Physicians (Including Female Physicians) Are People Too

I am posting a compelling article written by Nina Shapiro which calls attention to an article which went viral, then was retracted due to uproar and outrage.
The original post can be found here.

Viral #MedBikini Response To Controversial Manuscript Leads Editor To Retract Article

Remember that time you saw your teacher at the grocery store? Maybe you’re still recovering from the trauma. Even though nine-year-old you knew that your teacher was, well, human, the idea that he or she engaged in human behaviors similar to those of your own family was a tough pill to swallow. Spotting a teacher on vacation? Perish the thought. What about your doctor? Your surgeon? They don’t actually eat food, do errands, or (gasp) go to the beach like the rest of us, do they? Well if they do, just hope you don’t have to witness it, right? With social media, oftentimes a click of a button will save you a trip out in public to peek at the private lives of those who care for you or your children. One group based in Boston sought to take their own peek into the lives of young surgeons via fabricated social media accounts. And they wrote about it in a highly respected academic journal.

In the August 2020 issue of the Journal of Vascular Surgery, a manuscript entitled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons,” was retracted by the journal’s editorial board yesterday. The article sought to identify what the authors consider to be “inappropriate” and “unprofessional” behavior on various social media platforms by young vascular surgeons, in efforts to recognize and, in turn, discourage, any such behavior which could have a negative impact on patient respect for physicians. While some of the issues addressed are clearly critical for patient care, including patient privacy violations, slander of colleagues, and illegal drug use, many of the other issues addressed can be construed as privacy violations into the lives of young physicians. Particularly female physicians. The investigators focused on recent vascular surgery residency and fellowship graduates, putting the average age of the study subjects (who did not give permission to be studied) at around 30-35 years old. They created “neutral” (translation: fake) Facebook, Instagram, and Twitter accounts to search the social media feeds of young surgeons.

  • The three fake accounts to search for unprofessional behavior were created by male students and fellows, ages 28-37 years old. Included in what they considered to be unprofessional behavior were photographs of “provocative” Halloween costumes and poses in bikinis. In addition, any reference to politically or socially-charged issues such as abortion and gun control were included as unprofessional behavior. The real social media world got word of this publication, and responded loud and clear. The notion that the focus was targeting young female surgeons on how they dress during their non-work time was met with disgust and uproar. The hashtag #MedBikini went viral on Twitter and Instagram, bringing countless women (and men) to proudly post pictures of themselves in bikinis or other casual attire, along with the #MedBikini hashtag, in mutual support of so-called “unprofessional” behavior outside of the operating room.

While the authors did address issues of patient privacy and uncollegial behavior, the focus on female surgeons wearing bikinis, especially tracked by male students and fellows under fake social media accounts, raised the “creep” factor to higher and higher levels as the issue came to the public. Hearkening back to the #ILookLikeASurgeon hashtag, which began in 2016, pointing out that, yes, even bikini-clad, all-shapes-and-sizes, all-genders-regardless-of-identity can be and are surgeons, #MedBikini is a trend to humanize, not de-professionalize, women in a traditionally male profession.

Dr. Mudit Chowdhary, a Chief Resident in Radiation Oncology at Rush University, shared his concerns with the study and on social media. When asked why he felt so strongly about the manuscript, he stated, “I have issues with the definition of unprofessional behavior…it is inappropriate to label social issues as unprofessional. We are humans first before physicians. Plus, the issues they label as controversial (gun control, abortion) are healthcare issues. Physicians are taught to be community leaders in medical school and we need to speak up in order to help our communities.” When asked about whether or not physicians should be held to higher standards, even on social media, he responded, “I do believe physicians should have some higher standards. For example, disclosing HIPAA information is something nobody else has to deal with. However, much of the issue is that the medical field is highly conservative and misogynistic.”

In response to such widely disseminated disgust with this publication, one of the lead authors, Dr. Jeffrey Siracuse, issued a public apology on Twitter:

And soon after, the editors of the journal issued a public statement with plans to retract the article from the journal. In their statement, they reveal that there were errors in the review process, including the issue of conscious and unconscious bias on the part of the investigators, as well as failure to obtain permission from national program directors to use the database in searching private and public social media accounts of recent graduates of training programs. Their retraction statement concluded as follows:

“Finally, we offer an apology to every person who has communicated the sadness, anger, and disappointment caused by this article. We have received an outpouring of constructive commentary on this matter, and we intend to take each point seriously and take resolute steps to improve our review process and increase diversity of our editorial boards.” (Peter Gloviczki, MD and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery).

There was some favorable response to this statement and retraction, yet many continue to feel that an assessment of professionalism was carried out in an extremely unprofessional manner, underscoring the irony of such an endeavor. Not to mention the lack of diversity in the editorial board, comprised of two male surgeons who happen to share the same first name.

While the issue of professionalism on the part of physicians should remain paramount, and does, indeed, require further exploration, monitoring, and careful attention, especially when it comes to patient privacy, social issues outside of the medical sphere should, perhaps, remain just social. But if you do see your surgeon out at the grocery store, or even at the beach, all that should matter right now is that they (and you) are wearing a mask.

The journal’s editor, Dr. Peter Gloviczki, commented that the paper had gone through the journal’s standard editorial review process, with three reviewers accepting the manuscript after major revisions. While the board is racially diverse, Dr. Gloviczki acknowledges that it lacks gender diversity. Soon after the concerns for the paper were made public, the editorial board “immediately reviewed the data collection, methodology, gender bias, results, and conclusions. It was obvious within our board that we found issues, including the fact that the list of doctors obtained from the Association of Program Directors in Vascular Surgery is designed for internal society use, not for clinical data collection.” In addition, Dr. Gloviczki noted the journal’s failure “to identify definitions of unprofessional behavior and we missed the issue of subjectivity and bias in the review process.” He emphatically apologized for the errors, stating “We learned from this. We will be changing our review process, initiating a series of changes, including expanding the editorial board to include more women.”

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It’s Dr. Naito, NOT Dr. Stacey

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Some of you are in the habit of referring to physicians by their first names, tacking on “doctor” before the name. In all honesty, those of you who do this are quite honestly showing disrespect in doing so, even if it isn’t your intention.

Please bear in mind that we physicians must endure four years of medical school, anywhere from 3 to 7 years of residency training, and for some physicians, additional years spent in fellowships. In addition, we must keep up with continuing medical education (my yearly requirement is at least 50 hours), maintain licensure, and recertify every few years for our board certification credentials.

So when doctors bristle at you calling them, “Doctor Bob”, “Doctor Stacey”, or “Doctor Karen”, don’t be surprised. It’s not cute, it’s far too casual, and again, it’s downright disrespectful.

I do NOT like being referred to as Dr. Stacey at all. I worked very hard to become a physician, and I deserve to be referred to properly. In addition, I refer to other physicians as Dr. (last name) at all times, unless a colleague gives me permission to refer to him or her on a first name basis.

If you have an issue pronouncing a doctor’s last name, ask the doctor for assistance in pronunciation. Sometimes, the physician may suggest that you use the first letter of the last name as an abbreviated version. For example, I could be referred to as “Doctor N”, which I am fine with. I will not respond well to “Doctor Stacey” or “Stacey” by a patient.

In case you were wondering, Naito is pronounced like “night”, with a long “o” at the end.

Are there any medical doctors out there who would like to chime in on this one?

Disrespect

Last month, while working an urgent care shift, I caught a bug from one of my patients which progressed very quickly from a viral upper respiratory illness to a bacterial infection. Because I was so congested, the infection also seeded in my upper airways, and I developed bronchitis. Whenever bronchitis sets in, I am in for a world of hurt, because the coughing jags are so violent that I almost pass out from them since I can’t get a breath in.

In an effort to keep social media world happy, I posted my health status just so people would know why I sort of backed off from social interaction during that time. I felt horrible, and my voice was reduced to a strange, congested baritone mumble.

What irritated me was that several people jumped onto social media with health advice. I understand that people were concerned and trying to be helpful. However, there were two facts which kept floating through my head, and which left me scratching my head over how people thought it was appropriate to post advice.

FACT #1: I never asked for any advice from anyone. I was merely posting facts about my condition.

FACT #2: I am a board-certified family practice physician who works regularly in the urgent care setting. Don’t you think I would KNOW how to take care of myself? Why would anyone offer unsolicited health advice to a physician?

I couldn’t help but be bothered by the influx of posts suggesting things like, “drink tea with honey”, or “take zinc”. As an urgent care doctor, I am just as likely to give general, common sense advice about upper respiratory infections as I am to give prescriptions for medications and order in-office nebulizer treatments. I know all about zinc, tea with honey, vitamin C, salt water gargles, etc.

Besides, I ended up needing a course of antibiotics, two prescription inhalers, two prescription cough medications, and three over-the-counter decongestants. No amount of tea with honey, zinc, or salt gargles would have fought off the infection and reactive bronchitis I had developed. One person on Facebook hounded me via Messenger, and when I said I couldn’t chat, sent me a bizarre set of instructions for a concoction which included red wine. I became irritated and berated him for giving me health advice, whereupon he took the opportunity to insult me for no good reason. His disrespect was so blatant that I blocked him. I don’t need that kind of hostility in my life.

Sorry, but I think it is presumptuous and insulting to attempt to give health advice to doctors. In the age of Google, so many people fall under the assumption that they are suddenly experts when it comes to just about everything. Don’t trust everything you read on Google!

When I really think about it, I doubt that people would give automotive advice to an auto mechanic, or financial advice to their CPA’s. So why insult someone with 7 years of medical training and 14 years of experience as a practicing physician?

I believe I have made my point.

Yes I Write Prescriptions. No I Won’t Write One For Your Brother.

As a fully licensed, board-certified physician, I have written my share of prescriptions over the years for medications, imaging studies, etc. I recognize that it is an incredible honor and privilege to be able to write scripts, and I never take advantage of it. However, there are people out there who think nothing of asking me to write prescriptions for them, simply because I am a fully credentialed physician conveniently standing there in front of them. What is especially irritating is when people dare to ask me to conduct curbside consultations or write prescriptions for their family members or loved ones who not only aren’t there with them to be examined, but who are complete strangers to me. Tell me, how in the world am I supposed to conduct a medical evaluation on a complete stranger, sight unseen? These same individuals also tend to get offended when I kindly tell them that their loved one needs to be seen in person by a qualified medical professional who can assess their condition and administer the appropriate treatment.

So if you are the kind of person who is in the habit of asking doctors to do similar favors for you or your family, please understand that your requests are unreasonable and inappropriate. If your husband, sister, son, cousin, or best friend needs medical attention, do the responsible thing and either tell that person to go see a doctor, or take that person to the doctor.

Of Orifices and Zero Freedom

As a physician, I have had the incredible honor and privilege of studying every part of the human body, to the most minute detail. I have hovered over cadavers which were fileted and displayed for they eyes of inquisitive medical students, and scrubbed in on colon resections, open heart surgery, neurosurgery, cataract removal, etc. During my first month of internship as a newly minted physician, I massaged a dying heart with my gloved hands (no, the patient didn’t survive). I have also delivered over 40 infants via vaginal and Cesarean methods, and have pronounced the demise of patients in the wards. In fact, there are many stories I have collected over the years, some incredibly sad, some disgusting, some frightening, and some infuriating, but all true, and all part of my experience as a doctor.

I knew full well that by signing up for an education in medicine, I would be subjected to disgusting, morbid, frightening things, and that I would face mortality on a regular basis. However, after several years of working in family practice, I began to notice that I wasn’t thrilled with the fact that I examined orifices of every kind on a very regular basis. Whether it was a nostril, a mouth, an ear canal, an anus, a urethral meatus (layman’s term pee-hole), or vagina I had to examine, I was never thrilled about it, and the orifices below the belt were certainly much more bothersome to address. My intense dislike of such examinations, combined with the tedium of primary care and the low insurance reimbursement for services and procedures provided, caused me to retreat from primary care and focus more on the areas I had more interest in, namely, physical medicine, cosmetic dermatology, and anti-aging medicine, all of which are much cleaner and which do not require me to conduct examinations on private parts.

Another feature of primary care which made me cringe was the intense demand on a practitioner’s time. The only time it ever seemed reasonable for me to literally lose sleep night after night as a physician was when I was in training. At this point, there is no way you could convince me that such a thing is healthy, and I refuse to sign up for that. I won’t give up weekends to take on three stacked 12-hour work shifts, and I will not give up the few holidays I celebrate (Thanksgiving, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day) in order to work. As it is, I give up other major holidays to work, but since the work I perform on those holidays is in bodybuilding and fitness, I don’t mind it at all.

I love being a physician, and I find it incredibly rewarding to make a positive impact on my patients. However, I will not sacrifice balance in my life, or the freedom to pursue my other interests, in order to prove to society what a good physician I am. I don’t believe for a second that running oneself into the ground working as a physician ever sends a positive message to others. I don’t ever want to be the kind of doctor who is saddled with so many chart notes to write that an entire weekend is devoted to completing them. Not for me.

Lasty, I think it’s so strange that society still assumes that doctors are supposed to give their time and knowledge at a moment’s notice, on demand, yet I don’t see those same demands placed on people in other industries. I can’t tell you how many times I have been in a brief conversation with a complete stranger, who dares to ask me a medical question as soon as my profession is revealed. I swear, one of these days I am going to get a t-shirt made that says, “THE DOCTOR IS OFF-DUTY RIGHT NOW…NO MEDICAL QUESTIONS PLEASE”!

Let The Doctor Rest

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One of the biggest grievances I have as a physician is the fact that people assume that I am on call all the time for every random medical question. People will ask me questions at the gym, the grocery store, and via email. Many people have even contacted me on Facebook with detailed medical questions which they expect me to answer, and some will even cop an attitude when I very nicely tell them that I cannot address their question via Facebook message. No other profession deals with the same amount of queries. Would you ask your tax person a detailed question via Facebook?

I have even gotten texts in the middle of the night (thank goodness I turn my ringer off while I sleep) with medical questions. Sometimes the questions don’t even pertain to the person asking, but to a friend or relative. That is when I get annoyed, because it isn’t my responsibility to dole out free medical advice to everyone.

I realize that by putting my foot down and setting boundaries, I will cause some individuals to seek diagnoses on their own, which is also quite frustrating. They will go online and attempt to find a diagnosis, despite the fact that they have no medical expertise whatsoever. These are the people who infuriate doctors, because they will march into doctors’ offices and behave as if they have all the answers. This type of attitude is not only frustrating to medical professionals, it can be downright dangerous when the wrong diagnosis is made.

Please understand that I will not diagnose your niece’s boyfriend’s strange skin condition, even if you send me five images of the condition, taken at different angles and at different stages of the flareup. Such requests take unfair advantage of all of my schooling and post-doctoral training, which I have every right to charge for. As a matter of fact, it would be irresponsible of me to respond to such requests.

If the medical malady is of an urgent or emergent nature, then I suggest that you avail yourself of the appropriate service. Urgent care centers and emergency rooms exist for a reason. I am not a stand-alone urgent care center, nor am I a doctor on call 24/7. Please respect my time off.

For those of you who are physicians or surgeons, I welcome responses to this post.

Curbside Consults

Even though my board specialty is family practice, this works!

Even though my board specialty is family practice, this works!

Ask any physician if he or she minds being asked a medical question by a stranger or acquaintance while at a party, and I will bet that the answer will bean emphatic YES across the board. Just because we docs take the Hippocratic Oath and are committed to the service of healing does not mean that we want to be on call wherever we go, doling out free medical consultations to anyone who asks. I am waiting for the day when an auto mechanic asks me to diagnose a medical condition so that I can respond with, “Hey, you’re a mechanic. Would you mind looking at my car and telling me what that ticking noise is?” Honestly, I am SICK OF IT. I have people private message me on Facebook because they know that I am a doctor, and they will go in to great detail in their descriptions of whatever ailment plagues them, then implore me to diagnose them for free.

There have been instances in which my friends have introduced me to people and have said, “Oh! Stacey is a doc…you know what? You should ask her about that thing on your shoulder!”, which is immediately followed by a quick history and an expectation for me to provide a quick consultation and diagnosis. I almost want to say, “Do you have any idea how much my education cost? Do you know how much it costs me for the privilege of being a doctor? Yet you want a free consultation? I’m trying to get to my gym bag here!” There are a few professions which get such queries for free advice, such as massage therapists, chiropractors and attorneys. Perhaps we would communicate our exasperation more clearly if we just said, “You want fries with that?” when someone asked us for free professional advice. I think that reply would stop anyone dead in their tracks.

I implore any of you who are considering asking a doctor for medical advice to resist the urge. We often cannot diagnose sight unseen, and we certainly don’t wish to take on the liability of providing medical advise, diagnoses or treatment suggestions in such an environment. Though you may balk at the process of scheduling an appointment to see a physician and driving to the office, please understand that we cannot provide a fast food type service in medicine. When we are off the clock, let us enjoy our lives outside of medicine.

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