“If I had an hour to solve a problem, and my life depended on it, I would use the first 55 minutes determining the proper questions to ask” – Albert Einstein

We need to talk. It’s not me, it’s you. You make me feel as though I don’t have a free voice anymore. You’re so sensitive, I feel like I’m walking on eggshells. Everything I say seems to upset you. And it’s so difficult to know what is real and what is just spin. I can’t trust you. I don’t want this to end, but something needs to change if we are going to keep going. You’ve fallen into some bad habits and I just can’t take it anymore. You’re making it impossible for me to be who I am. Can we just start again, please?

My relationship with social media has never been totally comfortable, but since I’ve started using Twitter for my research work, it has become increasingly strained, so I think it’s high time that the issues I am experiencing are addressed in an intelligent and pragmatic fashion.

The first issue that needs to be addressed is political correctness. There is an ongoing debate about how far political correctness should be taken, whilst trying to protect our freedom of speech. Twitter seems to provide an oxymoronic platform, a confusing dichotomy of vehement protection of freedom of speech at the same time as almost illiberal censorship. To provide an example, a few months ago, a Korean research team, Jung and Kim, published a piece in the American Journal of Emergency Medicine that explored whether men were better than women at first attempt emergency intubation. Their hypothesis was that there would be no difference between sexes, and they went on to prove this with a robust piece of research that utilised a large data set and applied valid statistical methods. Great right? Wrong. I was bowled over by the negative reception that this work received by the Twitter-azzi. From what I could gather at the sidelines, the main objection was that anyone would dare to question whether there was a difference between men and women when it came to clinical skills. There was further upset at the research team’s use of a “non-inferiority margin” in their statistical analysis, which some took to mean that women were inferior in some way.

On the back of this, I decided to read three other papers that were referenced by Jung and Kim. These looked at the influence of gender on CPR performance, the influence of physician gender on hospital mortality and readmission rates and the influence of surgeon gender on post-operative outcomes. One found that men performed better and two found that women performed better. They were all well conducted studies with valid findings, but most importantly, I didn’t find any of them to be offensive. Maybe this is my naivety and I am willing to concede the possibility that I have #missedthepoint, but my understanding of research is that it exists to provide objective evidence. This means that if a question arises that requires an answer, we design a study to provide one, don’t we? If we read Jung and Kim’s paper in full, we can see that one of the reasons they conducted their research was because of the piece by Amacher et al (2017) that found that men outperform women at CPR due to the physical strength needed for effective compressions. Jung and Kim identified that emergency intubation also has a physical strength component to it and decided to investigate. They found no gender difference. Question answered, evidence logged. End of story. However, the outrage of the Twitter-azzi, which included some offensive and hurtful personal messages to the research team, made them feel that they needed to offer an official apology for conducting this research and remove the paper from publication. This raised an altogether different, but perhaps more important, question for me; are there some questions that we cannot even ask due to their sensitive nature?

This brings me onto issue number two. As a researcher, and as a nurse, I have always felt that I am primarily accountable to the public and that it is my primary responsibility to ensure their safety. This means that if there are practices going on in my place of work that I discover to be of little or no benefit, or worse, harmful to my patients or the public, I have a duty to highlight this regardless of whether my place of work would rather keep it quiet. I take this responsibility seriously and fully expect that I will open myself up to justifiable critical analysis and academic interrogation that leads to intelligent and reasonable debate. However, more and more I am seeing reputable media outlets and people in positions of power and/or influence spouting sometimes unsubstantiated or exaggerated rhetoric about all kinds of topics and then becoming wildly defensive when their claims are subjected to a critical eye or opposing opinion.

Let’s take Greta Thunberg. From a personal perspective, I stand with Greta. I try to do what I can to protect the environment and I applaud her efforts to implore politicians globally to do more to reverse climate change. From an academic perspective, I am sometimes disappointed by what she says and how it is received. For example, the world is not “on fire” as she has previously claimed. This is an exaggeration used deliberately to get people’s attention. There were several Twitter-azzi that noticed this and pointed it out, rightly so. But the response to this was unnerving. Apparently, it’s just not OK to highlight inaccuracies in someone’s claims if the person is under the age of 18 and definitely doing something good for the world. Hold up. It is correct that Greta is only 16 years old and therefore classed as a child by many definitions, however, she decided to put herself in the public realm to make a stand for what she believes in for the greater good of humanity. The fact that she is 16 does not make her immune to the same criticism that I would expect to receive in the same situation. If we choose to make our voices heard, we must all be prepared to defend our words with facts and evidence. However, it is never OK to pile on unnecessary hostility or make threats towards people who hold a different view to you. But it is also not reasonable to expect that we will never be challenged and I encourage anyone reading this to consider the way that they challenge and to take a moment to consider an alternative perspective before doing so. It’s not always easy to go against the crowd, but that doesn’t mean we shouldn’t.

My final issue brings these two previous issues together into one gigantic deal-breaker; to whom am I accountable when I engage in social media? To be clear, there are obvious professional no-go areas such as breaking patient confidentiality, using offensive language and posting inappropriate photos, but what about the more nuanced areas? Part of my role is to stimulate discussion and debate about a variety of issues related to healthcare and research. I fully expect to be held to account for what I say in the public domain and do my best not to say things that deliberately aggravate or offend, but my Code of Conduct also states:

“make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way”

This puts me in a quandary. Politics in particular is tied up with healthcare and research in a similar way to an infinity knot. They cannot be separated. It is my job to stimulate debate about current issues, but I am not supposed to express a personal belief about any of them. One of the prominent issues in clinical research is the lack of accessibility, so I have also been charged with bringing some personality to the CNMAR and being its “face”. But I’m not meant to bring my personal belief system into it. Can you have a personality without being personal? Or more specifically, should you?

My relationship with social media is fraught and uncertain. I often feel like I give more than I receive, and this makes me question its presence in my life. Sometimes I feel as though my slow and considered approach to debate has no place in the fast-paced world of online discussion. But in a strange way, it has also strengthened my identity. I don’t really fit in on Twitter. But honestly, I don’t really want to. I will always ask difficult and sensitive questions if their answers have the potential to improve the wellbeing of the public in some way. They might be about gender, politics, religion or sexual orientation, but I will always be prepared to stand by what I say, and I am willing to open myself up to intelligent and informed debate as well as opposing opinions. And finally, I will do my best to tell the truth because I think it’s important. And that’s my personal belief.

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