Common Sense

Your Voice Matters: 10 Ways to Battle Online Trolls

Issue: January/February 2023

Authors: Matthew Zuckerman, MD FAAEM, Social Media Committee Chair

As physicians, we frequently find ourselves advocating for our patients and our colleagues on social media. This can include messages about public health, vaccination, corporate practice of medicine, overdose, and the health impacts of racism. Increasingly, we are confronted with social media trolls who seem filled with hate as they seek to silence our voice. It’s important to remember that their goal is to distract from your message and intimidate you. This article will include important tips for combatting twitter trolls and getting your message out.

Almost a quarter of physicians report being attacked on social media.1 The intention is to gain notoriety as well as draw you into an argument. Fruitless arguments can disrupt the social media conversation you’re trying to create. Signs that you’re being trolled include blindness to evidence, name calling, topic redirects, condescending tone, and over exaggerating.2 Trolls are frequently attracted to certain issues (e.g., vaccines, gun control, abortion, smoking). Beyond that, the attackers seek to personally bully and harass physicians. This can involve racist or sexist attacks, doxing of personal information, and even, in some cases, threats of violence and sexual assault.

It’s important to be familiar with the community standards of the social media platform you’re on, as most of them have policies about such harassment.3 Reporting trolls to social media platforms is an important part of monitoring and preventing habitual behavior. Messages that include threats of violence and assault may also violate state and federal laws regarding cyber stalking and harassment.4 Short of that, it’s important to know strategies for dealing with online trolls.

1. Fight Fire with Ice Cream
Increasing social media participation can reduce the relative importance of negative online reviews.5 This is often much easier and more effective than getting a negative online review taken down.

2. Pulse Check
The first pulse to check is your own. Responding angrily is frequently what a troll wants and gives up the high ground that physicians generally hold.

3. Don’t Feed the Trolls
On social media, responding to a comment can increase its impact. Trolls want public recognition and an opportunity to increase their network. Ignoring negative messages takes away their power and discourages further trolling. Think about that agitated patient from your last shift and what strategies you used to de-escalate them. Sadly, no ketamine on Twitter.

4. Sleep on It
Though many of us experience social media in real time, there is nothing wrong with responding tomorrow. Like that angry email you never sent, saving a draft and reviewing the next day is often the best option.

5. Fight the Fight, Not the Fighter
Keep the discussion focused on facts despite trolls' use of personal attacks. Physicians are much more likely to remain professional and provide evidence online, and it works to our advantage. The fight isn’t to convince the troll (who will usually insist you “prove me wrong”), but educate all of the other people who are watching. 

6. Sidestep Response
Consider addressing the troll without engaging them. This can include sharing a screenshot (that doesn’t link back to the troll) or sending out a separate message addressing the issue. You may think there’s no point in arguing about mercury in vaccines with AntiVax666, but that doesn’t mean everyone is where you are at.

7. Mute vs. Block vs. Report
It’s totally reasonable to mute a troll to get them out of your headspace. Blocking goes a step further by preventing them from seeing your messages. Reporting inappropriate messages is generally easy, even if it doesn’t always result in our intended outcome.

8. Call on Community
The best feeling is watching a friend defend you online so you don’t have to engage with a troll. Consider reaching out via a DM or even IRL. This kind of support is important and can help put things in perspective when you’re fired up.

9. Three Rounds and You’re Out
KevinMD suggests limiting these types of arguments to three rounds (one is their response, two, your response, three, their response).6 If it’s not productive by round three then consider leaving the conversation.

10. Consider Kindness
Several years ago, the comedian Sarah Silverman made news by engaging with a troll about his chronic pain.7 Her kindness ultimately resulted in a GoFundMe campaign and connection to local health care providers. Though this is the exception, we should remember there are people on both sides of these arguments, often people in pain.

In summary, don’t let a troll push you out of the conversation. We manage agitated people every day, and can use our skills to make sure that our message continues to be heard.


  1. Pendergrast TR, Jain S, Trueger NS, Gottlieb M, Woitowich NC, Arora VM. Prevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media. JAMA Intern Med. 2021;181(4):550-552. doi:10.1001/jamainternmed.2020.7235
  2. McCoy J. 10 Effective Tactics to Defeat Internet Trolls. Search Engine Journal. Published October 7, 2021. Accessed July 14, 2022.
  3. The Twitter rules: safety, privacy, authenticity, and more. Accessed July 13, 2022.
  4. Colorado cracks down on harassment of healthcare workers. McKnights Home Care. Published May 24, 2021. Accessed July 13, 2022.
  5. Widmer RJ, Shepard M, Aase LA, Wald JT, Pruthi S, Timimi FK. The Impact of Social Media on Negative Online Physician Reviews: an Observational Study in a Large, Academic, Multispecialty Practice. J Gen Intern Med. 2019;34(1):98-101. doi:10.1007/s11606-018-4720-3
  6. How physicians can handle online trolls. Published May 14, 2015. Accessed July 6, 2022.
  7. Beck K. Sarah Silverman responded to a troll with kindness and it was beautiful. Mashable. Published January 6, 2018. Accessed September 28, 2022.

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