Doctors on TikTok: The Dark Side of Medical Influencers

A doctor examines a TikTok of an x-ray of ribs on a giant iPhone.

Medical data is supposed to be confidential. But social media is threatening the privacy and dignity of patients. For years, Martin Jugenburg—a Toronto-based plastic and reconstructive surgeon who goes by Dr. 6ix on social media—shared dozens of before-and-after photos and videos on Instagram of the altered bodies that had passed through his hands. There were tummy tucks, Brazilian butt lifts, and breast augmentations, all of them sorted into a kind of virtual assembly line for his thousands of followers to see.

But many of the women he featured in his posts—sometimes depicted post-op and sedated, their genitals and breasts blurred out—hadn’t consented to having their images circulated, according to an ongoing class action lawsuit, and some were only alerted of their presence online due to an investigation by CBC journalists. Unbeknownst to his patients and followers, investigators later found that Jugenburg was using a covert network of cameras in his clinic to perform a rigorous feat of surveillance, documenting thousands surgical procedures.

Women who realized he had posted images of them told investigators they felt violated; they were upset, embarrassed, and distressed. Dr. 6ix’s loose approach to respecting patient privacy on social media is hardly unusual in the world of “med Twitter” and “MedTok,” or medical TikTok. On Twitter, orthopedic surgeons complain about chronic pain “crazies,” nurses mock women who choose to give birth without an epidural, and doctors complain about “liars,” “Googlers,” and patients with conditions they are struggling to diagnose.

TikTok is worse. In a post by someone with the username Nurse Johnn, whose derogatory skits about dementia patients he claims are fiction, the nurse mockingly dances in blue-green scrubs on a hospital bed, imitating someone under his care. One nurse filmed themselves holding the hand of a patient they said was dying of COVID-19. There is a video of someone in what appears to be a psychiatric crisis and another of a patient having their toenails cut. A Miami-based doctor posted about how he “walks in the footsteps of giants” in reference to porn star Johnny Sins, who impersonates a doctor having sex with his patients.

To scroll through many medical social media accounts is to wade into a virtual subculture where patients have become fodder for derision, their privacy and dignity regularly violated. But since there isn’t really any oversight of this virtual world, patients must bear the repercussions.

Medical professionals spilling these traumatic, “hilarious” stories about their patients can lead to people not going to the doctor, says Shayna Hermann, a graduate student at the University of North Texas who studies criminology. This means the underlying health issue can “get worse and worse,” she adds—often with dire consequences.

The concealment of a patient’s medical information is an ancient custom, for such knowledge is a “holy secret,” according to the Hippocratic Oath. Medical students still refer to a doctrine of “doing no harm” that is based on the Hippocratic oath, and harm, to Hippocrates, included the dissemination of information shared between a patient and their doctor. Otherwise, trust in medicine could be undermined, disrupting treatment and diagnosis. Medicine is about acting but also about not acting.

The Enlightenment enshrined patient confidentiality as one of the formative values of the modern biomedical model. Ideals cherished under liberalism, like the individual’s right to autonomy over their body, would be impossible to respect without the guarantee that their medical records remained private. Those ideas would persist throughout the twentieth century. In 1948, the World Medical Association, an international body that now represents 115 medical associations worldwide, produced the Declaration of Geneva for the purposes of unifying an international standard for medical practice.

The document reads: “I will respect the secrets that are confided in me, even after the patient has died.” Today, a patient’s right to privacy has been legally protected in both Canada and the United States. If it is violated, doctors can be sanctioned and even lose their medical licence, temporarily or permanently. Despite this basis for the preservation of confidentiality, the growing presence of practitioners on social media presents a risk for breaches.

Physicians, like many of us, have used platforms like Twitter and Instagram since their inception, with 90 percent reporting they used social media to find information related to their patients and practice in 2017, according to a report by market analyst Research2Guidance. Today, lists of the top twenty-five “medical influencers” include accounts of family physicians and doctors who have been endorsed by celebrities and have millions of followers. And, at times, their posts contain jokes involving patient information.

A 2020 study by Wasim Ahmed of Newcastle University, which analyzed 348 tweets about living patients, found that nearly 47 percent contained details that would likely make patients identifiable to themselves. In some ways, packaging patient information for public consumption is in line with lesser-known traditions of the medical world. The history of medicine is also a history of performance; health care workers have advanced their careers through the exhibition of less powerful people for hundreds of years.

Despite the progress made around patient confidentiality during the Enlightenment, during the seventeenth and eighteenth centuries it wasn’t uncommon for both students and the public to pay an entry fee to witness dissections that took place as part of medical education in Europe. Many people viewed the practice as necessary for scientific advancement, but physicians used, almost universally, bodies of the poorest subjects, stealing cadavers from graves without consent and then displaying them for the public.

In the era before anesthetic was widely used, surgeons would operate on conscious patients before an audience of, at times, 700 to 800 onlookers. In an article for JSTOR Daily, Rebecca Rego Barry wrote that surgeons “seemed to revel in the showmanship aspect of their work,” receiving applause at the moment they entered what one medical college called the “pit.” It was this performative aspect of medicine—perpetrated by practitioners and revered by observers—that helped usher in the era of the celebrity doctor.

Of course, the conditions health care professionals train and work in have always encouraged physicians to establish public influence. Canadian hospitals and medical schools reward and publicly promote their most prestigious students, researchers, and clinicians; competition for esteem and funding from donors encourages already-high-achieving people to differentiate themselves and build lucrative research reputations. But television fundamentally changed the way we think about doctors, commodifying the act of giving medical care so that it could be sold as entertainment on a mass scale.

Just look at celebrities like Dr. Drew and Dr. Oz or shows like Dr. 90210 and Botched. Every week, viewers tune in to watch the assessment, diagnosis and treatment of patients, despite the criticisms these shows have received for exploitative practices. Reality shows like ABC’s NY Med used footage from actual emergency rooms and operating theatres, sometimes filming surgeries without consent from patients.

Joel M. Geiderman, an LA emergency physician, told Emergency Medicine News that he knows people who consented to being filmed while stressed and in the emergency department, then regretted the publicization of their medical treatment in the media. So, while the disclosure of medical secrets to the public is not particularly new, technology has made it much easier.

There is certainly a place for doctors online. Medical misinformation and vaccine hesitancy need to be confronted, especially in the era of COVID-19, and many clinicians have made invaluable contributions to online discussions about medical racism, homophobia, ableism, and misogyny. A number of physicians use social media to help patients with conditions underrepresented in medical literature self-advocate. Others advise oppressed patients on how to ensure they’re getting the best care possible and answer pressing questions about the pandemic.

But growing distrust in the medical establishment, which the violation of patient confidentiality encourages, must be reckoned with just as seriously. According to a recent survey by NORC at the University of Chicago, since the start of COVID, 32 percent of respondents decreased their trust in the health care system. This distrust is often particularly present in Black, Indigenous, and LGBTQ+ communities, which have been subjected to medical exploitation, experimentation, and harm for centuries.

Research shows suspicion of pharmaceutical companies continues to drive vaccine hesitancy. “COVID put physicians in the forefront of the cultural mainstream,” says Stephanie Lee, a hematologist at St. Michael’s Hospital in Toronto. “Everyone was looking to physicians for guidance on what was happening.” She adds that, for many physicians, there was a feedback loop of wanting more attention and likes on social media.

While she believes health care practitioners generally have good intentions, “when the well runs dry of content on COVID, people wanted to mine their professional lives to maintain their status. COVID accelerated what was already an issue.” The targets of these posts are, overwhelmingly, the oppressed. Faithful to the history of medical theatre, women with mental illness and patients who are geriatric, disabled, fat, impoverished, or perceived as uneducated are subjected to the majority of ridicule.

And it’s not uncommon for patients in similar situations to see these posts. Reacting to discussions of trans healthcare by physicians on Twitter, one person tweeted, “My lived experience/identity has been distilled to a saccharine and self-serving Aesop[’s fable].” Another nurse, who posted that she knew when patients were faking symptoms, inspired a #PatientsAreNotFaking hashtag used by thousands of people.

“Whenever I see nurses and doctors on TikTok . . . disparaging their patients . . . it makes it hard, for not just me but a lot of people, to be vulnerable to their doctors,” says the University of North Texas’s Hermann. She adds that patients who grew up in poverty, like herself, already distrust health care professionals, and social media has the potential to make it worse. Patients have already expressed a variety of concerns in the comments sections of these platforms:

“TikTok singlehandedly made me not seek medical care recently,” wrote one user; another posted about their anxieties around having emergency surgery, writing, “I was literally fearful of my nurses having their phones on them and videoing me while I’m vulnerable.” With no real oversight in place to monitor online behaviour, it’s clear that the regulations around patient confidentiality must evolve to capture these new concerns.

The Canadian Medical Association does have a data-stewardship policy that covers patient privacy, but it only mentions the sharing of patient details over email—nothing about social media. The issue has been addressed in the College of the Physicians and Surgeons of Ontario’s new set of guidelines for the use of social media by physicians, which includes the recommendation that doctors “exercise caution when posting information online that relates to an actual patient” and asks them to “bear in mind that an unnamed patient may still be identified through a range of their information such as a description of their clinical condition.”

These are, however, just guidelines, and they are still violated constantly online. Both Hermann and Lee think that social media use should be addressed in medical curricula; hospitals and medical boards already have disciplinary mechanisms in place for violations of patient confidentiality, which should be implemented when health care practitioners post derogatory content online with the same consistency that they are when practitioners are careless with physical copies of patient data.

Directives, they added, should take into account that comments deriding or ridiculing sick people in general can be as harmful to the public’s relationship with the medical system as individual violations of patient confidentiality. Lee believes that, when done correctly, patient narratives shared on social media can have a constructive and positive function. “There’s an opportunity to do a lot of good,” she says. “

But physicians need to take stock of how this is really helping our patients. Is there really a net material benefit to patients by posting this? Is there an alternative way that preserves the patient’s dignity better, maintains their anonymity better?” Asking for consent to post about a patient online is complicated, however. The power differential between patients and doctors, in most cases, is enormous.

It is difficult to imagine conditions in which patients wouldn’t potentially feel coerced into agreeing to let their physician share their information on a public social media account. “Hospital fundraising campaigns share patient information all the time, but the big difference is the patients’ stories are shared after the acute issue has been resolved,” says Lee, adding that, often, those narratives are shared in the patient’s own words, sometimes written in partnership with their former health care providers. “You have to empower the patient to be part of the process, to be part of sharing their story,” she says.

In 2021, following his disciplinary hearing at the College of Physicians and Surgeons of Ontario, Martin Jugenburg was suspended from his job for six months. At some point, he removed all the patient content predating November 2019 from his Instagram account. The committee wrote that there was a “troubling pattern of Dr. Jugenburg pursuing his own interests . . . in publicity and in cultivating a strong social media presence, at the expense of the privacy of his patients.” His “seeming indifference to these issues was appalling and is deserving of significant sanction,” the committee added.

Jugenburg has since resumed his career at the Toronto Cosmetic Surgery Institute and has publicly vowed to fight attempts made by patients to seek financial compensation for the damages done. His Instagram account is still public, and he has begun posting new post-op images of his patients—presumably with permission this time. It’s almost business as usual.

For patients, the situation remains unchanged. Questions about the function of social media in medicine have yet to be posed with seriousness, and solutions have not been identified or implemented. Meanwhile, influencer-doctors continue to practise the tradition of performance, prolonging a hidden history of sickness as spectacle.

“It’s really easy to detach empathy when you’re doing a TikTok. It’s really easy for those viewers to not see that person as a person,” says Hermann. “[But] I think, now, it’s coming to a head.”

Source: Doctors on TikTok: The Dark Side of Medical Influencers | The Walrus

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The IRS Goes Undercover As A Bitcoin Trader In $180,000 Sting

On the hunt for tax cheats, fraudsters, money launderers and dark web drug dealers, the Internal Revenue Service (IRS) has sent an undercover agent to work on a market for trading bitcoin, ether and other cryptocurrency.

In a search warrant reviewed by Forbes, the undercover IRS agent went by the name of “Mr. Coins” on LocalCryptos.com, a platform exchanging cryptocurrency for dollars and other fiat currencies. Mr. Coins’ profile, still live at the time of publication, had 100% positive feedback after shifting up to $200,000 in digital money.

But his biggest success may have been to take down an alleged dark web drug dealer, tricking him into sending more than $180,000 in cash to the IRS in exchange for cryptocurrencies, according to the warrant.

In June of last year, Mr. Coins put up an advertisement offering to buy bitcoin via cash by mail and above market prices. All sellers had to do was get in touch over encrypted messaging apps Wickr or WhatsApp.

Shortly afterward, a person going by the name “Lucifallen21” got in touch to inquire about the ad, according to the search warrant. The IRS, without saying how, determined that Lucifallen21 was actually Evansville, Indiana, resident Chase Hite. By July, he’d agreed to buy from Mr. Coins, wrapping up $15,040 in cash in clothes, putting the money in a box and posting it to the agent in exchange for approximately 1.59 bitcoin, according to the government’s account.

More payments came in, with nearly $20,000 posted in August, in exchange for approximately 1.34 bitcoin and 45.2 monero, another cryptocurrency that promises better privacy protections than its rivals, the government said, adding that nearly $65,000 was sent to the agent over following months.

Come March this year, investigators were getting ready to home in on the conclusion to the sting operation. A $28,000 cash package from Hite was intercepted and marked as lost by the Postal Service, according to the IRS, which then monitored calls to the post office, waiting for the suspect to call and complain. Investigators linked this call with a phone number that was paid for by Hite.

Further messages over Wickr indicated Hite was involved in dark web drug sales, claiming to sell “pills and opioids,” as well as cocaine and marijuana, the IRS claimed. As they deepened their relationship, the undercover officer agreed to provide Hite with a loan, by which the suspect would send $54,000 in cash and get $79,000 worth of cryptocurrency in return, according to the search warrant. When that last package arrived, forensics took fingerprints and linked them to Hite, the government added.

Hite was arrested in July and has not yet filed a plea. The charges were filed in the Eastern District of New York. His lawyer declined to comment. LocalCryptos hadn’t responded to requests for comment. The IRS declined to provide more information than what had been filed in court.

The tax collecting agency has a track record of going undercover to snare cryptocurrency-using criminals. Earlier this year, it was revealed that the agency had organized a payment to a service called Bitcoin Fog, which offered to launder money.

The agents said they wanted to launder cryptocurrency they’d earned by selling Ecstasy, according to a criminal complaint, first reported by Wired, in which a Russian-Swedish administrator was charged. And in March, the IRS pretended to be a seller of counterfeit Gucci products sourced from China, asking the defendant in that case to convert bitcoin that they claimed to have acquired in selling the merchandise.

But this latest sting is a rare case where the IRS set up a profile on a cryptocurrency trading platform and created what amounts to a watering hole, with agents just waiting for criminals to dive in.

This story is part of The Wire IRL feature in my newsletter, The Wiretap. Out every Monday, it’s a mix of strange true crime and real-world surveillance, with all the relevant search warrants and court documents for you to pore over. There’s also all the cybersecurity and privacy news you need to read. Sign up here.

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I’m associate editor for Forbes, covering security, surveillance and privacy. I’m also the editor of The Wiretap newsletter, which has exclusive stories on real-world

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Wall Street Seeks To Make Up For Long Hours With High Salaries

(Bloomberg) – Rooms at the Fairmont Royal Pavilion, located on Barbados’ platinum beaches, can cost more than $ 1,000 a night. In the morning, you can enjoy the catamaran snorkeling cruise and return ashore in time for afternoon tea.

For some Houlihan Lokey Inc. employees, this offer is now on the table: a five-night stay at this Caribbean haven, with money from the investment bank, as a reward for a year of record earnings. The offer is also a subtle plea to the company’s younger employees: please don’t quit.

That last phrase echoes across Wall Street, where turnover and burnout rates among young workers are accelerating. Banks have tried to turn the tide with raises, bonuses, vacations, and even free sports equipment. For all that, being a young banker in America has never been more lucrative.

However, the problem is that it has also never been more lucrative for aspiring workers to work outside the golden world of finance, as the gap between banks and other employers such as technology companies has narrowed.

“In terms of making money, is this the best time to be a banker? Sure, ”says executive recruiter Dan Miller of True Search. “Now, in terms of lifestyle, is this a terrible time? Absolutely”.

A presentation prepared by 13 first-year analysts at Goldman Sachs Group Inc. earlier this year prompted a reckoning on Wall Street after it highlighted the working conditions of junior bankers – some of them working 100 hours a day. the week while his physical activities and mental health suffered. Goldman responded by cutting weekend hours and promising to increase staff at its busiest businesses.

Earlier this year, a presentation prepared by 13 first-year analysts at Goldman Sachs Group Inc. prompted a reckoning on Wall Street after it highlighted working conditions for junior bankers – some of them working hundreds of hours a day. the week as his physical activities and mental health suffered. Goldman responded by cutting weekend hours and promising to increase staff at its busiest businesses.

However, some industry veterans have made harsh statements against those who complain about the workload. Cantor Fitzgerald’s Howard Lutnick suggested that some of the young workers considering leaving finance may simply not be ready for it. “Those young bankers who decide they are working too hard, choose another way of life,” he told Bloomberg TV earlier this month.

Furthermore, the exhausting workload of bank analysts has continued and, in some cases, worsened. When COVID-19 took over the nation last year, the “work hard, play hard” mantra became “work hard, sit on your couch,” all while the economy accelerated and deals proliferated.

Frustrated and overworked, many of them turned to the anonymous ex-banker behind the popular “Litquidity” financial meme account for support. In an interview, he said he was inundated with messages on Twitter and Instagram from young industry colleagues feeling fed up and weighing whether the work was worth it.

Lit, as he calls himself, was at the time a senior associate in investment banking and knew very well what they were going through. He too felt exhausted and stressed, and at one point he went to see a doctor to have his heart palpitations checked.

“Do you know the feeling when your stomach just sinks in? I felt it in my heart, “he said by phone from New York’s Central Park. The doctor concluded that his symptom was probably related to stress. Last winter, Lit quit her job to focus on growing the Litquidity brand and writing a daily newsletter. He says he is also working to launch a venture capital fund.

It is not only in finance where workers are becoming more demanding, a similar scenario that occurs throughout the country. Companies from McDonald’s Corp. to country clubs in Nashville, Tennessee, have raised wages and offered hiring bonuses to attract new workers. From March to May, the rate of American workers who voluntarily quit their jobs rose to its highest level in at least two decades. In Washington, lawmakers are arguing about raising the minimum wage to $ 15 an hour.

Of course, the isolated world of finance and some other professional services operate on a significantly higher plane in terms of pay. Last month, dozens of the nation’s top law firms raised first-year salaries to $ 202,500, roughly a couple thousand. They also offer multiple annual bonuses and additional time off as they struggle to retain talent and their workers face burnout.

Miller, who co-leads True Search’s financial services practice, says today’s young bankers have far more options than their peers previously had. Banks and consulting firms have long been a source of recruiting for private equity and, more recently, venture capital, technology, and fintech. These days, with many of those industries hiring at a record rate, many young bankers no longer have to hold out for two years. They can leave earlier or skip the stay in finance altogether.

Some bank bosses have promised to ease the pressure. After the junior analysts’ presentation, Goldman CEO David Solomon promised to better enforce the rule that they should have Saturdays off. But the sentiments carved in stone in banking culture for decades do not change easily. Additionally, Lit noted that Goldman’s policy of not working on Saturdays has been in effect since 2013.

“There has to be a way to make it stick,” he said. “What’s the use of earning half a million if you work 20 hours a day?

Source: Wall Street seeks to make up for long hours with high salaries – Explica .co

How Much Money Is ‘Enough’? Try This Experiment to Get an Exact Number to Aim For

a wad of money secured with a blue paper clip on a pink background

Have you ever read those articles where some extremely well-off family details their budget and then bemoans that they’re barely getting by?

It’s ridiculous that anyone could complain about raking in $350,000 a year, and it’s clear many of these folks are wildly out of touch with how privileged they are. But while these families may be extreme (and annoying), they aren’t alone. It’s not just the wealthy who fall into the trap of earning more only to spend more and feel just as dissatisfied.

How do you get off this treadmill?

The answer is not to compare yourself with others (Jeff Bezos will always be there to make you feel bad), or to blindly try to keep making more (there will always be some shiny, new thing to covet). The answer is to take a hard look at your own financial realities and aspirations and come up with a goal number. How much money is enough for you?


The Science of Money and Happiness

That number will be different for everyone, depending on your circumstances and values, but science can give us some sense of how much money might be “enough.” Research shows that up to a certain threshold (studies consistently put it at about $75,000 dollars a year, give or take a bit depending on cost of living) money has a big impact on both day-to-day happiness and life satisfaction.

If you’re below this level, making more will likely make you significantly happier. But beyond that point, each additional dollar adds a little less to your life. There is a level of wealth way before Bill Gates status that trading more effort and time for more money ceases to make sense (even Bill Gates says so).


Name Your Number

One way to calculate that point is to figure out how much money you’d need to make decisions based entirely on enjoyment and impact, without pressure to earn. This is the goal of the catchily named FIRE movement (for financial independence, retire early). Its boosters generally say that 25X your expected annual expenses is enough. So if $50,000 a year is enough for you to live comfortably, you need to save $1.25 million.

There are other more elaborate calculators that can give you a sense of what financial independence means for you. But perhaps the best way to get a feeling for your goal number isn’t math but a simple thought experiment from writer Brad Stollery:

Suppose you’re one of five people who have been selected by a mysterious philanthropist to participate in a contest. The five of you all have comparable debt-levels and costs-of-living, as well as similar, middle-class financial situations. You’re all roughly the same age, equally healthy, have the same number of children, and you all live moderately low-risk lifestyles. Privately, and one by one, a representative of the donor approaches each of you with a blank check and a pen, and poses the following question:

How much money would you have to be paid, right here and now, to retire today and never receive another dollar of income (from any source) for the rest of your life?

The catch this time is that whoever among the five players writes the lowest amount on the check will be paid that sum. The other four players will get nothing.

This thought experiment forces you to cut away the natural impulse to aim ever upward (if you do that you’ll bid too high and get nothing). That result is however much you ask for is your number, the amount you’d need to live comfortably and pursue your goals if status and lifestyle inflation weren’t a factor.

Your answer might be a little bit higher or lower than mine or your neighbor’s. That’s fine. It’s not important everyone agree on a number. The important thing is that we each reflect enough to have one.

Because the alternative is being one of those people confessing online how you burn through a healthy six-figure salary and still feel stressed and dissatisfied. Your expenses and desires can be infinite. If you don’t want to chase them miserably forever, you need to put a cap on your financial ambitions yourself.

By: Jessica Stillman

This post originally appeared on Inc. and was published February 5, 2020. This article is republished here with permission.

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