#ILookLikeASurgeon goes viral: How it happened

It all started with a few characters—#ILookLikeASurgeon—a hashtag, in the parlance of social media.

Hashtags take an eponymous piece of punctuation, the pound sign, followed by a word, phrase, or a string of letters and enhance a Tweet by “labeling” the text so it can be used to pull together similarly tagged posts and organize them in a way that, ideally, stimulates an exchange with other users on Twitter. Sometimes a hashtag generates interest and conversations to such a degree that they go “viral,” which is what happened with the #ILookLikeASurgeon campaign.

#ILookLikeASurgeon has generated more than 128 million impressions, nearly 40,000 individual tweets, and more than 7,900 participants, and those numbers continue to grow.¹ The hashtag has attracted the attention of medical and surgical societies and organizations, universities and resident training programs, hospital systems, surgical associations such as the American College of Surgeons (ACS) and the Royal College of Surgeons, and media outlets from around the world.

A movement is born

The movement started with a couple of tweets and a blog post on the evening of August 5. Friends Sara Scarlet, MD, and Heather Logghe, MD, both surgical residents at the University of North Carolina at Chapel Hill, were texting each other and discussing #iLookLikeAnEngineer, a movement and Twitter campaign characterized by women engineers and other marginalized groups in engineering and technology who are posting pictures with the hashtag or comment #iLookLikeAnEngineer. As Dr. Logghe, a Resident Member of the ACS, recalls, Dr. Scarlet made the comment that it was unfortunate that surgery didn’t have a hashtag along the lines of #ILookLikeASurgeon. A few tweets ensued, and on August 7, Dr. Logghe generated a blog post titled “#ILookLikeASurgeon. Tweet it. Own it: Be the Role Model You Always Wanted But Never Had,” and from there, the message spread across the Internet.²

Progress for women surgeons

The time is ripe for attention to the longstanding and multiple issues facing women in surgery. Issues related to gender, racial, and ethnic diversity in surgery have garnered increased recognition, attention, and study in recent years. Open and frank discussions, presentations, and lectures, as well as changes in policy and perspectives, have resulted in some tangible and welcome change. Notably, a new book about women in surgery was recently published, titled Being a Woman Surgeon: Sixty Women Share Their Stories (edited by Preeti R. John, MB, BS, MPH, FACS), followed by a July 2015 Bulletin column by ACS Executive Director David B. Hoyt, MD, FACS, that highlighted the accomplishments of women surgeons and the challenges this group continues to face.³

Both the book and the column were well received; the book received positive reviews, and both engendered positive comments across social media. These two noteworthy publications are a step in the right direction, but more must be done to address diversity and gender issues, where progress often seems to move at a glacial pace.

Social media backlash

Another social media campaign that influenced the #ILookLikeASurgeon is the “This Is What We Look Like” campaign, launched in March by two childhood friends, Margo Vallee, MD, an anesthesiologist, and Jessica Gordon-Roth, PhD, an assistant professor of philosophy, to draw attention and support for women in professions and careers traditionally dominated by or associated with men.⁴ This campaign sold plain white tee-shirts emblazoned with the catchphrase customized to the profession, and women were encouraged to post pictures of themselves on social media wearing the shirt. Soon after “This is what a surgeon looks like” shirts became available with support and encouragement from the Association of Women Surgeons (AWS), images of women surgeons wearing these tees began popping up across the Internet. Cardiothoracic surgeon and blogger from Australia, Nikki Stamp, MB, BS, FRACS, received particular attention after posting her image, and was interviewed in the local media, including a post on the site Steel Heels.⁵

What followed next was a string of negative events, which in turn sparked reactions that flamed across the Internet, grabbing media attention. The two incidents that drew the most attention, outrage, and ire, and which led to hashtag campaigns of their own, were #DistractinglySexy and #iLookLikeAnEngineer.

#DistractinglySexy was a hashtag and photo social media campaign that was created in response to comments by biochemist and Nobel Laureate Sir Richard Timothy “Tim” Hunt, FRS, FMedSci, regarding women in science and in the research laboratory, which he made to an audience at the World Conference of Science Journalists in South Korea. Though he later claimed his comments were meant as a joke, Mr. Hunt’s references to his “trouble with girls” in the lab engendered angry comments and rebuttals from both journalists and scientists, including Pulitzer Prize-winning science journalist Deborah Blum, which led to the creation of the #DistractinglySexy hashtag response.^6,7 Social media platforms were flooded with images of women scientists, often in their lab attire and protective gear or with their instruments, accompanied by brief and frequently humorous comments and the hashtag #DistractinglySexy.

The other movement that sparked a similar reaction in the public and on social media was the #iLookLikeAnEngineer campaign highlighted earlier in this article, which inspired the #ILookLikeASurgeon initiative. Isis Anchalee (Wenger), a platform engineer, was featured on one in a series of recruitment posters for her company, OneLogin, and her image on the posters generated a wave of social media commentary that questioned the notion that Ms. Anchalee was or could be an engineer. Disturbed by this reaction, she responded by creating the #iLookLikeAnEngineer hashtag in her August 1 blog post, and women engineers began posting to social media with images of themselves featuring the #iLookLikeAnEngineer hashtag and caption.^8,9 The hashtag went viral, generating an immediate response from press outlets and social media. The followers and users of #iLookLikeAnEngineer have now evolved into a bona fide organization to promote diversity in the engineering and technology fields.

#ILookLikeASurgeon

The #ILookLikeASurgeon campaign, which was able to capitalize on the momentum of the #iLookLikeAnEngineer, received an immediate response from the surgical community. Colorectal surgeon Alison McCoubrey, MB, BCh, BAO(Hon), MRCS, MSc, FRCS, from Northern Ireland, posted the first #ILookLikeASurgeon image and soon after more pictures started to appear on social media. The photos were initially posted by individuals in the U.S., Canada, the U.K., Ireland, and Australia, and, as the hashtag began to trend, bloggers joined in, expanding the conversation beyond the 140-character limit imposed by Twitter. Several days later, the Facebook page was launched by Kathryn A. Hughes, MD, FACS, author of this article. By then, the posts had begun appearing in foreign languages, and the movement became truly global, spanning both continents and cultures.

Unlike the #iLookLikeAnEngineer hashtag campaign, #ILookLikeASurgeon was not born of hurt and anger. It was not a backlash against a tone-deaf remark or negative comments or events. With a positive and affirming mission, this campaign underscores the fact that surgeons represent a diverse array of both women and men from a variety of cultures and backgrounds. In her original blog post, Dr. Logghe states, “I like the hashtag in the first person. As women surgeons, whether we are in our first year of training or an emeritus professor, it’s most important that we ourselves believe we ‘look’ like surgeons. Because we do.”²

Both the intent of and response to this campaign have been generally positive. Early on, in a move that separates it from similar campaigns, #ILookLikeASurgeon welcomed the involvement of men with the goal of including surgeons from all backgrounds, regardless of gender identity, ethnicity, culture, or physical impairment. The campaign seeks to bring a community of surgeons together to communicate and collaborate to address stereotypes in surgery that affect both men and women, and which ultimately affect all surgeons. The positive tone of the message and the spirit of inclusion have helped #ILookLikeASurgeon achieve global recognition, extending to more than 75 countries and 20 languages. Posting continues around the world, showing surgeons at work and at home; in the operating room (OR) and on vacation; with colleagues, students, residents, and mentors; with friends, family, and children—including more than a few family photos containing multiple generations of surgeons. Many have shared the opinion expressed by Terri Coutee, a breast cancer survivor and patient advocate, who noted in her post to the Allies for Health blog, “Quite simply stated, this Twitter trend has humanized a profession that, at times, is held to a standard that is difficult for even the humblest of individuals to live up to.”¹⁰

It did not take long for the surgical societies to take note of this activity. The AWS supported the message early on, followed by the Royal College of Surgeons in England and the ACS. In fact, one of the first tweets from the College was from then-ACS President Andrew L. Warshaw, MD, FACS, FRCSEd(Hon), who tweeted, “We all look alike in the OR. It’s quality, not gender, that counts.”

Surgeons, social media, and hashtags

So, what does the #ILookLikeASurgeon campaign mean for surgery? What are the implications for surgeons? The popularity of the #ILookLikeASurgeon hashtag across Twitter and social media has had two important effects beyond the idea and message itself.

First, the initiative has demonstrated that it is possible to communicate quickly and nimbly with a large, diverse group of surgeons. The communication, particularly on social media, is bidirectional and egalitarian. This campaign has effectively communicated in a horizontal fashion, with messaging and content spanning across geography, culture, academic and private practice, and urban and rural environments. The #ILookLikeASurgeon message also has been communicated with a vertical reach spanning the entire career spectrum of surgeons. With transparency and inclusion as guiding principles, this campaign has been extended to many other participants and stakeholders in the modern medical world, including patients, hospitals and health care systems, companies and industries, and the media.

Second, the #ILookLikeASurgeon campaign demonstrates that the Internet is a potent tool for building and maintaining a community. Consider this analogy—the ACS was founded in 1913 by Franklin H. Martin, MD, FACS, to bring together surgeons “…dedicated to promoting the highest standards of surgical care through the education of, and advocacy for, its Fellows and their patients, and to safeguarding standards of care in an optimal and ethical practice environment.”¹¹ The #ILookLikeASurgeon movement extends that vision into the modern era, because, at its core, the campaign is about inclusion and supporting a profession that provides the highest quality of care by a diverse group of surgeons. It seems that it is central to the character of surgeons and the ACS to come together and form a community centered on a common goal, a common philosophy. As an organization, and as Fellows of the ACS, we are united in our dedication to the art and science of surgery, just like the surgeons whom Dr. Martin sought to bring together more than 100 years ago. At that time, it took Dr. Martin eight years to lay the groundwork to bring a community of surgeons together in the U.S. and Canada as the ACS. With Twitter and other social media, through the use of a single hashtag, we were able to form a global community of surgeons in less than eight days. Therein lies the power and importance of social media for individual surgeons and for the surgical profession.

Future of #ILookLikeASurgeon

The mission and intent of #ILookLikeASurgeon dovetails with the mission and principles of not just the ACS, but of other surgical and medical organizations and institutions. More specifically, #ILookLikeASurgeon “…aims to celebrate women and diversity in surgery and show that a surgeon can, in fact, look like anyone. It is about challenging stereotypes (not solely gender-related), celebrating differences, and achieving equality in the workplace. It seeks to shine a light on gender and diversity issues in surgery and medicine, and promote dialog and collaboration between surgeons, their institutions, and their organizations, ultimately to turn celebration into action.” (Drs. Hughes and Logghe, and Marissa Boeck, MD, MPH, telephone and Skype communication, August 20, 2015.)

What began as a tweet with a hashtag evolved into a movement spawning a community—one that is now ready to become more formalized. #ILookLikeASurgeon, as a group, has dual goals. One is to provide the structure within social media to maintain the community that has developed using multiple social media platforms, and to develop a stable Internet presence with a website. With this, the group seeks to create a space where conversation, collaboration, and mentoring can occur, providing support and encouragement as needed. By virtue of being Internet-based, the organization can support efforts within the global surgery community where issues and interests align.

The group also plans to enter the realm of advocacy, to tackle the issues that this initial burst of energy and engagement on social media has brought to light. The issues include diversity in surgery, the wage gap, leadership barriers, work/life integration, burnout, surgical and workplace culture, and surgical stereotypes. These are issues that affect all surgeons, and acknowledging and addressing them, taking action and crafting solutions, will improve the lives of all surgeons and their patients.

Conclusion

As the #ILookLikeASurgeon campaign has demonstrated, social media, particularly Twitter, is a powerful tool for physicians and surgeons. These platforms provide unprecedented access and communication, transparency, and the ability to widely disseminate data and ideas. We have generally conceived of social media as a public-facing platform for interaction with patients and the public. This public face of social media is important, but physicians and surgeons increasingly use this form of communication to engage in discussion with each other in order to exchange information and foster collaboration. Social media is breaking down barriers and silos that exist between the various specialty, geographic, and practice settings.

Though it would be in vogue to claim that Twitter and other forms of social media will disrupt health care—and, admittedly, these tools are not without their challenges and risks—it is probably more accurate to claim that social media will have a transformative effect on the structure and practice of medicine and surgery. The potential is largely untapped; we have barely scratched the surface of what we might accomplish. The lasting impact of the #ILookLikeASurgeon campaign and the movement it created will likely extend beyond the mission and goals of promoting women and diversity in surgery. By pulling surgeons into social media, the impact may really lie in the transformation of surgery and medicine.

Acknowledgement

I would like to thank Dr. Heather Logghe for the conversations we had regarding this article, for her help reviewing the timeline of events, and for her general support in writing this feature.

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References

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