In Indonesia, laws to regulate internet use are relatively-new and limited in scope. There is the 2008 Information and Electronic Transaction Law—popularly known as UU ITE—but its
application draws much criticism. In 2021, a parody TikTok video created by a general
practitioner pretending to perform a vaginal examination while making a lewd face went viral. At the end, the doctor received a penalty for violating the code of ethics by The Indonesian Honorary Board of Medical Ethics.

Social Media Use for Doctors: A Risky Move?

“Social media is a double-edged sword. It depends on what you use it for. When it is done for good things, it will be good,” said dr. Mario Johan, a TikTok content creator and the founder of TikDok, an officially acknowledged community for doctors by TikTok Indonesia. His account was created in March 2020 and dr. Johan was among the first few doctors who began to actively use the platform, usually posting general information about health, sex, and lifestyle. “Since then [March 2020], there have been more and more doctors who use TikTok, from educational accounts to joke accounts.”

Just recently, to celebrate World Tuberculosis Day on 24 March, The Ministry of Health of Indonesia partnered with a few members of TikDok to create a variety of contents to spread awareness about tuberculosis, an endemic disease in Indonesia. One video managed to garner 1.2 millions views.

“When we talk about social media, the most important phenomenon to come out of it is branding. [The more] people know about us, we are ‘famous’, and this leads to more people believing what we said,” explained dr. Johan. “This phenomenon is reflected in what happened with the viral TikTok. He was a popular influencer. Many fellow doctors who created great contents unrelated to him also got some backlash [from his case]. There are even a few doctors who also showed disdains, saying things like ‘what’s the point of being famous as a doctor?‘”

“I think it is the wrong mindset to have. Social media is a tool that can leverage what you want to do,” said dr. Johan. “Being an educator is one of the most important roles of being a doctor. When social media is used well, the impact can be vast. It’s inexpensive—you only need your mobile phone. Holding a conventional workshop or a seminar, on the other hand, would need more resources.”

Medical Stigma and Bias: An Ongoing Issue

In Indonesia, doctors to people ratio is still way below the recommended level of WHO standard of 1:1000, which is only 0.4:1000 in 2018. These doctors are also still mainly located in the islands of Java and Bali, which causes a huge disparity in health access in many parts of Indonesia. With this chance to reach an even bigger audience, it is not surprising that more and more health professionals use social media more proactively. But how do you use social media ethically as a health professional?

“It is very tricky since there is no clear regulation for that yet,” answered dr. Sandra Suryadana, the founder of Dokter Tanpa Stigma (Doctors Without Stigma), an Instagram account created in 2019. “To create an effective educational content it will need both skills and experience, while minding our Hippocratic oath and Code of Ethics. All of which we didn’t learn in medical school.”

Dokter Tanpa Stigma was created as the result of years working in the medical field where dr. Suryadana saw how much negative stigmatization and discrimination came from health
professionals instead. She wants to educate both the doctors and the patients regarding these issues.

“I haven’t created any surveys about how many patients receive this kind of treatment
[discrimination, stigmatization], but I heard enough stories about it. Cases like this [the viral
video] already existed way before the digital era. Before this, maybe it was only limited to
doctor’s offices. But now, everyone can create content, including healthcare professionals. What then only happens in the doctor’s office, now can be brought into social media. We cannot blame social media for this. After all, it is a double-edged sword.”

Humanity: A Foundation of Health

drg. Dea Safira, a dentist who owns a popular feminist account Indonesia Feminis (Feminist
Indonesia) on various social platforms, echoed what dr. Suryadana has said. Even though most medical schools already have the subject of humanity and ethics as part of the curriculum, most of the time it didn’t manage to ignite a critical discussion on understanding on why it is important.

“When we were in [dentistry] school, we were never taught about social constructs. I got humanities class in dentistry school, but we never discussed genders nor sexual harassment nor other important things,” said drg. Safira. “I rarely see my colleagues correlate what happens in society with daily life [as a doctor]. It feels like since school is expensive, then we should look for profits once we graduate but that makes us unable to understand the structural problem of why our health system is not affordable, or to understand why people can get sick in the first place.”

“I learned about these social factors on my own,” added dr. Suryadana, looking dejected. “I
looked it up on my own. I analysed what I experienced. I learned from non-medical people to discuss these issues, which for me is so pathetic. It is terrible. Our doctors are academically clever, but there is a gap in their understanding [about social issues] and that causes many medical professionals to have difficulty empathising with their patients.“

In the end, social media is the individual’s responsibility. Even though it is not a foolproof system, dr. Johan has a set of principles he lives by. “[First], we have to get the context. Which direction do we want to take? Second, before we upload it, we have to ask ourselves whether it is beneficial to the public and to ourselves. Then, we have to consider whether there is a potential backlash. Lastly, don’t be afraid to ask others.”

Just a few days after the verdict of the viral TikTok video case, The Indonesian Honorary Board of Medical Ethics released a literal “fatwa” about social media usage for doctors, but it is far from a binding regulation. “Social media is 100% your responsibility and it is an art of communication. Art is boundless — but it still needs to be regulated, especially since it’s related to our profession as a doctor. I just hope that any regulations will not limit this creativity and can give protection to the doctors and also to the people,” concluded dr. Johan.

This article was written by dr. Gisella Tellys, MPH, a public health professional working at an
NGO that focuses on reproductive justice. This article was first written in May 2021, as a
response to the viral TikTok video case, and went unpublished.