Physicians and Social Media

Humans

How many likes does it take to get to the center of a self-esteem?” — Comedian Aparna Nancherla, Twitter, February 2, 2019

I was one of the first millennials to join Facebook, in the summer of 2004. At that time, the social network had just left the Harvard campus and had been released only to students in “elite” colleges. In the ensuing 15 years, I have been witness to the tremendous, unprecedented growth of social media nearly from its inception. Social media is like the mythical hydra; as you lose one “head” (e.g., Myspace), many others grow in its place (e.g., Instagram, Snapchat). Social media has completely upended how we lead our daily lives, at work, at home—even in love.

In my own profession of medicine, we are starting to recognize that the boundaries between physicians and patients can be blurred in this new world. Online professionalism is increasingly being taught in medical schools. This was a subject I myself was tasked to teach my peers, as I ran afoul of it as a medical intern when I posted something in frustration that could be construed as negative about my hospital, after the inevitable difficult week at work as a resident.

A physician’s career can be made, or broken, online, as was the case with Gary Tigges. Tigges, a Texas internal-medicine physician, wrote a brief, newspaper editorial declaring “female physicians do not work as hard.” In the world as it used to be, the piece would have been read by very few people; In the age of social media, though, this went viral and had serious effects on his career and reputation.

There have been numerous scientific studies in recent years on social media, and they have shown some surprising effects on the human brain. In one, the number of “friends” subjects had on Facebook significantly predicted gray matter volume in the left middle temporal gyrus, the right superior temporal sulcus (which is involved in speech and facial processing, and interestingly, the ability to attribute false beliefs to others), and the right entorhinal cortex (involved in memory formation). Unsurprisingly, photos and posts with many “likes” also activate the nucleus accumbens (NAcc), the reward center in the brain that is also activated by drugs and alcohol (confirming social media is truly an addiction).

The most dangerous aspect of social media is its “contagion effect.” This is when, like a deadly new influenza virus, someone who wants to spread false information, for example, takes advantage of peoples’ connections to propagate the lie. In a study on this contagion effect, individuals relied on the number of online “friends” or the photo of the perpetrator as a heuristic about that person’s trustworthiness.

This effect has been utilized to full effect by a new generation of con artists. William “Billy” McFarland, the mastermind behind the disastrous “Fyre Festival,” made one ingenious move that led him to successfully steal money from tens of thousands of millennials before he ended up in federal prison: he came up with the idea of Instagram “influencers” posting a simple orange square.

When you are rapidly scrolling through a feed filled with beautiful people, sumptuous cuisine and exotic travels, what could stop you dead in your tracks and make you pay attention? An orange square. Especially when that orange square is presented by an attractive Instagram celebrity with millions of followers. The contagion had taken hold.

The herd mentality is not limited to millennials who have grown up glued to our smartphones. Another young entrepreneur took advantage of this herd mentality at the highest levels of Silicon Valley. Elizabeth Holmes, now 35, leveraged her powerful personal connections to get funding from one of the biggest names in Silicon Valley, Tim Draper, the father of her neighbor and childhood friend (and a name my brother, whose career has been in the tech industry, instantly recognized).

Draper, at 60 years old, is not part of the social media generation. But he used his more old-fashioned social networks to bring in other titans of the industry (Don Lucas, Larry Ellison). Holmes then used her bubbly millennial charisma and her number of “friends” to promote trust, and released a dangerously flawed health care device before her fraud was discovered in late 2015.

Our society will never return to the way it was before the advent of social media. How do you protect yourself from its most virulent aspects? As a scientist, I’ve learned to question everything I see. Guarding yourself from the herd mentality by doing your own research and investigation is critical. Always find the source for the unbelievable headline you may read. If there is no source, eliminate that information from your consideration. It is also important to recognize that the social media profiles of most people are a façade.

Comparing yourself to someone else’s “photoshopped” life is terrible for your mental health. Recognize that your real friends who may not have thousands of “friends” and “likes” on social media (or, wisely, may not be on social media at all) are no less trustworthy. Go to the coffee shop around the corner and strike up a conversation. You may find someone interested in you: the real person, with all your real flaws, standing in front of them.

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