No abstract

Novel approaches are needed to address elevated tobacco use among people with schizophrenia. This exploratory study examined the frequency, timing, and type of communication about tobacco-related content on Twitter among users who self-identify as having schizophrenia compared with users from the general population. Over a 200-day period from January to July 2016, Twitter users who self-identify as having a schizophrenia spectrum disorder (n = 203) and a randomly selected group of general population control users (n = 173) posted 1,544,122 tweets. Communication frequency did not differ between groups. Tweets containing tobacco-related keywords were extracted. Twitter users with schizophrenia posted significantly more tweets containing any tobacco-related terms (mean = 3.74; SD = 16.3) compared with control users (mean = 0.82; SD = 1.8). A significantly greater proportion of Twitter users with schizophrenia (45%; n = 92) posted tweets containing any tobacco terms compared with control users (30%; n = 52). Schizophrenia users showed significantly greater odds of tweeting about tobacco compared with control users (OR = 1.99; 95% CI 1.29–3.07). These findings suggest that online communication about tobacco may parallel real world trends of elevated tobacco use observed among people with schizophrenia. By showing that Twitter users who self-identify as having schizophrenia discuss tobacco-related content online, popular social media could inform smoking cessation efforts targeting this at-risk group.

The duty to care for all patients is central to the health professions, but what happens when clinicians encounter patients who exhibit biased or discriminatory behaviors? While significant attention has focused on addressing clinician bias toward patients, incidents of patient bias toward clinicians also occur and are difficult to navigate. Clinicians anecdotally describe their experiences with patient bias, prejudice, and discrimination as profoundly painful and degrading. Though this phenomenon has not been rigorously studied, it is not unreasonable to postulate that the moral distress caused by patient bias may ultimately contribute to clinician burnout. Because women and minority clinicians are more likely to be targets of patient bias, this may worsen existing disparities for these groups and increase their risk for burnout. Biased behavior may also affect patient outcomes. Although some degree of ignoring derogatory comments is necessary to maintain professionalism and workflow, clinicians also have the right to a workplace free of mistreatment and abuse. How should clinicians reconcile the expectation to always “put patients first” with their basic right to be treated with dignity and respect? And how can health care organizations develop policies and training to mitigate the effects of these experiences? The authors discuss the ethical dilemmas associated with responding to prejudiced patients and then present a framework for clinicians to use when directly facing or witnessing biased behavior from patients. Finally, they describe strategies to address patient bias at the institutional level.