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Several surgeons recently authored a paper in the peer-reviewed Journal of Vascular Surgery. Prevalence of unprofessional social media content among young vascular surgeons.

The same article was presented at the Annual Symposium of the Society of Clinical Vascular Surgery.

The fastest and most reliable way to piss off a doctor is to call them unprofessional. The article has since been retracted and the authors apologized.

Details of the firestorm.

The authors intended to research whether vascular surgery trainees and recent graduates had public-facing social media accounts with content that could negatively affect their future reputations. Sounds benign enough. But the research failed to consider most of these doctors had not yet graduated and, predictably, did not have a professional web site, walling off their professional life from their personal life. Most doctors, over time, have two social media presences. Their public professional life and private life. Still, sometimes one bleeds over to the other. Most of the time, it’s of no import. Zilch. Nada.

What put the authors in a vat of boiling water was their loose definition of unprofessional content. They described “clearly unprofessional content” and “potentially unprofessional content.” Examples of clearly unprofessional content included HIPAA violations, intoxicated appearance, unlawful behavior, possession of drugs and drug paraphernalia, and uncensored profanity or offensive comments about colleagues / work / patients. Examples of potentially unprofessional conduct included holding/consuming alcohol, inappropriate attire., censored profanity, controversial political or religious comments, and controversial social topics. One of the “unprofessional” behaviors included in the study was “Inappropriate attire included pictures in underwear, provocative Halloween costumes, and provocative posing in bikinis/swimwear.”

For those interested in the statistical analysis:

There were 480 vascular surgeons identified. 325 (68%) were male, 456 (95%) held MD degrees, and 115 (24%) were integrated (0 + 5) vascular surgery residents. Of these, 235 had publicly identifiable social media accounts across all platforms. Sixty-one (26%) account holders had either clearly unprofessional or potentially unprofessional content. Eight accounts (3.4%) contained content categorized as clearly unprofessional: obvious alcohol intoxication in three Facebook accounts and uncensored profanity or offensive comments about colleagues/work/patients in one Facebook and five Twitter accounts. Potentially unprofessional content appeared in 58 accounts (25%) and included holding/consuming alcohol (29 accounts, 12.3%), controversial political comments (22 accounts, 9.4%), inappropriate/offensive attire (9 accounts, 3.8%), censored profanity (8 accounts, 3.4%), controversial social topics (6 accounts, 2.5%), and controversial religious comments (2 accounts, .9%). There was no significant difference in unprofessional content across sex, training paradigm (MD vs non-MD), or residency track (0 + 5 or 5 + 2; all P > .05). However, there was more unprofessional content for those who self-identified as vascular surgeons (33% vs 17%; P = .007).

And the conclusion. Drumroll, please.

One-half of recent and soon to be graduating vascular surgery trainees had an identifiable social media account with more than one-quarter of these containing unprofessional content. Account-holders who self-identified as vascular surgeons were more likely to be associated with unprofessional social media behavior. Young surgeons should be aware of the permanent public exposure of unprofessional content that can be accessed by peers, patients, and current/future employers.

The authors must have forgotten even doctors have real-world lives. Most, if not all, national specialty medical conventions sponsor an open bar during the welcome ceremony. It rarely leads to bedlam and debauchery. Doctors go to the pool, swim at the beach, have opinions, support political candidates, vote, go to church, eschew religion, celebrate Halloween, hate Halloween, and do lots of things that keep them from burning out. Good for them.

Once the arcane article was picked up by national media, the Twitter thunderstorm erupted. https://twitter.com/hashtag/MedBikini

Female doctors proudly described they will wear what they want when they want. And it has zero impact on whether they’re professional or not.

And, of course, solidarity from male colleagues.

Some surgeons also penned excellent scathing blog posts.

Other than the fact the research article was tone-deaf, does any of this matter?

Yes.

Boards of medicine are empowered to discipline physicians for so-called unprofessional behavior. Is unprofessional behavior defined by statute or regulation? Nope. It’s in the eye of the regulator. Discipline for unprofessional behavior can involve public reprimand, suspension, or revocation of one’s license. A harsh outcome. Can a doctor really lose her license for wearing a bikini? As an isolated event, probably not. But the better answer should be an unambiguous no.

Beyond the medical boards, can employers fire doctors for unprofessional conduct? Generally, yes. A private employer does not have to respect free speech rights. The government cannot shut you down for what you say (and even there, there are exceptions). Your employer can let you go. Every state other than Montana has “at-will” employment laws. That means the employer and the employee are each free to terminate the relationship. The only caveat is employers cannot fire a worker for discriminatory reasons. Discrimination may be based on race and sex. If an employer were to enforce off-hours dress codes, it would have to enforce it equally. No differentiation between men and women. Some states, such as California, Colorado, and New York make it difficult for employers to fire employees for behavior outside of work.

Doctors work hard. Doctors play hard. Most doctors wake up every day intending to do a great job for their patients. I doubt most patients fret if their doctor wears a bathing suit or has a beer. If these behaviors have no impact on patient care, patients should not care. My vote: The bar (no pun intended) for labeling some behavior as unprofessional should not be so low.

Enough of what I think. What do you think? Comment below.

PS: For those interested in the history of the bikini.

Clothing designer Louis Réard introduced his swimsuit in July 1946. He named it after the Bikini Atoll, where the first public test (Operation Crossroads) of a nuclear bomb had taken place only four days before. Purportedly, Réard—who hired a skywriter to advertise the new bikini as smaller than the world’s smallest bathing suit—claimed his version was sure to be as explosive as the U.S. military tests.

No runway model would wear it, so he hired a nude dancer from the Casino de Paris named Micheline Bernardini to model it at a review of swimsuit fashions.

A bathing suit qualified as a bikini, said Réard, only if it could be pulled through a wedding ring. He packaged the mere thirty squares inches of fabric inside a matchbox.
The Vatican formally decreed the design sinful, and several U.S. states banned its public use.

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Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.