Recommendations From the Twitter Hashtag #DoctorsAreDickheads: Qualitative Analysis

Abstract

Background The social media site Twitter has 145 million daily active users worldwide and has become a popular forum for users to communicate their health care concerns and experiences as patients. In the fall of 2018, a hashtag titled #DoctorsAreDickheads emerged, with almost 40,000 posts calling attention to health care experiences. Objective This study aims to identify common health care conditions and conceptual themes represented within the phenomenon of this viral Twitter hashtag. Methods We analyzed a random sample of 5.67% (500/8818) available tweets for qualitative analysis between October 15 and December 31, 2018, when the hashtag was the most active. Team coders reviewed the same 20.0% (100/500) tweets and the remainder individually. We abstracted the user’s health care role and clinical conditions from the tweet and user profile, and used phenomenological content analysis to identify prevalent conceptual themes through sequential open coding, memoing, and discussion of concepts until an agreement was reached. Results Our final sample comprised 491 tweets and unique Twitter users. Of this sample, 50.5% (248/491) were from patients or patient advocates, 9.6% (47/491) from health care professionals, 4.3% (21/491) from caregivers, 3.7% (18/491) from academics or researchers, 1.0% (5/491) from journalists or media, and 31.6% (155/491) from non–health care individuals or other. The most commonly mentioned clinical conditions were chronic pain, mental health, and musculoskeletal conditions (mainly Ehlers-Danlos syndrome). We identified 3 major themes: disbelief in patients’ experience and knowledge that contributes to medical errors and harm, the power inequity between patients and providers, and metacommentary on the meaning and impact of the #DoctorsAreDickheads hashtag. Conclusions People publicly disclose personal and often troubling health care experiences on Twitter. This adds new accountability for the patient-provider interaction, highlights how harmful communication affects diagnostic safety, and shapes the public’s viewpoint of how clinicians behave. Hashtags such as this offer valuable opportunities to learn from patient experiences. Recommendations include developing best practices for providers to improve communication, supporting patients through challenging diagnoses, and promoting patient engagement.

A Qualitative Analysis of How Individuals Utilized the Twitter Hashtags #NotOkay and #MeToo to Comment on the Perpetration of Interpersonal Violence

“…A total of 437 tweets across the two hashtags #NotOkay and #MeToo included details about the perpetration of interpersonal violence. This sample size is consistent with previously published qualitative thematic analyses of Twitter data (Bogen, et al, 2018; Bogen, Bleiweiss, 2021; Sharma et al, 2020). The study was considered exempt by the Institutional Review Board.…”

Emotional safetyispatient safety

“…There is ample evidence of the ways in which patients are made to feel unsafe in healthcare. Patients routinely experience disrespect, may have their physical autonomy violated while in a structurally vulnerable position, have their concerns dismissed, and be subjected to abuse, racism, sexism, and classism 9 12–16. We assert that violations of autonomy, dismissal of concerns, medical abuse, racism, sexism and classism in healthcare should be considered ‘never events’, comparable with the existing exemplars of never events, to better understand and bridge the gap between ‘feeling safe’ and ‘being safe’.…”

“…Operationalising obstetric racism as an adverse event and translating obstetric racism into a valid patient-reported experience measure of obstetric racism shift the power of knowing from quality and safety professionals to Black mothers and birthing people. 14 Naming obstetric racism as a patient safety violation illustrates the power and potential of amplifying patient voices and community wisdom in patient safety programmes and reconciles the harm and inhumanity of epistemic injustice.…”

“…Likewise, expansion of the terminology and types of ‘never events’ shifts the measurement selection and monitoring strategies from traditional, hierarchical, biomedical foci and frameworks. What we gain is a more contemporary, patient-focused, and human-centred experience and evaluation of safety that values misdiagnosis, delays in care, denial of access, disrespect, untreated pain, and failure to recognise clinical deterioration as defined for, by, and with patient and community experts 14 17 18. Such events do not occur in a vacuum, but as part of a system that performs as designed: to prioritise medical expertise, technology, efficiency and revenue.…”

“…Responding to acts of obstetric racism with prevention and mitigation strategies requires structural and systemic transparency, truth-telling, and trust in patient and community reports of feeling unsafe even within the context of achieving what professionals and experts in quality improvement and implementation science define as patient safety—that is, absence of defined medical error and specific classes of resulting physical injury. Operationalising obstetric racism as an adverse event and translating obstetric racism into a valid patient-reported experience measure of obstetric racism shift the power of knowing from quality and safety professionals to Black mothers and birthing people 14. Naming obstetric racism as a patient safety violation illustrates the power and potential of amplifying patient voices and community wisdom in patient safety programmes and reconciles the harm and inhumanity of epistemic injustice.…”