Staying safe on social media

Natalia Solenkova, MD, PhD, MLS, FACP, a Miami-based critical care specialist who worked on the front lines during the COVID-19 pandemic, woke up one morning in January to find she had become the target of a vicious attack on Twitter. As she would later come to discover, someone had doctored one of her old posts to falsely portray her as blindly and aggressively promoting COVID-19 vaccines while vilifying anyone who opposed them.

Dr. Solenkova received thousands of angry comments and messages about a tweet that she had supposedly deleted—but had never actually written. New followers retweeted the false post, questioning her integrity and credentials while tagging local politicians, her employers, and the American Board of Internal Medicine.

“This fake tweet with my picture, Twitter handle, and name went viral during the night,” recalled Dr. Solenkova, who before the incident had attracted more than 30,000 Twitter followers by sharing her experiences as a physician during the pandemic and debunking myths about COVID-19 and the vaccines. “Thousands of people I didn't know were attacking me personally and flooding all my past tweets about the vaccine or pandemic-related disinformation with threats and negative comments.”

The experience hasn't dissuaded Dr. Solenkova from using Twitter, where she continues to post about and debunk health misinformation. However, like other physicians active on social media, she's become more conscious of the risks and takes steps to protect herself.

“Participating in social media can have many positive benefits professionally through making connections and networking,” said Shikha Jain, MD, FACP, associate professor of medicine at the University of Illinois Chicago. “But the risks of impersonation or misappropriation are real and can definitely have negative repercussions on your professional reputation if you aren't able to control it.”

Tackling hot topics

In a survey of physicians done before the COVID-19 pandemic, 24% said they had been personally attacked on social media while 16% of women respondents reported being sexually harassed, according to results published Jan. 4, 2021, by JAMA Internal Medicine. Physicians recounted incidences of verbal abuse, death threats, reports to their employers and certifying boards, and posts sharing personally identifiable information in public forums.

Attackers tend to target physicians with large numbers of followers who speak out on issues such as vaccines, guns, or smoking, as well as those who identify with one or more minoritized groups, such as women of color, said Dr. Jain, a coauthor of the study, as well as a more recent perspective piece on misinformation published May 5, 2022, by the New England Journal of Medicine.

The pandemic exacerbated the problem, she added. A 2021 survey by Nature found that up to two-thirds of physicians and scientists who aired their views on social media or via traditional media outlets reported being attacked. More than 20% of the respondents said they had received threats of physical or sexual violence, while 15% reported getting death threats.

“The larger your following, the greater the likelihood of encountering very stressful and distressing situations,” said Avital O’Glasser, MD, FACP, associate professor of medicine at Oregon Health & Science University in Portland, who has a growing following on Twitter. “I personally have been on the receiving end of verbal and sexual harassment, and antisemitism.”

The lack of rules and regulations around social media participation make it harder to filter out misinformation and fake accounts, said Dana Corriel, MD, founder and CEO of SoMeDocs, which offers social media-related resources, training, and networking opportunities for health care professionals. For example, the blue verification checkmark on Twitter—the platform of choice for many physicians—was once awarded to prominent accounts that passed a vetting process to establish their authenticity.

The verification symbol is now rolled into a new subscription-based service called Twitter Blue. Introduced in April under new owner Elon Musk, the plan allows any user to display the blue checkmark if they successfully pass a verification process and pay a monthly fee. Legacy checkmarks have been removed from accounts that don't pay, potentially making it harder for users to distinguish real from fake accounts.

Also, there is no easy way to file a complaint or request action if your Twitter account is attacked, said Dr. Solenkova, who heard nothing from Twitter after reporting her attack in January. Consequently, the fake tweet continued to circulate and ended up being a topic of discussion on an episode of the podcast “The Joe Rogan Experience,” prompting a new round of attacks on her credibility.

That second incident forced Dr. Solenkova to mount an intensive campaign to clear her name, including reaching out to physician colleagues, medical association leaders, and journalists. Eventually her efforts paid off: Mr. Rogan apologized to his followers and deleted the episode, the American Medical Association issued a supportive statement, and several journalists tweeted or wrote articles debunking the fake post.

“One of the minuses of social media is that the world tends to believe anything that gets posted,” said Dr. Corriel. “People will make judgments about you without knowing the real story, and the onus will be on you to set the record straight.”

Sometimes misinformation is spread by physicians themselves, undermining trust in the medical profession as a whole, noted Dr. Jain and colleagues in the NEJM perspective. That's prompted the Federation of State Medical Boards and various medical and nursing boards to threaten action against perpetrators, including license suspension.

Connect with others

Despite the risks of impersonation or harassment, physicians say participating in social media has considerable professional and personal benefits.

“I can absolutely say that getting involved in Twitter has been pivotal for me in moving from early to mid-career,” said Dr. O’Glasser. “It's helped me become a content expert by gaining access to a community of other experts.”

Physicians who consistently post reliable information, especially on timely or specific topics, gain credibility and visibility among their colleagues and the public, she said. For example, she became known for her posts on issues affecting women and perioperative medicine, which led to conference speaking engagements and scientific journal articles—all of which helped her move through the ranks of academic medicine.

“Having a social media presence is not the only reason I've advanced professionally, but it's a tool in my toolbox,” Dr. O’Glasser said. “I've also connected with colleagues on a more personal level by joining communities on Twitter,” such as #MedGrind (health care professionals who love coffee) and #MedLasso (for “Ted Lasso” enthusiasts).

Connecting with other medical professionals is also an important strategy for preventing or responding to attacks. For example, the Illinois Medical Professionals Action Collaborative Team (IMPACT), which Dr. Jain cofounded, is a nonprofit group of health care professionals that leverages social and traditional media to fight misinformation.

Members of the group come to the aid of anyone who is attacked, retweeting the victim's response and adding their own perspectives, she said. The idea is to amplify the response of the person being victimized so that their words have as much or more visibility as those of the attacker.

“Early in the pandemic, one of my tweets was attacked by a conservative radio show in Illinois,” said Dr. Jain. “I posted about it in IMPACT and within minutes I had dozens of physicians and others coming to my defense.”

Physicians may also choose to join subscription-based platforms, such as Dr. Corriel's SoMeDocs, which offers a private forum for discussing ideas and issues with other physicians who use social media. Members can network and bounce ideas off each other via private chats or in periodic live sessions.

It pays to observe and connect with others before you start posting anything on your own, said Dr. O’Glasser.

“If you're going to engage in social media, do your homework to make sure you have a solid grasp of your topic, because people will come back at you,” she said. “Find mentors or role models and just observe for a while to see what does or doesn't resonate with you.”

Mentors can be helpful sounding boards after you start posting, she added, offering insight on why a post didn't have the impact you expected, for example, or what to do when a post goes viral.

She also recommends thinking in advance about how much personal information you're comfortable sharing in a public forum. Highlighting personal interests or photos can help attract followers but comes with risks if your posts touch on controversial issues.

Physicians should learn how to navigate and manage the risks of social media as early as possible in their careers, said Dr. Jain. She also advocates for medical schools to include courses on effectively communicating scientific information and identifying and debunking misinformation.

“I strongly encourage anyone who is involved in health care to use their voice to amplify and share evidence-based messaging on social media,” she said. “Just remember that what you post online stays there forever, so it's extremely important to be comfortable with what you post and back up everything with data and facts.”