During the HCSMgate debates and @mommy_doctor’s subsequent departure from twitter, I was really shocked to find that many people refused to believe that an act of bullying had occurred. I struggled to articulated my thoughts to those engaged in the debate until I realized that our community does not even have the vocabulary to accurately describe the unrecognizable violence committed against one of our colleagues. The “bullying” referred to in HCSMgate shall be hereafter referred to as “microbullying.”  This is a term derived from the words "microagression" and "bullying." I explain the etymology of the term and more specifically, how it applies to HSCMgate below.

According to Columbia University psychologist Derald Wing Sue, PhD microagressions: 

•  “[are] everyday insults, indignities and demeaning messages sent to people of color by well-intentioned white people who are unaware of the hidden messages being sent to them"
• “hold their power because they are invisible, and therefore they don't allow us to see that our actions and attitudes may be discriminatory."
  

According to the Department of Health and Human Services bullying involves:

• “Imbalance of Power: people who bully use their power to control or harm and the people being bullied may have a hard time defending themselves
• Intent to Cause Harm: actions done by accident are not bullying; the person bullying has a goal to cause harm
• Repetition: incidents of bullying happen to the same the person over and over by the same person or group"

Anything put into the digital space has the potential to grow and take on a life of its own. That is to say, content can "go viral." The power of social media and viral content has long been recognized. 

Microbullying is the INTENTIONAL and REPETITIVE use of social media POWER by WELL-INTENTIONED people who are UNAWARE of the HARM that is caused by SUM of each deliberate reaction, which may have been "harmless" or even constructive criticism on its own.

There is no single person to blame for @mommy_doctor’s departure from twitter. Yet to say she left twitter “because she wanted to” is to deny that any sort of violence was committed against her. I believe @mommy_doctor was the target of microbullying. If we each throw a pebble, eventually we have the power to crush with the mass of a boulder.  Despite the fact that some members of the community defended @mommy_doctor, perhaps her instant celebrity and infamy were too much of a burden to bear. 

As members of a community, we must be sharp in perceiving larger context and implications of our individual actions. In order to use Social Media mindfully we must exercise a greater sense of awareness and respect the magnitude with which our actions can influence others, for better or worse.
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I started my first blog, Chick Lit MD, in December of 2009. By the time I began filling out my medical school applications I had been actively blogging for approximately 7 months. As someone interested in the intersection between medicine and media, the use of social media was integral to my exploration of both fields. As such, I included my adventures in social media in my application in a tactful and strategic manner.  Now that I have actually been accepted to medical school, I’d like to to offer current and future applicants a few tips!


Be Professional -  If you are listing social media amongst the activities that have reinforced/ strengthened your interest in medicine, make sure you put your best foot forward. I wrote about ChickLitMD.com in my AMCAS essay and a number admissions committees definitely checked it out.  Some told me that they looked at the blog before the interview, and others informed me that they would check it out after the interview ( but before an admissions decision was made).  I’m proud to have my name on my website - make sure you are too!

Be Aware of Skeptics- Many physicians are quite conservative about physician exposure on the Internet. Make sure you understand these concerns and anticipate skepticism. I only encountered one interviewer who was skeptical to my face on the application trail. Thankfully I had read Dr. Brian Vartabedian’s advice on including social media in medical school applications before hand, so I was prepared for this sort of criticism. Above all, you should also be able to articulate the fact that you understand your responsibility to both the medical profession and patients and choose to use social media mindfully.

Believe in what you Blog - Did I mention that admissions officers will read any website you list in your application??? That makes all the content you post fair game for the interview.  Be prepared to speak intelligently about any of the material on your website. For example, during one of my interviews I was asked about an article I wrote on the health hazards of smoking Hookah. Despite the fact that I had written the article many months ago, I was asked to discuss the topic and  explain my rationale for including this content on my site.

Present Social Media as a Means to an End-  I found that interviewers interested in my social media presence were less interested in WHAT I was doing, and more interested in WHY I was doing it. If you blog about health, why are you doing it? What do you hope to achieve? How is social media helping you achieve these goals?  It's important to keep these questions in mind when writing about social media in your applications. In your descriptions you should aim to demonstrate ability, interest, and participation in the promotion of health and wellness. At the end of the day, each activity you describe in your medical school application should illustrate learned skills and demonstrate your potential to be an excellent physician.

Since I joined twitter in in 2009, I’ve become increasingly active in the medical community online. As a rising medical student I have enjoyed exploring the intersection between medicine and media with other colleagues active in both fields. I felt as though I was an equal player in the game. That is, until it hit me...I may not be an equal player just yet.


Recently I've seen a few physicians "call each other out" in a manner that I believe is akin to Theresa Brown's physician bullying in the New York Times. In these instances passive aggressive strategies were used to expose an individual's mistakes, rather than personally contacting the offending party and offering constructive criticism or suggestions for improvement. While it is important to educate medical professionals that use social media about best practices, I am disappointed by  the use of social media to amplify physician faux pas and embarrass or attack offenders. 

Other than writing this vague blog post,  I can’t really do or say much about the many instances of bullying I've seen. I’m just beginning my career, so I’m not in any position to confront any  physician on twitter, publicly or privately, especially those at academic institutions where I may one day need a job. In a school setting, it would be unwise for a medical student to directly confront an attending. It would be even more unwise for the medical student to make this confrontation public. So why would it be okay for a medical student to confront a physician online ? 

Twitter is not a democratic forum free of consequences, even for those who wish to engage in a productive and respectful dialogue with “superiors”. Even though I believe we should use social media to teach our colleagues, the extent to which I can teach other medical professionals is limited. The hierarchies that exist in medical education may exist in the digital space. I can't say I've specifically "confronted" a higher ranking physician, but I'm certainly not foolish enough to find out!

My guest post on KevinMD.com

I’ve read a number of recent articles on social media and medical professionalism. The latest post in the New York Times about physicians and Facebook prompted me to think about my own presence online. Dr. Ryan Greysen, a Robert Wood Johnson Foundation clinical scholar at Yale School of Medicine, says he is concerned about the professionalism of “the new generation of physicians and students who enter the medical world after years of saturation in social media.” As a member of the new generation, I’m wondering if I should be more worried about my digital footprint standing in the way of my future career?

The recommendations reported in the Times are suitable for more experienced physicians or for those who are new to social media. These recommendations however,  fail to take into account the realities of living and growing up in a digital world. Despite the fact that I never use my camera, I find myself tagged in new Facebook pictures every week-- some photos are candid, and others are not. I can untag the ones I don’t like, but whether or not those photos are visible on my profile, they still exist somewhere online. Because I don't post pictures myself, my untagged photos may still be accessible to people who can view my friends’ albums, and as  Dr. Danielle Ofori explains, you never know what “a friend’s friend’s friend might do with a photo.” Over the past six years I've accumulated exactly 1,602 tagged photographs, but I have no idea how many photos I have untagged...Is there an app for that?

Despite your best efforts to maintain a professional profile online, you cannot control every aspect of your digital footprint. Therefore, should you fear the possibility that a photo you didn't post could “cast a poor light” on your medical career? As a member of the next generation of physicians, I’m wondering what we can do to protect ourselves against this possibility in the future.

Maybe new physicians should give up the “fun and casual side of social media,” but what difference will it make if no one else makes the same sacrifice? Perhaps it won’t matter as much by the time I’m an intern because my residents and attendings will probably have untagged and unwanted Facebook pictures out there too.