The debate on defining health professionalism is at its peak as both generational and gender divides clash in ever-more-public forums. As young paramedics increase their presence on social media to advocate on public health issues, or for social justice, top medical organizations continue to recommend the separation of personal and professional social media accounts. While paramedic schools integrate “advocacy” training into their curricula and competency checklists, EMS organisations often advise clinicians not to speak out except through official public relations teams.
As both a paramedic and physician, I sometimes feel the need to have an alias to conduct well-intentioned advocacy and feel pressured to separate my personal and professional personas, especially on social media. But this instinct, while driven by organizational and social forces within my professions, is dead wrong. The very nature of advocacy demands use of one’s whole persona as currency to engage an audience, spark awareness, and effect change.
Yet almost unanimously, employers and regulators alike suggest that health professionals separate their personal and professional social media accounts (1). They dictate that the two should not mix.
The debate is not an abstract one confined to policy documents. Paramedics have been fired for social media posts; in one ridiculous example, a paramedic was suspended after a video was posted online of him dancing (2).
Perhaps no topic has been hotter than the gun control debate. On the issue of physicians advocating for stricter gun control, many have been told to “stay in their lane” when calling for stricter controls. Najma Ahmed, a Toronto-based surgeon was on call the night of a 2018 mass shooting in the Danforth district of Toronto. Shortly after launching anti-gun activitism, Ahmed was reportedly the target of nearly 70 complaints (3) made to her regulatory College by the pro-firearm community. She also faced harassment online. Elsewhere, there have been reports of healthcare workers, across the world, unable to speak out when they have disagreed with their government’s handling of the covid-19 pandemic, for fear of repercussions.
I myself have been targeted by bosses, peers and the public for speaking truth to power, finding strength in my allies, which include leaders who have protected me from retribution sought by less gracious players. Ultimately, there is risk to speaking up and speaking out; some organizations are even creating policies to prevent it (4, 5).
Many governments, hospitals and EMS services have “social media policies” that effectively silence paramedics who wish to speak publicly. Designed to maintain privacy and mitigate institutional reputational risk, these policies are so broad they can often be interpreted to include advocacy efforts. These policies are bizarrely strict, poorly enforced, open to interpretation, and miss the boat entirely on the essence of what makes an advocate any good at advocating – their ability to connect to an audience through authenticity.
While there are unacceptable posts on social media – like those that allow a patient to be identified unwantedly or racist remarks – times are changing for those advocating for thorny issues with pure intent. Dr. Ahmed wasn’t sanctioned for her anti-gun advocacy; in fact, after her regulatory College exonerated her, she was promoted to surgeon-in-chief. Paramedics are increasingly participating in social movements such as Black Lives Matters, wearing rainbow pins, or taking part in events such as pride parades or the protests after the death of George Floyd. We are ignoring the advice to “stay in our lanes” – because we are the social safety net, we can rightfully claim many lanes at once.
Separating the personal from the professional promotes the false idea that paramedics hold objective opinions only. How can we ask vulnerability of our patients while remaining machine-like or elusive? Making a therapeutic bond with a patient is a two-way street. In times like these, we must also make a therapeutic relationship with the public to advocate effectively, and the work of advocacy requires revealing our true selves.
A quick search for online advice for paramedics and firefighters wishing to avoid social media controversies misses the mark. The top three EMS websites all have prescriptive articles advising medics to crop out employer names on uniforms and vehicles, avoid commenting on local political matters, and even suggest leaving all work-related communications to the designated public relations folks (who, in my experience, do everything possible NOT to be in the news). While there are certainly rules and etiquette to follow, and proper training in storytelling and advocacy enables effective efforts, these archaic recommendations should be relegated to history; a new mantra is needed to carry paramedic voices to the masses and advocate for better health.
My Twitter, Facebook and website reflect who I am: an advocate for a better healthcare system for everyone. That means I raise perspectives that are sometimes controversial; I do so without regret, because I believe that the best solutions are found through public discourse, not in back rooms by those with limited perspectives and particular motives. I also post about who I am as a person; in fact, my most shared and viewed posts are not scientific articles, public health data reveals, or investigative headlines. They are pictures of me and my fiancee cooking in our backyard, having brunch in the park with my cat Doug, or expressions of exhaustion and sorrow coming off a night shift in the ICU. These posts may seem to be superfluous, but they build connection and resonance with my audience of followers, which allows me to connect to them with professional comments about the COVID pandemic, breaking health news, and new science.
Many of my posts could be accused of being non-compliant with the guidelines and policies of regulators and employers, because I speak out on public health advocacy issues. Are sanctions and disciplinary action in my future?
At a time when trust in medicine and science is low and the consequences of medical misinformation have never been more obvious, forming therapeutic relationships with the public has emerged as a new priority for health advocates. To better build trust, paramedics with an online presence should be encouraged to express vulnerability and authenticity, even when things get thorny.
This article is based off of an article in the BMJ co-authored with Sarah Fraser.
Competing interests: none declared.
1. Professionalism in the Use of Social Media [Internet]. American Medical Association. 2021 [cited 17 June 2021]. Available from: https://www.ama-assn.org/delivering-care/ethics/professionalism-use-social-media
2. Scott F. McConnell P, Scott F. McConnell P. First responders feel negative effects of social media [Internet]. Distance CME. 2021 [cited 17 June 2021]. Available from: https://www.distancecme.com/blog/social-media-posts-when-do-they-cross-the-line/
3. Toronto surgeon seeking handgun ban accuses firearms rights group of trying to intimidate her | CBC News [Internet]. CBC. 2021 [cited 17 June 2021]. Available from: https://www.cbc.ca/news/canada/toronto/najma-ahmed-surgeon-gun-control-rights-1.5048707
4. NPR Cookie Consent and Choices [Internet]. Npr.org. 2021 [cited 28 June 2021]. Available from: https://www.npr.org/sections/coronavirus-live-updates/2020/06/11/875161922/new-york-city-ems-workers-allege-retaliation-after-speaking-about-pandemic
5. [Internet]. 2021 [cited 28 June 2021]. Available from: https://www.jems.com/news/paramedics-could-be-fired-social-media-p/