Palliative Care: Healing beyond the operating room

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.

 

Social Media, Solitude, and Survival

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.

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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.

Six #ProTips for a Successful Departmental Social Media Presence

by Heather Logghe, MD



More and more surgical departments (and departments of all medical disciplines) are realizing the value of Twitter and other social media to build their reputation, promote the treatment offerings and research of their department, and connect with potential patients, residents, and faculty. Given the recency of social media, particularly as a critical component of a department’s public presence, there is much uncertainty and limited research to guide best practices. The tips and resources shared here are based on my presentation at the 2018 Association of Program Directors in Surgery (APDS) Surgical Education Week.





#1: Be Likeable
Just as with in person interactions, niceness, gratitude, and positivity go a long way. The book Likeable Social Media by David Kerpin offers a useful pyramid representing the building blocks of a likeable business on social media. It should come as no surprise these qualities are a recipe for successful departmental social media accounts as they also align with the characteristics of a kind, empathetic, and impactful physician.





#2: Be visual
Eye-tracking studies on internet readers show users spend more time looking at relevant images than text: visual content generates increased engagement over posts without. Tweets with images receive 150% more retweets than those without and Facebook posts with images generate over 2x engagement than posts without. Visual abstracts (graphic representations of research studies and findings) are particularly effective in increasing visibility of research findings.1







#3: Be educational

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Vikolian et al. found that tweets containing educational content2 generated more engagement than tweets with promotional content. Their article also details their use of a Twitter journal club to compliment their traditional in-person journal club, providing a unique opportunity for residents to serve as moderators. Lamb et al. at the University of Connecticut used Twitter to disseminate ABSITE questions, significantly improving ABSITE improvement compared to those who did not participate.3 Such efforts strengthens resident learning and contribute to program branding and international influence.







#4: Be listed
Twitter has an under-utilized list function that allows accounts to create multiple lists of users that can be viewed and followed by other users. These lists are an effective tool to showcase faculty, residents, and alumni of one’s department. For example, @JEFFsurgery has designated lists for all three. Thus, with just a few clicks, prospective faculty, trainees, and patients can see abbreviated profiles and easily follow of all users in the list. Note that lists appear more polished and welcoming when all users have a photo and completed profile as seen here.






#5: Be hashtagged

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When users search for, or click on a hyperlinked hashtag, they are shown tweets including that hashtag, regardless of whether they follow the associated accounts. Thus hashtags are a powerful way to expand one's audience. Useful hashtags in surgery include #SurgTweeting for tweets of general interest to surgeons; specialty-specific hashtags such as #plasticsurgery and #colorectalsurgery; disease-specific hashtags; education-oriented hashtags including #MedEd, #SurgEd, and #FOAMsurg (“free, open-access medical education” in surgery); and #ILookLikeASurgeon for tweets highlighting gender equity, diversity, and humanism in surgery. Finally most surgical conferences have a designated hashtag.




#6: Be smart, be respectful
Since the advent of social media, many have worried about physician professionalism and the potential for violation of patient confidentiality. It turns out that 1) physicians are as capable of conducting themselves professionally online as they are offline and 2) physicians have much to discuss without the inclusion of protected health information.4 That said, common sense and courtesy are essential. My advice is to consider whether something would be appropriate to share on a crowded hospital elevator. If not, it does not belong on social media.







References

1. Ibrahim AM, Lillemoe KD, Klingensmith ME, Dimick JB. Visual Abstracts to Disseminate Research on Social Media: A Prospective, Case-control Crossover Study. Ann Surg. April 2017. doi:10.1097/SLA.0000000000002277

2. Nikolian VC, Barrett M, Valbuena VS, et al. Educational content and the use of social media at US departments of surgery. Surgery. 2018;163(2):467-471.

3. Lamb LC, DiFiori MM, Jayaraman V, Shames BD, Feeney JM. Gamified Twitter Microblogging to Support Resident Preparation for the American Board of Surgery In-Service Training Examination. J Surg Educ. 2017;74(6):986-991.

4. Logghe HJ, Boeck MA, Gusani NJ, et al. Best Practices for Surgeons’ Social Media Use: Statement of the Resident and Associate Society of the American College of Surgeons. J Am Coll Surg. December 2017. doi:10.1016/j.jamcollsurg.2017.11.022

#ILookLikeASurgeon: With a moral obligation to tweet?

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?

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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

Tweet Chats 101

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.

The Unacceptable Cost of Silence

By Dr. Cedrek McFadden

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.

#ILookLikeASurgeon: My Grandmother's Silent Lessons on Life 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.

"Sharenting" and Social Media: Endangerment or celebration of a global community?

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.

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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]

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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

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[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/>

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

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

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