Joy versus Professionalism: Must We Choose? (My Take on #MedBikini)

Joy: a feeling of extreme gladness, delight, or exultation of the spirit arising from a sense of well-being or satisfaction (APA definition)1

Recently a research study that measured “unprofessional” behavior on social media by spying on vascular surgery resident physicians through the creation of fake social media accounts by the authors of the study was retracted by the Journal of Vascular Surgery. This is my response to the article that prompted an uproar by many in the medical arena who opposed the article, dubbed ‘#MedBikini’.

When I first read the article, I was not surprised of the topic – social media and professionalism in the medical community. I have published in this space with Dr. Julie Silver, on the topic of women physicians in social media2 in the New England Journal of Medicine (link to article). As someone who cultivates a large online community of women doctors, 12K, how we represent ourselves online, as well as cultivating healthy communities are both important to me. I read a lot on this topic, and I value the academic conversation on social media and medicine. 

As I read the article, I cringed. In my opinion, there were several flaws with the study design and I had ethical concerns. For example: the 3 study investigators who created false social media accounts to spy on the surgeons in training were all male; the majority were doctors still in training themselves or students, and were junior people. They did not have permission from their study subjects, nor did they use objective measures of professionalism but rather subjective criterion such as posting political views, or taking pictures in a swim suit or holding an alcoholic beverage. Regardless of the study outcome, I winced. How did this study idea make it out of peer review in their department? Where were their mentors? The relationship between professionalism and social media is a valid subject. But how did this study make it past journal peer review? And finally, how was it approved by the section editors? 

The publication represents many fails in leadership. If we are honest; we have all made mistakes in academia, especially when we were junior. All of us have had good ideas, that did not necessarily amount to good science. Most of us have learned this through manuscript or institutional review board feedback/denials, through mentors who teach and who review, and through redirections by leadership. Through failed hypotheses and journal rejections. Through academic oversight.

After the response to the study went viral, my group of 12K women physicians countered. Major influencers in medicine responded. It was on the national news, and the journal retracted the manuscript. 

I am a slow responder to issues online; I have to take time to think about how I feel about disputes, research things, and really break it down internally before I share my thoughts. There were many smart and well-known influencers weighing on this topic, I was not sure my voice was needed or unique. Everyone who weighed in focused on what part of the article bothered them the most; the accusations of political opinions as labeled unprofessional, the unconsented spying, the swimwear comment, or the presumption that private social media pictures of a physician holding a glass of wine was reported as unprofessional behavior.

After thinking about it for a few weeks, the most upsetting to me was the shaming, for all intents and purposes, of joy.

The labeling of joy as unprofessional, especially in the middle of serious crises fatigue amongst our medical community, made me want to weigh in.

I share as a physician, who is a mother of four. I share as a woman who nearly quit medicine, after burning out in 2013. As physician who after years of losing myself to motherhood and medicine, slowly started to embrace my authentic self; the one who loves to play on the beach with her kids. As a physician who started to embrace my humanity, and found my joy again doing things like wearing lipstick, going on hiking trips with my girlfriends, and creative writing. Are those professional? Some would say they have nothing to do with medicine; that is my private life. I say the opposite; they have everything to do with the type of physician I am.

And as woman physician who decided to challenge the status quo in medicine – you know the one that says you must look and act serious and not talk about anything other than medicine 24/7? I decided to embrace that I could be ALL of me, and still be an amazing doctor, I found me again. The joyful me. And by living that joy, I have become a better doctor for hundreds of lives, as the BEST, healthiest version of myself.

I write this as a physician who spends hours each week listening, consulting, and encouraging thousands of women physicians to embrace JOY. To not sacrifice their own health and wellbeing for the sake of appearing serious or perfect.  To fully embrace their abilities, their happiness, and their leadership. To try new hobbies, to take the vacation, to walk into the board room with all the expertise and confidence they own. To be themselves - fully. And to do so, unapologetically, as women.

I remind these women constantly to put their wellbeing above everything; it is how they will stay in a field that is full of grief, hardship and sickness. I remind them it is ok to laugh. That they should be offered the same margin of error as their male colleagues, and to not let anyone steal their joy. I also tell them – and have many times - to wear the bikini. And I can tell you this; if I was a man, leading a group of male physicians, I would tell them the same. Go play golf. Paddle board with your kids. Don’t wait until you are perfect, and do not feel guilt. Celebrate your life outside of medicine - so you can be 100% there for your patients when you are practicing medicine. 

I would tell them to embrace joy as if their life depended on it; because guess what? We know that it does. I would tell them to laugh every day, because physicians who find joy in their workplace and home life stay in the game. They have higher rates of resilience, workplace engagement, and career longevity. I would definitely tell them they can post pictures of joy. Being a physician, and being human, is not illegal. And it is definitely not unprofessional.

One of our well-respected governing bodies, that sets standards for how we train doctors to be professional, is the Accreditation Council for Graduate Medical Education (ACGME). The ACGME lists professionalism as one of its 7 core competencies; it states clearly: “The expectation for all medical professionals is that each and every one will treat all people with respect, compassion, and dignity.”3

As I read the ACGME over-arching definition of professionalism, I do fist pumps. As a physician who has dedicated 12 years of my life becoming a doctor, and another 13 to practicing anesthesiology, this is why I have committed a quarter of a century to the practice of medicine. My goal every day is to treat people as we would treat our mother, our father, our brother. As doctors, we put their needs above our own, because they deserve our dignity. We fight for them, for “the least of these”, when they are hurt, injured, sick, weak, or dying. We stop whatever we are doing and run from soccer fields, miss anniversary dinners, and take calls in the middle of vacations and concerts – to heal. We spend time calling patients who are scared, we usher new life into the world, we hold the hands of those breathing their last, and look into the faces of grief and whisper…We are so sorry.

It is a lot. It is exhausting work. It is blessed work. And we do it, 24 hours a day, seven days a week. We do it, because we believe in humanity. Because we believe in life. Because … we believe in joy.  We believe our patients deserve it; and we fight for it. It is called quality of life.

The definition of professionalism is based on – and should be – how we treat our patients. How well we see and hear them, doing our best to educate ourselves on our own biases. Putting our egos aside and consulting other doctors for help when needed. Our professionalism is demonstrated by the ways we show up for our patients, but also our colleagues who need us. How we stay focused and in control of our emotions; how we create safe and equitable work environments. Are doctors perfect? No. Do we have biases, make mistakes, and have our share of bad actors? Unfortunately, yes. Every industry does. 

I would argue that joy, is why we fix knees that hurt. Why we try everything under the sun to improve the life of someone suffering from dementia. Why we research cancer treatments and place mechanical hearts until we can perform a transplant. It is why we all run to codes, why we are there for every birth; why we take criticism and backlash for promoting immunizations and masks and all the other public health crises. It is because we are life givers, and hence joy protectors. We believe in it.

When I see a woman doctor laughing in a bikini alongside her kids, or I see a male colleague at a baseball game with his pals drinking a beer: I see a human. I see joy. 

I see life. I see humanity. I see a doctor, taking a moment to enjoy his or her life. I see them creating balance, reminding themselves why they work so hard, why they miss so many things. It is joy. To recall why she or he spends 24 hours fighting for life. For these moments.

That is the kind of professional I want taking care of me. Don’t you?

I hope we don’t shame another human for joy, and we don’t label it unprofessional in academic journals. Especially those in medicine who see so much grief, who suffer loss, who deal with tragedy daily. These are the lessons I hope we promote after #MedBikini: that doctors are human, they deserve joy, and they should never be shamed for embracing it.

Embrace joy. Your life, and the life of others, depends on it.

*Thank you to the women of Brave Enough who submitted their joy pictures.

References :

1. https://dictionary.apa.org/joy

2. https://www.nejm.org/doi/full/10.1056/NEJMms1801980?journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm&journalCode=nejm

3. https://knowledgeplus.nejm.org/blog/acgme-core-competencies-professionalism/