By Ruth Carol, contributing writer

Remember the bully on the playground? Well, the bully grew up and is now sending nasty text messages, posting insulting comments online, harassing people via email, and picking fights on Twitter.

In other words, the bully’s behavior has not changed; technology has. Cyberbullying is the willful and repeated harm inflicted via computers, cell phones, and other electronic devices, according to the Cyberbullying Research Center.

And if you think that cyberbullying only happens to teenagers, think again, noted Center Co-Director Justin W. Patchin, PhD. The majority of the calls that come into the Center are from adults calling about being cyberbullied by other adults.

This month, Dermatology World looks at cyberbullying, its prevalence in medicine, and the impact on physicians. 

Cyberbullying in medicine

Studies have suggested that between 10-20% of adults have been cyberbullied at the workplace. Little is known, however, how that translates to health care settings. Research suggests that nurses not only experience cyberbullying by other staff, but also by patients and their families. Nearly half (46.2%) of 158 trainee doctors who were surveyed for one study reported being cyberbullied at work. This experience adversely impacted their job satisfaction and mental health. Bullying among physicians, residents, nurses, and other providers can also result in increased job turnover and absenteeism as well as lower productivity and morale. According to one study, physician behavior may have the greatest impact because of the doctor’s position of authority on the health care team.

In a 2016 Sentinel Event Alert, The Joint Commission asserts that workplace bullying results in under-reporting of safety and quality concerns, and increases in harm, errors, infections, and costs. It’s easy to see how bullying could potentially negatively impact patient outcomes. As an example, a team member who is being cyberbullied may be too intimidated to question a prescription given by the offender or the offender’s lack of adherence to safety protocols, both which could lead to an adverse event.

People seem to be disinhibited when they sit behind a computer, noted George J. Hruza, MD, MBA, the Academy’s immediate past president. “They say things they would never say in person, but somehow feel they can ‘let loose’ on social media, even though they’re not really anonymous.” Keyboard courage empowers them to speak without the filter they would normally use if they were sitting face-to-face with a person, said Kara Jilek, the Academy’s social media manager.

“Because doctors are considered public officials, they are expected to be able to handle this,” Dr. Patchin said. “But we’re all human.” Victims of cyberbullying can experience sadness, fear, and frustration.

Limit response to cyberbullying

The best way to respond to cyberbullying is not to. Cyberbullies are usually trying to gain an audience, get people on their side, or make people laugh, Dr. Patchin said. In the case of patients, they could have a grievance; they’re upset, and they want people to know it. “If they don’t get the reaction they want or someone tells them that their behavior is inappropriate, they will stop,” he added.

Academy President Bruce H. Thiers, MD, concurs. Sometimes, the best tactic to counter individuals who are annoying, but not threatening, is to simply ignore them, he said. “Any response will beget another tirade, while a lack of response will frustrate the cyberbully who is just seeking attention,” Dr. Thiers added.

Additionally, keep evidence of all the content that was sent or posted, even if it doesn’t seem significant at the time, Dr. Patchin said. This includes screen shots, text messages, emails, tweets, and pictures. This evidence is helpful to determine the cyberbully’s pattern of behavior, he explained. It may show that the person is creating multiple profiles or enlisting others to join in on the harassment. It will be especially helpful if the cyberbullying escalates and the police must be contacted to investigate.

“If it’s happening on your social media page and you have control over it, don’t engage,” Jilek said. If the individual is being derogatory or offensive, delete the post and block the person. “If it’s happening on a social media account that you don’t have any control over, you can correct the content, but only if you can do it in a positive way,” she said. “You may want to reach out privately to provide the accurate information.” Many social media sites have policies prohibiting cyberbullying as well as mechanisms for reporting it.

The Academy has adopted several policies that address cyberbullying. (See page 53.) Dr. Hruza advises that if you are cyberbullied, it’s important to respond without injecting any emotions or counterattacking. “If you do respond, do it right away,” he said. “If you wait, the cyberbullies take credit for being right.”

If the cyberbullying is occurring at work, talk to human resources. “Let them know that a co-worker is harassing you on a work-related forum or blog,” Dr. Patchin said. “If the cyberbullying prevents you from doing your work, your employer needs to know that.” Workplace harassment can be difficult to address when the boss is the offender and the victim is concerned about losing their job if they report it, Dr. Patchin acknowledged. Bullies tend to target employees who have inadequate support or those who are unable to defend themselves from the aggression, according to The Joint Commission’s Sentinel Event Alert. If the person doing the cyberbullying is a patient, that’s harder to address because people are entitled to free speech, including criticizing their doctors, he added.