Posts on social media outlets have sunk the careers of many physicians. The things that get doctors in trouble usually are the result of bad decisions and poor judgment perpetuated over TikTok, Facebook, YouTube and other platforms—and there seems to be no end in sight to the wayward behavior of some physicians. Although their actions may not be intentionally provocative or harmful, doctors’ posts have received unwelcome attention from their peers, patients, and medical licensing boards. It is this close scrutiny that has sealed their dooms.
Here are the 10 most common types of gaffes I’ve encountered online:
Technical Miscues
Mark L. Tykocinski, MD, president of Thomas Jefferson University and dean of its Sidney Kimmel Medical College, was a Twitter novice who used his account to “like” tweets that were critical of diversity efforts on college campuses, questioned the science of COVID-19 vaccines, and called transgender reassignment surgery “child mutilation.” Tykocinski said he “liked” the tweets in order to bookmark them for later learning. Students from LGBTQ+ and underrepresented racial groups found his explanation difficult to comprehend, and did not believe Jefferson was taking their concerns about diversity seriously given that Jefferson’s medical college placed 115th in diversity out of 130 medical schools reviewed nationally in 2023, according to U.S. News and World Report’s “Most Diverse Medical Schools.” In response to criticism, Tykocinski said, “I regret my lack of understanding of how ‘liking’ a tweet is an implied endorsement. I also regret how my lack of understanding of the Twitter platform caused some to question my views on these complex issues.” Several months later, after only a year on the job, Tykocinski resigned and was replaced by a physician with a background in diversity efforts. Careless and uninformed use of technology can undermine the reputations of users and their affiliated institutions.
Mishandling Diversity, Equity, and Inclusion (DEI) Initiatives
Howard Bauchner, MD, a pediatrician, was forced to relinquish his prestigious position as editor-in-chief of the Journal of the American Medical Association (JAMA) in 2021 following a controversy sparked by a JAMA-sponsored podcast that questioned whether structural racism existed in medicine. Some physicians were so angered by the podcast and an accompanying promotional tweet that read “No physician is racist, so how can there be structural racism in healthcare?” that they decided to protest the influential journal and the American Medical Association. Bauchner apologized for “lapses” that led to the publishing of the tweet and podcast, acknowledging that although he was not directly involved in the episode, he was ultimately responsible for it. A petition was initiated calling for a formal review of Bauchner’s leadership and a restructuring of JAMA’s editorial staff to focus more attention on antiracism and health disparities. In the fallout, Kirsten Bibbins-Domingo, MD, PhD, a woman of color and an NIH-funded researcher specializing in internal medicine, epidemiology, and population health, was appointed the new editor-in-chief of JAMA.
Marketing Unproven Treatments
William Merlino, MD, a retired New Jersey family medicine physician, was sentenced to nearly three years in federal prison for manufacturing and selling the toxic chemical 2,4-Dinitrophenol (better known as DNP) over the Internet to hundreds of customers seeking to lose weight quickly. DNP is intended for industrial and agricultural use and has been banned by the FDA for human consumption since the 1930s. Although Merlino insisted the compound had positive effects on metabolism and weight, even taking the substance himself to shed 80 pounds, DNP has been associated with cataracts, liver damage, organ failure, and death in patients who were taking it as a weight loss therapy and to treat other conditions. Merlino sold DNP on eBay between 2017 and 2019. Shortly afterward, federal agents shut down his operation because a British body-builder who had purchased the drug from Merlino died while using it. The judge presiding over Merlino’s trial labeled him “arrogant” for forging medical documents to fabricate a diagnosis of pancreatic cancer in order to delay the trial, as well as for attempting to legitimize his online activities. The fact that there were many fake or unproven medical products and methods that claimed to diagnose, prevent, or cure COVID-19 certainly did not help Merlino’s cause.
Defying Government Agencies (DEA, IRS, etc.)
My medical school classmate, Elias Karkalas, MD, a family medicine physician practicing in suburban Philadelphia, worked part-time for an Internet pharmacy company. In 2013, Karkalas was indicted by a federal grand jury in Minnesota on 38 counts of violating the Controlled Substances Act by the distribution of Fioricet to patients with headache and other types of pain, as well as charges related to conspiracy, wire fraud, mail fraud, and introducing misbranded drugs into interstate commerce. Karkalas was arrested at his office and detained pretrial for 6 months. Most of the charges against him were dismissed before trial, and a jury acquitted Karkalas of all remaining charges. Karkalas successfully argued that although Fioricet, a combination drug, contains butalbital, a derivative of barbituric acid, which is listed as a controlled substance (Schedule III), Fioricet, itself, was not expressly listed as a controlled substance in the Physicians’ Desk Reference during the years he prescribed it (2005-2012). To vindicate himself beyond the acquittal, Karkalas countersued a federal attorney and DEA diversionary agent for unlawful prosecution, but he was unsuccessful. His Pennsylvania medical license was suspended in 2014 and reinstated in 2018.
Violating Existing Laws
Unlike Karkalas, who practiced within the framework of the law but nevertheless was charged with a crime, some physicians (and medical entities) have knowingly violated the law, and their corrupt behavior has been captured on YouTube and other social media platforms. One of the most contentious cases surrounds the world-famous Mutter Museum in Philadelphia, home to priceless artifacts, medical specimens, and anomalies exhibited for educational purposes. New leaders at the Mutter Museum and its parent organization The College of Physicians of Philadelphia—including president and CEO Mira Irons, MD, a pediatrician and geneticist—have been scaling back exhibits in light of a decades-old federal law that calls for the return of indigenous human remains to descendants and tribal nations. Despite the 1990 passage of the Native American Graves Protection and Repatriation Act, the remains of more than 110,000 Native American, Native Hawaiian, and Alaska Natives’ ancestors are still held by museums, universities, and federal agencies. The Mutter Museum has removed nearly all its violative and offending YouTube videos and many images from its website and Instagram account. However, the remains of 54 of 56 Native Americans housed by the Mutter Museum have not yet been made available for return, according to a 2023 report in The Philadelphia Inquirer. Any museum that fails to comply with the Act may be assessed a civil penalty.
Livestreaming Procedures
The license of plastic surgeon Katherine Roxanne Grawe, MD, was revoked in 2023 for livestreaming operations on TikTok. Grawe, aka “Dr. Roxy,” practiced in an upscale suburb of Columbus, Ohio, and had a large following on TikTok, Instagram, and Snapchat. Several of her patients were seriously injured, allegedly due to Grawe’s inattention to her patients while she was looking at the camera when filming procedures, meaning at those moments Grawe was operating blindly. Also, during some livestreams, Grawe engaged in dialogue to respond to viewers’ online questions while the surgical procedures were ongoing. Complications among her patients included bowel perforation, hepatic encephalopathy, rhabdomyolysis, and serious sepsis. Grawe continued to operate despite previous warnings by the Ohio medical board to protect patient privacy on social media. Many surgeons have been reprimanded by state medical boards for inappropriately livestreaming procedures on social media and producing content that violates HIPAA.
Spying on Colleagues
Boston University researchers culled snapshots of vascular surgical residents from their Facebook, Twitter, and Instagram accounts. The researchers wanted to assess whether the trainees projected a professional image on social media and, if not, encourage them to exercise caution when posting material to public websites. Inappropriate content included use of profanity, photographs of women in bikinis, and depictions of drug paraphernalia and intoxication. However, many readers objected to the study, arguing that the findings were inherently biased and blatantly sexist because the journal’s editorial board was primarily white and male. As a result, the journal (Journal of Vascular Surgery) retracted the article, and the authors apologized for being “judgmental” and making the young surgeons feel targeted. Revisions were made to the journal’s editorial policy and peer review process, to ensure that conscious and unconscious biases would not plague future studies.
Disseminating Egregious or Patently False Information
Simone Gold, MD, JD, is an emergency medicine physician originally based in Beverly Hills, California. She founded the physician volunteer group America’s Frontline Doctors, which advertises itself as “the nation’s premier civil liberties organization.” Gold became widely known for spreading debunked claims about COVID-19. She was sentenced to 60 days in prison—not for her unscientific and anti-vax views, however, but, rather, for illegally entering and remaining in the U.S. Capitol during the January 6 insurrection. According to Gold’s lawyers, the California medical board sent her a letter threatening to revoke her medical license for “an instance of misinformation.” Many medical organizations have since issued statements about the harmful effects of misinformation, including the Federation of State Medical Boards, which warned that promoting misinformation could put a physician’s license at risk.
Posting Poor-Quality Information
The main limitation of health information found on social media and other online sources is a lack of quality and reliability. Researchers from the University of Texas Medical Branch at Galveston examined the quality of content in YouTube and TikTok videos on dissociative identity disorder, a psychiatric condition characterized by the presence of two or more distinct personality states or an experience of possession. Only 5% of the TikTok videos were deemed “useful,” and the researchers rated about half of the YouTube videos as useful. Rare conditions such as dissociative identity disorder, which affects less than 1% of the general population, are frequently discussed on social media platforms. Although the discussion offers an opportunity for education, the threat of misinformation looms as well. Potential risks to physicians regarding the distribution of poor-quality information include damage to professional image, breaches of patient privacy, violation of personal–professional boundaries, and licensing or legal issues.
Behaving Unprofessionally
Professionalism is a core tenet of medical practice rooted in responsibilities to the patient, practitioners, and the profession. Occasionally, unprofessional behavior on social media platforms has resulted in disciplinary action. For example, in 2011, emergency medicine physician Alexandra Thran, MD, was reprimanded by the Rhode Island Board of Medicine for “unprofessional conduct” and fined $500 after making comments on Facebook about a patient. Thran did not mention the patient’s name in the post; however, sufficient information was included that others within the community were able to identify the patient. Thran’s hospital privileges were terminated, and she was required to take a continuing education course on physician–patient confidentiality. Investigations of doctors’ behavior on Facebook and other social media outlets represent an obvious sea change in HIPAA standards, resulting in a narrowing of permissible content.
Conclusion
When Forrest Gump said, “Stupid is as stupid does,” he meant that the actions of people, opposed to their appearance, often are an indicator of their intelligence or lack thereof. Physicians are among the brightest people on earth. Yet intelligence does not confer immunity from social media blunders.
Healthcare professionals should strive to create accurate content of high quality on social media platforms, particularly TikTok, in order to educate their peers and the public. Doctors should not sell products that are the medical equivalent of snake oil, or turn to voyeurism or writing prescriptions for unproven and illegitimate uses of medications over the Internet. Any procedure that is livestreamed should be well rehearsed and done only to demonstrate proper technique and technology with dignity and with the full informed consent of the patient. Lastly, doctors should not engage on social media platforms if they do not understand the inner workings of the application.