“We, the members of the world community of physicians, solemnly commit ourselves to . . . advocate for social, economic, educational and political changes that ameliorate suffering and contribute to human well-being.”
— American Medical Association Oath of Professional Responsibility. 1
As individuals and groups spread misinformation on social media platforms, there is a greater need for physician health advocacy.2 We have learned through the COVID-19 pandemic that rapidly evolving information requires public-facing health experts to address misinformation and explain why healthcare providers and experts make certain recommendations.2 Physicians recognize the potential for benefit from crowdsourcing education, positive publicity, and increasing their reach to a larger platform.3
However, despite social media’s need for such expertise and these recognized benefits, many physicians are hesitant to engage on social media, citing lack of time, interest, or the proper skill set to use it effectively.3 Additional barriers may include uncertainty about employer policies, fear of saying something inaccurate or unprofessional, or inadvertently breaching patient privacy.3 While these are valid concerns, a strategic approach to curating a social media presence focuses less on the moments created by provocative tweets and more on the movement the author wishes to amplify. Here, we propose a framework for effective physician advocacy using a strategy we term Mission-Based Tweeting (MBT).
Physicians can use Twitter to engage large audiences.4 MBT focuses an individual’s central message by providing a framework upon which to build such engagement.5 The conceptual framework for a meaningful social media strategy through MBT is anchored on the principle that the impact of our Twitter content is more valuable than the number of followers.6 Using this framework, users begin by creating and defining their identity while engaging in meaningful online interactions. Over time, these interactions will lead to generating influence related to their established identity, which can ultimately impact the social micro-society.6 While an individual’s social media impact can be determined and reinforced through MBT, it remains important to know that MBT is not exemplified in one specific tweet, but rather in the body of work shared by an individual that continuously reinforces the mission.
TWEETING FOR THE MOMENT VS FOR THE MOVEMENT: USING MBT FOR ADVOCACY
Advocacy typically involves using one’s voice to publicly support a specific interest. With that in mind, health advocacy can be divided into two categories: (1) agency, which involves advancing the health of individual patients within a system, and (2) activism, which acts to advance the health of communities or populations or change the structure of the healthcare system.7 While many physicians accept agency as part of their day-to-day job, activism is often more difficult. For example, physicians hoping to engage in health advocacy may be unable to travel to their state or federal legislature buildings, or their employers may restrict their ability to interact with elected officials. The emergence of social media and digital technology has lowered these barriers and created more accessible opportunities for physicians to engage in advocacy efforts.
Social media can provide an opportunity for clinicians to engage with other healthcare professionals, creating movements that have far-reaching effects across the healthcare spectrum. These movements, often driven by common hashtags, have expanded greatly beyond their originators’ intent, thus demonstrating the power of social media for healthcare activism (Table).4 Physician advocacy can provide accurate information about medical conditions and treatments, dispel myths that may affect patient care, and draw attention to conditions that impact their ability to provide that care. For instance, physicians and medical students recently used Twitter during the COVID-19 pandemic to focus on the real consequences of lack of access to personal protective equipment during the pandemic (Table).8,9 In the past year, physicians have used Twitter to highlight how structural racism perpetuates racial disparities in COVID-19 and to call for action against police brutality and the killing of unarmed Black citizens. Such activism has led to media appearances and even congressional testimony—which has, in turn, provided even larger audiences for clinicians’ advocacy efforts.10 Physicians can also use MBT to advocate for the medical profession. Strategic, mission-based, social media campaigns have focused on including women; Black, Indigenous, and People of Color (BIPOC); doctors with disabilities; and LGBTQ+ physicians in the narrative of what a doctor looks like (Table).11,12
When physicians consider their personal mission statement as it applies to their social media presence, it allows them to connect to something bigger than themselves, while helping guide them away from engagements that do not align with their personal or professional values. In this manner, MBT harnesses an individual’s authenticity and helps build their personal branding, which may ultimately result in more opportunities to advance their mission. In our experience, the constant delivery of mission-based content can even accelerate one’s professional work, help amplify others’ successes and voices, and ultimately lead to more meaningful engagement and activism.
However, it is important to note that there are potential downsides to engaging on social media, particularly for women and BIPOC users. For example, in a recent online survey, almost a quarter of physicians who responded reported personal attacks on social media, with one in six female physicians reporting sexual harassment.13 This risk may increase as an individual’s visibility and reach increase.
DEVELOP YOUR MISSION STATEMENT
To aid in MBT, we have found it useful to define your personal mission statement, which should succinctly describe your core values, the specific population or cause you serve, and your overarching goals or ideals. For example, someone interested in advocating for health justice might have the following mission statement: “To create and support a healthcare workforce and graduate medical education environment that strives for excellence and values Inclusion, Diversity, Access, and Equity as not only important, but necessary, for excellence.”14 Developing a personal mission statement permits more focus in all activities, including clinical, educational, administrative, or scholarship, and allows one to succinctly communicate important values with others.15 Communicating your personal mission statement concisely can improve the quality of your interactions with others and allows you to more precisely define the qualitative and quantitative impact of your social media engagement.
ENGAGING TO AMPLIFY YOUR MISSION
There are several options for creating and delivering effective mission-driven content on Twitter.16 We propose the Five A’s of MBT (Authenticity is key, Amplify other voices, Accelerate your work, Avoid arguments, Always be professional) to provide a general guide to ensuring that your tweets honor your mission (Figure). While each factor is important, we consider authenticity the most important as it guides consistency of the message, addresses your mission, and invites discussion. In this manner, even when physicians tweet about lived experiences or scientific data that may make some individuals uncomfortable, authenticity can still lead to meaningful engagement.17
There is synergy between amplifying other voices and accelerating your own work, as both provide an opportunity to highlight your specific advocacy interest. In the earlier example, the physician advocating for health justice may create a thread highlighting inequities in COVID-19 vaccination, including their own data and that of other health justice scholars, and in doing so, provide an invaluable repository of references or speakers for a future project.
We caution that not everyone will agree with your mission, so avoiding arguments and remaining professional in these interactions is paramount. Furthermore, it is also possible that a physician’s mission and opinions may not align with those of their employer, so it is important for social media users to review and clarify their employer’s social media policies to avoid violations and related repercussions. Physicians should tweet as if they were speaking into a microphone on the record, and authenticity should ground them into projecting the same personality online as they would offline.
We believe that, by the very nature of their chosen careers, physicians should step into the tension of advocacy. We acknowledge that physicians who are otherwise vocal advocates in other areas of life may be reluctant to engage on social media. However, if the measure of “success” on Twitter is meaningful interaction, sharing knowledge, and amplifying other voices according to a specific personal mission, MBT can be a useful framework. This is a call to action for hesitant physicians to take a leap and explore this platform, and for those already using social media to reevaluate their use and reflect on their mission. Physicians have been gifted a megaphone that can be used to combat misinformation, advocate for patients and the healthcare community, and advance needed discussions to benefit those in society who cannot speak for themselves. We advocate for physicians to look beyond the moment of a tweet and consider how your voice can contribute to a movement.
The authors thank Dr Vineet Arora for her contribution to early concept development for this manuscript and the JHM editorial staff for their productive feedback and editorial comments.