I remember the days of saying, “My children will never have access to social media.”
I was wrong.
I can control a lot of what happens on my home computers, but I can’t control everything that happens inside and outside my own home. To be clear, my 11- and 9-year-olds still don’t have their own electronic devices. On my iPad and their dad’s iPad they each have Messenger Kids. I am maybe too aware of the risks of media (television, video games, internet, etc.) and what it can do to my children ― specifically, the risk to their mental health and behavioral habits.
I want them to learn about how to use social media and communication devices in safe ways. Having a husband who worked for years as a public defender and in the juvenile justice system has only made this a stronger family goal. I counsel my families who come to me for care about how to use devices safely (and often to not allow children to use them at all before age 14.)
I have friends who tell me I’m being too conservative and that it is easy to monitor what kids are doing on their devices. I disagree. I have a full-time job already, and I don’t want a part-time job policing devices. I also know that things slip through. Kids download applications parents don’t know about. Kids delete conversations that they don’t want adults to see. I have kept my own kids device-free. However, more and more of the kids I know have devices. And in the spirit of, “If you can’t beat them, join them,” I find myself engaging my children’s friends on social media and learning how important that can be.
I was scrolling Instagram during the wee hours of the morning ― full disclosure: Having a newborn has increased my social media time substantially ― and there I saw it. A post by a teen I know well about her friend who had committed suicide. I knew this teen had been struggling with depression. I know her parents well and follow this teen on both Facebook and Instagram. I immediately sent a text to the mom, who quickly responded. She didn’t know it had happened and planned to check in in the morning. It went smoothly. Both parents checked in, stayed engaged with their child and her psychologist, and this teen, who I love dearly, mourned and recovered well.
My response to seeing her post about a friend’s suicide was alarm. I have read studies of suicide clusters in teens. A study in Ohio showed that there was increased suicidal ideation and suicide attempts in teens after they engaged with social media posts about suicide in peers. In this study, just seeing posted content about suicide introduced SI and SA in teens with no SI/SA history and a marked increase in SI and SA in those with SI/SA history. The risk of SI/SA was even higher in those who, after seeing their peer’s posts on SI/SA, posted or reposted content about SI and SA. Clearly, it is important that trusted adults are not only present in person, but also in the social media sphere of preteens and young adults who they are close to.
Many of my friends have teens or preteens. I have a special place in my heart for these kids. I invite them to go with us to the zoo and to the beach. I pay for them to do odd jobs around the house or to be a mom’s helper. I even have their cell phone numbers and send funny memes. I keep engaging them. And they engage me back.
As my eldest daughter enters her preteen years, I want the same for her. I want her to have an array of safe adults who can text her, laugh with her, see her shine as well as struggle. So much of children’s lives, especially in the past year and a half of the pandemic, has become dependent on social media, so I also engage my kids there. And my two older kids who have Messenger have many trusted adults on their contact list. This is how we need to grow our village now, not just in person but on social media.
The rapport we physicians build with preteens and teens is crucial. Just a few months ago, one teen I know wanted to switch from a pediatrician to a family physician. I recommended one of my good friends and colleagues. During the first visit, this teen came out to my friend and colleague. The teen told me later that he felt so comfortable with this doctor that he could tell him about his sexuality, his struggle with depression and his attention issues, all on the first day, and that he felt safe. He mentioned the pride flag sticker on the doctor’s computer and that he had found our clinic’s LGBTQ+ webpage. Our online content mattered in making him feel safe. He said he immediately knew that the doctor wouldn’t judge him for his sexuality. His new physician has been attentive, has checked in, and makes sure to keep the conversation going so that this teen can also be safe and cared for.
I underestimated how meaningful having that rainbow flag on our work computers could be. In my women’s health rooms I have posters about anatomy, safety, incontinence ― often things that patients of different ages may need to talk about but are reluctant to bring up. Those posters help foster important conversations. The rainbow flag on my computer also means something to my patients: My clinic is a safe space. Our clinic’s website takes that a step further.
While websites, stickers and pins are important in signaling cultural competence in LGBTQ+ space (and other spaces) to make patients feel comfortable, our clinics can and should build better visibility and access through social media. Social media has been studied in respect to LGBTQ+ youth. It is often used as a tool for them to find community and navigate their challenges. There are even guides now to help organizations improve communication, access and health care experiences for LGBTQ+ identifying patients.
In fact, preliminary data show that engaging preteens and young adults in our health care system with social media can be a powerful tool. They are high utilizers of social media, so teen-specific content can be shared and promoted to give our patients more access and information in a safe way that doesn’t require an office visit. Health care workers have adopted HIPAA-compliant apps to help with communication and streamlining patient care, such as TigerConnect. What we have to build out are more nuanced platforms to connect with this younger generation.
And it’s not just teens ― more than half of adults seek information online before talking to their doctors. Hospital systems have created webpages with patient information, but few have apps that provide medical information and guidance. A tool from Boston Medical Center is the first of its kind to link its obstetrical care with patients through a phone application, Hey Mama.
As a physician and as a mom, I advocate for the mental health, sexual health and gender health of my patients and friends by promoting openness and safe spaces both in the realm of health care and in the space of social media. Although the health care system has quickly adopted safety pins, stickers and posters, health care is a step behind the social media need. Our patients, especially the young, have a growing presence on social media and go there for health information and to decide where to seek care. If health care systems and physicians can create spaces that are safe for our patients ― especially underserved populations ― it will increase engagement with our patients, increase their access and provide needed information.
MaryAnn Dakkak, M.D., M.S.P.H., practices full-scope family medicine and is a clinical assistant professor at Boston University Medical Center. She is Women’s Health Director at Manet Community Health Centers. Her views do not represent those of the organizations with which she is affiliated.