Social media has taken on many forms over the past 20 years.
In the early 2000s, Friendster had just emerged for people to connect with friends on the Internet, just as the era of the dial-up connection began to evolve. Those were the days when every teen would hop onto MSN after school to connect, one short message after another – a liberation from the confines of the limited characters SMSs would allow. Myspace was the perfect platform for people to post about their lives and share their favourite music, if you could wait out the loading time on each page with your broadband connection.
We now fast forward to today, when our attention spans have whittled down to a mere 15 seconds – swipe up for the next TikTok, swipe left for the next Instagram story.
Life as Stephycube
In my life before medical school, I was a young musician in junior college, with about two years' worth of posts on my Instagram account. The username "@stephycube", the same moniker I used for my performances, is a play on my full name ("Steph Y Y Y" = "Steph Y³" = "Stephycube" haha)
I would shout this name out in between music sets, calling on the crowd to give the account a follow or to drop a "Subscribe" on YouTube if they liked the performance. Gone were the days of selling CD-ROMs or making cassette mixtapes. These social media platforms were the quickest and most efficient way of sharing my music, pandering to the way music was consumed.
My covers and original music would be uploaded, and I would document my life as musician and student in individual posts to share with those connected with my account. The outreach of the Internet was incredible, and listeners and users from all over the world – America, Spain and even Poland – would drop Facebook messages or direct messages on Instagram to share their thoughts and greetings.
As I continued on in medical school, we were introduced to what I am sure is now more than familiar to all of us in the medical field: the Personal Data Protection Act (PDPA). The Hippocratic Oath we had taken at the White Coat Ceremony had called upon us to "respect the secrets which are confided in [us]." Our lecturers had counselled us gravely on the story of an all-too-revealing blog post about a patient encounter. In general, the advice was to avoid posting anything that was related to our medical life.
Wanted to post a snap in the ward? "PDPA," someone would warn. A quick quip on Twitter about a certain patient? "PDPA" – the four letters hung tightly on the tips of our tongues throughout our time as students, each looking out for the other to ensure that we would not get in trouble from an accidental social media post.
Many of us became more careful with sharing about our personal lives on social media, for fear of an inadvertent slip-up that could reveal patient details. At the same time, the question of whether I should set up a separate Instagram account for my music weighed heavy on my mind – for one, to avoid such a risk of leaking confidential data, and simultaneously, to curate my music more specifically and avoid diluting its content.
However, as I grew as a medical student, I also grew in my music – life bleeding into art through school projects and personal conversations with patients, grappling with mortality and humanity. Furthermore, my interest in music extended to medical work, and I found myself being closely involved in music groups comprising medical students, such as carolling during Christmas, or being part of hospital-run bands with patients and doctors. There, I discovered that my identity as "Stephycube" could not be divided between that of the medical student and the musician, but that it was a whole representation of my life – and it was how I intended to share my identity with everyone.
Hence, @stephycube remained, and like my peers' accounts, it was maintained carefully to ensure that even if snippets of medical student life were featured, they would be bereft of any identifiable details. I went on to create more music and graduated to enter the healthcare workforce.
Life as Dr Yeap
Being a doctor is quite different from being a medical student – I'm sure many of us can attest to that. As work began, my music endeavours diminished.
Medicine was always my dream job, but amid the highly anticipated excitement of saving patients' lives also came the humdrum of the daily routine of rounding wards and running clinics, or just administrative work. My Instagram account now featured mainly the more entertaining bits of life, such as exercising, nice dinners and the occasional singing clip.
As I became a medical officer, my interest in surgery and procedures grew – from every ingested fishbone that got grasped out with a flexible bronchoscope and creepy-crawly that was retrieved from a ear, to the heart-warming stories of triumph over disability when patients with traumatic brain injury recover well. I witnessed my fellow colleagues celebrating their clinical achievements and accounts of learning as well – from tales of the Emergency Department with a successful return of spontaneous circulation from a resuscitation case, to the quiet personal talks with the ailing grandmother in the geriatric ward talking about her last wishes.
These anecdotes lay testament to the small and great victories in medicine and the work we do in helping better people's lives.
The landscape of social media remains ever-changing, and just like the rest of our non-medical friends, our use of Instagram and other platforms remains closely entwined in daily life. Doctors, nurses and healthcare staff are, after all, just regular people experiencing the evolution of technology at the same pace as everyone else. How best then could we as healthcare workers navigate social media while protecting the very people we work with – our patients?
Some set up anonymous accounts to post memes (ie, a photo or picture captioned with text, often funny but mostly with pointed commentary) which other healthcare workers could relate to. The especially creative among us drew original comic strips, detailing their emotional encounters of life as a doctor while maintaining anonymity behind these doodles. Many, including myself, would post short 15-second Instagram Stories on our day, with de-identified versions of our anecdotes. I've found that even something as seemingly mundane as the food I eat on call makes for a relatable experience with others trudging through the night in another hospital.
Not only did this foster a sense of community among healthcare workers – that we were not alone in these successes and failures – but it also allowed nonmedical followers to catch a glimpse of our amazing day jobs.
Those who followed my Instagram page from my music days also took notice of these – some would comment on how cool the experiences were; others, including medical students and even younger followers, would be intrigued to find out more about certain procedures and life in medicine.
Then came along my exciting role of running the Instagram page of the Singapore Medical Journal (SMJ; @smj.sg), as part of their social media team. By creating infographics of highlighted articles from each month's issue, we have helped to translate academic information into bite-sized posts not just for quicker consumption by our healthcare colleagues, but also for the layperson interested to know more about medical research in Singapore. Furthermore, we designed each month's posts to share briefly about pertinent recommendations and guidelines in Singapore, such as screening measures for colorectal cancer and breastfeeding advice from a medical perspective.
As it seems, social media is becoming more friend than foe to doctors and other healthcare workers in connecting with the non-medical world.
Life as a social media user
I have realised now that there need not be a clear distinction between my life as a doctor and my personal life on social media. It is easy to fall into the temptation of portraying a certain persona on these platforms for followers to perceive. However, rather than crafting disparate identities of being a musician versus a doctor, I have learnt to reconcile this by taking care to respect personal data while curating these objective experiences.
Of course, there remain challenges ahead in navigating social media as a doctor. As society becomes more interlinked via the Internet, so do our patients reach closer into our personal lives and even closer in communication with us. What happens when a patient drops us a follow on our page, or what if they use information from our personal accounts – such as our relationships, families and hobbies – against us in a professional setting?
A recent study in the SMJ titled "Doctors and Social Media: Knowledge, Gaps and Unsafe Practices" by Low et al1 highlights that despite an existing set of recommendations established by the Singapore Medical Council Ethical Code and Ethical Guidelines (SMC ECEG), there remains "much heterogeneity in social media-related knowledge" among doctors. For one, the SMC ECEG states that "if you are active in social media, you must ensure that exposure of your personal life and your words and behaviour do not diminish your professional standing before patients or the public, or bring the profession as a whole into disrepute."
Low et al surmises that though official guidelines are available, in reality "it is impossible to formulate similar guidelines for all possible usage scenarios given the broad application areas and involved stakeholders."
Therein lies the difficult balance of doctors as social media users. Such platforms serve as a means to connect with others and a powerful method of self-expression, but we must maintain vigilance – not just to protect our patients, but to protect ourselves in an increasingly litigious society as well.
Indeed, we as a society will continue to explore new frontiers of technology, and the demand for efficiency of information will continue to rise. Even today, TikTok presents itself as the latest and most attractive form of content now, but who knows what more gripping forms of social media lie ahead of us?
As doctors and healthcare workers living in this day and age, we must harness the potential of these platforms. We remain passionate in sharing our knowledge with the world, to celebrate rather than be afraid of our achievements in our work and to quench curiosity rather than stifle it, all while keeping true to the very first creed we undertook – to serve humanity and protect their secrets confided in us.