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Bereaved and aggrieved in the age of social media
Cancer and Society
painting to protect and promote psychoemotional wellbeing. But she acknowledges that art therapy may not be for everyone, and says
that she herself also gained strength from meditation, and the support of friends and family. Her message is not that everyone must paint, but that
everyone must care for themselves holistically.
Emily Jenkins
Society Bereaved and aggrieved in the age of social media
David Leahy, Cultura /Science Photo Library
It is an increasingly common scenario. An ashen-faced intern considers her future as she scrolls through a venomous social media rant. Her supervising oncologist offers what meagre comfort he can, yet he too has been named online. He seems to be bearing up well, but his colleagues see the slump in his shoulders, the almost imperceptible change in his gait. Yet another debriefing session for the ward staff takes place. And the grief of a family reverberates through the digital ether. Of course, physicians familiar with the gut-wrenching experience of delivering the news that death is inevitable are used to being on the receiving end of tears and even anger. We try not to take it to heart. For we know that although a minority of bereaved individuals demonstrate a response to loss that is severe and prolonged, most people do recover from their feelings of grief. At some point they find a way to make sense of the death, or at least find meaning in their experience of loss. However, when the despair and rage of bereavement are directed towards medical staff online, the collateral damage can be immense. Respected colleagues—doctors, nurses, allied health professionals—are now the subject of vile social media feeds and blogs, streams of expletives, unsubstantiated accusations of incompetence, obfuscation, and worse. Why? Because humanity has forgotten that death is a part of life? Because someone has to be to blame? Because it’s acceptable to threaten your doctor? There is no simple answer. Part of the problem is the evident decline 1008
in the value and status of medi cal professionals as providers of health-care advice. Unfettered access to information online is creating a deluded sense of expertise among patients and their families, as individuals search the web for snippets of text to validate opinions they already hold. We are also seeing emerging dialogue suggesting that the care and expertise of doctors will soon become redundant, as commentators discuss the inevitability of automation of medical decision making and the use of artificial intelligence. The pervasive creep of email and text messaging as mechanisms by which patients and their families communicate with their doctor has enabled overfamiliarity and erosion of boundaries. Further, the instantaneous nature of digital communication engenders a sense, if not an expectation, of constant availability, of being “on-call” 24 hours a day, 7 days a week—a commitment that few of us can reasonably meet. Finally, the respect doctors have traditionally enjoyed has been degraded by the increasing commod itisation of our profession. Although in previous times the idea of a doctor advertising their services was anathema to many, most of us now have at least some online presence. Increasingly we see websites dedicated to “doctor rating”, as if we were a hotel, a movie, or a restaurant. Thus medical expertise is seen as any other dish to be selected from a virtual menu. The problem is that for physicians treating life-threatening illnesses such as cancer, the advice we have to give is almost always unpalatable.
Separate from the issue of the devaluing of expert medical advice are the societal effects of the increasing use of digital communication. The combination of immediacy and remoteness is eroding thoughtfulness and civility in our interactions with one another. Behaviour considered unthinkable face-to-face is given a veneer of acceptability in a world where we spend more time looking at a screen than at each other. Finding solutions to “doctorshaming” is problematic, yet left unchecked it poses risks of substantial psychological and reputational harm, particularly at a time when we are trying to address issues such as physician suicide and medical workforce stress. Sadly, many of the contributing factors are intractable since we cannot reverse the march of progress, and nor would we necessarily want to. But we can control how we market ourselves, the information that we post online, and be judicious in our own use of social media platforms. Clearly the appropriate response to individual incidents will depend on the particular facts of each case. Yet we acknowledge that most times, angry families are in need of comfort and care rather than retribution. The importance of the provision of psychological and bereavement services should not be underestimated, particularly in environments such as cancer medicine and hospice units. If we value compassionate care at the time of infirmity and death, investment in such preventive strategies is crucial.
Catriona M McNeil, Martin H N Tattersall www.thelancet.com/oncology Vol 18 August 2017
painting to protect and promote psychoemotional wellbeing. But she acknowledges that art therapy may not be for everyone, and says
that she herself also gained strength from meditation, and the support of friends and family. Her message is not that everyone must paint, but that
everyone must care for themselves holistically.
Emily Jenkins
Society Bereaved and aggrieved in the age of social media
David Leahy, Cultura /Science Photo Library
It is an increasingly common scenario. An ashen-faced intern considers her future as she scrolls through a venomous social media rant. Her supervising oncologist offers what meagre comfort he can, yet he too has been named online. He seems to be bearing up well, but his colleagues see the slump in his shoulders, the almost imperceptible change in his gait. Yet another debriefing session for the ward staff takes place. And the grief of a family reverberates through the digital ether. Of course, physicians familiar with the gut-wrenching experience of delivering the news that death is inevitable are used to being on the receiving end of tears and even anger. We try not to take it to heart. For we know that although a minority of bereaved individuals demonstrate a response to loss that is severe and prolonged, most people do recover from their feelings of grief. At some point they find a way to make sense of the death, or at least find meaning in their experience of loss. However, when the despair and rage of bereavement are directed towards medical staff online, the collateral damage can be immense. Respected colleagues—doctors, nurses, allied health professionals—are now the subject of vile social media feeds and blogs, streams of expletives, unsubstantiated accusations of incompetence, obfuscation, and worse. Why? Because humanity has forgotten that death is a part of life? Because someone has to be to blame? Because it’s acceptable to threaten your doctor? There is no simple answer. Part of the problem is the evident decline 1008
in the value and status of medi cal professionals as providers of health-care advice. Unfettered access to information online is creating a deluded sense of expertise among patients and their families, as individuals search the web for snippets of text to validate opinions they already hold. We are also seeing emerging dialogue suggesting that the care and expertise of doctors will soon become redundant, as commentators discuss the inevitability of automation of medical decision making and the use of artificial intelligence. The pervasive creep of email and text messaging as mechanisms by which patients and their families communicate with their doctor has enabled overfamiliarity and erosion of boundaries. Further, the instantaneous nature of digital communication engenders a sense, if not an expectation, of constant availability, of being “on-call” 24 hours a day, 7 days a week—a commitment that few of us can reasonably meet. Finally, the respect doctors have traditionally enjoyed has been degraded by the increasing commod itisation of our profession. Although in previous times the idea of a doctor advertising their services was anathema to many, most of us now have at least some online presence. Increasingly we see websites dedicated to “doctor rating”, as if we were a hotel, a movie, or a restaurant. Thus medical expertise is seen as any other dish to be selected from a virtual menu. The problem is that for physicians treating life-threatening illnesses such as cancer, the advice we have to give is almost always unpalatable.
Separate from the issue of the devaluing of expert medical advice are the societal effects of the increasing use of digital communication. The combination of immediacy and remoteness is eroding thoughtfulness and civility in our interactions with one another. Behaviour considered unthinkable face-to-face is given a veneer of acceptability in a world where we spend more time looking at a screen than at each other. Finding solutions to “doctorshaming” is problematic, yet left unchecked it poses risks of substantial psychological and reputational harm, particularly at a time when we are trying to address issues such as physician suicide and medical workforce stress. Sadly, many of the contributing factors are intractable since we cannot reverse the march of progress, and nor would we necessarily want to. But we can control how we market ourselves, the information that we post online, and be judicious in our own use of social media platforms. Clearly the appropriate response to individual incidents will depend on the particular facts of each case. Yet we acknowledge that most times, angry families are in need of comfort and care rather than retribution. The importance of the provision of psychological and bereavement services should not be underestimated, particularly in environments such as cancer medicine and hospice units. If we value compassionate care at the time of infirmity and death, investment in such preventive strategies is crucial.
Catriona M McNeil, Martin H N Tattersall www.thelancet.com/oncology Vol 18 August 2017