Article In Brief
Physicians in general and pediatric neurologists in particular have experienced online harassment in response to their efforts to promote awareness of the need for vaccines. They share their stories and tips for how to address the cyberbullying.
Eight years ago, after I wrote about the human papillomavirus vaccine for boys, the story received a barrage of angry letters and posts full of blistering criticism from what appeared to be an organized effort. I now consider myself lucky. I wasn't attacked personally, I wasn't threatened, and it did not cause damage to my professional reputation. These days, with the proliferation of social media, retaliation for medical opinions can result in all those things. Called cyberbullying or online harassment, digital attacks against physicians have become well-orchestrated, methodical, and meant to cause deliberate harm.
Dana Corriel, MD, an internist in Pearl River, NY, was one such victim. In September, she wrote on Facebook that the flu vaccine had arrived and she encouraged patients to come to her office for a shot. By the end of the day, her post was flooded with thousands of comments from anti-vaxxers and soon she began to see one-star ratings from people she had never met.
They called her a “pharma vaccine whore” and a “child killer,” according to screenshots that Dr. Corriel shared for a story in the March 18 Los Angeles Times, which revealed that more than 50 online campaigns against health providers who promote vaccines, have taken place since late 2017—some of which have led to threats of harm that prompted calls to the police.
That is likely an underestimate. A 2017 Pew Research Center survey of 4,248 U.S. adults found that 41 percent of Americans have been personally subjected to harassing behavior online, and an even larger number (66 percent) have witnessed these behaviors directed at others. In some cases, these experiences were disregarded as a nuisance of online life, likened to offensive name-calling or efforts to embarrass someone. But nearly one in five Americans (18 percent) acknowledged that they had been subjected to particularly severe forms of harassment online, such as physical threats, harassment over a sustained period, sexual harassment, or stalking.
Neurologists in the Crosshairs
While the hostility targeted against physicians has been largely focused on pediatricians and internists like Dr. Corriel who administer vaccines, child neurologists have also fallen victim to attacks. In July of last year, Donald L. Gilbert, MD, MS, FAAN, FAAP, child neurology program director and director of the Tourette Syndrome and Movement Disorders Clinic at Cincinnati Children's Hospital Medical Center, agreed to be interviewed about pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) for the ABC show “20/20.”
In his televised interview, Dr. Gilbert said that even if PANDAS is a legitimate diagnosis, it is most likely extremely rare and over-diagnosed. Around the time it aired, he gave a related Grand Rounds, which his institution placed online, and co-authored a review article on the subject, which was published in the August 2018 issue of Journal of Pediatrics. All that national exposure caught the attention of the P.A.N.D.A.S Network, a patient advocacy organization, which posted this call to action to its members on its Facebook page excerpted here: “If you have been a patient of Dr. Don Gilbert at CCH and did not receive adequate care for your child OR you are concerned about his recent grand rounds presentation, you may file a complaint through any or all of these three options: (1) CME complaint, (2) Provider complaint with the State Medical Board of Ohio. (3) Report a patient safety event with the Joint Commission.”
The post went on to provide numbered step-by-step instructions as to how to submit those complaints. Dr. Gilbert was soon deluged with emails from angry viewers and one-star reviews on patient review sites like Vitals.com. (Physicians have fallen prey to similar attacks on other physician ratings sites as well as Google and Yelp, noting one-star reviews from zip codes distant from their office locations.) “Fortunately,” Dr. Gilbert said, “I had a very supportive institution that trusted my reputation and expertise in this area, and residents who rallied around me when they heard what happened.”
Early on, Dr. Gilbert turned to Max Wiznitzer, MD, FAAN, pediatric neurologist at the Neurologic Institute at University Hospitals Rainbow Babies and Children's Hospital, and professor of pediatrics and neurology, at Case Western Reserve University School of Medicine, who has had similar experiences. As an expert on vaccine safety, Dr. Wiznitzer often speaks out about the lack of scientific evidence about vaccines as the cause of conditions such as autism and attention deficit-hyperactivity disorder. Having received numerous angry emails and letters for over 30 years, he urges restraint to those new to the digital battlefield.
“When something like this happens, take a deep breath, step back, and think,” Dr. Wiznitzer advised. Studies of vaccine hesitancy have found that there is a very small group of true believers, he said, noting that the larger group are hesitant because they are anxious or don't have sufficient information.
“The key is to differentiate between the two,” he said. “Do nothing that same day and come back the next day and ask yourself if the comments are worthy of a response.”
As he told Dr. Gilbert, “If it's an ‘ad hominem’ attack, you are unlikely to change any minds by responding, and if you do respond, you are likely to stoke the flames.”
Dr. Gilbert followed his counsel and stopped looking at those emails. Eventually, the attention died down. He never heard from his state medical board or the Joint Commission. He contacted Vitals.com and they responded after about a month and deleted most of the fake patient reviews.
While online harassment can be orchestrated by groups, it can also be the tactic used by disgruntled patients. Carrie Dougherty, MD, assistant professor of neurology at Medstar Georgetown University Hospital, and headache specialist, learned this first-hand several months ago when a patient, for whom she denied a request for permanent disability, posted a screen shot of a portal message she had sent her on the American Migraine Foundation's “Move Against Migraine” Facebook page. “In the post, my patient told everyone how awful I was and linked it to a recent member spotlight of me at the American Headache Society website,” Dr. Dougherty said.
“Do nothing that same day and come back the next day and ask yourself if the comments are worthy of a response. ...If it's an ‘ad hominem’ attack, you are unlikely to change any minds by responding, and if you do respond, you are likely to stoke the flames.”
—DR. MAX WIZNITZER
“Luckily a colleague alerted me and I was able to request the post be removed quickly,” she added. But it made Dr. Dougherty more cautious about her online presence. Since this incident, she is much more careful about what she writes in portal messages and considers how her replies would hold up in a court of public opinion.
“You have to think about how your statements might be taken out of context,” she explained, pointing out—as other physicians in her position have acknowledged—it is not a level playing field. “Bound by physician-patient confidentiality, I was unable to post a reply in defense of my position.”
Speak the Truth
As neurologists take on more responsibility for public health in this climate, particularly when it comes to vaccines, the risks of angering both individuals and patient groups and being victims of online retribution may be worth considering.
Pediatric neurologist Bruce H. Cohen, MD, FAAN, director of the NeuroDevelopmental Science Center at Akron Children's Hospital, said his department recently undertook a quality project to increase flu vaccination rates for their patients, vulnerable children with the whole range of neurological disabilities. “Although it is generally considered the responsibility of the primary care provider to ensure that patients get flu vaccines, we feel that it is all of our system's responsibility,” Dr. Cohen said.
The flu, he explained, can be a devastating illness in any person, but in people with neurological illness, the risk of secondary pneumonia, dehydration, and neurological deterioration are considerable. By offering vaccinations during the visit to his center, he hopes to increase the overall vaccination rates of their patients.
“The convenience and cost savings to the families is considerable if their child has a visit during flu vaccine season, October through March,” Dr. Cohen pointed out.
Dr. Cohen recognizes that the infrastructure necessary to do this project is not going to be easy. He also acknowledges that experiences like Dr. Corriel's come with the territory. As a neurologist, his initial thoughts regarding the question, “Is it the neurologist's responsibility to vaccinate our patients for infectious diseases?,” has shifted from “Not really” to “Well, it sort of is.”
Dr. Wiznitzer believes that we all have a responsibility as neurologists to speak the truth and educate the public. “If we don't provide accurate information, the public will only be exposed to misinformation from the other side,” he argued. “If we don't speak up, who will?”
Ultimately, despite the cyberbullying, Drs. Corriel and Gilbert expressed compassion for their detractors. “I understand frustration and fear, so I try to not put the other person and their experiences down—only they've walked in their shoes,” Dr. Corriel said. “But I still try to stick with the science and respond politely.”
Dr. Gilbert, who spoke about his experience at the Child Neurology Section meeting at the 2019 Annual Meeting in Philadelphia, also understands the challenges parents who have children with neuropsychiatric disease face. “We are neurologists, and this comes with the job,” he said. “These people have terrible things happening to their child, so it's understandable that emotions are high.”
How to Monitor Your Online Reputation
Andy Beal, an online reputation management consultant and coauthor of several books on the subject including Radically Transparent: Monitoring and Managing Reputations Online and Repped: 30 Days to a Better Online Reputation offered advice to physicians facing cyberbullying.
- Whenever you voice a specific medical opinion, it's important that you understand your audience and they understand and trust your expertise. When stating your opinion, also state your credentials, cite trusted studies that support your opinions, and share on a platform that is also trusted. An opinion piece written for Neurology Today will garner more respect than one written for Facebook. By doing so, you will insulate yourself from any attacks by those that disagree with you. You may still face an attack on your reputation, but it will carry little weight if unbiased readers can see that you are a trusted expert.
- When facing an attack on your reputation, consider the motives and trust of your detractors. If it's clear that the attack comes from a patient group that has a reputation of attacking anyone that counters their beliefs, consider letting them have their say, but leave them alone. If you get into an argument with them, you may stir them up for further attacks and also leave the impression with others that you are a doctor that lacks patience and empathy.
- Understand your centers of influence. Where do your patients hang out online? Where have they told you they found you? Whether Vitals, Healthgrades, or even Facebook, make sure you keep an eye on your reputation at those locations. Be proactive in funneling happy patients to those centers of influence. If patients tell you that you have been an immense help, thank them and then ask them if they would mind sharing their experience at Vitals or Healthgrades.
- If you feel a review is due to an unwarranted or unrelated attack, then let the review platform know via an email to their customer service or flagging the review as spam. Just don't spend too much time worrying over it. Those that read the negative reviews will look at the reason. If it's because of an online attack from a patient group, they will likely ignore it. Studies have shown that word of mouth is the number one way method for doctor recommendations.
- Many online review sites such as Yelp and Google have algorithms to filter out fake reviews. They also easily let you flag a fake review and generally have it removed or filtered out within just a few days.
- Legal recourse is really only an option if the review meets the criteria for defamation. If so, an attorney can help you obtain a court order to have the review removed from the review platform or from Google's search results.
- If you're actively voicing your opinions on social media, be aware that you will face online “trolls” and detractors at some point. Anyone, in any profession, will tell you that when you voice your opinion online, someone will try to argue or smear you. Be conservative with your opinions, show respect and empathy for those who disagree, and most importantly, once you state your position, let your credentials and experience be what supports your reputation. Finally, don't get into a fight with someone who may have their own reputation as a fighter.