The last presidential campaign unleashed a new age of online hostility. Facebook, previously a place to “like” photos of happy occasions and special accomplishments of friends, family, and colleagues and to collect “likes” of your own, became a minefield of angry responses to any remotely political post. Like many others, I found myself hiding, unfriending, and even blocking particularly persistent offenders and asking others to do the same to me if my views were offensive to them. I even received an old fashioned hand written note by regular mail from a facial plastic surgeon I had unfriended who called me a “jerk” for unfriending him. Perhaps it was all to be expected, given the deep emotional and wide chasms in the current political landscape. I responded by stepping away from my personal social media and focusing on my work feeds. Certainly discussions by and among professionals should be a safe zone, right?

Wrong. I wasn't surprised when I received ranting accusations of collusion and quackery from a random reader of one of my Instagram posts about the importance of sunscreen. When she became abusive, I clicked “block.” My first negative experience with someone in our industry was with a nurse injector who responded to an article comparing the training of core cosmetic physicians to other injectors with the assertion that non-physician injectors provided safer experiences than doctors. I should have known better than to have responded, even with a respectful preface. What are statistics when dealing with an all-or-nothing opinion? Certainly other core cosmetic physicians would not behave in that way?

Wrong again. A plastic surgeon with a huge Instagram following posted a story about the importance of sweating for detoxification. As a dermatologist, that's my pet peeve—the skin isn't an organ of detoxification. We had what I thought was a reasonable discussion via messenger, until I disagreed with his reading of a study he said proved his point. I asked another question; he never responded. No matter. But after I politely (and very briefly) questioned the science behind his post that a filler I use regularly should never be used, he blocked me. His page. His rules. No loss, but I was disappointed that a physician could not handle a scientific discussion, even if to acknowledge he understood my point even if he wasn't comfortable with it.

But what about a group designed specifically for discussion among colleagues? Certainly collegiality should reign. Nope! I was repeatedly asked to participate in a Facebook group for board-certified dermatologists, where I shared one of my MA “Heideas for Aesthetic Practice.” I expected “Dear Millenial Physician” to promote discussion and hoped it would be a forum to create better understanding between generations. Instead came a deluge of “She's mean” and “No one should work for her.” No one acknowledged when I asked them to clarify their points of contention. I even suggested members write letters to the editor (none were ever received). One young dermatologist messaged me and suggested “we” write a paper about the millennial view but lost interest when I said it was a great idea that “he” write it. I left the FB group. Not a hard decision for me—I have a large group of trusted friends and colleagues with whom to discuss cases and appreciative trainees and young physicians to mentor. I don't need to share with 3,500 strangers. Since then, numerous physicians, many of them leaders in the field, respected colleagues, and dear friends, have been viciously attacked in that group.

So how can we deal with professional cyberbullies? One easy answer is not to participate. Most bullies are insecure and jealous: they can only feel big by making others feel small. Take away their audience and you take away their power. That certainly works when dealing with individual bullies. If you can't stand what they post, unfollow them. If they become true internet trolls, block them. The problem is that many younger or more isolated physicians often rely on internet groups as their sole source for professional support and advice. They are unlikely to stand up to the bullies for fear of becoming a victim and ostracized. Isn't ignoring those people and conversations just silent acquiescence?

Since this behavior feels like grade school, perhaps we need to work it out like kids. We could all chant, “Sticks and stones may break my bones, but names will never hurt me.” Unfortunately, as anyone with a bad Yelp review will tell you, names can hurt you. In our small industry, rumors can cloud an entire career. So I suggest we follow the after-school-special template. One by one, let's all stand up and say this behavior is not acceptable. Asking critical questions is one of the keys to innovation. But I propose each of us make the pledge not to write anything online about someone that we wouldn't say to that person, face-to-face, with full eye contact, in public, at a grand rounds or academy meeting. Sure, there will be a few nasty Neds and Nellies left, but I bet we could get back to the business at hand: raising each other up, rather than cutting anyone down.

If this was one of my social media posts, the soundtrack would be the themesong of Underdog:

There's no need to fear! Underdog is here!

Cyberbullies, beware! I may not be Underdog, but my posse of do-gooders and I have our superhero capes ready, and we aren't afraid to use them.

—Heidi Waldorf, MD
Co-Chief Medical Editor