By Jeff Segal, MD, JD, ByrdAdatto and Medical Justice

Tired of COVID-19? Me too.

Several surgeons recently authored a paper in the peer-reviewed Journal of Vascular Surgery called "Prevalence of unprofessional social media content among young vascular surgeons."

The same article was presented at the Annual Symposium of the Society of Clinical Vascular Surgery.

The fastest and most reliable way to upset a doctor is to call them unprofessional. The article has since been retracted and the authors apologized.

Details of the Firestorm

The authors intended to research whether vascular surgery trainees and recent graduates had public-facing social media accounts with content that could negatively affect their future reputations. Sounds benign enough, but the research failed to consider most of these doctors had not yet graduated and, predictably, did not have a professional website, walling off their professional life from their personal life. Most doctors, over time, have two social media presences—their public professional life and their private life. Still, one sometimes bleeds over to the other. Most of the time, it's of no import. Zilch. Nada.

What put the authors in a vat of boiling water was their loose definition of "unprofessional content." They described "clearly unprofessional content" and "potentially unprofessional content." Examples of "clearly unprofessional content" include HIPAA violations, intoxicated appearance, unlawful behavior, possession of drugs and drug paraphernalia, and uncensored profanity or offensive comments about colleagues, work or patients. Examples of "potentially unprofessional conduct" included holding or consuming alcohol, inappropriate attire, censored profanity, controversial political or religious comments, and controversial social topics. According to the study, "Inappropriate attire included pictures in underwear, provocative Halloween costumes, and provocative posing in bikinis/swimwear."

For those interested in the statistical analysis:

There were 480 vascular surgeons identified. Three hundred twenty-five (68%) were male, 456 (95%) held MD degrees, and 115 (24%) were integrated (0 + 5) vascular surgery residents. Of these, 235 had publicly identifiable social media accounts across all platforms. Sixty-one (26%) account holders had either clearly unprofessional or potentially unprofessional content. Eight accounts (3.4%) contained content categorized as clearly unprofessional: obvious alcohol intoxication in three Facebook accounts and uncensored profanity or offensive comments about colleagues/work/patients in one Facebook and five Twitter accounts. Potentially unprofessional content appeared in 58 accounts (25%) and included holding/consuming alcohol (29 accounts, 12.3%), controversial political comments (22 accounts, 9.4%), inappropriate/offensive attire (nine accounts, 3.8%), censored profanity (eight accounts, 3.4%), controversial social topics (six accounts, 2.5%), and controversial religious comments (two accounts, .9%). There was no significant difference in unprofessional content across sex, training paradigm (MD vs non-MD) or residency track (0 + 5 or 5 + 2; all P > .05). However, there was more unprofessional content for those who self-identified as vascular surgeons (33% vs 17%; P = .007).

 

And the conclusion. Drumroll, please:

One-half of recent and soon to be graduating vascular surgery trainees had an identifiable social media account with more than one-quarter of these containing unprofessional content. Account-holders who self-identified as vascular surgeons were more likely to be associated with unprofessional social media behavior. Young surgeons should be aware of the permanent public exposure of unprofessional content that can be accessed by peers, patients, and current/future employers.

 

The authors must have forgotten even doctors have real-world lives. Most, if not all national specialty medical conventions sponsor an open bar during the welcome ceremony; it rarely leads to bedlam and debauchery. Doctors go to the pool, swim at the beach, have opinions, support political candidates, vote, go to church, eschew religion, celebrate Halloween, hate Halloween and do lots of things that keep them from burning out. Good for them.

Once the arcane article was picked up by national media, the Twitter thunderstorm erupted.

Female doctors proudly declared they will wear what they want when they want. And it has zero impact on whether they're professional or not.

This is what happens when I am in a bikini after #breastcancer. Kidding but also not kidding. #MedTwitter #MedBikini pic.twitter.com/o9oJZewzgX

— Dr. Meadow Maze Good, DO, FACOG (@MeadowGood) July 24, 2020

#MedBikini bc I'm in a hospital at 4 am, and if you don't think 12 mi hikes, beers, and bikinis don't make me a better doctor you're nuts. pic.twitter.com/0M7kGpWxFv

— Lauren Agoubi (@laurenagoubi) July 24, 2020

Surgeons can wear bikinis. ❤️🇲🇽 #medbikini pic.twitter.com/VFf4tHzsUS

— Dr. Daisy Sanchez (@ladaisysanchez) July 25, 2020

 

And, of course, solidarity from male colleagues.

Although no one will want to see this Dad bod here it is in full support of my female colleagues and this misogynistic study. Without my female mentor in medschool and the one in residency, I wouldn't be the surgeon I am today. #MedBikini pic.twitter.com/nSlDtA5hTZ

— Anthony Tucker (@AnthonyTuckerMD) July 24, 2020

Some surgeons also penned excellent scathing blog posts.

Other than the fact the research article was tone-deaf, does any of this matter? Yes.

Boards of medicine are empowered to discipline physicians for so-called unprofessional behavior. Is unprofessional behavior defined by statute or regulation? Nope—it's in the eye of the regulator. Discipline for unprofessional behavior can involve public reprimand, suspension or revocation of one's license—a harsh outcome. Can a doctor really lose her license for wearing a bikini? As an isolated event, probably not. But the better answer should be an unambiguous no.

Beyond the medical boards, can employers fire doctors for unprofessional conduct? Generally, yes. A private employer does not need to respect free speech rights. The government cannot shut you down for what you say (and even there, there are exceptions), but your employer can let you go. Every state other than Montana has "at-will" employment laws; that means the employer and the employee are each free to terminate the relationship. The only caveat is that employers cannot fire a worker for discriminatory reasons; discrimination may be based on race and sex. If an employer were to enforce off-hours dress codes, it would have to enforce it equally, with no differentiation between men and women. Some states—such as California, Colorado and New York—make it difficult for employers to fire employees for behavior outside of work.

Doctors work hard. Doctors play hard. Most doctors wake up every day intending to do a great job for their patients. I doubt most patients fret if their doctor wears a bathing suit or has a beer. If these behaviors have no impact on patient care, patients should not care. My opinion: The bar (no pun intended) for labeling some behavior as unprofessional should not be so low.

Enough of what I think. What do you think?

PS: For those interested in the history of the bikini:

Clothing designer Louis R√©ard introduced his swimsuit in July 1946. He named it after the Bikini Atoll, where the first public test (Operation Crossroads) of a nuclear bomb had taken place only four days before. Purportedly, R√©ard—who hired a skywriter to advertise the new bikini as smaller than the world's smallest bathing suit—claimed his version was sure to be as explosive as the U.S. military tests.

No runway model would wear it, so he hired a nude dancer from the Casino de Paris named Micheline Bernardini to model it at a review of swimsuit fashions.

A bathing suit qualified as a bikini, said Réard, only if it could be pulled through a wedding ring. He packaged the mere thirty squares inches of fabric inside a matchbox.

The Vatican formally decreed the design sinful, and several U.S. states banned its public use.

 

Jeffrey J. Segal, MD, JD, is a neurosurgeon turned serial entrepreneur turned attorney at ByrdAdatto who has literally been in both business and medicine. Segal was a neurosurgeon in private practice before beginning the second phase of his career as a serial entrepreneur in the health care field. He then founded or co-founded four separate health care startups. Segal lives and breathes health care and understands it viscerally.