Why Doctors are Posing in Swimwear on Social Media

A study purporting to uncover “unprofessionalism” spurred a #MedBikini backlash

BY ARGHAVAN SALLES, RENA MALIK Scientific American - BEHAVIOR & SOCIETY | OPINION

Beginning on July 23, physicians all over the world took to social media to post pictures of themselves in bikinis, using the hashtag #MedBikini. Against the backdrop of the ongoing COVID-19 pandemic and our broad social awakening to a second pandemic of systemic racism, why would thousands of doctors post pictures of something so seemingly frivolous as themselves in swimwear? We are both surgeons, and watched this play out in real time.

It initially started with a study published in the Journal of

Vascular Surgery that purported to analyze the behavior of physicians on social media. The study, conducted by a team of researchers based at the Boston Medical Center and Boston

University School of Mecicine, was an attempt to classify the posts of trainees in vascular surgery as either professional or unprofessional.

Of course, we can point to any number of costly mistakes people have made on social media. Just in the last two months,

Nick Cannon lost a contract with ViacomCBS for his longtime improv comedy show Wild ‘N Out because he made anti-Semitic remarks on his podcast. Similarly, Dee Nguyen, a cast member on MTV’s The Challenge, was fired after she made racist comments about the Black Lives Matter movement on Twitter and Instagram. So, one could understand why the authors were interested in ascertaining whether the posts of trainees in their own field might be professionally risky.

When the article was widely disseminated on Twitter, however, the authors faced a backlash for what was seen as their own lack of professionalism. For one thing, people raised concerns about the methodology used in the study, in which three members of the research team created fake social media accounts to spy on the accounts of these young trainees.

The bigger problem, which led to the #MedBikini hashtag, were the authors’ definitions of “unprofessional,” including

“controversial political or religious comments,” “controversial

social topics” and “inappropriate attire.” In that last category, they included “pictures in underwear, provocative Halloween costumes, and provocative posing in bikinis/swimwear.” And whether something was provocative or not was judged by the nearly all-male research team

The researchers also concluded that physicians should not post about “controversial” topics such as gun violence or abortion. But physicians have long been advocates for social causes. In recent years, physicians have risen up to fight gun violence with the #ThisIsOurLane movement, and with the current administration there have been many challenges related to abortion rights. Many physicians have rightfully spoken out about racial disparities in healthcare outcomes during the COVID pandemic, and when the murder of George Floyd sparked protests around the world, physician voices joined that battle cry as well. The Physician Charter on Professionalism, endorsed by over 108 organizations, says physicians should promote justice and advocate for the elimination of discrimination publicly.

In addition, it’s completely inappropriate for researchers to determine whether a woman’s Halloween costume or swimsuit is too “provocative” to be professional. It’s unclear how posts of this nature, outside of work, relate to a woman physician’s career. But what this study has shown, and why there has been so much outrage around it, is how people with privilege can use the label “professionalism” to target women, people of color, sexual and gender minorities, and anyone else they don’t approve of.

In the study’s defense, Dr. Erica Mitchell, the sole woman author of the manuscript, said on Twitter: “People get judged everyday by what is available on social media in all forms. It is the reality of today’s world in medicine or any other profession—like it or not. These impressions and the SM content stick and are hard to eliminate.” But in the face of withering criticism, she and some of the other authors and journal editors

subsequently apologized for the paper and their approach to the study. The article has now been retracted.

We don’t believe anyone had malicious intent. But that is exactly the point. One need not have malicious intent to cause harm. In the same way, the gender pay gap, though perhaps not intentional, affects women, and implicit bias of physicians impairs the care of Black patients. In this case, researchers harmed the medical community by suggesting that speaking up about social causes, consuming alcohol when not working, and wearing a bikini were unprofessional. We may be doctors, but that doesn’t mean we’re not human.

The point is not who these researchers are or even what they did in this particular study. The authors, the institutional review board (which is supposed to watch out for ethical problems), the reviewers of the article and the journal’s editors all thought this was worth publishing. This is because in the culture of medicine, harassment and subjugation of those who don’t look like the dominant group is not only tolerated, it’s the norm.

At least one good thing has come out of this, though. That is the outpouring of support for women in medicine, with a number of our male colleagues posting pictures of themselves in their swimsuits. We are still fighting COVID-19, despite not having all the necessary tools to do so, but maybe this study and the #MedBikini hashtag have brought us all together.

Having a drink outside of work, wearing a bikini at the beach, and caring about social issues are just as appropriate for us as they are for anyone else. In our minds, advocating for social justice is more than appropriate: it’s our duty. The next time you see a doctor, remember that we’re human, too. And when you see your doctor post about wearing a bikini or going to a Black Lives Matter protest, we hope you won’t think it’s unprofessional.

ABOUT THE AUTHOR

Arghavan Salles, M.D., Ph.D., is a scholar in residence at Stanford University School of Medicine, where she leverages her doctoral research on stereotype threat to study issues related to diversity, equity and inclusion. You can follow her on Twitter @arghavan_salles. Original published in Scientific American

scholars position racism as a potential driver of the inequity. Instead, this approach remains an accepted way to investigate and interpret racial health inequities. And it illustrates a common misreading of the harms of the Tuskegee Syphilis Experiment, which stem from coercion and systematic exploitation, not mistrust. These harms include the creation and maintenance of an elaborate economy of suffering used to advance science. Since

Tuskegee, decades of research have evaded the profitability of suffering to instead belabor patient trust as a cause of health disparities. As a result, innumerable interventions now aim, as a primary or secondary outcome, to increase patient trust as a solution to racial health inequities.

While patient trust certainly shapes health care use behaviors and is an important part of the patient-physician relationship, incessant racial health inequities across nearly every major health index reveal less about what patients have failed to feel and more about what systems have failed to do. To be clear, patient trust will never solve racial health inequities or narrow gaps in outcomes, by race. The solution to racial health inequities is to address racism and its attendant harms and erect a new health care infrastructure that no longer profits from the persistence of inequitable disease.

Obfuscating The Role Of Racism In Determining Health And Health Care

The academic publication process, through authors, reviewers, and editors, has legitimized scholarship that obfuscates the role of racism in determining health and health care. This renders racism less visible and thus less accessible as a preventable etiology of inequity. It enables the health care infrastructure to unduly blame individual patients for the neglect and harm of systemic processes that undergird individual and population health inequities. It subjects countless patients, spanning generations in communities of color, to ineffective behaviorist approaches to problems that are actually institutional in nature. It permits authors to publish despite failing to cite at least two centuries of work, much of which has been accomplished by scholars of color (particularly Black scholars), that articulates how racism shapes conditions germane to racial health inequities. This process unfairly advantages white academicians and disadvantages scholars of color whose careers may be stunted when the academy undercites and thus undervalues their contributions. Obfuscating the role of racism in driving racial health inequities also gives frames such as implicit bias undue traction. This stalls progress to end inequities by entreating clinicians to tame “unconscious beliefs,” rather than confronting explicit practices that undergird systemic inequities. It also unfairly centers white authors’ reflections on racial inequity without demanding corresponding solutions to end racial © Can Stock Photo / MattiaATH inequity. This practice undertheorizes racism as a clinically relevant cause of poor health and underelaborates solutions to racism as a health intervention. As a result, patients who suffer the physical tolls of inequities are doubly burdened by the emotional toll of researchers interested in documenting inequities but not addressing them.

Rigorous Standards For Publishing On Racial Health Inequities

To address the shortcomings listed above, we propose several standards for publishing on racial health inequities, intended for researchers, journals, and peer reviewers.

Researchers • Define race during the experimental design, and specify the reason for its use in the study. Such definitions should be couched within a sociopolitical framework, not a biological one, that explicitly reviews all relevant social, environmental, and structural factors for which race may serve as a proxy measure. For the reader, these additional details enable careful interpretation of study results and implications. But for authors, it engenders critical thinking about racial constructs that prevent the reification of race as a biological entity. • Name racism, identify the form (interpersonal, institutional, or internalized), the mechanism by which it may be operating, and other intersecting forms of oppression (such as based on sex, sexual orientation, age, regionality, nationality, religion, or income) that may compound its effects. A critical race theory framework lends authors a vocabulary for discussing racism and its potential relationship to the study’s findings. And naming racism explicitly helps authors avoid incorrectly assigning race as a risk factor, when racism is the risk factor for racially disparate outcomes.

Never offer genetic interpretations of race because such suppositions are not grounded in science. If race and genetics are being expressed jointly, painstakingly delineate the intended implication. Solicit patient input. Use community review boards or form patient panels to ensure the outcomes of research reflect the priorities of the populations studied. Identify the stakes. “All policy is health policy,” and all research on racial health inequities has implications for broader public policy and clinical practice. Inform readers of these potential applications. Cite the experts, particularly scholars of color whose work forms the basis of the field’s knowledge on racism and its effects.

Journals • Reject articles on racial health inequities that fail to rigorously examine racism. This will require continuing education on the part of existing editorial staff and efforts to hire and promote new editors who are well versed in critical race theory and its application. • Revisit editorial and publication guidelines, including the uniform requirements for manuscripts submitted to biomedical journals, regularly to ensure they capture the evolution of racial definitions and sociopolitical structures. Publicly share the guidelines online and with peer journals. Consider compensating reviewers particularly reviewers of color who are often asked to share their expertise without remuneration. Use experienced reviewers who have demonstrated, through their own scholarship and work, facility with racism and its pathophysiologic mechanisms.

Reviewers • Be critical of work that reifies biological race or provides a genetic basis for racial differences in health outcomes.

Inform the editors and authors that such statements are unsubstantiated and request clear explanations of suggested genetic etiologies to ensure such claims are not misinterpreted as biological race. • Review the citations and when appropriate recommend authors expand their literature review to include the wealth of data on racism. • Consult experts and inform the editors if one’s individual expertise is insufficient to advise regarding an important aspect of the paper from study design and methodology to the analysis.

Closing the gap in racial health outcomes in the United States will only be accomplished by identifying, confronting, and abolishing racism as an American tradition and root of inequity.

Originally published in the Health Affairs Blog at healthaffairs.com

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