Elizabeth was scrolling through her TikTok feed last year when she saw a video of someone claiming bubbles in a cannula cause life-threatening air embolisms. As a doctor, she knew this was wrong.
Elizabeth — a pseudonym granted by Crikey to protect her from professional consequences — responded by filming herself explaining why it’s normal and harmless to have small air bubbles in intravenous tubing.
Within 24 hours, Elizabeth’s TikTok account went from two followers to 10,000. People began asking her questions in the comment section about why it took so long to see a doctor. She answered with more videos.
“I thought it was great to create an avenue to explain how the system works,” Elizabeth told Crikey. “It took off.”
Elizabeth branched into new topics, sharing videos describing what it’s like to work as a doctor and acknowledging the racism and sexism that had historically been present in the medical system.
“I started making videos about vaccines and it all went to shit,” she said.
Subjected to complaints from anti-vaxxers and trolls
Elizabeth started to receive notices that she was the subject of professional complaints (officially called “notifications”) made to the Australian Health Practitioner Regulation Agency (AHPRA).
Her tens of thousands of social media followers had exposed her to vexatious complaints — frivolous or baseless objections to her conduct that were filed with the intention of causing distress or harm.
Elizabeth told Crikey that it wasn’t just anti-vaccine complainants either. One of the notifications called her an “asshole”, she said, whereas another claimed that her “vibe” would discourage people from going to the hospital where she was working.
“I attracted the ire of anti-vaxxers, but a second part of my online persona was breaking down the historical system of discrimination in the medical system and I think some people weren’t a fan of that either,” she said.
Social media is awash with medical misinformation. The gamut runs from well-intentioned but misinformed users creating health content to full-blown conspiracy theorists. While the tech companies promise to police their platforms, their reactive content moderation systems mean that they are responsible for amplifying misinformation to new audiences.
Doctors, nurses and other medical practitioners are taking matters into their own hands by using TikTok to debunk fake information and share important public health information with people where they are. Complaints are just one of the hurdles these creators face.
Anyone can make a complaint about a doctor, nurse or other health practitioner’s conduct, even if they’re not a patient. These are recorded in an internal database, assessed and typically investigated. If judged to be placing their patients or the public at risk, practitioners can be cautioned, have conditions placed on their conduct, or even have their registration suspended or cancelled.
Complaints aren’t common — fewer than 1% of the 825,000 registered practitioners received complaints in 2020-21 — so Elizabeth was shocked to find herself as the subject of numerous complaints, including five in a single day.
Responding to AHPRA complaints is a time-consuming and costly process. Elizabeth said she would spend 10 to 20 hours responding to each. The ensuing process can take years to resolve.
Another online creator, Dr Michael Mrozinski, who has nearly 300,000 followers on TikTok account @dr_michael_says, said that he’s spent “thousands and thousands on legal fees” responding to complaints.
“I realised that as my following grew, I would only get more complaints,” Elizabeth said.
Elizabeth recorded a final video explaining what she was going through, deleted all her videos and stopped posting. She quit.
Her experience resonated with other creators. Ellie is an emergency room registered nurse whose TikTok account @eswift95 grew to 30,000 followers after she started making videos about her gruelling shifts during the pandemic. She told Crikey she’s had people online threaten her with complaints because they don’t like her content.
Earlier this year, the NSW Nurses and Midwives’ Association shared one of Ellie’s videos to their Facebook page. The video shows Ellie, dressed in scrubs, taking off sunglasses in dismay accompanied by the the caption “when you’re walking into work and there’s a line of Ambos outside of emergency”. It was a snapshot into her frustration working in a health system that’s the middle of a ramping crisis.
Out of the 500-odd comments of support, disgust and every emotion in between, one Facebook user wrote “No one can complain like nurses”. When Ellie replied by telling him to consider who takes care of his loved ones when they’re sick, the user said he was looking her up on the AHPRA register and promised to make a complaint about her conduct the next day. (No such complaint eventuated.)
Mrozinski made a TikTok responding to Elizabeth’s goodbye video calling on AHPRA to do more to protect practitioners on social media from “vexatious complaints”, which culminated in a petition signed by more than 5000 people.
he pandemic highlighted this problem, he said, as practitioners used social media to correct misinformation about COVID-19 at the same time as proven medical science became a more controversial topic: “People opposed to vaccines have found an easy way to intimidate doctors and threaten their license,” he said of AHPRA notifications.
How the internet weaponised the complaint system
Vexatious complaints existed long before social media. An AHPRA spokesperson referred Crikey to existing resources, including a Vexatious Notifications Framework introduced in 2020 to address complaints.
While the framework does not stop vexatious complaints from becoming a notification, the framework now allows these complaints to be identified and managed at an earlier stage in the process.
The Australian Medical Association (AMA) declined to comment on this specifically, but pointed towards their previous work lobbying for reforms to the notification process. In the past, they’ve raised concerns about investigations that have dragged on longer than a year and a trend of increasing number of notifications (up from 3601 in 2016-17 to 10,147 in 20-21).
“It is true that we sometimes receive vexatious complaints. Our data suggests vexatious complaints are rare, and this is backed up by independent research,” the AHPRA spokesperson said.
AHPRA’s 2017 report Reducing, identifying and managing vexatious complaints determined that fewer than 1% of complaints are vexatious. It also identifies a number of motivations behind these complaints, including a category of ideological complaints made against practitioners “regarding controversial ethical issues which would not constitute a breach of law if proven”.
The report does not mention social media. In fact, It was published before TikTok was even available outside of China. That any practitioner can be instantaneously exposed to enormous audiences through social media platforms presents a new risk, according to Information Futures Lab associate editor Stevie Zhang.
“By nature of garnering a large audience, you are putting yourself and your content in front of more and more people, and thereby increasing the possibility that it might land in the lap of a bad actor,” they told Crikey.
Zhang said there are large online communities of anti-vaccine, anti-COVID-19 restriction individuals who are prone to target healthcare workers by abusing bureaucratic processes. These include flooding vaccine injury reporting programs with false reports, launching baseless legal challenges or filing complaints against people for promoting vaccines.
“Weaponising bureaucratic processes can be a really effective way to silence opponents, because it lends your complaint, no matter what it may be, a sense of legitimacy,” Zhang said.
Elizabeth has no plans to revive her TikTok account, despite receiving positive feedback about her videos from her audience and other practitioners.
She believes that there’s a public benefit from humanising the medical system — “it broke down some of the barriers in people’s perception of doctors being an old white dude in a coat” — but decided that, ultimately, it wasn’t worth risking her own career as a doctor.
“I’ve got nothing to gain. I’ve got no desire for attention. It’s just really frustrating,” she said.
