FOAMed and the Social Media Minefield- Dan Schwester

I am what you would call a social media fan…just ask my infinitely patient spouse. I came somewhat late to the game, but I have enthusiastically embraced it as I found I could find people with like interests, healthy debate, learning, and a lot of memes. I have a Twitter feed with a decent number of followers that grows slowly, an Instagram primarily for seeing my kids’ activities, and a Facebook that serves as a primary family contact and political forum.

From a professional perspective, social media has been revolutionary. I have been exposed to some of the current thought leaders in emergency and prehospital medicine and have even gotten to interact with them in a virtual and sometimes real world. As a fan of Free Online Medical Education, (FOAMed) has taught me things that have deepened my knowledge of my practice, changed how I treat patients, and overall made me a better teacher and paramedic. Scott Weingart taught me to use push-dose pressors. Rich Levitan showed me the path to be a better airway clinician. Jim DuCanto showed me that I could intubate a contaminated, bloody, vomit-filled airway with confidence. Cliff Reid and Chris Hicks taught me that relaxing and engaging my teammates made things a hell of a lot smoother than me barking orders under stress.

All these things made me better and no doubt helped my patients.

The culmination of my travels through the virtual world of collegiality came last June, when I scored one of the coveted tickets to attend dasSMACC in Berlin, Germany. For those of you unfamiliar, the Social Media and Critical Care conference was a medical conference unlike any other. They used new techniques of reaching the audience. No reading off PowerPoint. Everyone was engaged through physical discussion as well as a huge social media presence going on at the same time as the presenters. It was a celebration of what this new media could do. I met people walking through the Tempodrome who, when seeing my attendance badge would say to me, “I follow you on Twitter!” It was cool to have that happen, and to start a conversation with a total stranger whom you knew only from a picture and posts. I felt like I was one of the cool kids.

I had a conversation with airway guru Rich Levitan, and he was gracious and a very nice guy. I bumped elbows (literally) with podcasting pioneer Scott Weingart and met a bunch of amazing people. All in all, it was a great trip and one I’ll remember.

So, at this point, you’re probably saying, “Where’s the problem?”

Like any other thing in this world of ours, FOAMed has not always been shiny and happy, to paraphrase Michael Stipe and REM. There have been instances where disclosures have been made, battle lines drawn, and consensus reached in a virtual world where anything goes.

There have been instances of clinicians in the FOAM world who fell from grace. Most notably, a New York City emergency physician (and SMACC contributor), was convicted of sexual assault on patients. This was debated heatedly among those who follow the FOAMed world.

There has been debate in social media about personal behavior and cultural issues in medicine, some that would surprise you when you see how much people will share with others they barely know. This has led in some cases to problems as social media posts have gotten people into hot water with their respective departments or agencies, which inevitably sparks the constitutional rights debate among those on the platform and their followers.

Never mind that the Framers of our Constitution had about as much knowledge of modern participation media as I do about quantum drives and interstellar warp travel.

The fact is, while yes, you CAN post pretty much whatever you want within legal reasoning; your employer doesn’t have to let you keep working for them if it gets back to them you’re shitting on other agencies, them, or anything else they deem contrary to their ideals. And yes, there are people in our profession who have been fired for being too open on social media. Before the Berlin conference got off the ground, there was some controversy online regarding the treatment of women at the SMACCDub event in Dublin, Ireland. Some opted out of the Berlin conference for this reason. 

To be honest; I was clutching my dasSMACC confirmation like Charlie and his Golden Ticket. It was not really something I had been party to or aware of; and like most things on the Internet, it eventually passed, and the show went on.

At dasSMACC, there was a serious discussion in the FOAMed world, mostly played out on Twitter, about an event referred to as GelFest. This was a party at a local club in Berlin where teams competed in games using point of care ultrasound (POCUS).

If you’ve ever seen the movie Beer Fest, you get the idea. There were vomiting manikins being suctioned and intubated, thumping club music, relay races involving FAST scans…and yes, as you might guess, there was beer. (It WAS Germany, after all).

This party, which was not a fully-sanctioned event in the dasSMACC program, sparked Twitter posts galore about the propriety of using alcohol responsibly, acting appropriately, and whether as medical professionals we should condone this activity as contrary to our beliefs as clinicians. A lot of people chimed in, some of whom had been there, feelings were bruised, and in the end, I’m not sure what got settled, except that there was a debate, and lots of people had an opinion.

I was there. I saw no one acting inappropriately, stupidly, or causing trouble. Everyone there was having a good time; and nobody in my observation was over any line. But still, there was debate about a group of adults having a night out on their vacation. I discussed it on the MedSchoolMedic podcast with Ed and moved on.

The newest darkness coming out of social media and FOAMed has been the story of #GuGate. I tried to summarize it as best I could from Twitter, and by no means is this chronological, but the medical satire blog GomerBlog covered it much better.

Anyway, here’s my take:

Surgeon with a social media presence and liking attention gets dropped by his residency program, which is attributed to the content of the posts which show support for progressive causes. However, we don’t know for sure; because employers cannot disclose the reasons for terminating employment easily. Surgeon attracts a LOT of attention, including yours truly; who followed him because of shared beliefs and the perception he got screwed somehow. But there’s no real evidence besides what Surgeon puts out on the feed.

Surgeon attracts more attention. He gets blocked by none other than POTUS, and parlays this into even more media attention, which prompts a release of a legal record indicating a charge of domestic violence.

Surgeon loves the social media attention, starts making accounts to retweet and support his posts. Nobody notices.

Surgeon meets Medical Student at some point and, is impressed by her, as well as her number of followers on social media (I’m NOT kidding). At some point, a relationship starts. Gets Medical Student to retweet him regularly to her audience, which is bigger than his. There is a dating relationship. When it doesn’t work out; starts to send questionable messages to student purported to be from a new companion who asks for intimate details of their relationship and other general poor behavior.

Medical Student is justifiably creeped out, puts distance between them and moves on.

At some point, Surgeon gets involved in viral posts that attract attention of his residency. At some point, Surgeon is released from residency, which he states is because of his posting and his political views.

Surgeon continues to tweet, attracting more followers and generally chiming in on issues that Surgeon feels important.

The worm turns when Surgeon makes a comment about July 1 being a bad time to be in the hospital, due to the influx of first-year residents (the so-called Intern Effect).

Physician, who also happens to be active Internet blogger and personality calls the comment out for not being accurate, as many others in social media do as well.

Surgeon uses manufactured account to accuse another physician of racist profile picture (It wasn’t).

Physician says he’s leaving social media; followers of Physician who feel he’s being unfairly called out marshal resources and start uproar.

In the general uproar over the avatar, people looking into this on the Internet notice some odd similarities; find out it’s a burner account, start calling Surgeon out about it. Surgeon denies any impropriety. More digging, more burner accounts.

At this point, Medical Student steps in with revelation that this account is the one Surgeon has been using to harass her. She then decides, with a lot of courage, to share incidents of their relationship, one of which could be considered as a sexual assault.

Internet Medical Superstar (seriously) calls out Surgeon on his activities, blood is in the water, Twitter responds with hashtags and unfollows.

Surgeon attempts to conference with Internet Medical Superstar privately, gets shut down and reposted for the world to see. The storm continues.

Surgeon then posts HIS side of the story to Twitter, complete with body-shaming and counteraccusation of improper behavior/assault by Medical Student. This does not have the effect Surgeon hopes. Instead of vindicating or at least giving him a plausible alibi, Surgeon puts himself in even deeper, confirms fact that burner accounts were used.

The more people are looking, the weirder it gets. Again, all played out in real time, a phone click away.

Surgeon announces “taking a break” from Twitter.

Following this, people on Twitter keep noticing odd accounts in their feed generally causing annoyance and harassment. Coincidence?

So, as of this blog post, this is where we are. Hard to follow? Try doing it on a 5-inch screen. But it does bring up a lot of questions, with no good answers.

In criminal law, there is the concept of probable cause. Probable cause is defined as enough evidence that justify the reason for making an arrest and charging a person with a crime. It is more than reasonable suspicion; where you have an idea or hypothesis that a criminal act may be occurring. It is the basis for depriving someone of their property, liberty, etc. under the Constitution.

But probable cause is not enough to convict in a court of law.

Looking at what we know right now and based on the experience and legal knowledge of your intrepid blogger, Surgeon is swimming in probable cause that he used social media to manipulate and harass Medical Student.

His attempts to deceive and conceal his burner accounts, his ham-handed explanations, all point to confirmation of this probable cause. The preponderance of what we know is that Surgeon is in the wrong.

What my concern is, what about the next time? Are we always right? And what happens if the Internet gets it wrong? We know trained law enforcement and investigators can make errors. But there is a process to exonerate people in that position.

In the world of social media and the Internet, there isn’t a process. And in a world where your online life can have real, physical consequences, is that a problem?

Where are we going in a society where this stuff gets played out in real, digital time?

What can we learn from this? First, your online persona is just that: a persona. It can be whatever YOU make it, but it is not necessarily you. And everyone else out there can do the exact same thing.

Second, knowing this, maybe we shouldn’t equate a social media follower or friend as someone we truly know as well as a close friend. Numbers are cool, you may even get a little edification from your Internet popularity, but don’t equate it with real life. The people you talk to online may not be the person they seem.

Third, while these movements have exposed some really bad behavior on the parts of some, maybe we need to realize that due process doesn’t exist on the Internet. Will that change how we look at things? I’m not sure. Maybe we are too far down the virtual rabbit hole to come back.

For the record, I believe the accounts of victims who show courage and come forward to expose abusive behavior. Nobody reading this should take my words any other way. Period.

I’m disgusted that Medical Student was treated this way. As a father, husband, and human being, Medical Student was victimized in multiple ways. In my final analysis, this case is clear cut. Surgeon is 100% wrong. If Medical Student was my colleague, friend, relative, or anyone I knew personally, I would encourage them to speak to law enforcement.

Finally, people need to understand that what you do on the Internet is by no means anonymous. Whatever it is, someone, somewhere knows what you’re doing out there. There is no hiding forever, on a medium that has no expiration date. My profile, my comments, retweets, posts, blogs, etc. are all out there. Forever. And available for anyone who wants to do background on me to find and share.

If you’re one of those people that do not have to worry about this, one who treats people with respect and decency, you’re probably OK. And that’s great. Keep it up. We need more of you online and in social media. It’s a great tool when used the right way.

But if you’re one of the others, the ones like Surgeon, who think that the Internet gives you ability to hide behind false identities and cause others pain and grief, just remember that eventually, you’ll be found by someone who will put it together.