Welcome to Medical Twitter or MedTwitter. You may have joined to learn or to network. It won’t take long for you to realise it is a strange place.
It’s an inclusive and diverse world where everyone agrees that Civility Saves. It’s nice to be important but even more important to be nice. Tweets are posted in threads going well over double figures spreading education, values, and virtues. There are educators, researchers, and authors. ‘Celebrities’, quacks and peddlers. It’s a game of choosing who is worth a follow and who is worth a mute. It’s saccharine, occasionally sanctimonious, often banal but always nice. Until it turns. Gosh, how it can turn.
You may be going in with the most virtuous of intentions but it’s important to be armed with the knowledge of the vices you might encounter on your way. The seven deadly sins have been part of Christian teaching since about the fourth century and feature the vices to be avoided: Pride, Wrath, Greed, Envy, Lust, Gluttony, and Sloth. Whilst it seems churlish to compare Medical Twitter to an actual religion (although many tweeters would like to be seen as prophets) these vices are similar to those you’ll see on your tweeting journey.
I am by no means the first person to cock a snook at the world of medical Twitter. Having been heavily inspired by @SamuelBS85, @JTweeterson, and @placemat_the I tentatively present for your consideration the seven deadly sins of MedTwitter:
Pride
I’m certain that when Tim Berners-Lee invented the internet in 1989 he did not have education at the forefront of his mind. Or connectivity. Or widening participation in society. No, I am certain he was hopeful that three decades later there would be a website on the internet where doctors would finally be able to debate the correct way of introducing themselves on the telephone.
We start with Pride because this is perhaps the most pervasive of the Deadly Sins of MedTwitter. I’m not talking about a student proudly posting they’ve passed an exam or a doctor announcing they’ve made it as a consultant. Pride in MedTwitter exists in a number of forms.
First, there’s virtue signalling. By no means a phenomenon isolated to MedTwitter but the variant seen amongst doctors on Twitter can be amongst the most virulent. I bow down the aforementioned superior blog of @jtweeterson on this matter and implore you to read their guide to virtue signalling.
However, Pride in MedTwitter goes further. Pride is what convinces someone that their hot take on whether or not we should call hyperkalaemia ‘hyperkalaemia’ is actually really important and needs to be shared. Of course, it’s nonsense. Of course, it’s a totally pointless endeavour but Pride means that people will reply. And discuss whether we should call something that it is called. And this will dominate MedTwitter for a good day or so. And nothing changes.
It’s difficult to predict what will be the latest hot take. Maybe it’s whether we should write ‘deny’ in our notes. Or what sort of job title we should allow non-doctors to have. Or someone thinks they should be allowed to review the notes for the actual President of the United States. Pride is hard to predict but it will always be there. But it’s not the initial post that is important. It’s the self-aggrandising discussion it prompts as well.
You may see doctors so full of Pride they refer to themselves as ‘angels’ or ‘heroes’. Fair enough if this comes from a grateful patient or relative but healthcare workers are not heroes or angels. They are people doing a job. Calling ourselves heroes or angels sets a level of expectation and moral authority that’s impossible to maintain. It also avoids real discussions about the issues in healthcare. But that’s not the point. It’s all about Pride.
Let’s get out our electron microscopes to start splitting the finest of hairs. Just be careful about getting torticollis from all that navel-gazing. Remember, for 99.9% of all human beings none of this matters.
How to spot:
Virtue signalling is incredibly easy to spot. Remember: it achieves nothing except making the poster look virtuous. The poster gets likes and retweets and gets praised for being an example to us all. It’s not there to share best practice or knowledge or to even promote a trust or hospital. It exists only to make a person look good and therefore is mostly disingenuous. It also implies that anyone not meeting these lofty examples is failing. There won’t be any education or tips or actual, measurable quality improvement.
There might also be a slogan attached such as “every patient, ‘every time, without fail” or ‘“the standard you walk past is the standard you accept”.
There may be an empty gesture such as a consultant giving their lanyard to their F1 as this ‘flattens the hierarchy’ even though everyone from the cleaner to the matron knows who’s really the boss. This will always be accompanied by a hashtag such as #Leadership or #HumanFactors.
Nurses are a common target for tactical virtue signalling by doctors in a condescending way of showing your virtuous credentials. Even if the rest of their output suggests they are anything but virtuous.
Remember: for a lot of people their virtue definitely doesn’t go without saying/tweeting.
A ridiculous hot take will tend to follow these four simple steps:
The original tweet is sent something like “Stop calling potassium ‘potassium’ it’s elitist and wrong”
There’s immediate support praising the tweeter as a visionary for daring to question the status quo, of course, it’s wrong to call potassium ‘potassium’ and everyone who does is basically a fascist
There’s the counterargument pointing out how ridiculous this is all is
There’s the counter-counter argument telling those in Step 3 to #BeKind
And nothing changes. Plus ça tweets, plus c'est la même chose.
Wrath
You have to worry about the blood pressure of many doctors on social media. The constant, sheer anger. They tweet about their rota, the cafeteria menu, their uniform, their break times, the government, parking, their supervisor, their portfolio…the list goes on and on. And they get their likes and their replies and their validation and so they keep churning out their anger. And nothing gets solved. Because rather than following correct channels in place through which doctors can voice their grievances they emit them into the void.
Because that’s their brand. No solutions offered or discussions had. Just impotent rage. It is important that nothing actually improves because then they would have nothing to actually post about.
How to spot:
First and foremost every tweet will be a complaint. Read any random segment of their timeline and you will be left with such a sense of righteous indignation on their behalf; that no-one in the history of Medicine, or perhaps mankind, has ever been so wronged.
You’re right, how dare the consultant be two minutes late for a ward round! You are literally the new Nelson Mandela, you should definitely strike!
Doctors taking a knee outside Downing Street…in the same week as George Floyd was killed…classy…
There may be terrible political gestures: sanctimonious lecturing on public transport or doctors in full scrubs (and stethoscopes) handing out documents at a Labour Party Press Conference. They may take a knee outside Downing Street in the very same week as George Floyd was killed by a policeman in Minnesota. Or threaten to resign unless the Chief Advisor to the actual Prime Minister resigns first.
Remember: absolutely nothing productive will come from wrath. It may generate some newspaper column inches and the doctor will talk about the intangible benefit of ‘increasing awareness’ but no actual benefit will actually be made. Ever. In fact, the only tangible impact I’ve ever seen was a few medical students in tears the day after the last election because doctors on social media had convinced them that the Tories ate children.
Greed
This is where we take Pride even further. Of course you’ll still be all about virtue signalling. And there’s Wrath. But that doesn’t pay the rent. It’s time to get some green.
We can’t all get that sweet Furniture Village gig. It’s time to monetise the one thing you’ve got ready access to: patients.
Time to write the definitive pandemic journal. Until the next one. Each journal is more definitive than the last. Let’s get sharing those intimate moments your patients trusted with you. Well, they didn’t say they didn’t want you writing about them did they? Suckers.
Each elderly patient is just the same as the other, after all. You have a point to prove in whatever narrative is in Chapter 8 so let’s get mushing all those lives together to fit it. The patient said they didn’t want resuscitation but they didn’t mention amalgamation did they? Of course changing names and details will definitely not offend any relatives whose opinions you didn’t seek in the first place. Is this a fair way to treat the lives of fellow human beings? La-la-la can’t hear you!
The pandemic has made people want to buy masks. Time to step up. You’re a spokesperson now. Get your ‘brand’ on some knock-off PPE and get people buying so you can keep sharing your truth. Keep saying how “inspiring” and “breathtaking” you’ve found the NHS. In fact, the only thing more breathtaking is your sheer gall but hey, you’re the one getting to make it rain!
How to spot:
They will almost certainly have joined Twitter during the junior doctors’ strikes in 2016.
They will have been described as “the voice of junior doctors/the NHS” and, while they may not have first called themselves that, they definitely won’t argue. You imagine they spend every evening sticking pins into their doll of Jeremy Hunt.
They definitely write for The Guardian or HuffPost. Owen Jones and various Labour backbenchers will certainly retweet them. A link to their book at Waterstones or a Just Giving page will never be far away. In fact, it’s probably their pinned tweet.
Criticism is possible, but you will unleash the full force of fury and accusations of jealousy and heresy. They even have found a lawyer friend to be their ‘Head of Legal’ to hunt you down for your sacrilegious behaviour.
It’s better to mute but not before remembering that every day their first emotion is sheer fury at the fact that they are not Adam Kay before unleashing an Edvard Munch-esque scream to the cosmos.
Envy
You know how it is. You’ve reached a level of achievement in your profession. You’re (probably only technically) a consultant or a professor. You’re probably known for tweeting about a single topic or condition. And, let’s face it, apart from a few notable examples you’re a man. Suddenly, a pandemic has come along and the general public suddenly wants to hear from that dweeb Chris Whitty rather than you. What to do? Only one thing for it. Incessantly tweet. Make it all about you and your favourite topic. Never mind that you know nothing about virology and epidemiology. Remember: you’re a genius and the world needs to hear from you.
Domestic violence against women? Definitely something you should comment on. Is there really a second wave? You should definitely share your gut feeling that PHE is wrong and that lockdown doesn’t work with the world. Evidence-Based Medicine? Leave that to that nerd JVT. You’re here for likes and retweets only, baby. COVID-19 is due to too much processed sugar and you need to get the word out that people can buy your badly written book to make it all go away. Insult if you must. If people ask for evidence you can always block them.
How to spot:
Their timeline is one long circle jerk to their magnificent ego. They’ll make every event about their area of ‘expertise’. After tweeting about how Black Lives Matter is all down to gluten they’ll retweet not only their original post but each and every supportive reply they’ve ever received, even if critical responses are in the majority 10:1.
They will definitely have appeared on Good Morning Britain or whatever radio programme is hosted by Julia Hartley-Brewer. They may have written for the Daily Mail or Daily Express. They’ll absolutely have quoted ‘data’ from that Statistics Guy Jon. They’ll be retweeted by such luminaries as Allison Pearson, Lawrence Fox and Anthea Turner.
Once again, there’s no discussion. Dissent is not tolerated. If in doubt they’ll claim to be the sole voice of reason in a profession of idiots. Bringing the profession into disrepute? Do one mate. The GMC doesn't care. Trust me.
Lust
It’s easy to a cock a snook and sneer in Medicine but actually it is pretty amazing. Passion for our job is a good thing and inspires us to do our best. Lust is something else though. Passion is about building and trying to be better. Lust is all about the glory.
Take your passion and tell us EXACTLY what happened.
You’re the on-call doctor and you’ve been called from home by your junior? The simply passionate would merely fulfill their contractual obligation and come in and do their job. Not for the lustful. Over at least 30 tweets you will reveal in painstaking detail exactly how you fulfilled the basic demands of your job. Don’t just tell us what was said, tell us HOW it was said. Make sure you mention exactly how breathless you were. And make sure you take a photo of the junior to stick right at the end of your thread? Why? Lust. That’s why.
Conflict at work? A private conversation between you and a colleague? A patient’s last moments of life? Definitely share these with your followers. Added points if you can mention when the patient coughed or cried or how breathless you all were.
Your sycophants will thank you for sharing YOUR story even though it never is your story or yours to share.
How to spot:
Invariably the tweet will have ‘A thread’ someone in it. Or a number. The truly professionally lustful will calculate exactly how long their thread will be and kindly orientate you by putting (1/34) at the end.
Is it a private moment or conversation? Are they revealing the last words of a patient’s FaceTime with relatives before intubation? Do you get an awkward, voyeuristic feeling as though you’re encroaching on something private? Listen to that.
It’s fair to say that few tweet formats are as annoying as “that’s the tweet” but brevity is a sweet delight in comparison to the unruly mess of 30+ long thread of nauseous saccharine. The lustful will release a steady stream of intrusive, mawkishness to feed their followers. You can point out how they’re violating confidentiality which won’t go down well with their sycophants. So it’s best to just mute them. After you’ve finished dry heaving. And checking if it’s possible to develop ocular diabetes just by reading.
Gluttony
This is the one we are all guilty of. Because we are.
Something mildly funny and relevant comes along. Bernie Sanders at Biden’s inauguration. Jackie Weaver. Oprah’s face. Someone uses the meme in a post which generates some love. You want in on those intoxicating likes and retweets.
Time to get flooding Twitter with “Bernie as every anaesthetist ever” or “Oprah’s face as the reply when a Group and Save is rejected’. Of course this is a game of diminishing returns because every tweet ruins the joke just a little bit more. So your tweet will never get the response it deserved because you’re destroying the very thing you love.
This led to the wave of TikTok embarrassments last summer as medics ‘challenged’ each other to wear PPE and dance to Mambo No. 5. In the same afternoon as tweeting about how busy the NHS was and people should stay away. Luckily we were spared the insanity when some nurses did the haka and were accused of racism. The lesson: @DGlaucomflecken is the only medic who should be allowed to use TikTok. The rest need blocking immediately.
How to spot:
This is easy to spot as soon as you log in. Your timeline will be a sea of the same meme over and over again. You will roll your eyes but soon you’ll be their trying to fit Hagrid into your thread of ‘Hogwarts teachers as ODPs’ or finding a fresh angle on ‘Jessica Fletcher as the on-call anaesthetic SHO at a DGH on a Bank Holiday when there’s a fire drill’.
This is why we can’t have anything nice. We’re sick.
Sloth
Sloth comes from a translation of the Latin term acedia meaning ‘without care’. Sloth in MedTwitter is not about laziness but instead about doctors not taking care with the information they put out.
It might start off innocently enough. You’ve read an article stating that mortality in 2020 was actually lower than previous years. You only casually glance at the methodology and hit the retweet button to broaden the debate. That is the gateway to the sloth-side of MedTwitter.
Before you know it you’re commenting on things you know nothing about. Sure you specialised in Endocrinology but you definitely should be able to discuss complex epidemiology with the BBC. The media has a role in this too of course. The Guardian appeared to have their own sideline in approaching re-deployed F1s for opinion pieces entitled “As an ICU doctor…” They are guilty of sloth too. Such has been the demand for a talking head we’ve been saturated with doctors talking far outside of their lane of expertise with all the inherent risk.
You read that hats with names on save lives. Boom, that’s a retweet. Medical error is the third biggest cause of death? Boom, that’s a retweet. Blood clots following the AstraZeneca vaccine? Boom, that’s a retweet.
If you feel it you post it. You think your PPE is ‘flimsy’ despite it being fully PHE and WHO compliant? Make sure the world knows. Never mind that this is the same thought process of every vaccine hesitant patient who looks at the evidence yet feels they know better. Never mind that doctors are trained to use evidence. Felt it? Post it. Somebody else already posted it? Boom, that’s a retweet.
Sloth is what happens when we don’t take just a moment to question what we’re reading. Sloth is what allows all the other sins to get away with it without being challenged.
It literally only takes a moment, a few seconds to use our training and ask a question:
Does this statistic really make sense?
Is this opinion being presented as fact?
Is this doctor using confidential information to peddle their latest book?
Am I just being manipulated into buying some masks?
Is someone whose fame is entirely based on appearing on a reality TV show REALLY the best person to speak for our profession?
Once again we are all guilty of this. The trick is to recognise it.
How to spot:
The trick is to just take one moment and question what you’ve read:
OK, you’re telling me that medical error is the third biggest cause of death in the US.
That might seem reasonable but if we think about it would therefore mean that medical error kills more people in the US than road traffic accidents. Does that make sense? Of course not. Just one moment, one question and suddenly that number doesn’t stand up.
We can then have a read about it and realise just how badly that number stands up. Suddenly other claims being made might be questioned:
You’re telling me now that if I have a hat with my name on it it’s been proven to save lives?
It once again is merely the matter of a moment to assess the evidence and find conclusions such as how names on hats “could improve communication in crisis scenarios and help break down hierarchical barriers on a daily basis, resulting in improved patient safety” and how the results are based on staff responses not patient outcomes and how “there is currently a lack of academic evidence to show that knowing a name and role improves patient outcomes”.
Just a few minutes of thinking and checking and we can spot the arse gravy.
In the words of Take That “it only takes a minute” to identify those peddling utter arse gravy on MedTwitter, mute them and suddenly the whole experience is a better place to be.
Stick to your lane of expertise. Remember the difference between opinion (no matter how considered) and fact. Check your ego. And always keep in mind that there will always be someone who knows more than you about something. And you don’t have to like them for them to be right. And just because you like them it doesn’t mean they’re not wrong.
So there we have it. The Seven Deadly Sins of MedTwitter. I’m aware by writing this I’m guilty myself of quite a few of them. But hopefully you’ve enjoyed this nonetheless.
It’s really important to remember: none of it really matters. If in doubt, mute and put your phone down and so something important.
As the Jewish Book of Sirach said of the original Seven Deadly Sins:
“If you keep adding to them, you will not be without reproach; if you run after them,
you will not succeed nor will you ever be free, although you try to escape.”