I enjoy using social media (SoMe). These social communications-based, user-generated platforms part of Web 2.0 can be a great way to eat up time while scrolling mindlessly through funny posts, “how-to” cooking videos, or find breaking news updates (while being mindful of source reputation, of course). In medicine, SoMe can be an exceptional tool to combat medical misinformation, evolve traditional medical hierarchies or scholarly activities, and redefine physicians’ relationships with each other and the patient populations we care for. Free SoMe platforms like Twitter/X, Meta, and YouTube can also globally democratize the accessibility and dissemination of medical information, including for those in resource-limited environments.

In pathology, we may post de-identified gross and microscopic images while safely providing high-yield teaching points without compromising patients’ private health information, share unique or challenging educational cases/reports, provide brief updates on the latest research or academic conference findings, and network/collaborate with other pathologists, trainees, and medical students anywhere in the world. #PathTwitter (or #PathX) are hashtags that represent pathology’s presence on Twitter/X, which is the most widely-used SoMe platform in my field. Connecting with pathologists, other trainees, and medical students on this platform helped catalyze pathology as a career interest for me when I was still a transitional year medicine resident. Today, I still use SoMe professionally and encourage others to do the same as their schedules and bandwidths allow.

At the same time, SoMe can be medicine’s (and pathology’s) “double-edged sword” when used unprofessionally, unethically, or without etiquette. Foul language, poor tone, demeaning comments, and sharing of inappropriate links or images on SoMe are only a few ways physicians can easily break the trust online (and, consequently, in person) of other physicians or patients/families. Name, age, or career status does not matter – no physician is above the proper practice of always exhibiting kind and courteous behavior online.

Maintaining a healthy online persona is critical in today’s growing digital age of patient care and medical education; negative or aggressive behavior displayed on SoMe by any physician is simply unacceptable. Even if a physician deletes an inappropriate post right after making it live, there is no guarantee that someone has not already screenshotted, saved, or reshared that post through another modality (e.g., text message). Whenever in doubt, it is in any physician’s best interest to not post something on SoMe if it could be negatively or aggressively received by other SoMe users. Proper SoMe guidance from professional physician organizations has been previously outlined.

Understanding this, it truly alarmed me when another physician trolled me on SoMe. Now, when many of us think of trolls, we may think of the hairy creatures commonly described in Nordic or Norwegian fairy tales (or the popular kid’s toys/movies).

But these are not the trolls I am talking about.

Regarding SoMe, a “troll” is anyone who perpetuates negative online interactions through tactically cynical or indecorous posts with hopes of invoking negative responses in return. Though anyone can be a troll online, trolling (and aggressive or self-defeating humor styles) is often associated with “Dark Tetrad” personality types – Machiavellianism, narcissism, psychopathy, and sadism. Additionally, persons with psychopathic or sadistic personalities are more likely to have immediate motivations for trolling. This behavior can also be seen in conjunction with other online anti-social behaviors, like harassment and bullying, due to “recreation and reward” and “being a perpetrator” motives. Though the reasons behind why some choose to engage in these aggressive online behaviors are complex, dysfunctional personal factors such as high moral disengagement and low mindfulness may be contributory.

So, what did I do in the moment when I was trolled? It was simple. I chose not to respond and carried on with the rest of my evening as if nothing happened. Because, in reality, nothing happened.

With SoMe usage continually rising (not just in medicine but by the general public), we as physicians must always be conscientious regarding how we present ourselves online. The last thing any one of us should do when using SoMe professionally (or personally, for that matter) is to respond to online negativity with more negativity. Our colleagues may see this, our employers may see this, our families may see this, and, finally, the patients and communities we provide care for may see this. It is not a good look, nor is it morally sound or “good practice.” Our professional lives as physicians can be challenging at times, and busy enough as it is, there is no real positive reward for taking any aggression out online or engaging in online discussions with inappropriate tones.

If you are a physician and a recipient of trolling, which many of us are or will be at some point, remember that it is your right and free will to choose not to respond (i.e., you do not have to respond). Trolling-style comments or posts are intentionally disruptive to invoke negative, emotionally driven responses from recipients. Whenever I am trolled, I find it best to 1) pause, 2) briefly think about it, 3) consider laughing about it (whether out loud or inside), and, finally, 4) let it go. You do not owe any troller – even if he or she is another physician – a second more of your already busy time or energy. Furthermore, do not let trollers prevent you (as I will not let them prevent me) from continuing to share real, sincere, positive, and heartfelt messages of support or vulnerability. If we want to make medicine, particularly online, a better place, we must embrace and beget positivity, not negativity. What I am trying to say is: just ignore the trolls … there is no need to take them personally, even if they can sometimes (dishearteningly) be our physician peers.

In conclusion, another physician trolled me on SoMe, and I am happy I did not respond.