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Surgery, a manuscript entitled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons,” was retracted by the journal’s editorial board yesterday.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.

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.”