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This July, marked a new chapter in my formal education as a healer, when I began a year-long fellowship in Hospice and Palliative Care Medicine. I'm thrilled to have the opportunity for this training and hope to someday join the ranks of those board certified in both Surgery and Hospice and Palliative Care Medicine. While the combination of surgery and palliative care seems to surprise many, it was actually a Canadian surgeon and urologic oncologist, Balfour Mount, who first forged the concept of "palliative medicine." Surgeons including Geoffrey Dunn, Robert Milch and Anne Mosenthal have spread the ideals surgical palliative care in the United States, by espousing their importance through the ACS and other surgical organizations. I'm grateful for visionary surgeons Red Hoffman, Pringl Miller, Buddy Marterre and founding the Surgical Palliative Care Society.

With hopes to inspire more synergy in surgery and palliative care, I share my personal statement:

My interest in Palliative Care has always been deeply interwoven in my dream of becoming a surgeon. As a first year medical student, I understood doctors to be professionals skilled at making patients “feel better.” I believed surgical training would provide the broadest skillset to relieve patients’ suffering. As a third year medical student however, I quickly realized the misdirection of my perspective. I was initially perplexed to witness modern medicine’s prioritization of curing disease and prolonging life over the amelioration of suffering. I didn’t understand why costly interventions were performed without a moment’s consideration for the discomfort they inflicted, when low cost treatments for symptom management and pain control weren’t even considered.

Then I learned about palliative care. The interdisciplinary, patient-centered nature and focus on comfort and relief of suffering made sense to me. Addressing “total pain”, inclusive of physical, emotional, spiritual, and social realms enables the ease of suffering that had been intuitive to me. My only question was why these goals and skill set would be limited to palliative care physicians. In fourth year, I spent two weeks with the palliative care service. It was encouraging to observe how services provided by the palliative care team facilitated treatment of the whole patient. I found the privilege of guiding patients and their families through end of life decisions on par with the privilege of operating to return patients from the brink of death. Still I remained steadfast in my pursuit of becoming a surgeon and aspired to be equally skilled at alleviating suffering and enabling dignity when death is inevitable. 

Three years into general surgery residency, I am that much closer to realizing my dream. The exhilaration I feel each time I hold the scalpel reaffirms my career path. Poignant moments in patient care strengthen my aspirations to treat total pain and support patients and their loved ones through the passage of death. I will never forget intern year and the patient brought in by EMS with a nonpalpable pulse after a motor vehicle collision. Our heroic efforts in CPR brought her back multiple times during the primary trauma survey. When she finally maintained a pulse long enough to complete the CT scan, an obvious discontinuity in her cervical spine explained her lack of sympathetic tone, rendering her demise unavoidable. As soon as we showed her parents the CT scan and explained her prognosis, they asked that we cease resuscitation. With the medical team no longer surrounding all sides of the patient, her family was able to hold her hands and kiss her cheeks as they each took their moment to say goodbye.

It saddens me not every death I’ve witnessed has played out so peacefully. At present, primary palliative care is not a proficiency required of trauma and acute care surgeons. I find this paradoxical in light of the deep surgical roots of palliative care. Fifty years ago, it was a urologic oncologist, Balfour M. Mount, MD, who introduced and championed the field of palliative medicine. The American College of Surgeons established a committee on surgical palliative care in 2003. Yet the implementation of palliative care principles into trauma ICU care and an alliance between surgeons and palliative care clinicians has been slow to non-existent. The potential for synergy at the intersection of surgery and palliative care inspires me to become a trauma surgeon trained in palliative care. I can imagine no greater honor than to operate on trauma survivors and support their loved ones through their time of crisis. 

Training in palliative care will provide me the tools I need to palliate my patients both before surgery, and after. Surgical treatment is unique in that it often causes significant pain and suffering before patients experience long term benefit. It is imperative I have tools to minimize post surgical suffering and pain. It is equally important I am facile in supporting patients and their families in making medical decisions reflective of their goals and the richness of their life experience. Whether it be the 94 year old woman with intracranial hemorrhage secondary to falling while on anticoagulation, or the 30 year old construction worker who fell from the second story, the decision to discontinue artificial life support is never easy or straight forward. In the words of Cicely Saunders, “How people die remains in the memory of those who live on.” As a future trauma and critical care surgeon it is an unachievable goal to cure every disease or traumatic injury; my goal as a surgeon is to heal patients and their loved ones, in life as well as death.

Conversations and advice on intern year tend to focus on surviving, the implication being that thriving can come later. Indeed, this is how intern year has felt for me (twice!)--endless patient care “checky boxes” in the hospital with limited time at home consumed by family life and studying squeezed between requisite personal hygiene, nutrition, and sleep to sustain human life. For interns of the 2019-2020 academic year, surviving meant not only adjusting to 80-hour work weeks and learning to respond when referred to as “doctor”, but doing so in the midst of a once-in-a-century global pandemic. Just when I’d made peace with being too busy to attend family events, much less make a dentist appointment, I found myself geographically separated from my husband and children for 8 weeks, with all dental offices closed for the foreseeable future.

My family was blessed with the option of staying with relatives nearby; the sacrifice for this safety and seclusion being I saw them solely through a video screen for 8 weeks. I was especially grateful for this convenience, weeks into the separation, when I spiked a temp of 102 less than 24 hours after my immediate co-worker tested positive for COVID. Thankfully I did not require hospitalization. Even still I have never felt so profoundly ill in all my life. As I mindfully adjusted by breathing to alleviate the burning sensation triggered by air passing through my bronchi, I was especially comforted to know my family was safely secluded, miles away. Thankfully, I was able to return to clinical duties 14 days after I came down with symptoms. I survived largely unscathed, though I did experience weeks of alopecia a few months after recovering, and noticed a post-viral tremor--something which I’ve seen scarcely discussed in the literature. 

As someone who leans on my closest friends when stressed, I disengaged from social media as a means is of survival. I continued the virtual solitude when my second year schedule was unwittingly front loaded with the most difficult rotations packed into the first 6 months. Now with my critical care rotations, months of nights, and the ABSITE behind me, I have space to reflect on the last year and a half. What strikes me is that while I may have been on a social media hiatus, the spirit and positive energy of the SoMe community were with me every surgeon-paced step of intern year as well as every moment immobilized on the couch, while I willed the air to stop burning my lungs. I am so grateful for each and every social media connection and memory; I can’t wait to return to the community--to meet the newcomers, and catch up with old friends.

I close with two quotes by the poet, Rainer Maria Rilke, that capture my experience of solitude from social media, as well as my excitement to return.

“But your solitude will be a support and a home for you, even in the midst of very unfamiliar circumstances, and from it you will find all your paths.”

“I am so glad you are here. It helps me realize how beautiful my world is.”

― Rainer Maria Rilke

Wishing you health, happiness, growth, and connection in 2021.

One thing the #ILookLikeASurgeon movement has made unambiguously clear is that surgeons are on Twitter. Literally thousands of tweets later, the surgical Twitter community has congealed and specialty hashtags such as #plasticsurgery and #colorectalsurgery have emerged. As the surgical Twitterverse continues to evolve, what are the roles, opportunities, and even responsibilities of academic surgeons? Do surgeon scientists have a moral obligation to communicate with the general public?

Photo Credit

Many say yes. In our new reality of “alternative facts” and “fake news,” world citizens are turning to social media as their main news source; if scientists do not join the conversation, who will lead the scientific discourse? Rather than depending on journalists to bridge the gap from scientific journals to the lay press, today’s surgeon scientists can utilize social media to directly communicate the importance of their findings to the general public. Surgeons are accomplishing this through social media posts that utilize photos, videos, graphics, and blog posts.

Inspiration abounds. See the #PresentYourPaper videos put forth by the Journal of Transplantation. Search the #visualabstracts inspired by Dr. Andrew Ibrahim’s work as creative director for Annals of Surgery. To create your own, check out his primer on “How to Create a Visual Abstract.” Whether you are a presenter, mentor, or simply an attendee of #ASC2017, you have a leadership opportunity to disseminate and communicate the scientific discourse to the greater public.

Here are my top 5 #TwitterTips for disseminating the findings presented at #ASC2017.

1. Complete your Twitter profile--this includes a real photo, brief bio, and geographic location. A complete profile allows you credit for your contributions and adds credibility to your tweets.

2. USE VISUALS. As always, a picture is worth 1,000 words. Research shows that tweets that include a photo or video get more retweets.

3. Mention people. That is, include Twitter usernames whenever possible. The beauty of Twitter mentions is that they inherently provide an introduction through links to profile pics and bios.

4. Link to previous research. This adds background and evidence (whether supporting or conflicting) to the current discussion. See here for a great example by Dr. Elliott Haut.

5. Wherever possible, use emoticons to communicate. For a great examples of strategic use of emoticons, see Drs. Adil Haider and Marissa Boeck.

Finally, have fun! #SurgTweeting is about more than promoting our work, it’s about supporting each other and celebrating moments of accomplishment!

@AcademicSurgery @jonessurgery @LoggheMD After submitting 4 grants in 6 weeks, walking into #ASC2017 like... pic.twitter.com/Yx98LI0dCR

— Drew Shirley, MD (@drewshirleymd) February 6, 2017

What is a tweetchat? updated 3/15/2018

Tweetchats are Twitter conversations that occur at a set time on a pre-determined topic. All tweets are labeled with a designated hashtag and ready followed by searching the hashtag or using a program such at Tweetchat. As hashtags can be used by anyone, there are no limitations on who can join. For a great list of health care tweet chats, see Symplur.

How do I prepare for the chat?

Make sure your Twitter pic and profile represent you in a manner you wish to be represented. Your Twitter profile will serve as a supplemental, unspoken introduction during the chat. For tips on completing your profile, click here. In terms of preparing for the topic of a tweetchat, that will depend on the chat topic and your goals for the chat. Often no preparation is needed.

How do I follow so many tweets?

To participate in a tweetchat, search the hashtag in Twitter's native search function, then sort by "latest" for reverse chronological order. In this method, Twitter autopopulates the hashtag into your tweets, however you have to enter it yourself when replying to a tweet.

Is there any etiquette I should be aware of?

• You may want to quote tweet the announcement for the chat, with a note to your followers that your tweets will be increased during the upcoming hour.

• Be sure to introduce yourself at at the start of the chat. Even if you plan to only “lurk.”

• If your tweets are in response to specific topics or questions, try to label them T1 or Q1, Q2, etc.

Any final tips?

Have fun! Don’t be afraid to chime in or simply follow along. (Both are encouraged!) Tweetchats can move along quickly. Most tweetchats later post the complete transcript, which can be more carefully digested and followed up on after the tweetchat.

Nearly a month before our national presidential election, a video surfaced online capturing a conversation between Presidential candidate Donald Trump and reporter Billy Bush. During this 2005 “private” conversation between the two, Trump lewdly brags to Bush about kissing and groping women without their consent. He is even heard boasting he can “get away” with this behavior because of his celebrity status. Trump has been heavily criticized for his words and actions. Billy Bush, on the other hand, was criticized and fired from the “Today” show for what he did not say. There is no footage of Bush stopping and discouraging these comments by Trump. Instead he plays along and is heard saying “whoa” and “whatever you want.” He has since apologized and expressed feeling “embarrassed and ashamed” for his lack of immediate condemnation of Trump’s suggestive comments and for playing along.

The backlash that ensued reminded me of times in my own life when I played along or remained silent in the presence of language or actions I genuinely wanted to condemn. As I spend a great deal of my time at the hospital, many of these incidences have occurred there. Unfortunately, these incidents transpire more times than most of us in the medical community would want to admit. What is the cost of our silence? In the case of Billy Bush, his inaction cost him his job and perhaps his career. When we as surgeons, fail to speak up in the presence of inappropriate behavior, injustice, and bias, what are the stakes?

The operating room is one place where I have witnessed these types of incidents. The offending culprit was the attending surgeon. Generally, the attending surgeon controls the social climate and atmosphere. So, for example, if that surgeon wants classical music playing, there will likely be classical music playing. Aside from the care the patient requires, the surgeon is the next most looked after person in the OR. When the surgeon engaged in otherwise offensive conversation, no one on the surgical team spoke up. No one expressed concern that the language or tone was inappropriate. No one changed the subject to signal that the content or nature of the conversation was not ok. At worst, the joke was countered with a similarly vulgar example. "Sadly, several members of the team responded with either silence or laughter, but no one stopped or condemned the conversation."

Such derogatory, offensive, or discriminatory comments to or about another person or group are not confined to the OR. The subject of the comments have ranged from patients, nurses, hospital administration, or even other physicians with racist, sexist, or ageist undertones. My years in medical school and early years as a resident, when I was most vulnerable and the least powerful and influential in the medical hierarchy, coincide with the times I was most tolerant of this behavior.

So, regrettably, I acknowledge that I, too, have remained silent in the immediate presence of injustices, and because I did not speak up, I have continued to internally replay these moments, wishing I had responded differently. One specific example haunts me to this day. While I was on the interview trail for surgery residency, a department chairman made a racially insensitive comment to the group of interviewees, including me, an African-American, about not taking care of “tar babies” at their hospital. In the moment, I said nothing. I did nothing. In hindsight, I am ashamed of that fact.

In the ensuing years, I now understand I was unable to fully process what was happening in the moment.  Partly, I was in shock. After having time to think about his comments, I think this is likely true of others who may have been in very similar situations. Several questions come to mind. What should you say? When should you say it, and how?  Secondly, I believe there is a certain cost to speaking up against ethically unjust and offensive language. One could certainly not be accepted or in some cases could be detested for “stirring the pot.” It could lead to social isolation. Nevertheless, I question whether the cost of speaking up (social isolation and exclusion) may not compare to the ultimate cost of not speaking up (further discriminatory and defamatory practices, preventing forward societal progression). But regardless of the cost, I now hold myself accountable and will speak up and address, in a variety of ways, any offensive, derogatory, or discriminatory language.

The demographics of the world are changing, which is appropriately reflected in the surgical profession. Fifty years ago, blacks had great difficulty getting access to surgical residencies and women were considered primarily for degrees in nursing. Today, our surgical societies and residencies have had made progress in increasing diversity to more accurately reflect the patient population and create a culturally sensitive health care environment. This change should also be reflected in what we say and what we tolerate being said in our presence.

How would things have been different if instead of tolerating those words spoken by Trump and playing along, Billy Bush would have discouraged it or even just brought up a different topic? What if every man (and woman) who heard him relay stories of or bore witness to his behavior against women spoke up and declared it unacceptable? But Bush didn't, no one did, and we continue to have debate and even protest about this and other offensive and derogatory words and actions of not only Trump but also others. While these protest and arguments create a great dialogue in our society, real change occurs in the exact moment and space when inappropriate, discriminatory, and ethically debased language is spoken and a courageous person makes the decision to intentionally speak up against it.   

Dr. Cedrek McFadden

@cedrekmd

Dr. McFadden is a husband, father, colorectal surgeon, mentor, speaker, and believer in health and wellness.

“I come as one. I stand as ten thousand.”

        -Maya Angelou in her poem Our Grandmothers

I am a surgeon. I am proud of this fact partly because I am the first in my family to go to medical school. I am also proud of this fact because I recognize that me becoming a surgeon has been less about me and more of a collective and cumulative effort of my parents, grandparents, great-grandparents, and countless other hard working ancestors, many of whom remain nameless. More than any other, perhaps the one person that would influence my initial decision to become a physician was my grandmother. She would also later influence my decision to become a surgeon. Seeing her sprawled out on her kitchen floor after having a massive heart attack when I was 5 years old would, furthermore, influence my resolution to become that surgeon committed to wellness.

        My grandmother was the center of our family. Growing up in a very traditional and conservative African-American home, I was surrounded by a large, loving, and supportive family. Family gatherings at my grandmother’s home were frequent and sometimes without any specific cause. She was generally in charge of deciding the menu items during these gatherings, many of which she prepared herself. At the time, the food was delicious and filling. In hindsight, it was oftentimes, greasy, fried, and nutritionally sparse. The paradox presented in this is that at the same time, my grandmother had many chronic illnesses. I always knew her to be diabetic and was unfazed watching by her self-administering her insulin injections. I became well-versed in hearing about her “Coumadin levels” or her “heart pills.” I knew she was not well as she had difficulty walking short distances and went to the emergency room on a frequent basis, but at the end of the day, medication was the only lifestyle modification for her problems.

        Growing up in this setting, I wanted to know the “why” of her health problems. I was not satisfied with knowing generic glossed-over answers, but I constantly asked questions, which eventually led to me choosing medicine as a way to learn more and answer those questions. As most of her health problems were chronic, she was on many medications with oftentimes no immediate change. As a surgeon, I would have the ability to make almost a direct change in the patient’s health, which in addition to a love of anatomy and being in the OR, subsequently became a strong incentive to become a surgeon.

        I was fortunate to train at an institution where the hospital embraced the concept of wellness with “eat right” programs and even offered discounted gym memberships. So it was never odd to have a mind towards personal wellness in this setting. I had many attendings that were great examples to me because of their own commitments to eating well and physical fitness. They themselves took time to exercise, spend time with their own families, go to church, and encouraged me to do the same. One attending was known for making climbing the stairs mandatory during rounds! Regrettably, during the early years of my residency, I struggled to find the time and energy to squeeze in exercise and make good food choices. I was at the hospital at 5 and leaving later in the evening. I made poor dietary choices and skipped out of  going to the gym. This compromise resulted in weight gain and continued fatigue. Ultimately, towards the end of my training, I had to make my workouts a top priority. By doing so, I was able to foster the required discipline to train and to successfully complete my first marathon during my chief year.

        Now as an attending surgeon, my commitment to maintain a sense of personal wellness continues to be a longstanding, purposeful, and intentional journey. By this, I remain in a much better position to prevent burnout and not become detached and frustrated with my patients and the care they require. I am able to handle the increasing physical and mental stressors of being a surgeon much better as I continue to recognize the value of exercise and have kept it a part of my routine. I make time to go to church and spend time with my family. Dietary changes have been the most difficult to make and maintain partly because it has required creating a complete turnaround of what I understand about food. The culture in which I grew up was not particularly health conscious, but after seeing the health problems of those I loved, I recognize that pattern was not one to observe and continue.  I have gone through periods of being a vegetarian and even maintained a strict Paleo diet. Ultimately, while not 100% protective, my goal has been to make better dietary choices so that I reduce my risk of having health problems I observed as a child in my family.

        The night that I saw my grandmother in cardiac arrest on the floor of her kitchen was fortunately not the last time I saw her alive. She was able to recover and lived another 20 years. In the end, she was unable to recover after a surgical procedure. At the point of her death, I was no longer a confused 5 year old boy but now surgical resident with a better perspective and understanding on the various factors that contributed to her declining health. I now recognize my life as a surgeon is a composite of the invaluable and mainly unspoken lessons my grandmother taught me about health and wellness of my mind and body, and the personal responsibility to ensure I am continually taking care of them both.


Dr. Cedrek McFadden
@cedrekmd

Dr. McFadden is a husband, father, colorectal surgeon, mentor, speaker, and believer in health and wellness.

After signing onto Twitter for the first time in 2011, there have been two events that have triggered my absence. The first was the birth of my daughter, Sierra, in 2013, and the second has been the birth of my son, Orion, this past May. Both times I have found caring for a newborn to be all-consuming--swadling, nursing, and bathing the little one left no time for social media. Since the #ILookLikeASurgeon movement, it has been much more difficult being “away” from my social media community. When the #ILookLikeASurgeon hashtag was born, there was no question that I wanted to post a photo celebrating both surgery residency and motherhood. Some may be surprised to learn it was the first time I posted a photo of Sierra online. Until that moment I had shared very few photos of my personal life online.

After Orion was born, I was eager to celebrate the new addition to our family with my global network of social media friends, yet I found myself hesitating. I questioned the potential dangers of sharing photos of my children on social media. While it is generally accepted that there are “risks” involved in posting photos of one’s children online, I had seen very little in terms of specifics on these risks. Before jumping back into social media, I decided to do my own research in order to make an informed decision when it came to posting photos of my children. Given the popularity of the #SurgParenting hashtag, I thought others might be interested in what I found.

First, I would like to share some statistics on the elephant in the room--the vast majority of children born in the United States today find themselves online from the day they are born. Perhaps earlier, if we count ultrasound photos. Studies show that 92 percent of kids in the United States have an online identity by age 2.^[1] On average, parents post nearly 1,000 photos of a child online before the child turns 5.^[2] It’s no wonder non-parents can feel they are drowning in “cute” photos of their friends’ children. Why all the posts? According to a 2015 survey by Pew Internet Research, 74% of parents who use social media get support from their friends online.^[3] Surgeons appear to be no exception.

Are we “oversharenting”? Oversharing seems to be judged in the eyes of the beholder. A survey by Parents magazine found that 79% of respondents said other parents overshare on social media -- yet only 32% felt that they overshared themselves.^[4] Similarly, when asked to judge others, 80% of adults say they’ve seen parents put attempts to get the perfect photo ahead of their child’s enjoyment of an event.^[5] While these statistics are striking, I argue it matters more that parents and their children are comfortable with the photos than what others think. For a great post on a parent and child who are both mindful and enthusiastic in their approach to social media, see here.

I had a difficult time finding examples of negative consequences of parents sharing photos of their children. Extensive googling and article skimming revealed only two examples of misappropriation of photos posted online.^[6] Many of the dangers cited in articles discussing the cons of photo sharing seem ephemeral. While it’s true that future college admissions committees, employers, loan officers could peruse baby photos of my children someday, I can’t help but wonder why? Predatory behavior from pedophiles is also frequently cited as reason not to post photos of one’s children. However Prof. David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire, says “this is not the way it happens” and that such dangers are falsely inflated. While it’s true predators seek victims in chat rooms, they do not peruse photos posted by adoring parents.

One study found that 58% of respondents admit posting the perfect picture has prevented them from enjoying life's experience. According to the study’s co-author, Joseph Grenny, “We enjoy important life moments less when we’re focused on capturing them rather than experiencing them.”^[7] Does this mean we must put our phones away and forgo sharing the moment with friends and strangers? Not necessarily. Rather than being controlled technology, it can be used to draw us into an experience. A photo can become  memento to treasure and share.

A recent survey of children 10 to 17 found that nearly 1 in 5 wanted control over the information their parents posted about them online.^[8]  Catherine Steiner-Adair, author of“The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age” and research associate at Harvard Medical School’s Department of Psychiatry, suggests that “Kids should have veto power over the pictures we take and post on social media. We need to teach children the message that we own our body and we own our image and ask questions like, ‘Would you mind me sending it to grandma or grandpa?’”^[9]

Photo Credit

Rather than worrying about unrealistic dangers, I recommend three questions to ask yourself when posting photos of children.

1. What is the purpose of a my post? (For a powerful example of a post with a clear purpose, see here.)

2. Am I comfortable with this image/information becoming part of my child’s digital footprint?

3. Would my child approve? And do I have their permission? (If consent is age-appropriate.)

If you are not a parent, and are considering posting a photo of a niece, nephew, or friend’s child, I recommend asking yourself same questions and then checking with their parent for permission.

What are the benefits of posting online photos? Many parents find that virtual sharing allows them to build an online community and connect with other parents. Particularly for parents living away from family, sharing special moments through social media can foster a sense of community and support, providing a network of “friends” they would never have access to otherwise. While children may not directly benefit from this online community, they have a lot to learn from parents who include them in the process. Understanding the magnitude and significance of their digital footprint is a “life skill” that will serve them well as they enter adolescence and beyond.

What did I decide? For me and my family, the benefits of sharing outweigh the risks. While my husband chooses a very limited online presence for himself, he is comfortable with the thoughtful choices I make in posting photos of our children. I hope the snapshots and moments I chose to share make them feel cherished and celebrated. Rather than a detriment, I hope the posts serve as a sort of “virtual memory book” highlighting positive moments of their childhood. As they grow, I will involve them more and more in the process of choosing which photos and moments are appropriate for sharing.

In the meantime, I am excited to share special family snapshots with our global friends and family. I never dreamed I would celebrate my newborn son hiking with a surgeon, @dr_imogen, I met through #ILookLikeASurgeon and now affectionately refer to as his Australian Godmother.

Welcome to the world Orion. #AdventureAwaitsYou

[1] "American Girls - Time." 2016. 28 Jul. 2016 <http://time.com/americangirls/>

[2] "Read this before posting photos of your kids on Facebook - MarketWatch." 2015. 29 Jul. 2016 <http://www.marketwatch.com/story/read-this-before-posting-photos-of-your-kids-on-facebook-2015-08-05>

[3] "Parents and Social Media | Pew Research Center - Pew Internet ..." 23 Jul. 2016 <http://www.pewinternet.org/2015/07/16/parents-and-social-media/>

[4] "How Social Media Is Affecting Your Parenting - Parents." 2015. 23 Jul. 2016 <http://www.parents.com/parenting/better-parenting/style/how-social-media-is-affecting-your-parenting/>

[5] "Download." 2015. 3 Aug. 2016 <https://embed.widencdn.net/pdf/plus/vitalsmarts/hnbt5l4k8o/Likes-Over-Life_Executive-Summary.pdf?u=qhidu7>

[6] "Guardians of Their Smiles - The New York Times." 2009. 5 Aug. 2016 <http://www.nytimes.com/2009/10/25/fashion/25facebook.html>

[7] "Society's New Addiction: Getting a “Like” over Having a Life - Press ..." 2015. 8 Aug. 2016 <https://www.vitalsmarts.com/press/2015/03/societys-new-addiction-getting-a-like-over-having-a-life/>

[8] Hiniker, A. "Study - Fatherly." 2016. <https://www.fatherly.com/wp-content/uploads/2016/03/a0f093_3ca344c37a2a4271a32a8670eeec5abf.pdf>

[9] "Read this before posting photos of your kids on Facebook - MarketWatch." 2015. 4 Aug. 2016 <http://www.ma

I’d like to express my gratitude to the male surgeons who have shared the joys and challenges of parenting with me personally as well as with the Twitterverse. I have been touched and inspired by conversations of balancing family and career with both male attendings and residents. For those of us who enjoy #SurgTweeting, I think we have all smiled at the #SurgParenting pics that pass through our Twitter feed.

Synergistic with the role modeling shared through the #ILookLikeASurgeon movement, seeing the #SurgParenting photos of male surgeons integrating career and family life has been inspiring for all genders.

#SurgDads, thank you!

Dress Like Your Dad Day at church today. #surgparenting pic.twitter.com/NCq2MqkfSp

— Brad Dennis (@TraumaDawg) June 19, 2016

@LoggheMD How’s this? Then and now, with daughter Emily. #ProudDad #ILookLikeASurgeon pic.twitter.com/DGpCPWG9pm

— Scott LeMaire (@scottlemaire) February 3, 2016

My little girl today. Will #ILookLikeASurgeon tomorrow. @LoggheMD pic.twitter.com/vlYGhkajOb

— Sam Atallah (@SamAtallahMD) August 22, 2015

@mcsassymd Should note that @DocSelbs also got some great action shots. Look at the concentration! #SurgParenting pic.twitter.com/cMzcIsibZN

— Luke V. Selby, MD (@LVSelbs) June 18, 2016

So, this happened @mghfc today: Teddy Bear Clinic! #SurgParenting @SurgTweet pic.twitter.com/Nd8JIa7xJY

— Joel Thomas Adler (@joeladler) June 4, 2016

#SurgParenting #LittleMan is on the way to #TeamSurgOnc @DocSelbs pic.twitter.com/NbhRB7bRjy

— Luke V. Selby, MD (@LVSelbs) May 12, 2016

And just like that, she wraps her hands around my heart. #surgparenting pic.twitter.com/v06DXco17r

— Dr Eric Levi (@DrEricLevi) May 7, 2016

@mcsassymd @DrEricLevi my dad never missed a recital, built a treehouse, coached little league. Did it all. And FACS pic.twitter.com/umCcYDoXsx

— Joel Topf, MD FACP (@kidney_boy) May 5, 2016

My current and your future boss. #SurgStory #SurgParenting #ReadingHenryFordsBiography pic.twitter.com/vXB5qImfaT

— Amir A. Ghaferi (@AmirGhaferi) April 13, 2016

Keeping the tradition alive... #SurgStory @joeladler pic.twitter.com/hxtGW4GkVn

— Amir A. Ghaferi (@AmirGhaferi) April 7, 2016

#surgparenting done right. Where's Waldo with Loupes. pic.twitter.com/cWxMRuZM6X

— Dr Eric Levi (@DrEricLevi) March 29, 2016

Today @DocSelbs & I expanded our #SurgParenting brood & got #LittleMan a baby bro. Everyone doing well, dad v. proud pic.twitter.com/HcNeIC9rDc

— Luke V. Selby, MD (@LVSelbs) March 28, 2016

Enjoying #postcall day after my first laparoscopic TEP hernia repair. Feeling #Blessed #SurgParenting pic.twitter.com/FsCRu5gk0O

— John Vance (@JohnFVanceDO) March 23, 2016

Apple. Trees. This kid's got no chance #ILookLikeASurgeon #pressuremuch? @Kfraserkirk pic.twitter.com/rXoy9fVViG

— dr grant fraser-kirk (@grantfraserkirk) February 8, 2016

Testing out the new shades for Hawaii. #PCSA2016 won't know what hit it! #longflight #loudcrying pic.twitter.com/RILTg3SzO3

— Matthew Martin (@docmartin22) February 1, 2016

#ILookLikeASurgeon Look like a future surgeon.....or two! pic.twitter.com/s1jYoBe0aU

— Matthew Martin (@docmartin22) October 29, 2015

I suppose surgical skills do help with parenting sometimes. #SurgParenting pic.twitter.com/11Mmuxp5LL

— Dr Eric Levi (@DrEricLevi) December 20, 2015

#ILookLikeASurgeon For The first time time My youngest son (3rd Y Med school) scrubbed in with me Yesterday. pic.twitter.com/WQynqSrjRb

— Andrés Hanssen (@anhanssen) December 10, 2015

Saturday mornings with dad. #SurgParenting pic.twitter.com/aJ3n6fC3VU

— DrChrisMerry (@drchrismerry) October 31, 2015

Dress Like Your Dad Day at church today. #surgparenting pic.twitter.com/NCq2MqkfSp

— Brad Dennis (@TraumaDawg) June 19, 2016

Am I just getting older, or are these WTA presenters getting younger and younger? @TraumaDawg @goscar #WTA2016 pic.twitter.com/FFRREFn8Rj

— Matthew Martin (@docmartin22) March 2, 2016

Good looking kid! Can't believe its been 1 yr for my 2 little B-EASTS @AdilHaiderMD @EAST_TRAUMA #EASTKids #EAST2016 pic.twitter.com/cHZDW19ouk

— Matthew Martin (@docmartin22) January 12, 2016

Heading out for Western Trauma - Tahoe or bust! #WTA2016 pic.twitter.com/hzwG0QbaIz

— Matthew Martin (@docmartin22) February 28, 2016

#daddydaughterdatenight = a bunch of grown men crying when they play "Butterfly Kisses" pic.twitter.com/9CLlcsugLg

— Trent Wilson, MD (@TrentWilsonMD) February 13, 2016

Not a flattering post-call pic, but that's #SurgParenting for you.#ILookLikeASurgeon pic.twitter.com/Fgjj46LjgJ

— Christian Jones (@jonessurgery) February 28, 2016

That's more like it: #lazysunday with @prsjournal#ILookLikeASurgeon #surgparenting pic.twitter.com/Y4BXfkaC3L

— Dr. Daniel Liu (@danielzliu) December 6, 2015

I'm not gonna say this is the proudest moment of my life. But it's close. #SurgParenting #Ilooklikeastormtrooper pic.twitter.com/eky1kNkndR

— Drew Shirley, MD (@drewshirleymd) October 29, 2015

Meet our chief of the week: Parth Patel, MD https://t.co/7h0hlhOKjT #SurgTweeting #SurgParenting #MIS pic.twitter.com/BECyK5KaIS

— NJMS Surg Residents (@NjmsR) October 22, 2015

Having way too much fun on this #ColumbusDay with @SnapCircuits!
⚡️💡🔋🔊 #Science4Girls #SurgParenting #STEM pic.twitter.com/Ukbl6cKzGc

— Dr. Daniel Liu (@danielzliu) October 13, 2015

#ILookLikeASurgeon My daughter as an intern being mentored by an old friend @MontefioreNYC @EinsteinMed pic.twitter.com/oYCUr3k0MM

— Michael Zenilman (@mzenilman) October 9, 2015

Aiden learns surgical robotics @VaScienceFest with @CarilionClinic and @daVinciSurgery @IntuSurgNews #SurgParenting pic.twitter.com/2lzjG6qxFJ

— Farrell Adkins, MD (@FarrellAdkins) September 26, 2015

great music festival this weekend @onblackheath I'm celebrating equality in life for my children #ILookLikeASurgeon pic.twitter.com/ExqhoYvuZc

— Duncan Bew (@duncanbew) September 15, 2015

@LoggheMD Out with the family on a break, do #ILookLikeASurgeon?! @drheatherfurnas @KickAsana pic.twitter.com/wXBgIcDsJr

— Pallab Chatterjee (@pallabc) September 5, 2015

Future surgeon...she immediately blamed anesthesia for the mess #surgparenting #ilooklikeafuturesurgeon pic.twitter.com/sAvZbTDsJn

— Dan Parrish (@drdanmd) August 22, 2015

#ILookLikeASurgeon pic.twitter.com/irUGuO1PrC

— Christian Jones (@jonessurgery) August 14, 2015

Afterwork pediatric splinter surgery #ILookLikeASurgeon #ilooklikeadadtoo pic.twitter.com/boz5WxAEPF

— Dan Parrish (@drdanmd) August 12, 2015

Blessed to know @PorterOnSurg
His Powerful Storyhttp://t.co/3UEdaSVGvi#ILookLikeASurgeon #ILookLikeAUrologist pic.twitter.com/5qOjquwV6K

— (((StorkBrian))) (@StorkBrian) August 14, 2015

When career & family both suffer. Written for the #ILookLikeASurgeon campaign http://t.co/A5Piin6SDN pic.twitter.com/aQUTVr7yL5

— Chris Porter MD (@PorterOnSurg) August 16, 2015

@LoggheMD making surgery work #ILookLikeASurgeon #surgfamilies #flexible @Kfraserkirk pic.twitter.com/P5mjmoeH69

— dr grant fraser-kirk (@grantfraserkirk) September 13, 2015

Me and Michael going to church last Sunday. Love that guy, but he doesn't behave in Sunday school. That's why I help. pic.twitter.com/xjSCL47KoW

— Anthony Firilas (@FirilasMD) March 11, 2015

"Alright, kids! Hands to yourselves." #ILookLikeASurgeonScientist #PapaSurgeon #LabSaturdays pic.twitter.com/i5z1aRAm0e

— Drew Shirley, MD (@drewshirleymd) August 22, 2015

Thnk u Dr Robinson & awesome @BrighamWomens team- we r so blessed 2 welcome a lil girl @BWHSurgery #ILookLikeASurgeon pic.twitter.com/U2ubm0COKR

— Adil Haider (@AdilHaiderMD) September 4, 2015

#ILookLikeASurgeon #SurgParenting earning #Surf Desserts at @Challenge_Amer #ChallengeMaine #50WomenToKona #5Q pic.twitter.com/JAbC8iO7CB

— Luke V. Selby, MD (@LVSelbs) August 30, 2015

#SurgParenting on vacation @ThinkeryATX #ILookLikeASurgeon pic.twitter.com/7LAOtawH2c

— Niraj J. Gusani, MD (@NirajGusani) August 25, 2015

#ILookLikeASurgeon with my first (and best) surgical mentor #MyFathersDaughter pic.twitter.com/5X8luhQPLH

— Dr. Deanna Attai (@DrAttai) August 12, 2015

According to Twitter data analytics from Symplur, #ACSCC15 had record Twitter participation with over 50 million impressions, 14,000 tweets and over 2,500 participants. Statistics, however, only tell part of the story; they do not reveal the interactions and interconnections of those who tweeted. In other words, they reveal little about the network. To illustrate these connections, Twitter data can be organized graphically into interactive network visualizations.

Using Twitter’s API, I (Mookie Thayer, of @PresentServices) built interactive data visualizations for #ACSCC14 and #ACSCC15. These visualizations were created using the mentions, favorites and retweets of all tweets that included the conference hashtags. The #ACSCC14 network visualization of mentions and retweets can be viewed below.

2014 – #ACSCC14 Twitter network of mentions and retweets.

The dots or “nodes” represent Twitter users such as @AmCollSurgeons and @WomenSurgeons. Hovering over a node reveals the username. Connecting lines represent interactions such as a mention, favorite, or retweet. The colors highlight “communities” or “conversations” revealing sub-networks within the overall conference dialogue. Clicking on a node highlights the network of the selected user, allowing you to view the individual user’s impact and participation in the overall network. Being able to visualize the network of an individual user serves as a proxy for their influence within the Twitter community. For example, click on the pink node in the bottom right; you will see the sub-community of @heatherevansmd. Notice the multiple nodes connected only to her. Those are her colleagues back at home, participating in #ACSCC14 through Dr. Evans.

#ACSCC15 – Massive growth of conversations and users

To establish the data set, I imported all the tweets that contained a “mention” (i.e. @name), those that had been favorited or “liked”, and all retweets. The initial visualization of this much larger group of tweets from #ACSCC14 looks like an explosion of connected points. To make it more legible, I then limited the data points to nodes of users with 10 or more mentions/favorites/retweets.

Multiple algorithms were used to determine data points of interest. For example, the “Degree Distribution Average” (i.e., the average number of connections to each node) was a bit over 4 Twitter users per community, but only the top 10 communities are color-coded.

The “communities” were determined by calculating the modularity of the tweets and colorizing those users whose tweets demonstrated intense modularity. Modularity is a measure of the strength of division of a network into modules (also called groups, clusters or communities); in this case the modularity increases with increased strength of interactions as measured by retweets, replies, and favorites.

Once the nodes were colorized based on their communities, the nodes (i.e. users) were weighted based on volume of mentions, retweets, and favorites.

Finally the visualization was manipulated for clarity by expanding the spacing, adding and removing gravity from the weighted objects, adjusting alignment, and labeling.

This non-interactive version is 1080p with a black background. Download it to zoom in to see all those users and connections!

1080p – High-res version of #ACSCC15 Twitter user network.

Zoomed in Screenshot

The last step is to take the data and make it more interactive, enabling the user to view the network as a whole as well as to break down each user’s network. (The programming involved in this is beyond the scope of this blog.)

#ACSCC15 – Twitter User Network Data Visualization

Click here for the interactive version of #ACSCC15

What changes do you see between 2014 and 2015? Look at the number of followers many of the users picked up over time. Who were the major Twitter influencers at the conference each year? What surprises came out of the visualizations?

Similar visualizations will be created for the 2016 Academic Surgical Congress. Follow @presentservices for future visualizations of the #ASC2016 Twitter communities.  You can discuss and ask questions in our comments section, or you can always tweet me.

I’d also like to thank Heather Logghe and Christian Jones for helping me co-author and explain the data for this project.

– Matt “Mookie” Thayer – @presentservices

Public perceptions of surgeons matter; fear of an intimidating surgical persona can prevent patients from seeking needed care, undergoing potentially beneficial surgery, and complying with treatment plans. Biases rooted in negative perceptions can influence patients’ hospital experiences and consequently physician ratings. These perceptions also influence those who choose to enter the profession; sadly the world may be missing out on caring and perceptive surgeons due to inaccurate stereotypes of the “surgical personality.”

A recent opinion article titled, “There is no place for the surgeon myth in modern medicine,” by Alexis Sobel Fitts provoked ire within the surgical Twitter community for its “misguided opinion” and being “uneducated and poorly researched.” Despite being an aspiring surgeon, I was not offended by the article as I felt Ms. Fitts was writing sincerely from her own personal perceptions and delving into surgical history in an attempt to make sense of them. Ms. Fitts describes being motivated to write the article after hearing her sister’s generalizations of lack of diagnostic skill among surgeons that were inculcated during her first year of medical school. I believe Ms. Fitts was struck by the discordance of her sister’s observations with the heroism, glamour, and grandeur she had seen portrayed by surgeons in the media.

In an attempt to explain this discordance, Ms. Fitts’ article details the history and evolution of modern surgery--from the Middle Ages’ ‘barber-surgeons’ when surgeons were at the bottom of the medical hierarchy to the implementation of modern anesthesia and antiseptics, culminating in the image of an “outsize personality required to carve into a human body.” She goes on to state, “An operation is performed within a distinctly macho context: a showdown between disease and individual doctor, leading a team through authoritative decision-making. Surgeons are valued for their ability to execute, not analyse.” I suspect many surgeons would disagree strongly with these statements. Still, it’s important to remember that with the evidence available to her, these are the conclusions the author made.

In fact directly contrary to the stereotype of the decisive and authoritative surgeon, a study on surgical leadership styles by Hu et al. showed that transactional (task-focused) leaders achieve “minimum standards” compared to transformational (team-oriented) leaders who “inspire performance beyond expectation.” Sadly I could find no blog post and only one lay press article conveying these results to the general public. This is unfortunate as the results of the study likely have implications and applications to settings far beyond the operating room. Fortunately the numerous team photos of #ILookLikeASurgeon actively counter this stereotype.

Indeed images are among the most powerful tools to change perceptions. A 1987 image of one of the world’s first heart transplant surgeons, Dr. Zbigniew Religa has literally been dubbed a picture that “changed the world.” Similarly, the images of #ILookLikeASurgeon showing surgeons having fun, with family, exercising, cooking, and living a life outside of the operating room have served to--as blogger Terri Coutee put it--“humanize the profession.” Ms. Coutee further writes,

I have a suspicion, unfounded and non-evidence based though it might be, and I will own it. My suspicion is this; the surgeons who have posted on this Twitter trend have high ratings with their patients. These are the surgeons who respect you as a team member in your health decisions, sometimes tagged as #SDM (shared decision making) on Twitter. These are surgeons who go the extra distance not only as team members with their colleagues but spend the extra time it takes to research evidence based medicine (#EBM) to hone their practice and skill achieving the best in patient outcomes.

Surgeon authors Drs. Atul Gawande and Pauline Chen as well as surgeon bloggers such as Dr. Nikki Stamp and guest posts on KevinMD such as this one on teamwork by Dr. Starla Fitch provide insight to the general public on the experience of both becoming and living life as a surgeon, bridging what sometimes feels an uncrossable chasm between the often contrasting lives of surgeons and their patients. Given surgery is one of the most intimate forms of healing, it should come as no surprise that patients seek a connection and understanding with those they grant this intimate invasion.

In the end, I feel the lack of congruity between the title and the content of Ms. Fitts’ article is most revealing; by stating, “There is no place for the surgeon myth in modern medicine,” Ms. Fitts suggests she does not believe the existing stereotypes and media portrayal of modern surgery are true. Yet, at the close of the article, it seems she is left yearning for a more realistic definition and image of “surgeon,” one that is both human and a team player. I believe her vision is today’s reality. Follow #ILookLikeASurgeon for surgeons who are living that reality!

on August 5 and writing an accompanying blog post, I never imagined #ILookLikeASurgeon would become a movement. I am truly humbled and inspired daily by the powerful, global response the message has generated.

In meeting advocates of the movement at the American College of Surgeons Clinical Congress, I realized that many are also curious about my own story--who I am and what inspires me to start and sustain the movement. While some articles have simplified my background and described me as a “general surgery resident,” it’s actually a bit more complicated than that. Perhaps not surprisingly, my life trajectory has been anything but stereotypical.

Growing up, doctors seemed superhuman; a profession far beyond the reach of anyone in our small, agricultural community. I was raised on a dairy farm in rural Wisconsin, and both my maternal and paternal grandparents and great grandparents were dairy farmers. When I was 6 years old I was asked to draw myself “20 years from now.” I drew myself looking out the kitchen window, doing the dishes. Fast forward to 8th grade “tech ed” class (i.e. woodworking) where we were encouraged to choose a career from the Department of Labor Occupational Handbook. I chose surgery because it combined my love of science and my passion for helping others. Given there were no physicians in our community, there was really no one to tell me I couldn’t do it. Yet in many ways, the paucity of role models from a similar background has led me to question many times whether I “belong.”

When it came time to go to college, I received an academic scholarship to the University of Wisconsin, Madison and thus didn’t feel the need to apply anywhere else. As a first year student, there were more people in my dorm building (1100) than in my entire home town. While geographically a 4-hour drive, it felt worlds away. That first semester my mind expanded to greater dimensions than the previous 18 years combined. College proved to be a time of both professional and personal growth. I majored in psychology and earned a certificate in women’s studies. The women’s studies courses enlightened me to the strong gender socialization I had internalized growing up in rural America. Also, having grown up in an all-white community, I was eager to attend every “diversity” event I could. While Wisconsin may not be the most diverse state in the nation, the community of Madison is passionate about celebrating diversity and promoting equality. Such opportunities included attending courses at the Institute for the Healing of Racism founded by renowned bassist, Richard Davis.

Part of my journey of uncovering and unlearning my own internalized gender stereotypes included healing from personal experiences with sexual violence. I found empowerment in social activism. I started a peer education program, “Silent Crimes, Outspoken Voices,” which used stories of actual survivors of sexual violence to educate peers. We also started a men’s group focused on pro-feminist, gay-affirmative, and anti-racist issues as well as ending male violence against women. Skills and wisdom gained from these experiences have informed my leadership in the #ILookLikeASurgeon movement.

In medical school at University of California, San Francisco, I found tremendous inspiration in my surgical mentors who modeled a strong history of improving public and global health through learning from and giving back to local and global communities. As a student I was encouraged to continue my passion for advocacy, hosting conferences on both domestic violence and bias in medicine. After graduating from medical school, I took a year before residency to have our first child, Sierra. During that time I worked with a few health tech startups in Silicon Valley. It was a formative learning experience to witness the challenges at the intersection of medicine and entrepreneurship. It was also inspiring and rewarding to work with the many e-patients advocating for their own health and for positive change in medicine. These experiences brought to life the power of social media to connect patients and physicians and inspire innovation.

When the Monday before Match Day arrived, I clicked open the anticipated email and learned I did not match. I consulted with my mentors and quickly made the long list to whom my application was subsequently sent. That Wednesday I secured a spot as a preliminary general surgery resident at the University of North Carolina Chapel Hill (UNC) and was subsequently invited back for a second preliminary year. I loved my experience at UNC, and continued to be inspired by strong female and male role models. Given the limited time residents enjoy outside of the hospital, I chose to focus on expanding my clinical knowledge and caring for our growing toddler at home, rather than aggressively seeking a categorical position. It was not a surprise last July when UNC did not magically have an opening to offer me as a third year resident and thus my initial plan was to work on research projects, network and apply for a categorical position to complete my general surgery training.

As is often the case, “life is what happens while you’re busy making other plans.”

In early August my husband, Chris, was offered a position opening a battery research lab for Tesla Motors. Chris had set up Tesla’s first battery research lab and left this dream job to be the lead parent while I was in residency. We quickly realized that me taking two years out to do research or industry work would allow Chris the opportunity to return to the workforce for this once-in-a-lifetime project, while at the same time give us the opportunity to have a second child. Given that I developed a cystocele at week 26 of my first pregnancy, it is important that I not be clinical (i.e. on my feet) during pregnancy. It does not serve me or my (present and future) patients to put my health, the pregnancy, or ultimately my career at risk.

It was the culmination of these life experiences that inspired the #ILookLikeASurgeon movement.

Given the magnitude of the movement and the doors it has opened, many have asked me if I plan to return to surgery. The answer is a resounding YES! I love surgery and my goal is to secure a categorical position and complete my training. To me, the privilege of cutting open the human body and healing it from the inside out is the single greatest honor that can be bestowed upon someone. Similarly, it has been an honor and a privilege to lead the efforts of #ILookLikeASurgeon.

Not in my wildest dreams did I think I could impact the world of surgery in this way, especially at such an early stage of my career. Yet, when I look back on my life so far, I have lived my belief that we can inspire and help others on their journey, even as we are in the midst of creating our own.

#ILookLikeASurgeon has uncovered a global community of surgeons who are shedding the outdated surgical stereotype. They forge their own unique paths, maintaining their individuality, and prioritize being both the best people AND surgeons they can be, rather than forcing themselves into an ill-fitting stereotype. Personally and professionally, I—along with countless others—have learned that I am not alone. Surgeons come from all walks of life. The pictures and tweets shared publically, as well as the direct messages shared privately, have been a gift and a responsibility.

So what is next for #ILookLikeASurgeon? My vision for #ILookLikeASurgeon is for it to serve as a supportive community promoting positive change, ideally strengthening the networks of existing surgical organizations in the process. This will be accomplished through the continued conversations on Twitter and Facebook as well as blogs and more formal publications. The message remains the same since the very first tweet, that we can ALL look like surgeons. Just like our patients, we are all unique and we all have our own story—often much different than appearances might suggest.

@RoshanaMN

11/11/2015: Junior Doctor Contracts - Where are we now?

A lot has happened since I last wrote about the threatened imposition of a junior doctors contract in the UK. Opposition has been so widespread that we are being covered in one form or another in the media almost daily. Despite the uproar and the near unanimous condemnation of this contact; our government plans to press on with its implementation.

We are now at a stage where the British Medical Association, our union, is balloting for strike action, with results expected in the coming weeks.

Other developments:

• A protest rally in London drew 20000 junior doctors and supporters calling for the halting of this contract imposition, this was followed by protests in cities up and down the UK

  

• The shadow health secretary Heidi Alexander announced her condemnation of the contract

• The Conservative party’s own member of parliament and Chair of the Parliamentary Health select Committee rejected this contract in its current form

• Ireland, Wales and Scotland have all rejected the use of this contract for their doctors

• Letters of support from thousands of consultants and GPs have been written to junior doctors and to the health secretary advising him against this unsafe contract imposition

• Our Royal Colleges, in an unprecedented step, have written to the health secretary advising him not to impose this contract

• Press heavily allied to our Health Secretary has now started sensationalist smear campaigns against visible figures in the junior doctor movement including the chair of the BMA and myself

At this time, whilst we ballot, I would ask for your support. Everyone who reads this contract knows it is unsafe and unfair. The voice has been unanimous: ‘STOP!’ they say. Our government won’t listen.

10/3/2016
As a female surgeon I followed the #ILookLikeASurgeon campaign with much excitement; what a worthy and relevant cause for a global movement! Women being mothers, daughters, sportswomen, fashionistas, etc... AND being surgeons.

I couldn't have known that just a few weeks later, I would be contacting the organisers of this movement to help me demonstrate that the world stands in solidarity with junior doctors in England, as they face the imposition of a contract that threatens patient safety and is unfair to dedicated professionals. I feel that the values imbued in our campaign against this contract – the primacy of patient care, fair treatment and conditions, and an end to gender discrimination – are relevant globally and not just in the UK.

The government has announced it will impose a draconian contract on all junior doctors (any doctor who is not a consultant or general practitioner) in England from August 2016, in the middle of one of the worst retention and recruitment crisis the country has ever seen. Needless to say, with such poor conditions on offer, physicians will vote with their feet, leaving the system even more understaffed and overstretched. This will have a profoundly deleterious effect of patient safety. Those that are left will have to cover the gaps and work unchecked hours. Tired doctors make mistakes. Patient safety is hit again.

Please watch this video for the story to date.

Why is the contract so bad? 

• It removes the mechanism for safeguarding (monitoring hours and fines for overworking) - to ensure doctors are not too tired or overworked and therefore do not harm patients by being so.

• It is even more unsociable than the current contract, further disruption to our private lives will not properly be renumerated - Pay rates for Saturday evening are to be classed the same as working Tuesday morning. Who will provide childcare on Sat evening? Do doctors not deserve to be renumerated for working the most unsociable hours? A hit to morale, our ability to pay our mortgages or look after our children and thus a massive hit to recruitment.

• It is potentially discriminatory - it penalises those who take maternity leave, part time working or researchers; leading to potential financial hardship for women bearing children and discouraging lifesaving research. How can we allow such a step back?

Our union, the British Medical Association, voted to ballot us for industrial action. The government should never have let it come to this, but I'm afraid they only have themselves to blame.

We will fight this - not just for us, but for those on the cutting block next, our nurses, for those across the world facing similar battles, and ultimately for our patients!

I am truly in awe of how, as a profession, we fight through adversity (be it the challenging situations at work, the emotional toll or this latest contract saga) with such resilience. All of us, including our colleagues; nurses, physiotherapists, cleaners, clerks, pharmacists etc...in the healthcare world deserve recognition for what we do, not least a fair and safe contract.

Please stand with us in solidarity this Saturday, October 17th and tweet to make your voice heard!

Sample tweet: "I stand in solidarity with the #ILookLikeASurgeon community and oppose the #NotFairNotSafe #JuniorContract!"

Thanks for reading.

Roshana Mehdian, MBCHB MRCS BMSC PGCEMedEd

Trauma and Orthopaedic Registrar, Concerned Junior Doctor
@RoshanaMN

@paulaferrada1

While reading an article about finding happiness, I found one reason to always smile: Gratitude! Finding things to be grateful for, stimulates your brain in a way that act almost as a natural antidepressant.  For all foreign graduates reading; you know how hard it is to become a surgeon in the United States and the things we did and still do to become one… so regardless of the situation I am on, I always take time to remind myself: I fought for this position because I wanted with passion to become a surgeon- and I won! This was my choice!  And immediately things are better (or at least better in my brain which is the beginning for improvement in other places).

#ILookLikeASurgeon VCU Department of Surgery thank you all! ‪#‎diversitymatters‬

So I made a list of amazing things our profession offers, things that I am grateful for while being a surgeon.

1. Immediate Gratification: I am a trauma surgeon. Immediate gratification for us is evident- I don’t need mountain biking or bungee jumping to have an adrenaline rush… There is not highest high that saving someone’s life! And this feeling,  is totally irrespective of what anyone else thinks or say- even if no one pats you in the back. There is no better satisfaction than walking out of a room and knowing you did it!

2. Wonderful Patients: The satisfaction to see patients that are grateful, and more importantly that recognize that they are a pivotal part of the team; patients that want to get better, that participate and are engaged in their healthcare. This is for me, especially true after I see them recover from a life threatening event. When after being in the ICU for months they come to clinic with their families, and back to their normal life! I feel privileged to be part of their recovery.  

3. Team building and leaderships skills on the go: I truly believe surgeons since early in our training are placed in situations where leadership skills have no other choice but to develop- sure; it would be amazing if we all had formal training, and I am not saying all surgical training programs will prepare you to be a Chairman or CEO; BUT; you will learn to prioritize, to triage information and clinical urgency, to manage a team, to deliver information to patients and colleagues effectively. For all residents: You know all those extra hours preparing morbidity and mortality conference? They will serve you well as public speaking training; time management and control of your audience. Seize these opportunities!

4. Job security: Surgery in one of the specialties that thus far is irreplaceable. The best cure for cancer in most cases is a complete resection, the best way to stop life threatening bleeding is in most cases,  in the operating room; the only way to control sepsis from bowel necrosis is resection; and I can go on and on with examples. We are blessed to be in a field in which we are needed! And likely for many years to come!

We have so many reasons to stay strong! If we are proud of who we are and what we do- If we maintain a sense of belonging, and camaraderie, we have more chances in moving the walls that prevent us from reaching higher; we have better chances at making this profession even more rewarding and change the things that discourage many talented professionals from staying in it.

These are the reasons I’m grateful to be a surgeon--what are yours?

~Paula Ferrada, MD, FACS

@paulaferrada1

@DrKpodzo

Born to a family of scientists --  my father an engineer and my mother an  oral surgeon -- I was given a clear message  that I could do anything. Case in point: at age nine when I declared my career goal of being “president of the world” nobody batted an eyelash. Their unwavering confidence followed me through college at UC Berkeley and medical school at Harvard and continues to be a sustaining factor in moments of doubt.  Entering medical school, I was certain I would not become a surgeon. The stereotypes and messages about surgeons being malignant and aggressive deterred me. Independent of the people and the culture, I fell in love with operating and treating surgical disease. I followed my heart, my passion, and my talent to the field of plastic surgery and did not turn back. Countless mentors (most of whom did not look like me) were vested in my success and allowed me to grow in this challenging field.  To my surprise I was the first black woman to complete the Harvard Combined Plastic Surgery residency program. I didn’t know there were still “firsts” like that.  While I was fortunate  to train with four female plastic surgery attendings over the course of my residency, there were some aspects of my experience as a “first” which felt unique, lonely, and difficult to share.

Being a surgeon is challenging for anyone.  However being a female surgeon and a black woman add additional layers of frustration.Verbally, the message can be clear: “Are you going to do my surgery?” or  “When is the doctor coming?” from a patient; or as stated by a colleague, “We really have to get you into a white coat so that you can look like an attending.” In actions, the sentiment can be even more explicit and hurtful. Patients hand me the meal tray when I enter the room, or continue talking as if I had never entered at all. I speak to an anesthesiologist who is so focused on determining  the title on my name badge that she misses all of my instructions about the case.  

During residency I remember receiving a page at 3AM for what would be my seventh consultation that night.  There was a family who came in for treatment of a small laceration on their child’s lip.  They seemed confused as I entered the room. Their demeanor questioned my abilities and they stated outright that they were transferred from another hospital because they needed “one of the old white male surgeons” to take care of their child.  I was tired and definitely not in the mood for this exchange. I was there to provide care and to help, not to deal with their racism and sexism. Even more aggravating was that these false expectations had been validated by my fellow medical colleagues.  I willed my lips into a smile, channeled my inner nine-year-old President, and told them that luckily for them, they got me tonight and that they were in the best possible hands.

Yet another experience occurred as the chief resident. I entered the room with my team which happened to be comprised entirely of males with the exception of the nurse practitioner and myself.  We had been rounding on this particular patient for the last 3 weeks dealing with a challenging abdominal wound.  I informed the family of the plan for the day and delegated one of my junior residents to return and change the dressings. Later on I returned to check on the patient and to verify that the task had been successfully completed.  As I started looking at the dressings the patient’s mother anxiously requested that I consult with “Dr. Junior Surgeon” before making any changes. I laughed and informed her that as a member of my team “Dr. Junior Surgeon” reports to me and not vice versa.  It was interesting to watch the awareness slowly manifest itself upon her face. She blushed, apologized profusely and said she hoped she had not gotten “Dr. Junior Surgeon” in trouble. She was an extremely lovely lady and until that moment, I believe she was unaware of the degree to which she was influenced by these stereotypes.

On top of all the pressures already inherent to being a surgeon, each of these moments required emotional restraint and redundant explanations that I was, in fact, the surgeon.  While it is rewarding to make people (patients and their families, colleagues and hospital staff) aware of their biases and shatter stereotypes it can also be frustrating, burdensome and repetitive. My energy should be focused upon caring for my patients, not defending my position. Contemplating the amount of time and energy spent on these interactions makes me feel resentful and cheated out of some of the joys of being a surgeon.

Constant messages that you are not the right person for the job can be particularly damaging in a field where confidence is key.  I realized that I was not alone with fleeting moments of self doubt when a surgeon well known to be tough as nails described to me how a medical error brought him to tears as he hid on one of the back staircases at the hospital. Many highly successful professionals suffer from impostor syndrome, and highly successful female professionals disproportionately so. In spite of the quantitative and qualitative proof of success, there persists an internal voice that wonders if you will soon be discovered and everyone will know that you do not belong. In surgery, confidence is essential, but the truth is that surgeons have moments of doubt. When I am daunted by a particularly difficult case, or perhaps recovering from a recent complication and trying to get back on the horse, it is taxing to muster the additional energy needed to enter the hospital and overcome the verbal and nonverbal messages challenging my position, knowledge and training; telling me I do not belong.

Heather Logghe's “ILookLikeASurgeon” hashtag has been a rousing call to action about diversity in surgery. The response in social media has been inspirational and indeed overwhelming at times. #ILookLikeASurgeon is the loud answer to the subtle but insistent question that hovers over women and other under-represented groups in surgery...do you belong? From the outpouring of responses to  #ILookLikeASurgeon, it is very clear that surgeons have been aching to look that 100lb gorilla in the room squarely in the eye and say YES!! Even patients are weighing in and expressing that they are tired of the stereotypes, and that race and gender should not affect care. Seeing my fellow surgeons of all ages, genders, ethnicities and backgrounds share who they are inside and outside of their surgical masks has been magnificent.  Their tweets and photographs show complex women and men like me with amazing talents, interesting hobbies, families and successful careers. With every tweet I am reminded that I am not alone; I am not an imposter.  There are many others in the ranks, and we share a powerful collective experience. Thank you Heather, for distilling the problem in such a compelling way and giving it voice. Being a surgeon is not determined by age, race or gender. Regardless of societal expectations and stereotypes, #ILookLikeASurgeon, along with countless surgeons the world over who have shared their image and voice in the movement. May we continue to post our pictures, celebrating the diversity of our profession and our lives.

 Dzifa S. Kpodzo MD, MPH

@DrKpodzo

A native of Ghana, West Africa, Dr. Kpodzo also grew up in Germany, the United Kingdom, and Canada, and moved to the United States during high school.  After graduating with honors from the University of California at Berkeley with a B.A. in Integrative Biology, she completed a dual medical doctorate and master in public health at Harvard Medical School and the Harvard School of Public Health.  Dr. Kpodzo has received unparalleled education by world-renowned surgeons.  She trained in plastic surgery at the Harvard Plastic Surgery Combined Residency Program where she also served as a chief resident and became the first African-American woman to graduate from her program.  She then completed her fellowship in oculoplastic (eyelid surgery) and aesthetic (cosmetic) surgery at Paces Plastic Surgery in Atlanta.

As an Assistant Professor at Morehouse School of Medicine, Dr. Kpodzo is proud to be the first full time plastic surgeon on faculty.  She is dedicated to teaching, academics and service. She has received numerous academic awards, published book chapters and peer-reviewed articles, and presented to national professional medical organizations.  She had the honor of participating in 3 full face transplants during her residency training, and received recognition through the Partners in Excellence Award for Teamwork.  She has shared her skills internationally providing care in Ethiopia with Operation Smile, as well as spending time in her homeland Ghana. She is a member of Delta Sigma Theta Sorority Incorporated and remains involved and active in the community in various ways.

by Heather Logghe, MD

With over 100 million impressions on Twitter, the #ILookLikeASurgeon movement demonstrates the diverse faces of surgery. The #ILookLikeASurgeon Twitter feed also makes it clear that the topic of family is at the forefront of many surgeons’ minds.

In 2015, it is imperative that surgical culture embrace an inclusive and progressive definition of family. In order to define family this way, we need only look at the broader community of which we are a part. So far, we have heard from Dr. Chris Porter, who at first glance appears the stereotypic surgeon--white, male, forthright, confident. But beneath the surface he struggles to balance the responsibilities, pride, and joy of being a single parent with his passion for and dedication to his surgical career and patients. We've also heard from Dr. Elinore Kaufman, a queer resident-in-training, who shared her experience as a mom whose female partner carried their child. Family transcends gender and orientation.

Luke Selby, MD and his son

Balancing career and family commitments is no longer a “women’s” issue. Male and female residents ask senior colleagues for advice on work-life balance in equal numbers. Furthermore, male surgeons have felt progressively more comfortable expressing the distress resulting from not being allowed time to witness and celebrate their child's birth or to help care for their infants. Fathers and mothers both agonize over when to have children. Both partners grieve when one suffers a miscarriage. Even single, childless surgeons can face family obligations when caring for aging parents. These modern voices offer a perspective that is vital to enriching our discussion about family in surgery.

Pregnancy Then and Now

I have been passionate about this topic since hitting the interview trail for residency 6 months pregnant. As a medical student I heard the legend of a well-known woman surgeon continuing to suture through contractions as she went into labor. It was an unspoken but clear precedent for others* who might become pregnant. The part of this legend that is frequently omitted is that these contractions led to premature labor, resulting in the first weeks of her child’s life being spent in the NICU. As women surgeons, we take pride in our strength, but sometimes to a fault. It worries me that appearing “tough” and “committed” in the OR can be in direct conflict with our own health and that of our offspring. One resident begged a colleague to place a foley catheter in her so she could operate without bathroom breaks. Her co-resident acquiesced and she went into labor and delivered the next day, a month early. These stories send the message that accommodations for pregnancy are unwelcome, if not blatantly rejected.

When I learned I would be pregnant during the residency application process, I consulted multiple mentors on how to address this “issue” during interviews. I was advised by two of my most respected female mentors not to mention a word about the pregnancy, despite the fact that I would be 6 months pregnant and likely showing. While this recommendation was evidence-based, I did not feel comfortable following it. The sacrifices of women who came before me made it possible for me to question this status quo. I have the utmost respect for the women who did not have the option of publicly discussing their pregnancies and the inherent challenges, likely out of a realistic fear that it would jeopardize their careers. I am happy to report that I received no negative comments on the interview trail. I’ll never know what role my pregnancy played in the match, but I ended up with a prelim position.

My husband and I had timed the pregnancy to ensure that pregnancy did not interfere with training. Little did I know that the impact of pregnancy on one’s body can last long after the labor pains are over. I’ll never forget when six months after giving birth during intern year, I sprinted a few steps to the ER, and on the fifth step I felt my cystocele protrude, with my bladder literally falling out of my body. Fortunately the women’s clinic was housed within the hospital, and the female nurse practitioner on our team allowed me time to step away. I remain grateful to the administrative assistant who recognized the fear and concern on my face and convinced one of the gynecologists to see me without an appointment. In 15 minutes I was back on the wards with a pessary in place.

The Future of Pregnancy in Surgery

Throughout #ILookLikeASurgeon, we have heard stories and seen pictures boasting women operating with nine month baby bumps, accompanied by encouraging hashtags such as #RoleModel and #MakingItWork. While this may be perfectly safe and appropriate for some women and their pregnancies, it is not a healthy model for all pregnancies or all surgeons. Studies** show that surgeons have poorer pregnancy and birth outcomes compared to average American women. Clearly the current approach is not working. It behooves us to acknowledge that growing a human being takes significant energy and an undeniable toll on women’s bodies.

At the top of La Honda at 38 weeks

Achieving healthy pregnancies and newborns should not require women to avoid becoming surgeons or surgeons to forgo pregnancy. The cultural and professional expectations we place on women both in the operating room and as life-giving human beings must account for the hard work and dedication it takes to be successful at both surgery and parenthood. Neither is accomplished without community and institutional structures of support.

As physicians, and as surgeons in particular, we rely on our bodies to be vessels of healing. Taking care of ourselves, such as with my cystocele and visiting the doctor for a legitimate medical emergency, should not require luck or fortuitous circumstance. While the pessary served as an effective “band-aid,” it is only now, during my research years, that I have time to return to a physical therapist for pelvic floor rehabilitation. After the traumatic loss of one of its residents, Stanford launched an innovative “Balance in Life” program that facilitates regular primary care and dental visits. They also required interval psychologic evaluation to identify and mitigate burnout. Other programs shouldn’t wait for a resident death to actively create an environment that promotes the health of its residents.

My Story

Ride for World Health 2006

The challenge of family planning that has touched me personally is how to create a professional work culture that fosters healthy pregnancies, labors, and newborns for surgeons and surgeons’ partners. Before I delve in, I’d like to disclose that I am no stranger to physical pain and endurance. I have trained in Brazilian Jiu Jitsu, completed multiple marathons including two Ironman Triathlons, and cycled across the country (SF to DC). Yet, I was shocked by the heavy physical toll the first trimester took on my body. Of course, there does exist the rare, lucky individual who sails through pregnancy, but we cannot predict or expect this. Even my “healthy” pregnancy was not without significant challenges.

My husband and I had originally hoped I would become pregnant during my 4th year of medical school. When that didn’t happen, I decided to take a year between medical school and residency to have a child. It is notable that we conceived the first month after graduation. I cannot help but conjecture that the stress of clinical rotations and the competitive nature of medical school inhibited our ability to conceive.

Brazilian Jiu Jitsu

I was alerted to my pregnancy when I had cardiac pain while cycling up a mountain days before my period was due. Thus the physical impact was evident within days of conception. In addition to seeing stars every time I stood up and frequent urination, I also suffered severe shortness of breath and debilitating low back pain requiring chiropractic care. Mind you this was all during the first trimester, before I had gained a single pound.

The low back pain shocked me. I was only 10 weeks into my pregnancy when I noticed shooting pains upon shifting positions in my seat. It literally hurt to move. I called my midwife based on the sheer terror that I would not be able to move for the remainder of my pregnancy. She hypothesized that I had had a tailbone injury years earlier (true) that was somehow reactivated by the hormonally-driven ligamentous and muscular relaxation of pregnancy. After Googling possible solutions, I decided to seek care from a chiropractor, which made a huge difference. Ultimately I found that once or twice weekly deep tissue massage treatments (“torture” sessions in my opinion) enabled me to continue the active lifestyle to which I was accustomed.

I also found an online group of pregnant “mommas” who ran, which was invaluable. It was one of the internet “mommy boards” that reassured me that my shortness of breath was normal, encouraging me to continue running throughout the first and much of the second trimester. Around week 25, I began to notice a fullness in my pelvis, prompting me to cut back on my running. Soon after, the feeling morphed into the peculiar sensation of a tampon falling out. At that point I decided to inspect things, only to realize that I had developed a full blown cystocele! In addition to once or twice weekly chiropractic care, I now added weekly sessions of specialized physical therapy to keep my insides, well, inside! I remain eternally grateful that I was without clinical responsibilities at the time, allowing me time to attend deep tissue massage and physical therapy appointments in addition to normal prenatal care.

Proud parents

My saving grace throughout this was that while riding my bike, aside from some significant huffing and puffing, I barely felt pregnant! I continued cycling throughout my pregnancy, completing a century ride at 16 weeks. I even tried mountain biking at 22 weeks, but after two crashes and a concussion, decided it maybe wasn’t the best idea. Up until the day I delivered I was able to cycle mountains and complete rides of up to 40 miles. The day I didn’t feel “up to it” turned out to be the day I went into labor.

In the end, I delivered a healthy, 5 lb 12 oz baby girl, full term, but 10 days early, just as my “Exercising Through Pregnancy” book predicted. I had three months with her before starting residency and was able to pump and continue breastfeeding still today. It’s hard to imagine residency without her :-)

Share Your Experience

Now I’ve shared my story. To realize how #ILookLikeASurgeon can transform our profession, I encourage you to share yours. These may not be  pregnancy or infertility stories, but also stories about how we create and support families; the challenges, barriers, and creative solutions we can replicate. Only through an open and authentic conversation, with participation from all genders, can we set the foundation to create lasting solutions. You can share your story through your own personal blog, a guest blog post on Allies For Health, or even a simple email or direct message. Now is the time to finally speak up and let your voice be heard.

*Given there are transgender and gender nonconforming people who bear children, I have intentionally aimed to use gender-neutral language in reference to pregnancy. Special thank you to Dr. Elinore Kaufman for this recommendation.

**Articles on pregnancy outcomes among surgeons:

Hamilton, A. (2012). Childbearing and Pregnancy Characteristics of Female ... Retrieved from http://jbjs.org/content/94/11/e77.

Lerner, L. (2009). Birth Trends and Pregnancy Complications among Women ... Retrieved from http://www.journalacs.org/article/S1072-7515(08)01455-5/abstract.

Phelan, S. (1988). Pregnancy during residency: II. Obstetric complications. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3043291.

Phillips, E. (2014). Does a surgical career affect a woman's childbearing and ... Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25260684.

Turner, P. (2012). Pregnancy Among Women Surgeons: Trends Over Time. Retrieved from http://archsurg.jamanetwork.com/article.aspx?articleid=1150115.

@JBBC

Getting Started on Twitter? Do This One Thing First

So you’ve decided to set up a Twitter account and you are now ready to send your first tweet to announce your arrival in the Twittersphere. Before you hit send, take a moment to consider what people will see.

Will they see you?

This may seem like I am stating the obvious, but it is surprising the number of new (and not-so new) Twitter users who start tweeting from an account with no clearly identifiable name, bio, or profile picture.  The first and most fundamental thing to understand about Twitter is that it is a conversation. Would you approach someone at an event and not introduce yourself first? Would you keep your face hidden from view while you hold a conversation? And yet this is precisely what some users do when they set up their Twitter accounts.  Your Twitter profile is the first place someone will look when they read your tweets, so make it credible and professional by following these tips.

Don’t be an egg head. Add a personal picture to your profile.

Many Twitter users will not follow accounts without a profile picture on the assumption it is a fake account. A study  published by researchers from Microsoft and Carnegie Mellon University, “Tweeting Is Believing? Understanding Microblog Credibility Perceptions,”  analyzed how users assess Twitter credibility. The study found that:

• users are poor judges of truthfulness based on content alone, and instead are influenced by heuristics such as user name when making credibility assessments.

• users represented by the default Twitter icon, or a cartoon avatar are perceived as significantly less credible than users with  a personal photo.

The phrase “egg head” refers to Twitter’s default  profile image. As soon as you have created your Twitter account, you should replace the default image with your own picture.  This is easily done in your Twitter account settings. Twitter is about human connections. When uploading a picture, don’t use a cartoon, or any other animate or inanimate object for your profile. A professional close-up head shot works best.  You also have an opportunity to personalize your profile by uploading a custom header image alongside your profile picture. Use this opportunity to bring more authenticity to your account, as this image shows.

Create your Twitter bio

Add your (real) name, provide a brief bio and include a link to your institution’s website, and/or your LinkedIn profile so people can learn more about you. If you are hesitant to identify yourself, then consider if Twitter is the right platform for you. You may be better with a LinkedIn account which is restricted to connections you control. Remember on Twitter your tweets are there for all to see.  

You may also wish to add a medical disclaimer to your Twitter profile, which states that you do not offer medical advice through social media, and/or the views you express are yours and not that of your employer. Finally, don’t be afraid to inject a little personality into your bio as this example illustrates.

Find People To Follow

Next you will want to find some people to follow. Use this list  of Surgeons on Twitter http://list.ly/list/lX1-surgeons to discover some surgeons who are already established tweeters. The list is updated regularly with new names so check back regularly and tweet me @JBBC if you wish to have your name added to the list.

While you will want to follow friends and colleagues, don’t restrict yourself to just this list. One of the great benefits of Twitter is its ability to be a global melting pot of ideas and people to learn from.  Including a diverse mix of health care professionals, policy makers, and patient opinion leaders in your Twitter mix will enhance your learning and professional development. You will find a wealth of knowledge and an opportunity to contribute your expertise through following health related hashtags. Some of the best conversations happen through the medium of Twitter chats.  These are pre-arranged chats which include a predefined #hashtag which links the tweets together in a virtual conversation. You will find a full list of health hashtags via Symplur's Hashtag Project.  

Send Your First Tweet

Now all that remains to do is to send your first tweet. This is an important step. A Twitter profile without any tweets may be mistaken for a spam account.  If you are not sure what you should tweet, try something simple, like introducing yourself to the Twittersphere.

Your professional reputation online is just as important as offline. Your Twitter account is one of the most visible descriptions of you on the Internet, so make sure it is projecting the best professional image.  Follow the steps I have outlined and you will be ready to create a Twitter account which will enhance your reputation both on and offline.

About the Author

Marie Ennis-O’Connor is a writer, keynote speaker and social media consultant, specializing in healthcare communications.  Follow her on Twitter @JBBC

Surgery has a rich culture, full of strengths that exceed and defy the stereotype of surgeons as privileged white men who believe they are gods. In surgery there is a shared commitment to a goal, to individual excellence but also to true teamwork, to honoring the privilege of our patients' trust, to  finding problems and fixing them, to getting quickly to the heart of the matter, whatever it is. As a surgeon-in-training, I am learning how to perform operations, but I am mostly learning how to make high-stakes decisions in imperfect circumstances, and as an imperfect individual.

This is what makes being a surgeon the best job in the world, and it has been inspiring to see surgeons celebrating one another through #ILookLikeaSurgeon. The photos from around the world show a broad understanding of the people who bring diversity to surgery, but also of how our diverse backgrounds inform our work. As a queer woman and a surgeon, this conversation feels rich, inclusive and important.

As surgeons we have a lot in common, but we also bring our own unique experiences to the work. As I learn to operate, I draw on my attendings' teaching and expertise, my patients' generosity, but also on my background as an artist. Working with paint, fiber and clay has taught me the joy of working with my hands, learning new physical skills, and balancing speed and precision. I also bring my identity as a queer person to surgery. This can mean building a special bond with my lesbian, gay, bisexual, transgender and queer (LGBTQ) patients, making sure their partners, families, and identities are not only tolerated but welcomed. It can sometimes mean giving advice about anal sex after hemorrhoid surgery. It means always, always, always using the name, pronouns, and gender that a patient prefers.

Being queer in surgery means living in a world that assumes I am straight, and coming out over and over again. Although the reactions of my surgical colleagues are rarely hostile, they can be a bit awkward. Being queer in surgery also occasionally means pulling a colleague or student aside to tell them why I didn't laugh at a particular joke, or why they shouldn't assume that a married man has a wife. It also means letting some of these moments slide, wishing that it were someone else's turn to intervene.

I've been involved in LGBTQ organizing and activism in one way or another since middle school. I've been out since high school. It's a little bit about who I'm attracted to, and a lot about how I see the world. At the beginning of medical school I was one of two openly LGBTQ people in my class of 200, and I spent a lot of time not only explaining myself to my classmates and teachers, but also working for the inclusion of LGBTQ health issues into the curriculum.

For me, being queer in surgery means giving special attention to what alienation from healthcare feels like. Many of us from have experienced real discrimination at the individual or community level, leading us to present late or not at all; or to act in ways that perplex or annoy our doctors. Depending on our healthcare providers’ responses, this can lead to worse health outcomes. It also means being aware of  health disparities that affect LGBTQ people beyond HIV: disparities in cancer, mental health and substance abuse, as well as insurance and access to care.

It means being aware of transgender-specific health care: transgender people are among the only individuals who often need surgery just to be themselves. Trans people, often with limited resources, save money for procedures that can be life-saving, but that insurance often doesn't cover. They frequently travel for services that are only available in a few places. Not every trans person wants or gets surgery, and gender confirmation surgery is not in the scope of all surgeons’ training. But still, our  profession plays a critical role in transgender people's lives.

Thinking about the experiences of my LGBTQ friends and patients also gives me a special appreciation for surgeons just being surgeons. Surgeons like to get to the point, and we can be single-minded about it. We don't usually like endless debates or complications. While at times this might make us less sensitive to certain issues that affect our patients, it can also be a good way to approach everyone equally. For LGBTQ patients this can be an advantage. The average surgical history does not include a lot of invasive, personal questions. Being brisk can sometimes make us less judgmental, not more. So I was pleasantly surprised when, as part of a surgical team caring for  a transgender woman with acute cholecystitis, the only person who cared about her genitalia was the person putting in the Foley.

I approached #ILookLikeaSurgeon with some suspicion. I am a woman and a surgery resident, and I know there are not enough of us, especially in leadership and mentorship positions. But as a white, upper middle class woman with an elite education, I come to surgery with an enormous amount of privilege already, and this disparity does not seem like the most urgent one. In addition, many discussions of women in surgery often seem to assume a uniform experience about life as a woman and a surgeon, and as a queer person, my life works differently. The assumption is often that all the women in the room date and marry men; have children at all or in the same way; and think about childcare as primarily their responsibility. I know many colleagues find solidarity in these conversations, but these are not my assumptions or my experience, and I have often felt invisible in these conversations. In its own way, invisibility is as exhausting as Q3 call.

Like many, I had a baby during my research years. Unlike my straight female colleagues, my partner got pregnant and gave birth. I did not operate pregnant or miss clinical time for prenatal visits or maternity leave. But more than that, my partner was not raised to believe that someone else would be the primary caregiver, so there's no pressure from reversing stereotypical gender roles. When I finish research in June, I know I am going to experience stress and sadness from not spending as much time with my kid as I wish I could. I know many of the fathers I work with feel this tension as much as the mothers, even if they are not expected to talk about it. On the other hand, I do need to make sure that my job offers partner benefits for health insurance that will cover us all. I'm only going to let my career take us to cities where we feel comfortable; where we have community; and where we are going to feel okay about raising our kid without her feeling like she's always the only one who has to explain her family. There are some family-friendly towns and institutions that might not be as friendly to my family.

So yes, #ILookLikeaSurgeon, I act like a surgeon, and I also look and act like myself. Our diversity matters to us, and it matters to our patients. We can bring our whole selves to their care, and they need us to.

Elinore Kaufman, MD

@ElinoreJKaufman

Andrew M. Ibrahim MD 

@andrewmibrahim

Over the last two weeks the #ILookLikeASurgeon movement has gone viral on Twitter, with over 72 million impressions and 5,000 participants. Countless surgeons have joined Twitter for the first time just to post their photo and join the community.

Scrolling through the snapshots and stories, two statements are clear. First, surgeons come from all backgrounds, across gender and geography, overcoming odds and static traditions. Second, surgeons have lives outside the OR. It has been humanizing and inspiring to see notable surgeons and mentors proudly display their roles as a parent, spouse, entrepreneur, cyclist, artist, or community member. It's less of an "I can do it all" stamp, and more of a "stay true to yourself" reminder.

The images, in aggregate, celebrate diversity in surgery--revealing its strength and hope for the future.  Such diversity is a necessary foundation for innovation. The challenges facing healthcare certainly require many full time clinicians, but also need physicians who can bring something else to the table. In the past it has been limited to bench research or surgical education. But if we want to harness the energy of this movement we ought to broaden our ideas of diversity even further to embrace a breadth of surgeon innovators with a love for technology, a spirit of entrepreneurship, an intuition about policy reform, an aesthetic for the arts and so on.

Wisdom on how #ILookLikeASurgeon can move forward may be found in the prose of literature professor, Matthew Shenoda, who offered this advice to young writers:

Aside from all of the standards of reading and writing and honing in your craft, is to live; to find the spirit within you; to find the fire and understand why you do this.

Don't isolate yourself from the rest of society like many writers tend to do, but really engage in society; understand the tempo and rhythm of humanity and bring that to your work.

Study your own history, understand knowledge of self and bring that to your work.

Engage in the human experience on every level you can and bring that to your work.

And understand that this a healing art.

Understand that this art has more power than any of us truly realize and come to it with that humility, come to it with that understanding and help shape the lives of other people through this art.

But my biggest advice is to feel an urgency in your work, and to bring that to table.

Know that this art can transform lives, it can change people...

If young people do that, and bring that with the fire of youth, they're unstoppable.

Cover Art: Surgical Anantomy. 

AM Ibrahim 2012

Being true to yourself as a surgeon can be met with resistance. While my small attempts to humanize patient interactions -- asking ED patients about their favorite sports teams, giving pediatric patients a cartoon dressing, sneaking floor patient’s real coffee from Starbucks or playing a patient’s favorite music while pushing them back to OR -- were sometimes recognized as valuable, more often they were discouraged as “inefficient” or a “waste of time.” My choices in research elicited similar responses. In addition to peer reviewed scientific publications, I chose to also publish a painting with an essay about caring for a patient with a terminally ill spouse. While sometimes discredited by my surgical peers (one suggesting to not even list it on my CV), it was an important expression about what we experience caring for surgical patients. And if the data on quality of life for surgeons is any indication on what ails our profession -- 40% report being burned out, 30% depressed -- it may be exactly those kinds of humanizing interactions that we should be encouraging, rather than silencing.   

Most recently, I decided to forego the traditional two years of bench time “in the lab” to pursue research in health policy and innovation. Some of you may be reading this thinking, “Great! Of course we need surgeons to train in policy and pursue research that helps guide healthcare reform.” Still, many surgeons were quite comfortable to enumerate aloud all the better ways to spend my time. Fortunately for every detractor, there have also been advocates. Not surprisingly, many of them are also the same leaders who were the first to tweet and support the #ILookLikeASurgeon movement.

More than just celebrate diversity (a tremendous feat on its own), the #ILookLikeASurgeon movement has paved the way for a new era of surgeon-innovators. Our leadership and mentors now have a duty to embrace the diversity of surgeons -- their backgrounds, their skill sets, their passions, their visions, their career goals -- and create environments where our true selves can be developed as a strength rather than discouraged as a weakness.  Celebrating diversity is the first step to innovating our profession.

Andrew M. Ibrahim MD | @andrewmibrahim

Robert Wood Johnson Clinical Scholar

Institute for Healthcare Policy & Innovation

University of Michigan

Who knew one simple Medium post could ignite such a profound movement?

#iLookLikeAnEngineer is now being spread globally in over 50 countries. It has received over 75,000 tweets and has been covered in countless international news outlets.

The fact that this campaign has been adopted and continued by such a vastly ranging demographic illustrates the dramatic need for it to be addressed. This is not just about my voice; your voice is equally important. This is about the voices of thousands of people all over the world, unified together under a mutual message.

Together, we have the power to create a sustaining positive impact.

Gender diversity challenges seem to be what mainstream media has picked up on the most. While I think that it is absolutely wonderful that this has sparked so many positive discussions about the way that women are treated in STEM, I want to clarify that #iLookLikeAnEngineer is intentionally radically inclusive.

It’s not just about me and it’s not just about women.

#iLookLikeAnEngineer is about anyone and everyone who wants to pursue STEM, regardless of their external appearances.

Labeling this as a “campaign for women” is very limiting, and will only further separate us from everyone else in the community.

We see ourselves as equals, so we must also recognize others as equals, starting with our own actions and words.

Fighting exclusion with exclusion will not help us get closer to forming a solution. It is important to realize that we are all on the same team; this movement is for everyone regardless of skin color or X-chromosome count.

Do you have any ideas that would help create a positive change? There are many alternative paths that can be taken towards creating the solution; increasing awareness and discussions is only one route.

Isis Wenger getting an award from
the City of San Francisco for challenging stereotypes
in the tech industry  (Photo by Kenny Hoff)

As individuals we have the the power to influence our own environments so that we can be more mindful and empathetic towards others. When we know better, we can do better.

Starting with ourselves we can work together towards co-creating a more respectful and inclusive community.

I will continue advocating for this cause and I encourage you to share your voice because yours matters too.

This appeared originally in the Washington Post.