Editorial board member Alex McDonald, MD, talks with Jessica Gray, MD, of The Med Edit Podcast, about why it is important for physicians to engage the public through social media.
Contributors
Program Director
Fontana Family Medicine Residency
Family Medicine Physician
Co-Host, The Med Edit Podcast
This transcript has been edited for clarity.
Welcome back to PeerPOV: The Pulse on Medicine, a podcast series by Physician’s Weekly showcasing the latest insights from your peers across the medical community.
This week, Physician’s Weekly editorial board member Dr. Alex McDonald returns to talk with Dr. Jessica Gray about why it is important for physicians to maintain a social media presence.
Dr. McDonald: Welcome everyone to today’s Physician’s Weekly podcast. Thanks for listening wherever you may be, between patients, in the car or wherever it is you listen. We appreciate you jumping on.
Today I’m excited for a conversation with Dr. Jessica Gray. We’re going to be talking about social media, one of my personal favorite topics. Dr. Gray, thank you so much for joining us today.
Dr. Gray: Thank you for having me. This is going to be fun.
Dr. McDonald: It’s going to be great. We’re going to be talking about the good, the bad, and the ugly of physicians and social media, including perceptions, practice, and marketing, and all the things therein. My opening question here is always, tell us who you are and what you do.
Dr. Gray: Yeah, of course. I’m a family medicine physician in West Texas. I’m specifically in Lubbock, Texas. Not many people know where that is, but we’re up in the panhandle area of Texas. I take care of a large outpatient panel and I’m an assistant clinical professor for the Texas Tech University Health Sciences Center.
I also do some fun stuff on the side. I sit on several different boards. I’m the team physician for a Division I, Big 12 athletics basketball team, which is lots of fun. Then, of course, I’m deeply involved in physician leadership, education, and community health. That’s what brought me to the social media world.
Outside the clinic, I also host a podcast myself called The Med Edit Podcast, and we create digital content focused on evidence-based medicine. I really love preventive care and making healthcare more understandable and more human to people who don’t have a healthcare background.
Dr. McDonald: Awesome. Fun fact, I did a triathlon in Lubbock, Texas, maybe 16 years ago at this point. So, I know exactly where Lubbock is.
Dr. Gray: It’s changed a lot in that time. Maybe you can come back and visit now that we’re bigger.
Dr. McDonald: I will do that. Tell us how you first got involved with social media and realized the power, the good and the bad, that social media could be, that it’s not just a distraction, if you will. How did you first get involved and what was that first “aha” moment for you?
Dr. Gray: I’ve been attending going on my ninth year. I remember coming out of residency and thinking it was a huge risk and very unnatural, and nobody else was doing it. I created a social media page, starting with a Facebook page that was a professional landing page and then creating an Instagram. My goal at that time was to grow my practice and give an inside look at some education, but also who I was. Growing the practice happened very quickly, so my social media use shifted toward helping with some frustrations that I was having in clinic.
I’d spend 20 minutes explaining something that took 30 seconds to misinform online. Over the last nine years, social media has drastically exploded when it comes to healthcare, especially around COVID-19. It was around the COVID-19 pandemic, when I was working in a hospital parking lot, swabbing people, with all the misinformation online, that I started to pivot a little more toward showing both the humanity of medicine and what we are doing, as well as trying to fight back on that information that people are asking for but are not necessarily getting in the most reputable ways.
It was a scary time. It really just came back to wanting to educate, advocate, and connect to patients and other physicians who may be going through the same experiences I was.
Dr. McDonald: Yeah. Did anyone mention social media, public perception, or marketing at all during medical school or residency for you? Because I didn’t get anything, personally.
Dr. Gray: Oh, no, not at all. That wasn’t even a though—in fact, so much so, that I was scared to do it at first because I thought that the company I work for (a large hospital system) was going to immediately be like, “This is a bad idea.”
But funnily enough, several of them started following me, and then, at one point during the pandemic, they said, “Hey, we saw a post you did. Is there a way that you could write that out so we could print it in our distribution mailing stuff?” Because they thought it was a very good connection. I wrote about an experience I had during the COVID-19 pandemic, working with patients and healthcare workers who were really scared about what was going on.
It was shocking that it was better accepted then. But what’s even more interesting now is, nine years later, you’ve got med students, college students, and residents with gigantic social media followings. I’m sure we’ll touch on some of that later—that becomes a very different animal that we probably do need more education on.
Dr. McDonald: Yep, absolutely. We won’t put the cart before the horse, but the reason I think there’s been a void within social media for so long is because initially, people, physicians, and healthcare organizations were afraid to comment or put their voices into the social media space. There was a need, an interest, a desire for this healthcare information, and it got filled with junk.
That’s why I think having physicians, having trusted voices, present in the social media ecosphere is not only important, it’s critical, especially in this day and age. I think part of the reason we’re in the position we are now with so much mis- and disinformation is because for a long time, physicians and trusted messengers were not there. But, again, that’s my own bias.
Dr. Gray: No, I completely agree. In fact, I think that it’s done a disservice, and it’s a little bit our fault as physicians for not taking more risks, getting in front of this, and teaching this in medical school and residency—thinking ahead about how to go with the times, or you’re going to get left behind. I think we got left behind, so now we’re trying to play catch up, but I think that’s a pretty hard thing to do in this day and age.
Dr. McDonald: The horses are out of the barn. The horses out of the barn and across the field and down the mountain at this point.
Dr. McDonald: So, you already touched on some of these things—the good aspects and the benefits of social media—can you delve in a little bit more deeply? What are the biggest benefits you see in terms of education and myth busting? What are some other pieces that you found most useful for you, both personally and professionally?
Dr. Gray: I think you can put that into two buckets for me: personally and professionally. Professionally, it’s actually nice for me. I do learn from some really amazing, reputable physicians that are putting really great CME on Instagram and/or TikTok, whatever you choose, in nice bite-sized amounts. And they are evidence-based. They’re factual. I follow so many cool dermatologists who are doing things that I don’t experience and see much in clinic, but it has such a large benefit.
Especially being in primary care, unless you’re going to go read specifically what their societies just put out, you are getting some benefit from that specialist information if it’s a true, trustworthy source material. I think is a really cool benefit.
The second is personal networking connections. It’s neat that you can meet other people, learn things. I’ve done a lot of speaking events based on social media use. They’ve invited me to come speak. I’ve interviewed them. It’s been a really neat interaction to expand that networking opportunity.
And then of course, at the same time, it’s just something that we can use to scale our own education beyond what our typical textbooks or our typical board review courses are. Again, there’s always a big caveat to making sure you’re getting the right information and making sure that it is reputable. But at the same time, it’s definitely out there. It’s coming out more and more.
For the patients, that’s a whole other angle too. We are actually scaling our education beyond what we can just do in the class—I was going to say classroom. It’s a classroom too, but an exam room. I guess I’m a teacher. If I wasn’t a doctor, I would want to be a teacher. So, I think that’s what’s happening: I’m getting to teach in a different way. I have my med students that I teach, but I also get to teach my patients. I get to teach them while we’re in the exam room, and then while we’re out of the exam room.
I think the thing that is really important—and there are some people who are very skilled at their delivery method—is countering some of that misinformation. I follow some of the public health experts that are on social media and I love it. They’re credible voices that are able to counter some of that misinformation, and I love reposting some of that stuff. It doesn’t have to be my content either—I can just share it in stories or comment on it, and it’s nice that we can amplify some public health voices that aren’t normally getting amplified.
Then, of course, the humanizing of physicians has been nice. I think that we went from “healthcare heroes” to “money-grubbing big pharma shills.” It’s just a very interesting dynamic to go through in the last 10 years, where you went from one thing to something completely different. We’re rehumanizing medicine, too, and showing emotion and how we care for our patients. We attend their funerals, we live their lives, especially as a family medicine physician.
I even have med students that have come up to me and said, “Hey, I’ve started following you. I’m interested in family medicine.” I just love the idea that family medicine is getting more of a spotlight because we do so many diverse things.
Dr. McDonald: Absolutely. So much of what you just said, I’ve experienced personally and heard from multiple different people. I love that idea, of a teacher, because do you know the Latin root of physician actually is teacher? Somebody fact-checked me on that because we teach patients one at a time, but if we can teach patients en masse—there’s not enough primary care physicians as it is, and if we can amplify our voices to teach thousands or millions of patients at once, how beneficial is that as a society overall? I love that piece.
The other piece I love is humanizing us as physicians. We’re all people, and I think I’ve seen some folks really be very vulnerable on social media when it comes to burnout and the mental health aspects of what it’s really like to be a physician and have bad patient encounters. Humanizing the work we do and who we are brings a lot of credibility, but it also helps people better understand what it really is to be a physician.
Most of our listeners are physicians. I use the analogy: imagine you have 20-minute meetings all day long, back to back to back, and every single 20-minute meeting needs to have action steps, a deliverable, and follow-up direct outcomes. Can you imagine if the business world worked in 20-minute meetings like that? It’s just unfathomable for some folks, I think.
But anyway, we’re clearly on the same page, which is helpful. Let’s shift now. Not everything’s all sunshine and butterflies and rainbows—so what are some of the pitfalls of social media? What are some of the challenges that may exist?
Dr. Gray: I think we’re seeing some of that play out recently, with some of the bigger names on social media. There’s been some drama about transparency, about funding. That’s a bit of pitfall. Also, trying to do too much too fast and losing your voice; the most successful people on social media are pretty authentic.
You really need to make sure what your goals are before you go into this. For me, I had zero desire to be any kind of influencer, grow any kind of following. I’m not even that big compared to some of my colleagues, but at the same time, you sit there and you’re like, “Wow, 21,000 thousand people!” That’s a lot of people that are looking at something you’re saying, so you want to make sure that you’re very careful about what you say without losing your authenticity.
And a lot of people like to mimic what’s trending instead of what’s authentically you. I don’t think that’s always the best approach.
Dr. McDonald: Yeah. You mentioned you work for a big organization. Have you ever been approached by people who are a little bit skeptical or afraid of what you’re doing, or have you been told to remove a post about anyone or anything?
Dr. Gray: Once. In the time I’ve been doing this, only once. I’m actually really thankful that my organization has been very supportive. I’ve never had an issue. I love that the legal department follows me, so shout out to them.
Dr. McDonald: That’s always helpful.
Dr. Gray: Yeah, I did have one time, and this I think is a good learning lesson for anybody who is a physician that’s posting and sharing stories. I do think that people really resonate if you can share a story from a patient encounter. I’ve always tried to be very, very careful: de-identified everything I possibly can, even genders. Some of my stories, if I do share anything, are over a decade old.
You try as hard as you can. I run a lot of it by friends who are physicians as well and ask them if they feel like it’s de-identified enough. Some of these friends are ultra-conservative about it and others are not as much, so it’s kind of nice to get all that background.
But yes, I had one post ever. It was this past year. I had a patient with colon cancer, and I de-identified everything on a CT scan report. There was no date, no name, no facility location. I de-identified everything I possibly could, but with just the description of the tumor, legal did give me a call. They felt like with the specific description of the tumor itself, somebody could trace back because of the image.
If I hadn’t said the words out loud, it may have been fine, but because it was the picture of the image…. So, lesson learned completely. I did not argue. I did not have any problem, and I was very thankful for their advice because I understand that and then can take that going forward. I think the post was up for two minutes. So again, thankful the legal department’s right on that and being my advocate. They were so kind about it.
But what’s so funny is that I took that down and, still feeling the passion to talk about the reason I did this, I immediately went and created a different post that became way more impactful and was way more viral. It was kind of neat that it was still touching on the same colon cancer discussion, but it was even greater audience. So, I’m lucky, but yes, that does happen. I’m actually thankful for having that backup, completely.
Dr. McDonald: Yep, definitely. Medicine is a team sport, and I think that expands beyond the four walls of our clinic or our hospitals also.
Dr. Gray: And wouldn’t that be great if this was something to teach in med school? I would love to go in now and be like, “Okay, if you’re going to post, you think you’ve de- identified enough, but maybe this is how we can do it further.” Even legal said, “It doesn’t cross the line, but I feel like we’re getting close to gray, and we don’t like gray in legal.” And I was like, “I don’t like that either, so let’s make sure we’re all clear.” This is something we could teach, and then you could feel more confident.
Dr. McDonald: I think your example is a really good one, where there are multiple stakeholders, and building relationships and having shared lines of communication and line of sight is really helpful. When I first became a member of my organization, I met with our public affairs team and I said, “Hey, I love using social media. I love educating patients. Here’s what I’m about, and here’s what I want to do. ”
Letting them know ahead of time, and having them understand where I was coming from, really helped to mitigate and prevent a lot of complications or misunderstandings later down the road. They have my cell phone number. They literally text me all the time. If there’s something where they have questions, they will even reach out to me to then create some content for them specifically. I think there’s really a shared collaboration.
A lot of physicians I talk to say, “Well, I work for an organization and what if they fire me?” But I think being proactive, and making them understand you’re coming from a place of wanting to help improve your community health and educate people, you’re going to have a lot more buy-in versus if you’re trying to build relationships after there’s a mistake or a misstep. Nobody’s perfect; it’s going to happen at some point.
Dr. Gray: I think that’s the best advice that you just said. If you’re in an institution (not a private practice by yourself), you need to go reach out to whoever you can and let them know you’re doing it. Maybe don’t fully ask permission, but loop them in and make them feel a team player.
Just as practical advice, I’m not going to go get on here and start talking horribly about the company I work for. You wouldn’t want to have that with your employee either, right? You don’t want your nurse going around like, “I can’t stand Dr. Gray. She’s crazy on the internet.”
At the same time, I think talking about physician burnout or frustration or being exhausted after clinic—so far, they don’t seem to have any issue with that because I think it’s relatable to you and your emotion and being authentic, without taking down the specific system you work for. We all know medicine has problems and we’re trying to fix it by having these conversations.
Dr. McDonald: Yep, that’s a great point. Have you ever had any posts which were misunderstood, weaponized, or criticized? And if so, how did you respond?
Dr. Gray: Oh my gosh, yes. In West Texas, we were having our measles outbreak several months back, and it was wild here. I mean, I’ve diagnosed measles myself for a patient and I was like, “This is so crazy. We never thought we’d have to do this.”
An infant passed away here from measles. It was just a very emotional time. I had a young baby that was the same age that was too young to be vaccinated and was counting on herd immunity. So, there was a lot of emotion. I feel like I’m pretty logical and try not to be too emotional in social media posts, but I was sharing a little bit about the frustrations that we, as physicians, have when we’re seeing something that we feel is a public health problem that’s being misrepresented and creating a lot of fear.
I posted something very short and then, oh boy, that algorithm figured it out and made it run down every anti-vax chain that could possibly exist. I got hundreds of comments, very negative, going after me and saying that big pharma paid for my medical school, that I am a big pharma shill, that I am too young and have been five minutes out of medical school. (It’s been a decade since residency, so that’s a little different.)
But then there was some influencer who has 300,000 followers, and she took my video and made fun of it publicly to her followers, and then it grew that way. It was one of those moments where you’re like, “Why am I doing this? Why am I subjecting myself, on my own free will, to be absolutely torn down by people who they don’t have the education and are not treating the patients. This is all misinformation.” It’s very frustrating, and it makes you want to cry. It happens.
The nice thing is, eventually the algorithm shifts and it goes back to physicians and other people that can back you up. But you have to have thicker skin than I usually am prepared for on social media because this is going to happen inevitably. Especially if you’re growing a following, it will happen.
Dr. McDonald: Thick skin is definitely helpful, but also, it depends on how you reframe it. If you’re going viral and people are responding, whether it’s positive or negative, you’ve clearly hit on something. So, if you’re getting trolled, I’d take it as a badge of honor, meaning you’re doing something right.
You’re doing something that is helping break down misinformation or hitting some kind of a nerve. You’re having those conversations or raising that issue amongst the public. Again, I know it can be emotionally challenging at the time, and I’ve been there myself, but if you reframe it as, “Alright, it’s going viral, people are trolling me, that means I’m doing something right, honestly.”
Dr. Gray: Someone told me that and I agreed and I was like, “That made it so much better.” And then it hit 2 million views, and it had thousands and thousands of comments. In the end, if you really look, most of them are positive by the end of it. You’re like, “Okay, okay, every mean thing that people said actually made this thing go faster.”
Dr. McDonald: I think this is also part of us supporting each other. Those of us who are in the social media space can like, share, amplify, and support the positives. For every troll, if there’s two or three people in support, it can make a difference overall.
We tend to focus on the negative, right? It’s always like, “Oh, I have a million comments and they’re all bad!” But if you look at them, only 20% of them are bad. Most of them are good, but it is what it is. It can be definitely very emotionally challenging when you wake up in the morning, and you see a post has blown up. There are a lot of emotions that run through you.
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