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Some physicians scream and run out of the room at the mere mention of social media, yet a few stalwarts are online regularly, educating and combating misinformation. The benefits are few, particularly for Canadian physicians, who have no need to raise their profiles in a medical setting where wait lists are a mile long. What keeps them going?

An Obligation

Tyler Black, MD, psychiatrist at the University of British Columbia in Vancouver, sees it as an obligation. “We’re at a really important scientific crisis in the world,” he told Medscape News Canada. “I think that anti-science information is winning, and pro-science information is losing, and we’re losing ground on things that we had made incredible ground on. There are important political discussions coming up that should matter to every physician.”

Black has been battling misinformation online for as long as there has been an internet, and like many supporters of science, ultimately found his footing on the social media platform X. He enjoyed the collegial, collaborative nature of pre-pandemic X, but unlike many physicians, he remained, even after it experienced a surge of misinformation and trolls. His tweets about the pandemic’s effects on suicide rates among young people — his area of expertise — helped earn him recognition as an expert in suicidology. He also spoke up about masking and vaccines.

Like Black, Ken Milne, MD, staff physician at the Strathroy Middlesex General Hospital, Strathroy, Ontario, and associate professor of medicine at the Schulich School of Medicine and Dentistry in London, Ontario, feels that physicians have a responsibility to maintain an online presence. “From a family medicine perspective, you’re supposed to be a resource to your community. There is an online community, and your patients are online.” But he specified that it’s only a good fit for physicians who are comfortable with the medium and who can control their tempers well enough to represent their profession with dignity.

Milne came to social media through his love of teaching. “I’m very interested in helping people to think better,” he explained. “Not necessarily what to think, but certainly how to think…. It’s really a desire to promote skepticism and critical thinking.”

His journey began through teaching critical thinking and evidence evaluation to other physicians via Best Evidence in Emergency Medicine (BEEM) and continued through founding The Skeptics’ Guide to Emergency Medicine podcast. “I get no payment for it. I get no protected time or credit from my university for it. I just want to do this project,” he said. Milne’s role as a podcaster led to his presence on X and a wider general audience.

Not Such an Obligation?

As a specialist in obesity medicine, Yoni Freedhoff, MD, associate professor of family medicine at the University of Ottawa, Ottawa, is no stranger to misinformation. His daily blogs morphed into a social media presence on X, where he has remained despite, or perhaps because of, its perceived descent into the misinformation abyss. “That’s part of the job of a physician, to provide some public service in terms of health education and information,” he said. But he does not feel that physicians should feel obligated to wade into the muck. “Social media gives a person the perception that they’re very loud, and that they’re making a big difference. And the truth is, social media is not a big deal. It’s an illusion…. I really do wonder how much of a population-level impact we’re having.” Social media promotes echo chambers, and users risk preaching to the converted.

Handling the Pressure

None of the physicians interviewed for this story have public support from their peers, institutions, or regulatory bodies for their work on social media. While they may occasionally get a private pat on the back, they are largely on their own.

Black and Freedhoff spoke of the stress of being lightning rods for hatred, complaints to their institutions and regulatory bodies, and doxxing and death threats. None of the complaints have led to any sanctions, but they do suck up time and energy.

Black finds the lack of professional support as baffling as it is frustrating. “People are harmed by [online misinformation], and the [Royal College of Physicians and Surgeons] CanMEDS guidelines are clear that advocacy is one of our roles as physicians,” he said. “I don’t understand how the average physician can just be head-down, everything’s okay, while the rest of the world is de-vaccinating themselves from measles. I don’t understand why our organizations are so mealy-mouthed about it, why we put such muzzles on physicians for speaking.”

While all three physicians take pains to behave with decency and respect online, Milne’s approach has been to kill trolls with kindness, a skill he learned as an emergency medicine physician. “There’s a lot of anger, there’s a lot of rage,” he said. “I’m very interested in finding out the why…. What helps is that I don’t personally identify with my positions. That’s not who I am. Who I am is a critical thinker, a scientist, and somebody who’s kind. I see people suffering, frustrated, angry, and upset, and I’m not there to judge them on their lifestyle choices. I’m there to say, how can I help?… It’s hard to be mean to someone who isn’t mean back.” Perhaps it is because of that approach that he has never had to deal with complaints through official channels. 

Speaking up for Marginalized Communities

What keeps Freedhoff active on social media has been the rise in antisemitism in recent years, both on- and offline. “It’s important for like-minded people to see somebody speaking up,” he said. “I can’t tell you how many colleagues [and] friends who are Jewish or who are supporting their allies, don’t feel comfortable speaking up. It is dangerous, and it does make you a target. But it’s important for me to use whatever platform I might have so people can feel like there are voices speaking up out there…. It feels like an obligation to the people who died before me so that I could be Jewish in 2026 and be proud and speak up.”

For his part, Black has been galvanized by the uptick in abuse hurled at his transgender patients and the transgender community at large, both online and in the real world. On social media, he can let these patients know he’s a safe person who will defend their rights. It gives him tremendous satisfaction to donate the $1000 a month or so he earns via his X account to local transgender causes.

Black, Milne, and Freedhoff reported having no relevant financial relationships.