Why Medicine Needs More Glaucomflecken

Sterling N. Ransone, Jr, MD; William E. Flanary, MD


September 08, 2022

Sterling N. Ransone, Jr, MD: Do rural physicians truly rely on gas station–owning fan boat operators to complete their advanced imaging studies?

Hello. I'm Dr Sterling Ransone, a rural family medicine doctor, president of the American Academy of Family Physicians, and founding member of Primary Care for America. Recently, social media's favorite ophthalmologist, Will Flanary, MD, better known as Dr Glaucomflecken, made a couple of videos poking fun at the life of a rural physician. In one video, the doctor has to fax Texaco Mike, a fan boat operator who performs the best diffusion-weighted images around, while also dealing with an overwhelmed medical student, stoic farmers, and, yes, possum venom.

While comical, Flanary highlights the needs and challenges facing primary care physicians who practice in underserved rural America, which are largely considered to be health professional shortage areas. Does medical satire help or hinder the plight of the rural physician? We'll discuss our thoughts today.

Will, thank you for joining me here on Medscape. And more importantly, thank you for helping all of us laugh during this pandemic.

William E. Flanary, MD: Thanks for having me. When you lay it all out like that, it sounds even more ridiculous than it already is. But I appreciate that synopsis.

Ransone: Your work tends to stand out with medical professionals of every specialty, and many comments are made pointing to the accuracy of your satire. How do you come up with ideas for your videos?

Flanary: The further away I get from my medical education and training, the harder it is for me to tap into what it's like for other specialties. Ophthalmology is such a world on its own. So when I started this, all my experiences and the things I learned in med school were still fresh, so it was easy to draw on those. Now I have to do a little research. I pay attention to what people are commenting on my videos, and viewers often give me suggestions: "Hey, you should do neonatology" (which is on my list) or "You should do something about rural medicine." That idea kind of stuck with me for a while.

I do a lot of research, mostly on social media. Twitter and Reddit have sparked a lot of discussion. I read through what people say about rural medicine, the pros and cons, what people like or don't like about it, and I use that information for the bones of my skits and then build jokes and comedy around it.

Ransone: Did you use tracking chips on rural physicians? The reason I ask is because of how accurate that skit was. As a child, I had an airboat. We also had goats, although none of them ran for public office. The vice speaker of the AAFP was mayor of his hometown. And I deal with possum bites all the time. So when I saw your video, I was in stitches because it reflected so closely my reality and what I deal with every day in rural America. And the farmers! The only thing you had to add was some duct tape and it would have been perfect.

Flanary: For those videos, I drew on personal experiences. I did my residency at Iowa University, so I saw a lot of farmers and I learned about their personalities. Also, I grew up in Texas and every summer we would go to Big Bend National Park. There was a little town outside of the park where the mayor was a goat, so I built on that.

Ransone: Why do you think your videos resonate so well among the medical community?

Flanary: A couple of reasons. I think I came along at the right time. During the pandemic, people needed an escape, even if it's just for a minute or two — a reason to laugh and feel good and share something fun with their colleagues. That was so needed around medicine. So I started making these videos and they resonated from a mental health standpoint, letting people stop thinking about the pandemic for a short time.

Also, I think it's the way I approach humor. It's very easy to ridicule in a way that makes people feel taken advantage of. We see that a lot in social media with different groups and specialties. By approaching humor in a way that makes people feel more heard — that is really true about my specialty — without having people feel like I'm taking advantage of them or punching down or ridiculing them in a mean way.

Ransone: You got a little bit of criticism from a rural primary care physician, which you shared on Twitter. He said that videos like those you make about family medicine physicians may push people away from practicing medicine in rural areas. How did you react to that pushback?

Here’s the tweet Dr Flanary received, posted to his @DGlaucomflecken Twitter account:

Flanary: I always listen to any feedback I get, both positive and negative, because I don't practice in these areas of medicine. I take great care in in making sure I'm depicting certain specialties as accurately as possible while still providing humor and making fun of people. That's kind of what I do.

I find it hard to believe that people are avoiding certain areas of medicine based on a comedic video. I don't think I am presenting any information that's brand new. Everyone knows primary care physicians are overworked. We talk about it all the time. They're underappreciated and underpaid. Reimbursement needs to be higher. We've been talking about these issues ad nauseam for years.

So I feel like pointing out those things is okay. It's fair because a lot of it is true. But I did take some of that feedback to heart because it wasn't the first time I heard that. That's why I shared those comments. I wanted to find out how prevalent this notion was, that I'm causing more harm than good, because that's the last thing I want to do.

I have adjusted my content a little bit to focus more on the breadth of what doctors in primary care, family medicine, and rural medicine have to do. I'm trying to highlight and use humor to show off just how many things they have to do in the medical world and maybe focus less on the underpaid, underappreciated, and overworked aspects of it. Those are still fair, but there is a lot more to your job than that.

Ransone: Absolutely. Posting the letter and asking for comments was the perfect way to respond. I read through a lot of the comments. I personally didn't feel that way. The fact that you recognized exactly what we do in rural medicine and were able to blow up the ridiculous things that we have to deal with was fantastic. But some people are a little more sensitive. Some people worry about punching down from certain specialties. I really appreciated the way you handled that.

How do you handle trolls in general? Have you seen more trolls since the pandemic began, compared with earlier? You were pretty anonymous before the pandemic. I remember seeing the plague doctor that you used as your icon. Now you're well known and we know what you look like. How do you handle the trolls who go after you?

Flanary: As the platform has grown, it's gotten worse. If you get big enough on social media, you're going to get people who are trying to get a rise out of you and have a different point of view. And honestly, I accept that. I try very hard to ignore it. When I post a video, I monitor the comments for 20-30 minutes to see what people are saying. Then I leave it alone; I don't look at it for a while. Then after a couple of hours, I'll check in every now and then. I find that it's better to limit the number of comments I'm reading. You learn what feedback to take to heart and what you can ignore. There's some of both. It's never fun to hear personal attacks and read negative feedback. Learning how to not let it get to you takes time to figure out.

Ransone: They always say laughter is the best medicine. Do you think that satire is a useful tool to highlight problems within our country's healthcare system?

Flanary: I absolutely do. It's a big reason that my content has had such a big reach, especially when it comes to talking about our healthcare system or academic publishing or some of these areas of medicine where some harms are being done and big corporations are taking advantage of people. By presenting those issues through a lens of humor, it gets people watching. And they're more likely to share it. If you can make someone laugh about this very horrible, difficult (and sometimes scary) topic, you're going to get your message out to a wider range vs me holding a camera in front of my face and talking about it. For me, satire is humor, and it allows me to spread that message a little bit wider.

Ransone: My daughter is in her second year of medical school. She's mentioned the Fauci effect. They think that a lot of people applied to medical school due to Dr Fauci, that the increased applications to medical school were because of his fame. Do you think there will be a Glaucomflecken effect, where more people will go into ophthalmology because of the popularity of your videos?

Flanary: I hope so.

Ransone: That's what she thinks. I can tell you that. When I call her to ask what she is up to, she says she has been tailing a lot of ophthalmologists over the past few months.

Flanary: I mentioned earlier that I didn't think people would choose not to pursue a field based on my content, but I do think that some may be more likely to pursue a certain field based on what I say about that field. Whether that is true or not, I don't know. But I have certainly had much more feedback: "Hey, I want to do ophthalmology because of you" as opposed to the converse, "I was going to do this but you convinced me not to."

Ransone: You've been really open about your personal medical illnesses and concerns on social media over the past few years. Do you find that your comedy outlook has changed after being on the other side of the doctor-patient relationship?

Flanary: The message of my content has certainly changed. Since I had that firsthand experience dealing with our healthcare system, I've started delving into insurance issues and some of their predatory practices. My experience as a patient has absolutely impacted that line of content, but it hasn't changed my core sense of humor.

Ransone: Many of your viewers have a favorite character. Mine is Jonathan. I actually have two scribes who alternate when I see patients. It's awesome, and that's why my glasses and tie are straight, even though I'm a family doctor. Who's your favorite character to portray?

Flanary: I love ortho. Building that character is so fun. And any time I can do a surgeon and anesthesiologist conflict, those are also my favorites. I love recording those.

Ransone: Is there anyone new coming up that you can tip us off to on Medscape? Maybe some pompous medical faculty, I hope.

Flanary: I want to explore the rural medicine universe a little bit. I'd like to bring in an EMT. And maybe I'm going to slowly flesh out the Texaco Mike character. There are a couple of specialties I'd like to do. I'm going to do neonatology once I can feel comfortable and know enough about that field, which I've never encountered.

Ransone: Well, Dr Flanary, thank you so much for speaking with us today. Any final thoughts?

Flanary: I just want to thank everyone for watching my videos. The audience motivates me with their feedback to keep creating them. It helps to laugh, especially now in medicine. I encourage everybody to explore their sense of humor because we need more of it. Show who you are; show that side of you. Patients want their doctors to have personalities and see that side of them.

Ransone: Thank you for helping us laugh during this pandemic. We appreciate it.

Flanary: Thank you.

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