How Social Media Can Advance Humanism in Medicine

This article was originally published on February 28, 2019 on KevinMD.com. It can be found at https://www.kevinmd.com/blog/2019/02/how-social-media-can-advance-humanism-in-medicine.html

Image credit Rahul Chakraborty

Image credit Rahul Chakraborty

“In any given moment we have two options: to step forward into growth or step back into safety.”
– Abraham Maslow.

The New York Times recently published the op-ed “Dr. Google is a Liar,” written by cardiologist Haider Warraich, MD. Dr. Warraich describes the rise of fake medical news and the adverse consequences of a population who gets their medical information from social media. He shares that when countering these cultural memes of medical misinformation, which stir up strong emotions in our patients, stating dry medical jargon is not effective. He found that his patient was more open to his advice when he also shared about his own father’s heart attack. Dr. Warraich wisely argues for physicians to take back control of medical news by harnessing the power of humanism and narrative medicine to become effective storytellers.

Image via Sara Kurfeß

Image via Sara Kurfeß

I wholeheartedly agree with him. Let’s stop burying our heads in the sand and pretending we can convince our patients to resist Dr. Google. Let’s put ourselves back in the driver’s seat. I believe that the next generation of great doctors will be those who communicate on the Internet effectively and in a compelling enough way to sustain an audience and engender trust. In a time when trust in doctors is eroding, our patients want to see that we are human too and to do that we need to overcome our fears of showing our humanity. We know that when doctors and nurses are burnt out, patient outcomes decline. Literature also supports that when doctors display more empathy for their patients, outcomes improve. Humanism in medicine works best when it is a two-way street, wherein our health care system treats both patients and health care workers as human beings.

I believe there’s a natural link between humanism in medicine and social media. While there has been a core group of physicians on social media for the past decade, we are now seeing it become mainstream. Through this increased visibility, physicians are using social media mobilization to organize and to advocate for better patient care and better work conditions. Last November, as a criticism to the American College of Physicians’ position paper describing a public health approach to tackling gun-related deaths, the National Rifle Association tweeted that “self-important anti-gun doctors” should stay in their lane. The medical community swiftly responded with the #ThisIsMyLane campaign, rallying around their first-person, often harrowing accounts, of caring for the gunshot victims in ERs and operating rooms. Dr. Dave Morris, MD, a trauma surgeon in Utah posted a photo of his blood-soaked scrubs and said “Can’t post a patient photo, so this is a selfie. This is what it looks like to #stayinmylane.” The tweets and hashtags went viral, garnering national media attention, and physicians effectively steered the conversation.

Leo Eisenstein, a Harvard Medical Student, wrote about this in a New England Journal of Medicine Catalyst piece. He reminds us that the term burnout was coined by a psychologist who was caring for marginalized patients. In today’s broken health care system, clinicians are burdened by the reality that their patients are fighting socioeconomic and structural barriers that “no medicines can touch.” If both physicians and patients feel powerless against these forces, it’s not a big leap to envision physician advocacy as part of the antidote.

Part of makes what makes social media appealing is that it allows unheard voices to become public. This is crucial particularly for physicians, with many of us working long hours providing direct face to face patient care, and thus not having the time for community engagement. Social media platforms have become a watering hole of sorts, where it’s okay to share your perspective as a physician. Every Sunday night, @womeninmedchat (run by Dr. Petra Dolman, MD) hosts an hour-long Twitter chat, with guest moderators facilitating conversations ranging from how to negotiate pay, navigating residency interviews, and countering burn out, all searchable under the hashtag #womeninmedicine. The Facebook group SoMeDocs (Social Media Docs), founded by Dr. Dana Corriel, MD, has provided an engaging forum for physicians to discuss a variety of issues related to social media. #SoMeDocs is branching out to in-person live meetups aimed at building community, and advancing shared goals. For example, when Dr. Monique Tello, MD, MPH spoke out in support of vaccinations, she was targeted by anti-vaxxers online. Through the support of #SoMeDocs, Dr. Tello wrote a widely circulated blog post about online harassment and intimidation against doctors and successfully had the fake one-star online reviews removed.

Image credit Elena Koycheva

Image credit Elena Koycheva

With all of this momentum, it is important to remember that social media is a public space, and it should not be used to share protected health information or sensitive personal material. Some physicians argue that these risks mean we physicians should stay away from social media. However, with the next generation of doctors spending at least a decade of their life on Instagram and Snapchat before medical school, we cannot simply ignore the fact the social media has its own place in health care. Universities have been taking notice and creating positions to legitimize social media. My alma mater, Sidney Kimmel Medical College of Thomas Jefferson University in Philadelphia has named Dr. Austin Chiang MD, MPH as their Chief Social Media Officer. Likewise, the newly established Association for Healthcare Social Media aims to create best practices by which all health care professionals can be guided and protected in this emerging field.


I’ve met quite a few physicians who are even just one generation older than I am that are suspicious of social media. To them, it’s extra, and it’s dangerous. I can’t help but wonder if there is an underlying fear that the next generation is going about things differently? It seems there is denial and wishful thinking; as if we can turn back the clock in time and go back to the good old days when physicians could practice medicine without the burdens of out of control billing and EMR demands. My generation has inherited the reigns, and in my opinion, we got into this mess by physicians keeping themselves separate from other industries. Insurance companies took over medicine, and meanwhile, physicians were seeing patients, writing notes and faxing orders. We assumed that if we were providing excellent patient care, the rest would fall in line, and the work would speak for itself. Fast forward, and here we are.

Part of what’s gotten us off track in medicine is the dehumanization of patients and doctors. By sharing our stories, we remind the public that we are human too. We have successes and failures, tragedies and triumphs. We are human. I believe that doctors can serve patients, be professional, and make our opinions known. In fact, it’s our duty, and our profession depends on it.

What Makes Busy Women Go to the Psychiatrist

This piece was originally published in Doximity’s Op-Med on November 21, 2018: https://opmed.doximity.com/articles/what-makes-busy-women-go-to-the-psychiatrist

"I really want to come see you – but I just can't take the time off work." This is the typical refrain I hear from patients. I'm a Psychiatrist specializing in Women's Mental Health in Washington, DC. My patients are well-educated, well-resourced, and VERY busy. When depression and anxiety hit, it's not so convenient to stop by your local psychiatrist's office every week. I get it. But, what usually brings women back to my office is when their suffering starts to affect those around them – their children, their partner, their co-workers. 

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I recently returned from a trip to India where I presented my research studying women with depression at the Marcé International Perinatal Mental Health Conference. As some of you may know, I am a 1st generation South Asian American and spent a good part of my childhood in India. South Asian Hindu culture is largely based on traditional gender roles and these dynamics loomed large in my upbringing. My undergraduate and graduate education were done in urban research institutions where I was exposed to views questioning traditional gender roles. I chose to formally study gender as a Women's Studies Major and dual majored in the Biological Basis of Behavior at the University of Pennsylvania, before going on to obtain my medical degree from Jefferson Medical College. My desire to integrate my South Asian heritage and to resolve the dichotomy between traditional gender roles is the lens through which I approach both my professional and personal lives. Back in Washington, as I reflect on this particular trip to India, I've noticed patterns between these two worlds. 

A few years ago I conducted a small ethnographic research study working with rural Indian woman who lived on the outskirts of Bengaluru. I completed the field-work for this project when I was a psychiatry resident at the George Washington University, through their Global Mental Health Program. These women were all mothers seeking treatment for depression or anxiety at a community clinic through the National Institute of Mental Health & Neurosciences in Bengaluru. Interestingly, the majority of women had daughters, and their average level of education was 4th grade. Our project was qualitative, meaning that we conducted in-depth semi-structured interviews and a focus group with the women. We were not so interested in their diagnosis, symptoms or medications. Instead, my attention was on uncovering a nuanced understanding of the experiences of women living with depression and anxiety in a country where there is tremendous discrimination against mental health and against women. We wanted to understand how they made sense of their depression: what was the problem and what did they believe caused it? What had them finally decide to get help? 

The women spoke almost exclusively about their interpersonal lives. They attributed their illnesses to problems with their husbands (philandering and drinking away household income) or their mothers-in-law (overworking and belittling them). And, lest you jump to the conclusion that this was all in their heads – the evidence backs it up: Gender disadvantage factors like sexual violence, low autonomy in decision making, and decreased family support are independently associated with an increased risk for developing depression and anxiety in South Asian women. We know that depression lives and breathes within the walls of family life for South Asian women. 

Presenting at the Marcé International Perinatal Mental Health Conference at the National Institute of Mental Health & Neurosciences in Bengaluru in September 2018.

Presenting at the Marcé International Perinatal Mental Health Conference at the National Institute of Mental Health & Neurosciences in Bengaluru in September 2018.

What surprised me was these women from rural Indian villages had similar motivating factors for getting help as my patients back in Washington. They conceptualized their illness within the structure of motherhood, and their treatment seeking within the framework of being a good mother. Children, and taking good care of them, appeared to be a socially sanctioned means for women to assert agency in the face of a patriarchal family structure. In other words, it was difficult for women to be open about getting help. It could be dangerous and bring shame onto the family. But if they made the choice for the sake of their kids, then treatment for mental illness became valuable, even a priority. One interpretation of this phenomenon is that it is a protective defense mechanism. These were the resilient women – the courageous few who traveled hours, sometimes secretly, to get treatment.

You see, I hear this type of thinking over and over again from my patients. It's hard to ask for help and speak up unless you feel you're doing it on behalf of someone else. It seems impossible to justify spending time and money on your own mental health. It might even be self-indulgent! What is it about being a woman that makes it hard to admit to yourself and to others that you are suffering? Why is making that admission easier when it also unburdens someone else? I'm not a mother, but through my own work in therapy, I've come to understand that it's no coincidence I landed in a career which has me healing the emotional wounds of others. Most days, it is a joy and a privilege to bear witness to my patients' internal worlds. But to keep it that way, to keep myself feeling generous, it requires a great deal of work on my part. As women in medicine, I think we bear an even heavier load of this compulsion to self-sacrifice. 

My presentation: A Brief Ethnographic Inquiry on Women with Depression in Bengaluru: A Focus on Women’s Experience

My presentation: A Brief Ethnographic Inquiry on Women with Depression in Bengaluru: A Focus on Women’s Experience

I should be clear and state that I'm not equating the suffering of rural women in low and middle-income countries with that of upper-middle-class women in the West. What I am pointing to is when I look underneath, I find a kernel of truth that exists in both worlds. It might be radical to draw a clinical comparison between women's' seemingly endless ability to self-sacrifice and the patriarchy. Yet, we know that across the board, women are penalized for showing too many feelings, for being too assertive, for asking for too much.

Oppression and misogyny make you feel small on the inside – no matter what continent you live on. It feels like you don't matter. Like there is no space for you. Like being you is a burden to others. That it would be easier if you did not exist. Certainly, many of these feelings could be symptoms of clinical depression. But, they also describe what it's like to be a stigmatized group who has learned to survive by catering to the powers that uphold the system.