Health care workers speaking truth on social media: amplify and protect their voices

“I think a lot of doctors now are feeling that the worry and the panic about coronavirus is gonna be worse than the actual coronavirus for them.” That was Dr. Mehmet Oz opining on Fox News not long ago. Within seconds, health care professionals responded fiercely and forcefully on social media.

They described their work experiences and the lack of respirators and personal protective equipment. They told stories of friends and family who were in the hospital and dying.

As Dara Kass, an emergency department physician in New York who recently had coronavirus herself, wrote “the anxiety around #Covid19 is real. Actual #Covid19 is worse.”

Deciding what platforms to go on is a diberate choice.

Patients are everywhere and they need accurate information.

I am supposed to go on Dr. Oz on Monday.

I will state clearly.

The anxiety around #COVID19 is real.

Actual #COVID19 is worse. https://t.co/5JFCL3ZcV4

— Dara Kass, MD (@darakass) March 26, 2020

They even discussed their own fears, including their own mortality, their worries about their families, and their children’s worries about their safety.

New house rules…..kinda pic.twitter.com/iFGggAz3nv

— Geriatrician in LTC/rehab (@Human1stMD) April 4, 2020

Frontline health care workers have been taking to social media with their truths since Covid-19 first emerged. Pundits and politicians say something about the pandemic that is untrue or overtly misleading, then health care workers take to every form of media to combat that misinformation and tell the truth through their stories. They have discussed flattening the curve, social distancing, and the need for more testing.

Physician Megan Ranney has even been called a new kind of influencer for the way she was able to draw attention to the needs of health care professionals on the ground through #GetMePPE on Twitter.

1) First, we need funding and #GetMePPE

"Democratic leaders also said they wanted to add $100 billion for hospitals, community health centers & health systems…to shore up testing & distribution of critical safety gear for health workers" #COVID19 https://t.co/BHrkdCLWwZ

— Megan Ranney MD MPH (@meganranney) April 8, 2020

No one is asking these people to share their real, and really painful, stories. Yet it feels irresponsible and impossible for those who choose to do this not to do it.

As a psychiatrist who regularly participates in this form of advocacy, I see the therapeutic benefits in sharing experiences with each other. By telling a story and finding support, we receive validation, our experiences become normalized, and we create community. When we are angry or sad, and someone else is too, we feel a little less alone. There is also courage and power in vulnerability.

This kind of online advocacy also makes it feel like we are doing something to help in a situation that can feel beyond help. Simply spending an extra five minutes responding to a comment on Twitter or Facebook or talking with a journalist covering the hospital experience feels like an emotional win, particularly if it can help our patients and our colleagues survive.

The downside is that the truths we are sharing can traumatize the storytellers as well as the listeners. In therapy, it typically isn’t ideal for patients to tell their traumas right away. A therapist usually needs to set the groundwork, focusing on safety and self-regulation, to make sure the patient is ready.

A key part of the experience of trauma is a loss of control. Regaining that control is part of the treatment. You should get to decide when, where, and how you tell your story, and you should not feel forced to tell it when you aren’t ready — even if you are doing it to help others. But advocates must often tell their stories again and again as part of their advocacy, essentially reliving the trauma, something they need to be ready for.

When someone first shares a trauma, the initial response is critical to recovery. They need to be met with understanding and compassion. The internet is often not the place for that.

An insensitive or ill-informed response can worsen the trauma, inhibiting healing over both the short and long term. And though many people will support the sharer, not everyone is a safe person to share a traumatic story with.

In a long social media thread, a statement can get lost, or responded to with blame or criticism. Worse yet, a troll could respond. It may seem harmless on the surface, but that response could feel like an invalidation of someone’s experience and could even prevent him or her from sharing it in the future.

Under the best of circumstances, sharing stories and commiserating online can be part of metabolizing trauma. It is important to understand, though, that debriefing after a critical incident may actually be associated with an increased risk of depression or post-traumatic stress disorder (PTSD). What’s more, secondary trauma can occur to an individual who is supporting someone else through a traumatic experience simply by being indirectly exposed to it through their vivid recounting

It is even possible that someone not directly involved with the trauma can, by reading stories, become wounded by it. That’s particularly worrisome if the supporter or online reader is another health care worker. They do not need more trauma and are already at heightened risk for PTSD and other mental health issues related to Covid-19. They are also people who do not often ask for help and who will do everything they can to help others before helping themselves.

An extra worrisome wrinkle has recently been added to speaking truth on social media: It doesn’t just carry a psychological risk, but now can carry the risk of being fired. A nurse took a picture of herself in her hospital and posted it to Facebook, saying supplies were being rationed and asking friends to donate protective gear. Two days later, she was suspended without pay. Other hospitals are telling employees they cannot speak to the media or post on social media platforms. Some are advising employees to take down posts referencing work conditions. Telling the truth now carries fears of retaliation and termination.

Worrying about being fired for speaking out contributes to feelings of institutional betrayal that existed long before Covid-19 intensified it with staff going to work without the necessary personal protective equipment.

I am grateful to health care workers — nurses, administrators, janitorial staffers, respiratory therapists, EMTs, doctors, and so many others — others for risking their lives to save patients’ lives during the time of coronavirus. They are also risking their mental health and, in some cases, their employment to tell the truth about it. That, too, deserves recognition. To combat the gaslighting and misinformation that seems to pervade this outbreak, many of us in health care feel compelled to share our traumas and experiences to prevent untruths and poor policy decisions. But at what cost?

As the Covid-19 pandemic unfolds, we will be seeing more and more health care workers on the front lines share their stories. Please keep in mind that what they say is often difficult for them to share. And be mindful of how you respond to them. It may feel like part of their duty to tell their stories, but as with everything in health care, sharing is not without risk.

Now more than ever, we need to hear the voices of health care workers on the front lines of fighting Covid-19. We need to let them talk, amplify and share what they say, and protect them for speaking up. Without them, we would not be able to look beyond the rhetoric and into hospitals to see the truth.

Jessica Gold, M.D., is an assistant professor of psychiatry at Washington University in St. Louis.