By Josh Katzowitz, WCI Content Director
Most physicians don’t get all the financial training they need while in medical school or residency. And apparently, many of the current-day med students/residents aren’t learning enough about the dangers of social media either, particularly if you’re prone to writing careless things for a wider-than-you-can-imagine audience who might be looking for any reason to pounce on you.
Late last month, a fourth-year medical student in North Carolina responded on Twitter to a doctor who said she wore a pin on her work badge that mentioned her pronouns and how she had been berated by some patients for it. The medical student quote-tweeted that statement and reportedly wrote the following:
“I had a patient I was doing a blood draw on see my pronoun pin and loudly laugh to the staff ‘She/Her? Well of course it is! What other pronouns even are there? It?’
I missed his vein so he had to get stuck twice.”
The implication, of course, was that she stuck him more than once as a punishment for not subscribing to her political views (or for laughing at them).
No matter what side of the political aisle you reside on, this is obviously a horrendous action. Even if she was exaggerating her story for her Twitter audience to make a point, it’s an absolutely terrible idea for a social media post—and it’s having real-world consequences.
After the medical student wrote her tweet and after a number of media outlets picked up on it, the Wake Forest University School of Medicine announced it would be addressing the issue with the student (who had deleted the tweet), writing, “This student’s tweet does not reflect how Wake Forest University School of Medicine treats patients and provides patient care.”
Since then, multiple reports quoting a Wake Forest spokesperson said the student was no longer working with patients and had been placed on a leave of absence. The spokesperson also explained that while the student did stick the patient a second time, it was because she was inexperienced with the procedure and not because of their political disagreement.
Either way, the media will move on, and the incident will largely be forgotten.
But because of her callous words, the incident will probably follow her, possibly for years. If you google the student’s name now, nine of the first 10 results (and 17 of the first 20) are all about her tweet.
All of which means: DON’T TWEET STUPID STUFF!
“I'm shocked by this conduct if it really did happen, if she really did intentionally harm this patient,” Cheryl Erwin, a medical education professor and the director of the center for ethics and humanities at Texas Tech University, said, via Yahoo. “It may be minor, but it is a violation of your first responsibility as a health professional: do no harm. . .
Medical professionals need to remember they don’t walk away from their role. They have an obligation not to post things on social media that are harmful.”
And it could really cost you—your money and your career.
Think about it: Say you’ve gone through four years of college and four years of medical school. You know you’re going to owe $350,000 of student loans when you’re done that could take years to pay back. You’re banking on your $250,000 attending salary and 2-5 years of living like a resident just to get you back to broke.
But what happens if you don’t match because you tweeted something foolish? What if you were hired for a residency spot and then you bragged on social media about allegedly assaulting a patient? What if you wrote 46 simple words on Twitter and then torpedoed your career (and millions of dollars of income) because of it?
In 2018, a resident who had previously posted anti-Semitic sentiments and threatened to give Jews the wrong kinds of medicine was fired and then barred from practicing medicine. In the age of COVID, a number of docs who used their social media accounts to spew misinformation also were punished with either suspensions or terminations (and they could end up losing their licenses).
Though the generation of 20-somethings who are graduating medical school and matching into residencies grew up on the internet and have probably spent years on social media, some of them clearly don’t realize that what you write online has the ability to ping-pong across the world and potentially destroy your career in a matter of minutes.
All of which means: THINK BEFORE YOU TWEET!
I didn’t register for a Twitter account or get on Facebook until I was in my 20s, so there was certainly a learning curve for me on social media. But perhaps some old-school advice is still applicable in this new-school age. I was taught as a kid that if you were mad about something or if you had been treated unfairly, you should sit down with a pen and paper and write a letter. Pour out all your emotions on that blank sheet. Make your case. Explain why you had been wronged.
Then . . . you wait a day. You sleep on it. You get your mind off the topic for a few hours.
Then, the next morning, you take a look at the letter you wrote. Still feel angry and upset and disrespected? Then, send the letter to the person who needs to see it. But chances are high that you’ll have calmed down and that you won’t feel the need to send the letter any more. You will have made your point to the universe, even if nobody else will get to see it.
Maybe people should wait a few hours before they tweet something or post something incendiary on Facebook. Take a deep breath, let the emotion settle for a beat. Then, maybe you won't tweet about harming a patient.
Or maybe medical schools should be more diligent in teaching their students about social media.
Last week, I reached out to a few medical students to ask about their schools’ social media guidelines. One told me that her school had offered absolutely zero social media training. One told me that she had received some training. And one told me that his school was serious about making sure its students were aware, making them sign a social media policy and repeatedly sending students the document to review and remind them of the guidelines.
Even the smartest people can do the most foolish things. Don’t spew out social media posts without giving them any thought. Don’t brag about allegedly harming patients because they disagree with you. Don’t tweet stupid things. Don’t let it cost your career.
What I’m Reading This Week
Some Match Day Stats
Now that Match Day is complete and those who have been hired for residencies have begun planning for their new roles (and figuring out if and when they should pay off their student loans), the National Matching Registry Program released some interesting data points on the 2022 Match.
The Match was the largest ever with 39,205 total spots and with 36,277 first-year positions open (a 3.1% increase from 2021). Overall, 47,675 applicants registered for the Match (a decrease of 2.1% from 2021) and 42,549 of those submitted a rank order list. As for those who matched into a residency, the rate of 80.1% was a 1.6 percentage increase from the year before.
Emergency Medicine had the biggest growth in actual PGY-1 positions followed by Family Medicine, Psychiatry, and Internal Medicine. Interestingly, all those specialties also saw a decrease in the percentage of spots filled, though.
For a good breakdown of the rest of the stats, check out Life of a Med Student.
Happy Anniversary to an Important Column
One of my favorite speakers at WCICON22 was Michelle Singletary and her keynote presentation on “Where Much Is Given, Much Is Required” (you can see all of it on the Continuing Financial Education 2022 course). I chatted with her afterward to get her take on growing up without a financial role model and for another column coming in the future, and she was a sheer delight.
Now, she’s celebrating the 25th anniversary of her Washington Post column “The Color of Money,” and she wrote about the influence of her grandmother and how she was so frugal that “if she held a penny, Lincoln would scream.” But she didn’t take all of her grandmother’s advice either, and that’s led her to where she is today.
Check out her anniversary column. It’s a good one.
Another Crypto Hack
As WCI has begun writing more often about digital currency, we’ve noted that many kinds of crypto have been involved in some kind of hack or scam.
Now, you can add the NFT-based game Axie Infinity to the list. According to the Daily Dot, about $625 million worth of cryptocurrency was stolen from Ronin Network, an Ethereum-linked sidechain for the popular game.
In a statement, Ronin explained that its chain consists of nine validator nodes, which authors new nodes on the block and is a quicker way of making transactions. The attacker managed to take control of the majority of those validator nodes, and as the Daily Dot explained, “After exploiting five out of the eight nodes, the attacker could approve any transactions and withdraw whatever money they wanted.”
“As we’ve witnessed, Ronin is not immune to exploitation and this attack has reinforced the importance of prioritizing security, remaining vigilant, and mitigating all threats,” the company said in the statement. “We know trust needs to be earned and are using every resource at our disposal to deploy the most sophisticated security measures and processes to prevent future attacks.”
Money Song of the Week
A buddy of mine recently took home a six-figure sum by winning a poker tournament with more than 2,200 players. I once triumphed in a local No Limit Hold ‘Em tournament of about 70 players and, believe me, I felt like the 1987 version of Hulk Hogan in the days and months afterward. I can’t imagine beating out more than 2,000 other people and taking home 265 times what you paid to buy in to the tournament.
So, in celebration, let’s listen to “The Gambler” by Kenny Rogers, revel in the story told during this 1978 song, and breathe in those iconic lyrics of “You got to know when to hold 'em, know when to fold 'em/Know when to walk away and know when to run.”
Of course, you should know that this song isn’t only about poker. It’s about investing and your money and your life. Rogers sings, “If you're gonna play the game, boy/You gotta learn to play it right,” and William Bernstein says, “If you’ve won the game, stop playing.” As it relates to white coat investors, it’s wise to listen to both men.
Tweet of the Week
A fascinating story from the mouth of the late Grammy-award winning folk singer.
Harry Chapin tells a short story about his grandfather. This is pure. pic.twitter.com/y0QXYavTtH
— Phil Bak 🎩 (@philbak1) March 29, 2022
Did you receive social media training from your job or your school? Have you ever tweeted something that got you into trouble? Could you have beaten Kenny Rogers in a heads-up Hold ‘Em match? Comment below!
[Editor's Note: Josh Katzowitz is the Content Director for The White Coat Investor, and his work has appeared in the New York Times, Wall Street Journal, Washington Post, Los Angeles Times, and CBSSports.com. A longtime sports writer, he covers boxing for Forbes, and his work has been cited twice in the Best American Sports Writing book series. For comments, complaints, suggestions, or plaudits, email him at [email protected]]
I used to post political ideas on Facebook.
I stopped for two reasons:
1) Employers look at it and if you are openly progressive (or conservative) you might not get that job.
2) In today’s hyper partisan world where there is no truth and most people parrot talking points of the major parties, you cannot convince anyone of anything, ever.
Now I have family pictures, dog pictures and food pictures. I cull these about once a month to remove any that can infer wealth. If you are known to be wealthy, contractors charge you more.
I try to never mention I am a doctor. I’ll be retiring soon and can’t wait to be “just another person”.
I’ve also lost a dozen friends over politics, not that I mind. Like many Americans, I tend to mostly spend time with people who hold similar views.
Oh, there still is truth, even if an alarming number of people are willing to disregard it when they forward political memes that align with their partisan views.
That’s a sad story. I hope I never lose any friends over politics or religion. I certainly have many friends with differing views from me on both.
hmm it is very difficult not to lose “friends” when some clearly hold nazi idealogy or support those who do…I guss those were never your true friends…
Nazi ideology? I mean, I’m sure there’s a few neo-nazis around but you are implying that republicans are nazis. You need to stop watching CNN and MSNBC. Just because someone voted differently than you did doesn’t make them a nazi. You are part of the problem of close-mindedness in this country. Political debate should be encouraged.
Saw an interesting study that showed that Fox viewers who watched CNN and CNN viewers that watched Fox during the study moderated their views. I’m not surprised. It isn’t just the slant that is different between the two; they actually cover different news stories. If it’s not favorable to their side, they don’t cover it at all. So you’re missing half the news if you’re only watching one.
You do realize that NAZI is the term which referred to members of the National Socialist German Worker’s Party? The acronym is used rather loosely but implies some connection to, well, Nazis, of old. Are your “friends” Socialists? Do your “fiends” preach racial purity?
My best man and college roommate and I no longer speak due to the 2016 election.
I no longer think of my own mother in the same way after the last two election cycles. Her views are frankly embarrassing and we don’t talk about politics anymore.
One medical school friend and I have cut ties over politics. I made fun of his partisan social media network.
Another dozen or so Facebook “life contacts” from high school and elsewhere no longer speak to me and vice versa over politics. I used to engage them and others in discussions, but no longer do.
Anyone can have different views from me. No problem. I tend to draw the line at overt racism and lies that harm others. If someone blathers an easily disprovable lie, I have engaged them. Bad idea.
One boss I had who was also a mentor and a friend was an overt racist. I quit the job and reported him to human resources. He would not hire people of color. I had no idea until I worked for him.
The old advice to avoid talking about money, sex, politics or religion works fairly well. My dad used to say. “to each their own.” That works for me, but I simply won’t listen to lies and BS anymore. So, it’s not that I think I am right and they are wrong. Lies are lies, and some lies have consequences.
I have a lot of friends with different views also. I love a wondrous variety of perspectives. Just don’t like lies.
I got no social media training whatsoever, and that’s because I’m old. I graduated medical school in 2002. We had the internet and e-mail, chat via ICQ and AOL Instant Messenger, but none of the platforms we use today.
I was in residency when Friendster and MySpace were all the rage, and Facebook popped up just after them. It’s interesting to look back 20 years and wonder what will change in the next couple of decades. Web3? Please don’t make me strap on a VR headset all day. I’d rather be outdoors enjoying Earth 1.0.
Cheers!
-PoF
OF COURSE what she wrote was inappropriate and OF COURSE if she did punish him intentionally physically that was wrong and unprofessional and possibly worse.
But after 20 years of taking verbal abuse from patients in the ER, there is a large part of me that totally understands how hard it is to remain calm and professional when someone is rude, condescending, ie a total prick.
My residency emphasized professionalism, and I pride myself on maintaining that in the face of whatever is thrown my way. Taking care of difficult patients is part of the gig and we all will have patients that will test our ability to treat with compassion and give the best care as we would to our family.
But in the end we are still human and sometimes that JUST GETS OLD!
Excellent blogpost.
This is a problem for everyone, not just medical professions. Per an employment lawyer who deals with these issues fairly regularly. people get disciplined and even fired for their “free speech” on the internet.
Her rule of thumb is the following: Do not post anything on social media, or include in an email or any other public forum, that you would not want your partner/spouse, parent, child, present or future boss, chaplain, teacher, local law enforcement officer, etc. to read. In other words, if you can be embarrassed or harmed in anyway by it, by someone important in your past, present, or future life, don’t post it. And remember, once it is out there in digital form, it is as if it is written in stone. Yes, you can delete it on Twitter, but you cannot delete someone else’s screenshot of it.
Like others above, my social media posts consist primarily of photos of family occasions, pets, and vacations.
Just don’t do social media, period. It’s a waste of time. I have no Twitter, no Facebook, no Instagram, no TikTok. Live a real life in the real world. I have real friends I can wrap my arms around. Nobody really wants to see a picture of what you are having for lunch.
This!
Yeah but the people that work there can go around and call a patient a big whale really.
Agree with this. I remember when Facebook was getting big and everyone was looking up folks from high school and whatnot, and ol’ Zuck was changing the privacy rules every few minutes and saying that in the best world people would share everything. I’m pretty open with folks IRL but I was suspicious of this shtick and never signed up for facebook and ultimately thought that was a reasonable decision. Then facebook bought instagram, so no thanks. Etc. Turns out I don’t want to leave breadcrumbs like that for anyone to follow.
This hits close to home. When I was a resident, a patient was unhappy with my decision not order some labs, I was overruled by my attending and we found a minor infection. Patient was treated and i prescribed the appropriate medication. The family then used my name on the med to find my Facebook account and turned in unrelated jokes I made about my coworker resulting in an “indefinite” suspension. Luckily, it only remains a small blemish on my record…but I have had to work through issues with it during subsequent stages of training and job interviews.
Being defined by a few moments are unfortunately true about many parts of our life…but are especially true about social media and the permanence of all of our actions in the digital age.
Also, don’t wear your political views on a pin on your badge as a challenge to your patients and colleagues. (Yes, she did that.)
Except places are starting to put pronouns on badges and in your email signature. Remember…”silence is violence”.
Yes, the purpose if this is to force you to take a political side in the argument. And they keep thinking up these ingenious ways to do it while pretending that they are not doing exactly that. The entire reason she was wearing the pin was to provoke exactly that reaction. It was a dare.
Again, that is quite common. This particular student may have been doing it because that is just what people at her hospital do.
Or did it because they were told to do so.
Or did it because they wanted to make a point in objection to the practice and picked pronouns that comported with their appearance.
Hard to read minds in general. Particularly when given limited facts about someone you have never met.
To not realize that her pin was a political statement would speak volumes about the extent of the bubble that many people in medicine (especially academic medicine) live in. But it’s also difficult to believe that otherwise intelligent people don’t honestly realize this.
You keep assuming that wearing the pronouns was an unusual individual decision by one person. But at my place, wearing those pronouns is the norm. Since she, apparently, wore pronouns that matched her appearance, she may have objected to the practice and used she/her to express her opposition. Or listed her pronouns simply because that is what she was told to do.
If you object to people listing their pronouns then to you, doing so is s political statement. To many people, it may simply mean doing what they are told. You know, as 4th year students do all day long.
And this is America. She had as much right to wear her pronouns as she would have had to wear a Biden or Trump for President button.
The only problem is that she mentioned sticking him twice. That may or may not have been on purpose, but in any case she was foolish for talking about it.
Matt’s insistence that this is a political act intended to provoke argument is disheartening, and his protestations about “bubbles” reveals more about his than that of the medical student.
Anon’s response that it’s difficult to infer motivation is correct. I don’t wear these badges or discuss my “preferred pronouns.” But why malign someone who does? Should they not have the right to self expression, or to decide what they want to be called? We have no problem with name badges, including nicknames.
It’s hard for me to understand why person A would see that person B asks to be referred to in a certain way, then interpret that as a personal attack. It seems nosy and unnecessary to get offended when it may have nothing to do with them.
I find it helpful when people wear something that tells me their preferred pronouns. There are a lot of choices and it can be hard to remember. Right now, I default to “they/them” unless told otherwise.
Declaring preferences is common practice in education now. That some patient did not know this are had a problem with it should not deter people from saying who they are.
But I agree that it was stupid for the student to have narrated the incident. I did not take the tweet as reported here as meaning they stuck twice on purpose. But just shows how careful one should be.
Our students and trainees are told to be extremely cautious about posting ANYTHING about individual patient care. Not just for these reasons but also because the wide-open, “tell everyone everything” attitude absolutely does not apply to HIPAA.
On making political statements, it is a free country. That does not mean you cannot get in trouble for saying the wrong thing, but is should mean that a right wing state cannot refuse to give you a license due to your left wing posts.
At first I thought the student was startled by the joke and that’s why they missed the vein. If they did this deliberately, then what they did was absolutely wrong. You don’t get to hurt someone just because they said something insensitive or ignorant.
Having said that, it seems unfair to punish someone for a first time mistake, specially while they were in still in school. That’s where you get to make mistakes and learn from them. This person is never again going to make this mistake! Of course, I’m not a doctor, so I don’t know if someone should already have been educated in this by the time they were doing this procedure.
Lastly, it’s unfortunate that adding gender pronouns to someone’s name is considered political now. I’m a 6′ tall man and have a big bushy beard. No one is going to ever mistake me for a woman – except on the phone. My natural voice is a little high and if I forget to consciously speak a little deeper, I get m’am-ed sometimes. So, I welcome being able to attach my pronouns to my name wherever possible so they will know to not do that.
I don’t have the problem with people guessing wrong based on my voice. But it would not bother me if they did.
I can see why listing your pronouns is seen as making a political point, but gosh I wish that wasn’t the case. I don’t do it myself but it’s super common in my field. I don’t think it has anything to do with me or even with wanting to be an “ally” at this point, although I think the original idea was for people who present in more “traditional” ways to list pronouns so that anyone would feel comfortable listing pronouns. Which is getting to be the case and that’s good! I mean, hey, I definitely appreciate it when people pronounce my name correctly, or call me by the correct title if we’re all going to be formal (that’s Dr., not Ms.!), or otherwise indicate they want me to feel comfortable as a person.
The fact that I’m getting on in years means that no one thought to provide me with any kind of social media education. In 2002, I completed my studies at a medical school and became a doctor. We had access to the web and electronic mail, as well as instant messaging services like ICQ and AOL, but none of the popular modern platforms.