Doctors on social media should ask this question first [PODCAST]

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Your patients can see everything you post. So can the hospital that employs you. Tali Lando was posting funny videos from her office while two of her young patients lay in the hospital struggling to recover, and it left her torn. She is a pediatric otolaryngologist and airway surgeon. This episode is based on her article “The question doctors on social media should ask first,” published on KevinMD. You will hear why her hospital once shut her accounts down completely and threatened her job, what two longtime parents said when she finally asked them directly, and why she calls their answer a selected group rather than a verdict. She explains how a silly video lowers a scared child’s fear before an office procedure, how posting pulls her back from burnout, and the three things she tells physicians never to do online. Press play for the question she still has not answered and the limits she sets while she works on it.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Tali Lando. She’s a pediatric otolaryngologist. Today’s KevinMD article is “The question doctors on social media should ask first.” Tali, welcome to the show.

Tali Lando: Thank you so much for having me, Kevin.

Kevin Pho: All right, let’s start by briefly sharing your story, then we’ll jump right into your KevinMD article.

Tali Lando: OK. So I’m a pediatric otolaryngologist, which means I did a five-year ENT head and neck surgery residency followed by two years of an airway fellowship at CHOP. You can do one or two years. Then I joined a practice where I’ve actually stayed since I graduated, which is very rare, out in Westchester, New York. I have three teenage daughters, two dogs, one husband, and a very busy clinical and academic practice with residents.

Kevin Pho: All right. A couple of things there resonated with me. I’m actually in my first job after residency as well, and I’m part of that very rare group. I do internal medicine, primary care. I’ve been there for twenty-four years, and like you, it was my first job right out of residency. And I have two teenage daughters as well. So we have some similarities there. So tell us why you decided to write this particular article on KevinMD, and then talk about the article itself for those that didn’t get a chance to read it.

Tali Lando: OK, so many reasons. First of all, I’ve been really ramping up my social media presence. I’ll explain multiple reasons for that. I love it. It’s a passion. It’s a great outlet. It’s connecting me even more deeply with the people that I work with, actually, my nurses, my own staff, my residents. And I wrote a book recently, and it’s a way to get that recognition out there.

But, you know, I’m dancing around sometimes. I’m doing funny things. They like my shenanigans, as I like to call them, where I make fun of myself. And recently I had two really sick patients in the hospital, children, and things were not going really well with them. And one in particular, I know, follows me on social media. I’m very close with the family. They have my cell phone. We have a very open relationship. But I just kept feeling very torn, like, how could I be doing this funny thing when I have two patients I’m responsible for who were really suffering and having a hard time? And I don’t want the parents to look at my dancing and think I’m making light of their situation or I’m not focusing on their child as much. So when you have that dichotomy in your practice, I really don’t know how to navigate it, and I think about it because there is no right answer.

And that’s what prompted me. In the middle of the night when I couldn’t sleep, which is quite often, as going through perimenopause will do to you, I was like, “Well, what is the answer?” And I actually texted two of my other long-term patients who had been through that. One is ongoing; I’ve known her since she was a NICU preemie. The other one had a very long course in the ICU, and I know the dad follows me on social media and promoted my book. We have this complex relationship. So I sent off the question to them, and I said, “What do you think of the answer to this?”

Now, that’s a selected group, because these patients love me. Their kids did graduate. They did fly and do well, and so it’s hindsight, right? Not when they’re in the thick of it. But I used their answers to write this article while understanding that that’s a minority of patients that I’m very close with. And so, honestly, I’m very passionate about this question, and I don’t have the answer yet, but I do think it’s something we need to really think about.

Kevin Pho: So first off, I love the fact that you are on social media as a pediatric otolaryngologist. I’m actually looking at your TikTok page right now, and I’m watching some of your videos. I always like to ask physicians who have a presence on social media, because whenever I talk to them, I always say, “You have to have a reason. You can’t just be on social media for the sake of being on social media.” So what is your why? Why did you decide to take that extra step? Obviously, you have a family, a very, very busy life, of course. Why take that extra step to put yourself out there on social media?

Tali Lando: OK, so eight years ago, I wrote my first book. I had advanced breast cancer, and I was the doctor who became the patient. So right at the beginning, it was about how do I make a name for myself? I spent years writing this book that I think is so valuable, and now the world doesn’t know anything about it; it’s in my garage in a bunch of boxes. But then it changed very quickly from that to, back then when Instagram was kind of new for doctors, how to teach residents with my interesting cases. I have really cool cases, these really cool visuals, and I used it purely as a teaching tool. And I added my family in a little bit, and that’s how I built it up.

And then I got shut down by the hospital, 100 percent shut down, like threatened that I was going to lose my job. “You cannot have it.” It was obviously de-identified, or it was patients that fully consented, because I was in private practice at the time. But I got so demoralized by the way that the hospital shut me down without looking at the value of what I was giving, because I was really doing tutorials on clinical cases at that time. No funny stuff.

But I got really sad, and I missed it so much. It was this creative outlet. It made me happy. I felt like I was doing good in the world, and I had to figure out a second way. And I’m not saying I figured it out, but then in the last year, I really revisited this question of how can I put stuff out there that doesn’t use any imaging from the OR, even if de-identified, like laryngoscopic exams that only the patient’s parent would know about if I showed it to them. And that’s how I came toward probably the more traditional thing. I’d stayed away from any trends. I was like, “No, that’s not me.” But now, again, it’s to use it in this, I think, positive way.

And it was also very much pre- and post-COVID, because COVID shut me down. I was doing flash mobs, and then the world was depressing and serious, and it wasn’t a time for dancing. And that’s why I think about it again with regard to my own patients. Sometimes it’s not a time for dancing, but the social media machine, you kind of have to feed it.

So my answer is very deep and complex, but the why, right now, is some of my own sanity, some of my own happiness, connectedness with the people around me, and some of it is probably selfish reasons, feeding my own ego and getting that positive feedback. And again, I’m really getting deep into the YouTube space for pure education for parents on topics, but they don’t know you have YouTube unless you’re on social media. And the last one is that I wrote the second book, which is the love of my life, and it’s my whole medical drama literary contribution to the world plus all my life lessons, and it was a way to also get it out there.

Kevin Pho: So I’ve heard a lot of stories like these, where the medical institutions or hospitals that physicians are working for are, of course, uncomfortable with physicians developing an identity separate from the hospital. So when the hospital first shut you down, what was the reason that they gave you? And then how did you eventually work around that? Because obviously you’re back on now.

Tali Lando: OK. So when they shut me down, I mean, it was a full shutdown. We didn’t have any policy in my hospital except “You may not do anything.” No filming, no consents even existed, no way to get a medical release. I couldn’t even figure out how to get the patients’ permission. They didn’t even have a portal for them to sign up, and it was just, “You may not do this, and you’re going to have to sign a piece of paper saying you will never do this in any capacity.” And there was no voice for me. My chairman at the time was very old school, and he just said, “Tali, be a wallflower.” I said, “But that’s not my personality.” He said, “You need to not create noise. That is your only job.” And I was honestly depressed. Like, sad. I went home sad. I stayed sad. It’s so antithetical to who I am and how I teach my residents and how I interact with the world that I really was dejected.

And I didn’t actually find a new way. I’m trying to figure it out within the framework of a lack of a policy in my institution. So I’m just trying not to ruffle feathers, and now I’m going to partner, I’m probably going to partner with them from a position of strength rather than weakness, because I think we all know once you hit certain numbers, the hospital’s ears perk up a little bit more. And I’m being very, very careful, to the extent I can be, that I don’t say anything controversial, because I don’t want to. I don’t say anything political. I don’t use, obviously, any specific examples, but I don’t have the full answer yet. I’m probably risking myself.

Kevin Pho: So obviously the hospital relented, because you are back on. So what exactly, or was there even something specific, that changed their mind and let you back on and relented a little bit?

Tali Lando: One is I have a new young chairman who has the complete opposite view. And so I finally have someone in my corner for the first time. And I just want you to know what made me so upset is that I give my life to this hospital. I am the number one busiest surgeon in my entire institution. So I was coming at it from, like, I’m super efficient. I don’t take away any time. I’m just trying to be more positive and actually not annoyed when there’s turnover or the downtime. I’m not taking away from the time. And they didn’t actually give me permission to start again. I just started again. But now I really am taking a risk myself, because I care so much about this medium, really.

Kevin Pho: So you mentioned that you talked to some patients and families, and there was a little bit of that dissonance between some of the stories and some of the experiences that they’re going through and some of the content that you put out. So for those who didn’t get a chance to read your article, just tell us an example of some of their responses and stories that they shared.

Tali Lando: So the reason that I really wrote this in a timely fashion, as it was occurring, which was this past week, is that, like I said, I had two patients in the hospital at the same time where it was not a common evolution, meaning they really had what might have been a more straightforward case take a long time to recover because of the complexity of their underlying pathology. And I was really, really struck by what happens when they see me dancing on a video in my office, maybe making light, and they think, why am I not at their kids’ bedside at all times? I mean, we understand that doctors have lives, but do you really understand it on a deeper level when you’re sitting in an ICU with a kid who’s in trouble? It’s not that I could change the reality for that child that day. The plan was set forth, and whatever I did with the rest of my time wasn’t going to change that child’s reality. But it doesn’t necessarily feel that way when you’re a parent.

But when I reached out to these two parents who were on the other side of it, they both had a strikingly similar response, which was, “No, we love watching you. It actually helps us.” And I was very surprised at how extremely positive they were. Even though they’re both wonderful families that I know think only in the best terms of people, I was surprised at how extremely supportive they felt of the idea that they wanted that lighter side. They wanted the connection. Actually, they both mentioned loving feeling a personal connection to me outside of our patient interaction, and that that helped them. I was really surprised by that.

Kevin Pho: One thing that I found is that social media, as you know, humanizes physicians, because too often there’s a wall between families, patients, and physicians. And what you do on social media, what I do, and what other physicians do on social media, like you said, it’s that connection. It helps build that relationship and allows patients to see doctors as more human. And I love hearing that story, especially what happened in recent weeks with you and those two families.

Tali Lando: Oh, wait. One more thing I just wanted to add. Because I am a pediatric ENT, now every time I come into my office, and I see about thirty-five patients a day, maybe five of them, not all of them, will say to their kid, “Don’t be scared of that doctor. Remember we watched that funny video that she did? Look how nice she is.” And they’ve seen some of my stuff, and they’re referring to it. And the kid actually responds to that. Not a little kid who’s two and scared, but the adolescents and the preteens and even the five- and six-year-olds.

Kevin Pho: So do you have other physicians within your immediate vicinity or within your network come to you for advice on how to put themselves out there, knowing how successful you are at it as a busy pediatric otolaryngologist?

Tali Lando: I think that’s going to start. It’s funny that you’re asking me, because the answer is no, not yet. But I feel it coming. Someone just reached out on my website the other day, and I really don’t know what this is, because I have to talk to them, but it was from, I live in New York, it was from the University of Indiana, asking me to be the speaker for their upcoming event on, it wasn’t on social media, but it was women in otolaryngology. But I’m not known. I mean, I’m really good at what I do, but I’m not the top of my field in terms of complexity, and I’m very aware of that, and I’m comfortable with that. And so I’m not the person you call to speak at the International Airway Symposium on complex LTR revisions, laryngotracheal reconstruction revisions, which is, you know, the heights you can reach as a peds ENT. But maybe I’m starting to be known for this, having this maybe multifaceted life that people are looking for. And I have a lot to say about it, but I haven’t been asked that much yet, until today, actually.

Kevin Pho: Wonderful. And that is another reason why physicians should put themselves out there, because sometimes the opportunities they get are totally unexpected. And I’ve had physicians get book deals, television appearances, speaking opportunities. Building a brand, I think, is important today, right? Because sometimes a physician’s identity can’t just be tied to a single institution like it used to be.

Tali Lando: Yeah. And another thing is, and I’m sure. How long have you been out in practice?

Kevin Pho: I’m just starting my 24th year in practice.

Tali Lando: Oh, right. You said that. Sorry. You did say that at the beginning. So I’m in my 16th year. And obviously this is a whole other topic, but burnout is real. And one of the ways I use social media is to combat burnout for myself. That was another thing that really drove me to restart it, because it just invigorates me. It energizes me. After we’re done, I have twenty patients to see, but weirdly I get the adrenaline from some of these interactions, and it drives me to be a better physician. I know it seems like it would take away, and it depends on your personality, but I think that’s another tool that we have to deal with some of the stuff that beats us down. And, you know, we are resilient people by nature, and we’re fighters, and that’s why we went into this profession and slugged it out so long. And this is another power we have, a voice that we never had before, that we can use on a higher level.

Kevin Pho: So I’m going to put you on the spot here. Can you remember or share an unexpected impact that you had on a patient or their families? I think that you did mention those unexpected connections that you made with patients, sometimes as a pediatric otolaryngologist. You mentioned previously new patients or kids finding you on social media and being more comfortable when they first meet you. But has there been a specific time where you really made an unexpected positive clinical impact on a patient or family because of your social media presence?

Tali Lando: I really think it’s come down now to this, like you said, the humanizing interaction. But you have to understand, as a pediatric ENT, I do a lot of invasive things in the office, a lot. So I might scope 50 percent of my patients with a flexible scope, and they freak out if they’re nervous, even though it’s not painful. Some kids are just calm because that’s their personality. It’s really an unbelievable way to get these patients’ fear factor down, because I always tell parents, you know, 50 percent of the kids I scope are screaming like you’re really hurting them, and 50 percent aren’t. And that isn’t because I did the procedure differently. It’s so much about the anxiety. So these are very powerful tools, whatever you want to call it, placebo effect or desensitization effect or whatever.

And it works on parents as well. Sometimes the parent walks in the door and says, “I just want you to know I’m super anxious about surgery, about anesthesia,” because that’s what I’m often about to talk to them about. And I’m just meeting them really quick, and I only have a tiny window, and you could wish that I didn’t, but that’s what subspecialties are like in the United States, especially in peds. So here’s another tool to really, really give them that comfort zone. You know how it is. It’s like with a celebrity. Why do you feel like you know them? You don’t know them. You’ve just been exposed to them in some way, enough that if you bump into them on the street, you think, “Did I meet you before?”

Kevin Pho: Now, let’s say there is a physician listening to us now. It could even be a surgical subspecialist, and they’re really inspired by what you say, and they really want to put themselves out there and get on social media. What are some powerful tips from your own experience that you could share with them to get started? It could be that first step. It could be navigating a more conservative institution. Just share some tips that you have with these other physicians who may be listening and want to get started.

Tali Lando: OK. Maybe I have some what-not-to-do tips that I wanted to mention. Number one is, do not get controversial at the outset. It’s not a good look. It’s a really bad idea if you’re still in training. You have to be much more careful if you’re in residency than if you’re out in practice. And you can’t just be like, “Well, I’m my own person. It shouldn’t matter.” I mean, we can’t be that naive, OK? You do represent someone else. And when you’re a resident, you are not a free agent, no matter what you want to believe. So be very careful when you’re in training, much more than later. Don’t be controversial just off the bat.

And a third one that is my pet peeve is, don’t talk about things that don’t relate to your specialty. I know it’s nice to get on the trends and to comment on just what’s out there. Even me, I don’t like talking about vaccination, which I’m a huge proponent of, unless it relates to ENT problems. So vaccination, like the typical pneumococcal vaccines that kids get, relates to peds ENT, for ear infections, for strep, even for the complex things we see, for the meningococcal vaccine. So it relates to me, so I can talk about it. But you don’t need to be talking about just any random thing because it’s trendy. I know it gets more followers and reactions, but you do need to take some responsibility and be careful.

Kevin Pho: We’re talking to Tali Lando. She’s a pediatric otolaryngologist. Today’s KevinMD article is “The question doctors on social media should ask first.” Tali, let’s end with your take-home messages that you want to leave with the KevinMD audience.

Tali Lando: OK. So for the broader audience, it’s that life is long, and that applies to trainees. So life is long. You’ve got to do what you love. Don’t shortchange your training, because there are so many ways you can reinvent yourself later. And that’s what I’ve been learning, that you can keep evolving. You can have different iterations of your life. Even though you and I are in the same job that we started, you’ve done crazy other things. You’ve opened a million doors.

You don’t remember this, but I wrote an article for you way back when you started, and now you’re this mega celebrity who’s an authority, like you are. When I talked to my anesthesiologist a year ago, she was like, “Why don’t you just get on KevinMD?” Like, that’s the way to get recognition, and you started from nothing, right? You just started your own thing. And I’m just saying there’s so much possibility. So work hard. You can do it within the framework of a busy career and dedication to your job, and just find the way forward without throwing out one thing or the other. But you have to train and you have to do the work, and then you can have the fun, or you can have the fun on the side, but it’s not all at once.

Kevin Pho: Tali, wonderful story. Thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Tali Lando: Absolutely.

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