones that were too short. When asking why I couldn’t wear those things, the responses I received were, “the male teachers don’t want to see you like that”, and “you will distract the boys”. It was clear that my body was sexualized, even as a minor. All of this putting the blame on the ladies for looking too “provocative”. Here, in this study, like in most public schools we have men making the determination on what is unprofessional with regards to women’s bodies. Men continue to sexualize women’s bodies, even in the context of medical academia. Without the perspective of a woman during the research process of studies like these, the results will become skewed. The presence of women are also mandatory for the discussion of professionalism that will continue to happen as we face the consequences of this paper.
Besides unveiling misogyny in medicine, the #medbikini paper brings another important conversation among providers:
The need to discuss “controversial” and “political” topics such as gun control and abortion as mentioned in this article under “potentially unprofessional”. Medicine has been politicized with policy makers making decisions that can ultimately bring more harm than good to the patients of our doctors. When speaking on such topics with their expertise and experience in the hospitals, they are labeled as “unprofessional” and told to “stay in their own lane”. Abortion and gun control is a health issue. As an OBGYN will tell you, their duty is to look after women’s health and anyone with reproductive potential. Abortion services, fall under the category of women’s health. Additionally, an ER doctor will also tell you that gun control policy falls into their lane. In 2016, the first leading cause of deaths to minors were injury. If broken down further, the second leading cause of death for people under the age of 18 were firearm related injury, while the first was automobile accidents (2018, Cunningham). Among these gun related deaths, 80% of the time, suicide by firearm was done by guns owned by their parents or relatives (2010, Johnson). This brings forth a clear reason for ER doctors, specifically ER pediatricians get involved by advocating for laws that require that all firearms be stored with a lock in place.
The interesting thing about this article is that it also creates a sort of paradox. Something misogynistic is happening in medicine, an article was published with an intent lost on its viewers with great harm being done with women across the board. Bathing suits and other revealing clothing is deemed “unprofessional” not mentioning the context of the photo. But this article also says we are not allowed to talk about it on social media since this might actually be deemed “controversial”.
The Breaking of IRB Rules
The final issue with this article is the blatant breaking of IRB (Institutional Review Board) rules. As stated in the methods section they used a list of Vascular Surgery Resident names obtained by the organization they were affiliated with. This list was not IRB approved, nor did they obtain consent from the “participants”. The fact that this paper had not been shut down following IRB approval and that this paper was successfully published by a renowned Journal, exemplifies the need to have more rigorous IRB and review processes.
Although this article had done harm, it is clear that an opportunity also came from this. While uncomfortable as it is, this article has highlighted the need for us to continue this conversation, even though the paper has been retracted. Over the last forty-eight hours we have uncovered a few things:
- There is a problem within the ethics and review committees itself. Given that this paper was published with clear IRB infractions demonstrates this.
- A presence of misogyny that quickly needs to be addressed within the medical community.
- Danielle Belardo, MD (@DBelardoMD) asked her Instagram followers “What has been your experience with sexism in medicine?”, the results were startling with endless stories of abuse and microaggressions.
- A conversation around guidelines for professionalism is severely needed.
- As the article noted, the holding or consumption of alcohol by providers on social media is a topic for further debate. While we can clearly say what isn’t “unprofessional” from this article, there is still much debate over what is and is not professional behavior over social media. My advice is to create these guidelines within each medical institution using a DIVERSE group of employees that have active conversations around the topic.
- A larger conversation around “controversial and political topics” is also necessary.
- As said above, the subject matter considered “controversial” and “unprofessional” in this study are also topics that MUST be discussed in the hospitals and clinics across the US.
The wonderful thing about #medtwitter is that we keep each other accountable. Physicians like Jason “Tik Tok Doc” Campbell MD and Mama Doctor Jones | Danielle Jones, MD have shown great strides in not only education but also outreach to their followers in the hope’s to create a more diverse, ethical, and equitable health system.
Side note: The history of using “professionalism” to oppress minority communities is a deeper conversation for another blog post. Please do not send hate to the researchers. Everyone is a lifelong learner, especially providers. From the responses on social media, they have a vast number of experiences to learn from.
- Cunningham, R. M., Walton, M. A., & Carter, P. M. (2018). The Major Causes of Death in Children and Adolescents in the United States. New England Journal of Medicine, 379(25), 2468-2475. doi:10.1056/nejmsr1804754
- Hardouin, S., Cheng, T. W., Mitchell, E. L., Raulli, S. J., Jones, D. W., Siracuse, J. J., & Farber, A. (2019). Prevalence of unprofessional social media content among young vascular surgeons. Journal of Vascular Surgery, 72(2), 667-671. doi:10.1016/j.jvs.2019.10.069
- Johnson, R. M., Barber, C., Azrael, D., Clark, D. E., & Hemenway, D. (2010). Who are the Owners of Firearms Used in Adolescent Suicides? Suicide and Life-Threatening Behavior,40(6), 609-611. doi:10.1521/suli.2010.40.6.609