Podcast

Sound Mind: Threats, harassment and trolls: Is being a “public” medical voice worth it?

October 28, 2021

Dr. Amy Tan shares how she endured months of online harassment during the pandemic for defending racialized communities. Dr. Najma Ahmed, trauma surgeon and co-founder of Canadian Doctors for Protection from Guns, talks about being the target of pro-gun activists, the toll it took on her mental health and the support systems that helped her to not back down.

“I was accused of being a Chinese spy, a communist. I had GIFs posted on my Twitter feed and at the bottom of the comments section for the online press that was done, with Chinese soldiers marching in Tiananmen Square in perfect formation, with the implication I was one of them.” – Dr. Amy Tan

During the pandemic, many physicians, like Dr. Amy Tan, have found themselves in the traditional and social media spotlight as medical experts or as advocates for the patients and communities they serve. Yet, they’ve also been on the receiving end of online threats, abuse and harassment.

Dr. Najma Ahmed knows what they’re going through. In 2019, she faced intense harassment by pro-gun activists after launching a public campaign for tougher gun control laws. In this episode, Dr. Ahmed talks to Dr. Caroline Gérin-Lajoie about the backlash outspoken advocates often face, how it can affect their mental health and whether “speaking out” is really worth it.

This episode is available in English only.

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The opinions stated in Sound Mind are made in a personal capacity and do not reflect those of the Canadian Medical Association and its subsidiaries.

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Threats, harassment and trolls: Is being a “public” medical voice worth it?

Caroline Gérin-Lajoie: Welcome to season two of Sound Mind, a podcast about physician wellness and medical culture. I'm your host, Dr. Caroline Gérin-Lajoie. In our first season, we explored the many ways COVID-19 has affected healthcare providers and we've seen how the challenges have been at times overwhelming. As ICU's began to fill up, and the public grew confused about public health measures or weary of new interventions, like vaccines, many doctors took to social media to engage with their patients, their community, and with Canadians as a whole. But for some, this engagement came at a high cost. Trolls, conspiracy theorists, and ideologues began to target physicians online. Dr. Amy Tan is an academic family and hospice palliative care physician prior to the pandemic. Dr. Tan was occasionally on social media, but the things she posted rarely generated much reaction. That all changed shortly after the pandemic was declared when Dr. Tan posted a video

Dr. Amy Tan: Where I was quite upset because my parents who are immigrants from Hong Kong and of Chinese descent and have been Canadian citizens for 50 years, they disclosed to me that they were scared to leave their house in Vancouver because of at that time, the increase random attacks on elderly East Asians, especially in Vancouver. There have been just an example of two Chinese women sitting in their car parked, and there was an attack. There have been multiple people around Chinatown and just the streets of Vancouver being attacked.

Caroline Gérin-Lajoie: Dr. Tan followed up that video with a tweet about mask wearing. Again, she spoke up against the treatment of Asian Canadians, some of whom were already adopters of masks.

Dr. Amy Tan: People of East Asian descent were wearing masks because of what had been learned with regards to SARS in 2003, which affected Hong Kong deeply. And people who were wearing masks were accused by people who weren't East Asian of bringing the virus to Canada, of having the virus, of being dirty. So I wrote back, I basically tweeted and said, this is not appropriate. This xenophobia, this ability to other people who have literally been Canadian citizens for 50 years because they aren't white is not acceptable. And to not be terrorizing elderly East Asians. That was the first where I got a lot of support and I got some trolling comments.

Caroline Gérin-Lajoie: A week later, Dr. Tan appeared in a couple of local news items advocating for patients in her north Calgary practice. Many of them were essential workers.

Dr. Amy Tan: They're working in crowded situations, in food processing industry, post offices, transit workers, and they wanted to wear masks to protect themselves as the one thing that they felt that they could do. And their employers were saying, no, because you're going to scare the public because they're going to think that this business or we have COVID. So I advocated to reporters about the fact that we needed to protect our essential workers. And I actually made the comment that it was not lost on me, that these billion dollar corporations were all owned and operated by white people, but all of their essential workers were racialized. And that's when it all started. When I realized that, trying to advocate, trying to give voice to people that haven't been covered by media was going to perhaps cause some consternation. I got accused of being a Chinese spy, a communist,

Dr. Amy Tan: I had GIFS posted on my Twitter feed and also at the bottom of the comments section for the online press that was done with Chinese soldiers being marching in Tiananmen square in perfect formation. And that I was one of them. I got accusations that I had brought the virus here because I am East Asian and that it was because of our quote unquote disgusting eating habits in our wet markets that this was happening. And then, as I started to advocate for mask wearing, it became that I was now in the pockets of quote unquote big mask, akin to big pharma. I was told that I was serving those like Bill Gates and the, the hoax of COVID-19 and that I must be being paid to go on national television and tweet about why we need to mask to keep people protected, but continuously through all that was still you're a Chinese spy, you don't believe in democracy, you're a communist, you're just trying to infiltrate our democracy, how dare you, go back to your country, oh you immigrant doctorsyou think you can take over our country

Caroline Gérin-Lajoie: On July 1st, 20, 23 months into the global pandemic CTV invited Dr. Tan to appear on its national Canada day special.

Dr. Amy Tan: And it was to reflect on myself as a racialized Canadian during the pandemic working frontline, but also having dealt with trying to advocate for racialized Canadians. At the time, the first wave in Alberta, this was the population that was getting hardest hit by COVID-19 because it started with things like Cargill and food processing plants and was spreading into their communities and they were carpooling. And so there was all of these social determinants of health that were completely ignored by public health. And so just really wanted to bring that to light. And half an hour later, I got an email to my work email, where somebody said something to the effect of, "before you go on national television, open your eyes a little bit more, you ugly racial slur directed towards an east Asian." And I remember being, I remember that moment, like being tearful, not because I haven't heard it before, but again, it was that very almost knife in your heart that he was making the message that because I wasn't white and because my eyes are much smaller because I've got East Asian eyes that I didn't belong on national television in Canada.

Dr. Amy Tan: And so it was kind of a cumulative effect of three or four months of this ongoing stuff to that point. And I remember being quite upset by that, but at the same time, I kind of felt a responsibility again with my advocating, for my patients, for advocating for people like my parents, and my own heritage and communities to say something, if people were willing to listen. Even though I knew that there was for every person who listened, there was at least one or two other people who were willing to come fight with me or worse.

Caroline Gérin-Lajoie: And sadly, the trolling did get worse. Through 2021, Dr. Tan has continued to advocate publicly for racialized Canadians. And in September she received a death threat at her workplace.

Dr. Amy Tan: There was a racist, misogynistic, violent threat made by phone to me. Which is different than keyboard warriors on Twitter, tweeting at me or emailing me terrible things. It's different when somebody seeks out your workplace phone number and asks to speak to you and isn't able to, but under the pretense of it being somebody, looking for Dr. Tan, which happens every day on a ward, so it was very violating and I felt quite vulnerable. So, it definitely has put my own safety in the forefront. I actually laid low in that one workplace that they contacted me. Like I didn't physically go in. I haven't gone in since, so it's been three weeks just because I wanted to see that there was anything else that came from there. I have opened up a PO box so that my professional mail goes there instead of my home. So I'm just going to put that extra layer of protection .

Caroline Gérin-Lajoie: That was Dr. Amy Tan, a family and hospice palliative care physician on Vancouver Island. While Dr. Tan's experience with online abuse began with the advent of COVID-19 this phenomenon, pre-dates the pandemic. Dr. Najma Ahmed is a Toronto trauma surgeon in 2019. She became the target of intense harassment by pro-gun activists after launching a public campaign for tougher gun control laws. Dr. Ahmed, thank you for joining us on this Sound Mind podcast. May I call you Najma?

Dr. Najma Ahmed: Please do, wonderful to be here, Caroline.

Caroline Gérin-Lajoie: Thank you so much. Najma, What is your reaction to Dr. Amy Tan's story?

Dr. Najma Ahmed: Right. Well, you know, listening to it, frankly, you know, my, my heart rate went up a little bit and I can feel, I could feel a little, the beads of perspiration on the back of my neck, thinking about how terrifying it must have been for Dr. Tan and her family and her colleagues and her desire, a rightly placed desire and frankly professional obligation to advocate for the communities that she serves and being targeted in such a hostile and unjust way. It made me think of a lot of compassion and empathy for the people who put themselves out there in the space on behalf of the communities that they serve. And also I wanted to reach out and give her a big hug.

Caroline Gérin-Lajoie: I also felt great sadness for her and also anger on her behalf.

Dr. Najma Ahmed: Yes, yes.

Caroline Gérin-Lajoie: How did your own experience with online harassment begin?

Dr. Najma Ahmed: It's been some time so I have to think back to it. As you rightly say, it was back in 2019. It was the after the shooting, the mass shooting on the Danforth in the summer of 2018 that a group of physicians along with myself started thinking that we are seeing an increasing number of patients affected by gun violence and the severity of these wounds, the number of victims coming into our emergency departments, and our operating rooms, and our ICUs has been increasing. And so, through the winter of 2018, the, and then the Fall and Winter we organized ourselves and launched as an advocacy organization advocating for a public health approach an evidence informed public health approach to gun violence in Canada, which has been on the rise for some time. And I was thinking, oh, it's going to be easy, simple, the evidence is clear, here's the paper or something in JAMA,

Dr. Najma Ahmed: The New England Journal of Medicine we've got work to do here. I'm going to talk to some people and they'll say, thank you very much for bringing this forward. And that'll be great. And in fact, the vast majority of Canadians and physicians were very complimentary and supportive, but I didn't take into account small group of highly motivated and very vocal pro gun advocates. Part of our advocacy included calling for stronger gun legislation, removing certain kinds of semiautomatic weapons from market, addressing social determinants of health increasing the social net safety network for women and children at risk for domestic violence or homicide, but certainly greater rigor and regulation related to civilian ownership of certain types of firearms. And, that of course caught the ire of certain people. So I was very much taken aback. I was not expecting this at all.

Dr. Najma Ahmed: And this started as tweets and then personal attacks and emails and calls to my workplace. Similar as Dr. Tan described a very hostile, very, you don't know what you're getting into, you better be careful kind of threats. It felt very threatening. It felt very ominous. And and then one of the representatives of one of the arms, of the Canadian gun lobby organized a mass sort of protest to the CPSO where many, I think as many as 80 people who I had never treated nor seen, made complaints to this, to our regulatory body, the CPSO claiming that my work in gun violence prevention and advocating for stricter firearm legislation in Canada was unprofessional. And so that had to be reviewed by the CPSO. And there were some, there's a lot of anxiety, of course. And as a physician, you know, that when you get an envelope or a letter from the CPSO saying, there's been a complaint against you, your heart sort of stops and you think, oh my goodness, what have I done? What could have gone wrong? Is this the end of my career, 80 complaints. But through a due process, which took many months, all those complaints were dismissed as moot and frivolous and abuse of process. But it was very distressing. And I also was, like I said very much caught off guard at the vociferousness and how, how pointed these attacks were. And I really wasn't expecting it

Caroline Gérin-Lajoie: For you. It sounds like the online harassment escalated essentially into a campaign. Can you tell us a little bit more about what was going on through your mind when that campaign was beginning?

Dr. Najma Ahmed: I remember thinking, what have I gotten myself into? This was like supposed to be a simple thing. And I started thinking, is it worth it? What am I doing? I'm a very busy person. I've got a career ahead of me, I've got a family to take care of. I thought about my reputation, the reputational harm at the university, at the hospital, with my patients, it was in the papers. And I, I started thinking really, am I, am I prepared to put myself out there for all these things? And there were some periods of self-reflection and doubt. I will say that my colleagues, the hospital, the university showed a great deal of solidarity. And when I spoke to trusted mentors, they reassured me that this was not going to leave lasting reputational damage. The CPSO would do their thing. We should just let them have their process.

Dr. Najma Ahmed: It's part of how the world works, but in the end, all would work out well and I shouldn't fear the reputational damage that would come. I did fear a little bit for, as Dr. Tan alludes to, you know, is this the end of it? Is there more coming? Are they going to be, is someone going to be standing at the end of my driveway when I drive home? Is someone going to be standing outside my office when I come to work one day? Because you know, not my home address, but my office address is publicly find-able information. And I, I did have start having those thoughts. I will say the hospital where I work was very good and for a time security would walk me to my car at the end of the day. And if I came in after call, if I came in, in the evening or on weekends, on call, I had the number of the security person to call their pager number and they offered to walk me into the hospital, walk me back in the evening or on weekends when it's a little bit more desolate around here. So I had a great deal of support, but it was not without a lot of reflection and thinking about what have I gotten myself into?

Caroline Gérin-Lajoie: So you shared some of the thoughts that you've had and started talking about feelings of surprise some feelings of fear. Can you tell us a bit more about just at that human level, how you felt through that experience?

Dr. Najma Ahmed: I felt that I was doing the right thing. I felt that it needed to be done. I felt that I had seen enough and I had the tools and the expertise that we could not let this crisis go on. And in the end, I resolved that, you know, someone has to speak, someone with lived experience, treating these patients, putting these patients back together and healing, the broken families after somebody dies. Somebody needs to tell those stories. It's not just about statistics, it's about the patients and how they suffered. These, these weapons are intended to kill. This has a mortality rate of 40%. And the people who survive, the majority of them are left with lifelong disability, physical and emotional disability. And very often they're young people. So this is preventable harm. So all those thoughts were swirling in my head.

Caroline Gérin-Lajoie: You've mentioned earlier that you have a family that you take care of. Can you share a little bit about how your family reacted through your experience?

Dr. Najma Ahmed: That's a great question. So I have one daughter she's an amazing, and as young children are, she's not that young, she's 17, but, now she's 17, but they're very intuitive. And they sense things and they understand things. And she did at many times express her hesitancy about what could happen, about our safety. She often queries me and asks me, you know, is it safe? Have you done everything that you can do? So just as the previous, as Dr. Tan said, I have also, our organization has a PO box where we receive our mail. I'm very careful about never posting on Twitter any personal pictures that would identify the neighborhood where we live, or our family structure or anything like that. I'm very careful about that. I keep that very personal and private. And although I'd like to, you know, say here's the picture of us at the beach, or here's a picture of us having breakfast on Sunday morning, mum made pancakes for the family. I don't, I don't because I know that my Twitter feed is viewed by lots and lots of people, many people who are admiring of the work, but a lot of people who are not.

Caroline Gérin-Lajoie: You've also mentioned earlier that your workplace had been very supportive. Can you tell us a little bit more about that?

Dr. Najma Ahmed: Sure. So in the early days, you know, I used to get regular emails to my email address about how I didn't understand the problem. You stupid woman, you know, you don't, and this is about hunting and sporting, and you're ruining it for us. And things like that. And even more aggressive language than that. And I initially did really didn't know how to respond to any of this. So I took it to our public relations people, and I got emails, our CEO got emails complaining about my work, and I have to say that our public relations shop did a great job. They would, you know, write directly back to these people, answer a few pointed questions, and end the communication. And I was very grateful that I didn't have to, you know, review and read and answer any, I never answered these people. I just would forward them on. And the ones that went to our CEO also, he would make me aware that I have received this, I sent this on to our PR shop and they are crafting a response, which you will see before it goes out. And it was always very, non-emotional extremely factual, which I was very grateful that they took that on and off my plate.

Caroline Gérin-Lajoie: Looking back at all this now, Najma what impact do you think that it has had on your wellbeing?

Dr. Najma Ahmed: That's a good question. It's a little bit hard to answer cause it's all folded in now with the COVID pandemic, which has had not a great result on our, any of our wellbeing. It's been a stressful time for the healthcare system for physicians and all healthcare providers. But when I think about my work in gun violence prevention, advocacy, I would say that it's been a lot of work. I've met amazing people through this work. And I have learned that really we have a voice and when possible and where possible, it's important to use your voice and one can be an effective advocate, and one's work can result in system level change. It requires persistence. It's going to take decades. Of course, these things do not happen overnight, but I have learned that, and that knowledge has been reassuring for my wellbeing, because if I learned that nothing's going to happen and no one takes notice, and nobody cares, and we're banging our heads against a brick wall, I think that would be more harmful for my wellbeing rather than learning that the change will come slowly and incrementally. And we have to keep working at it. We have to keep talking to the right people to keep, to have, to keep trying to help the public, understand about the harms of firearms and homes and communities, but we can change the discourse and we can affect policy.

Caroline Gérin-Lajoie: Some doctors and learners looking at your experience and the experience of Dr. Tan might think, oh my gosh, this is not worth it. What do you think? Is it worth it for physicians to speak out?

Dr. Najma Ahmed: I think that's a personal decision that every physician needs to make. I think it's also a very stage specific or could be, might be for every physician, a stage specific decision. You know, as we begin our careers, we have many responsibilities. You're raising young families or financial stresses. You're trying to get your career off the ground. So there's a time and a place for this would say that physicians have involved in ensuring advancing public health for many, many generations, hundreds of years. So, James Snow was a physician who lived in London, England during the cholera epidemic. And he traced the origin of the collar epidemic then, I think it was like in the 1800s, to a, a water pump. And he advocated with the public health officials of the day, I don't know who they would be, to have that water pump closed and thereby saving many, many lives.

Dr. Najma Ahmed: And now in COVID you see the advocacy on behalf of physicians and healthcare providers to keep our schools safe, to keep our hospitals safe, our workplaces safe. I think this is part of the role that we play and for the most part, not entirely, but for the most part, our voice is respected and needed because of the lived experience that we have at that patient doctor interface. The things that we see in the hospital and in our offices, the stories that we hear from our patients, very intimate glimpse into their lives that are not told by numbers. And because of our ability to decode the scientific literature, which most policymakers who don't have health or science background are not able to do. And which the public, for the most part, unless they're in science or medicine or related field are not able to do. So, I would say it's a very personal decision, but it can be very rewarding and physicians have a unique capacity and responsibility in this arena.

Caroline Gérin-Lajoie: If they do choose to advocate, how do you think they can best prepare themselves for the potential blowback?

Dr. Najma Ahmed: That is a great question. So first is to know that there will be blowback. So I did not anticipate this at all. I thought, oh, this is going to be a noble thing. The evidence is so clear. Everyone wants there to be less for gun violence in society. Who's going to argue with this? But I guess what I came to realize is that the world exists on some level, the world exists the way it is because somebody benefits from it. Somebody is benefiting from this. So you have to sort of understand that who is benefiting from the current situation and expect that they are not going to want it to change. So, you have to do your research a little bit about that. I think it's really important to have a wise mentor. I'm very fortunate to have been mentored in this area by Dr.

Dr. Najma Ahmed: Phillip Berger, who is a physician advocate. He's advocated for all kinds of things. And he is so experienced and wise. As well, to surround yourself with a compassionate and able colleagues that you can talk to. So I was fortunate to be surrounded by amazing people and mentors. And I think you have to sort of say to yourself, I'm going to do A, B, C, D E a, and I want to achieve A, B, C, D E. But if the following X, Y, Z happens, I'm out. And you have to have that conversation with yourself. Or if XYZ that happens, I'm going to step back and let someone else take the fore and that's Ok. And that's a conversation that you have with your team. I think it's also important that to recognize that when things get too hot in that area, you got to go silent.

Dr. Najma Ahmed: Some of these people are not interested in understanding your perspective. They're interested in intimidating you into silence. And I, I don't debate on media with people who show me that aspect of their, you know, of their argument. I'm very quick to mute people like that because I don't, it's, that's also part of my wellness. I block or mute people who I feel are threatening, or I feel are unreasonable. I don't want to engage in a conversation. It just escalates. And then, you know, we're all only human. I might say something that I could regret, and that would then harm the whole organization and the work that we're doing,

Caroline Gérin-Lajoie: It's been said that physicians have a duty or a moral obligation to inform the public on issues that directly affect health care. And that is science-based in fact, learning to become a health advocate is one of our CanMEDS roles in medical training. So do you think that advocacy on social media can be challenging at times because of the issue around the advocacy role itself? Or is it an issue that has to do more with the social media platform?

Dr. Najma Ahmed: So I think it has to do with both. I think in our training, we're actually very well trained and tested to advocate for the individual patient that we serve, but we're not actually trained or exposed to curricula or tools or resources that would help one necessarily advocate effectively at a system level for system level change in policy, change in healthcare funding, change in legislation. I wasn't taught these things when I was a resident. And I think that we could do better to help our trainees understand this world and understand their role within this world. We kind of stumble upon it, those of us who are interested. So I think that's problem one. And problem two is that social media is really a pretty new phenomenon in the history of healthcare and the history of the practice of medicine and science. And we're just learning, I think about the advantages and disadvantages of this tool. And, I think as the decades go on, I think we'll become more savvy and capable, but for now it's just an experiment for all of us. I think. So it's both things.

Caroline Gérin-Lajoie: Any thoughts, Najma on how institutions such as med schools, hospitals, governments, national healthcare organizations can best support physicians so that they feel safe when they speak out.

Dr. Najma Ahmed: I think that the public should understand that this is part of being a complete physician. So doctors have many roles in society. We treat the sick, we provide comfort when we cannot cure, we research better ways to treat diseases. We educate the next generation of doctors and we advocate. That's part of our job. But I think a lot of people don't really understand that's part of our professional responsibility. And, all physicians do different parts of those roles to different degrees and different parts of their careers. But this is all, this is part of who we are. And I think, yes, I think that physician, the university medical schools, training programs, workplaces can better prepare physicians for this role and the blowback that in many cases will happen.

Caroline Gérin-Lajoie: I have a final question for you, Dr. Najma Ahmed, if you had a young outspoken physician on your team who is thinking about being an advocate on social media, what advice would you give?

Dr. Najma Ahmed: So the advice that I would give is engage, but engage in a smart way, know your subject better than anybody else. You have to know the world's literature on your subject. And when you, when we engage on social media and argue a point, the best way is to attach a link to a study or attach the study. Our fundamental knowledge comes from science. So I think that you use the science and the evidence to show the facts and then where possible, in a very de-identified way, in a way to reset respects, of course the patient and their privacy, the stories are so powerful. I think that you do both. And that last piece of advice I would give is don't engage with unreasonable people. There are people who are unreasonable and they're not going to be convinced by the weight of your arguments. That's not why they're engaging with you.

Caroline Gérin-Lajoie: Najma Ahmed. Thank you so much for sharing your story with us. Your words were powerful and inspiring. Thank you.

Dr. Najma Ahmed: Thank you Caroline, it's been my joy and pleasure to be here and I'm delighted, and frankly, privileged that I was asked to share my experience.

Caroline Gérin-Lajoie: Dr. Najma Ahmed is a trauma surgeon based in Toronto. You've been listening to Sound Mind, a podcast about physician wellness and medical culture. If you're looking for resources, tools, and research on the topics covered today, please visit the CMA physician wellness hub at cma.ca. I'm Dr. Caroline Gérin-Lajoie, see you next time.

Sound Mind: Threats, harassment and trolls: Is being a “public” medical voice worth it?

Topics

Simon's Story

Social media and mental health

Wellness resources for faculty

A surgeon’s account of physician burnout and depression

Second victims in health care: current perspectives

Physician Wellness: A Perspective from Indigenous Medical Students

Are you in distress? Get help now.

Sound Mind: Threats, harassment and trolls: Is being a “public” medical voice worth it?

Topics

Related resources

Simon's Story

Social media and mental health

Wellness resources for faculty

A surgeon’s account of physician burnout and depression

Second victims in health care: current perspectives

Physician Wellness: A Perspective from Indigenous Medical Students

Are you in distress? Get help now.

Threats, harassment and trolls: Is being a “public” medical voice worth it?