Social epidemics and the role of physicians

In the first blog, I discussed infectious epidemics and the recent social epidemic of loneliness. In this second blog, I will briefly mention the burnout epidemic, which has received ample attention in our literature and professional meetings. I will discuss the epidemic of social media toxicity and its impact on our children.

The burnout epidemic

I hear physicians asking questions that I have been heard in surgical lounges and medical dining rooms. Some of these questions I've frequently heard include:

• Did I choose the right profession?
• Would I recommend a medical career for my children?
• Should I make a career change?
• Is it time to retire?
• Should I have stayed in private practice instead of being employed as a physician?

These are just a few questions indicating that medical practice blahs impact many of our colleagues.

Burnout can have many negative consequences for physicians. Burnout can lead to depression, anxiety, chronic stress, irritability, decreased self-esteem, and even increases the risk of suicide. It is noteworthy that the suicide rate among physicians is greater than in other professions and also higher than in the general population. It is also of interest that there are higher rates of alcohol use among physicians experiencing burnout.

Burnout can lead to decreased job performance, increased absenteeism, and decreased enjoyment of our practices. It can also lead to increased medical errors and increase the risk of a malpractice suit. This will ultimately affect patient satisfaction and can impact our online reputation. This decrease in enjoyment also motivates physicians to leave the practice of medicine at an earlier age.

Finally, burnout can also negatively impact our health and well-being. Burned-out physicians are at an increased risk for cardiovascular disease (Appels and Schouten, 1991; Toker et al., 2012; Toppinen-Tanner et al., 2009) and other health consequences, including hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, fatigue, headaches, gastrointestinal disorders, and respiratory problems. (Salvagioni et al., 2017).

Suggestions for beating back burnout

We can start small and make micro-adjustments that will improve our attitude towards our practices and make our situation more tolerable. For example, if you are a middle-aged physician and entering data in the EMR is daunting or emotionally painful, consider asking for a scribe to do the data entry. Now, we have software programs that use AI to convert voice to text, which may eliminate the need for scribes.

If we are having difficulty starting our office clinic at 9:00, we should consider negotiating different work schedules so we can start and end our day on time.

If working 60-plus hours a week is difficult, consider opting out of evening and weekend calls. Of course, this will reduce compensation.

Another suggestion is to leave your comfort zone and the boredom accompanying burnout. A personal example from my practice occurred after I performed my 3000th penile implant. I found I was bored with the operation and not having that dopamine rush which usually follows a successful operation. I changed my focus from men's health to female sexual dysfunction, which is a condition in its infancy. I attended lectures and meetings on the subject. This shifting of gears allowed me to leave my comfort zone and reduce my boredom.

A final suggestion is to consider a career change. Change can be challenging, exciting, and rewarding. When I speak to doctors who have changed careers, I often hear a response after six months in the new career: "I should have done this sooner!" For physicians considering a career change, I recommend reading Sylvie Stacy's 50 Unconventional Careers for Physicians.

Epidemic of social media

In the previous blog, I mentioned that Attorney General Vivek Murthy issued a report identifying loneliness as reaching epidemic proportions. In the spring of 2023, United States Dr. Murthy released an advisory called Social Media and Youth Mental Health, in which he said there is growing evidence that social media is causing harm to young people's mental health. The American Psychological Association (APA) issued its health advisory in 2024 requesting that the surgeon general place a warning label on social media platforms about the health hazards of excessive use of social media. This could be similar to the label required on cigarette packages warning about the dangers of smoking.

Social media use among young people is nearly universal now, based on surveys from the Pew Research Center. In 2022, up to 95% of teenagers surveyed (ages 13 to 17) reported using social media, and more than a third use it almost constantly.

Pew has also tracked which social media platforms (or "apps") teenagers use. In 2023, it found that the majority of teenagers—9 out of 10 for ages 13 to 17—use YouTube, followed by TikTok, Snapchat, and Instagram.

There are indicators that social media can cause profound mental health and physical harm to teens using social media. Murthy's advisory was based on a review of the available evidence. His report stresses that the brain is going through a highly sensitive period between 10 and 19 when identities and feelings of self-worth are forming. According to the report, frequent social media use may be associated with distinct changes in the developing brain, potentially affecting such functions as emotional learning and behavior, impulse control, and emotional regulation. The issue is the amount of time adolescents spend on platforms, the content they are exposed to, and how their online interactions disrupt activities essential for health, such as sleep and physical activity.

Over the last decade, increasing evidence has identified the potential negative impact of social media on adolescents. According to a research study of American teenagers 12-15, those who used social media over three hours each day faced twice the risk of having adverse mental health outcomes, including depression and anxiety symptoms. Although the minimum age most commonly required by social media platforms in the U.S. is 13, nearly 40% of children ages 8–12 use social media. That signals how difficult it can be to enforce these rules without parental supervision

Eating disorders are yet another concern. A review of 50 studies across 17 countries between 2016 and 2021 published in PLOS Global Public Health suggested that relentless online exposure to largely unattainable physical ideals may trigger a distorted sense of self and eating disorders. This is a particular problem among girls.

In addition, people who target adolescents—for instance, adults seeking to sexually exploit children, to financially extort them through the threat or actual distribution of intimate images may use social media platforms for these types of predatory behaviors.

According to Murthy's advisory, excessive social media use can harm teens by disrupting important healthy behaviors. Some researchers think that exposure to social media can overstimulate the brain's reward center and, when the stimulation becomes excessive, trigger pathways comparable to addiction.

Excessive use has also been linked to sleep problems, attention problems, and feelings of exclusion in adolescents—and sleep is essential for the healthy development of teens, according to the advisory.

The role of physicians in curbing use of social media

The American Academy of Pediatrics (AAP) offers a free digital tool called the Family Media Plan to help parents create a customized media use plan for their family. In addition to setting the age at which you plan to start giving your kids phones or internet access, this plan can be used to establish rules and educate children and teens about being careful about privacy settings, avoiding strangers online, not giving out personal information, and knowing how to report cyberbullying. Most pediatric experts agree that elementary school-age children should not have internet access using a device with all the social media apps.

One strategy is to make a social media plan for your family before the teenage years. Parents might consider starting with a dumbphone, or a cell phone that doesn't have email, an internet browser, or other features found on smartphones. The experts suggest delaying full access to smartphones for as long as possible. Go slow and start with a device allowing parents to add more apps as their child matures.

Experts suggest educating patients about the dangers of social media and steps they can take to control their children's use of it. This includes setting clear age-appropriate access limits, maintaining open communication, monitoring screen time, keeping devices out of bedrooms, and discussing online safety practices. Parents should also model responsible social media behavior themselves.

Experts are still debating the ideal age for a child to join social media, so parents should carefully consider their child's maturity level before granting access.

Responsible parents should set limits on screen time, designated social media hours, and specific platforms allowed.

Parents should discuss online safety, cyberbullying, privacy concerns, and responsible digital citizenship openly with their teens.

It is important to regularly check a teen's online presence but do so respectfully without invading their privacy.

Consider encouraging parents to keep phones and other devices out of the bedroom, especially at night, to promote healthy sleep habits. Research shows a relationship between social media use and poor sleep quality, reduced sleep duration, and sleep difficulties in young people. For teens, poor sleep is linked to emotional health issues and a higher risk for suicide.

According to the Surgeon General's report, on a typical weekday, nearly one-third of adolescents report using screen media until midnight or later.

Parents should try to create a culture at home where all phones are turned off by a certain time and at least one hour before going to bed. In my home, I had a policy that phones were not permitted at the dinner table or when the family went to a restaurant.

Parents should practice responsible social media use to set a positive example for their teens. For example, parents should not use cell phones at dinner time, and if they must take a call, it is polite to get up and walk away from the dinner table to talk.

Bottom Line: The healthcare profession has done an admirable job controlling infectious epidemics, including the AIDS virus, and creating vaccines for COVID-19 in a record six months. Now, we need to move on to social media epidemics: loneliness, burnout, and social media epidemics are as dangerous as infectious epidemics. Physicians need to take an active role in identifying these issues and discuss loneliness and social media use with patients and their families. Finally, physicians need to be concerned with their own mental health and find solutions for burnout in their own lives, which ultimately impacts the care we provide our patients.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.