Aline Charabaty, MD, on Transitions: Changing Institutions and Building a Social Media Presence

by Jill Gaidos, MD, FACG

Dr. Aline Charabaty & Dr. Jill Gaidos

After her presentation at the ACG Regional Course in Williamsburg, VA, Dr. Charabaty and I sat down to talk about how her role as an IBD doctor and educator has been expanded through her use of social media. Since our conversation, she was awarded a Healio Disruptive Innovator “Social Media Influencer” Award during the 2019 ACG Annual Scientific Meeting.

Jill Gaidos (JG): I recently searched for you on the internet and saw that you moved from MedStar Georgetown to Johns Hopkins School of Medicine. What triggered you to move to another academic center?

Aline Charabaty (AC): I did my training at Georgetown University Hospital and I was asked to stay on faculty to build the IBD service line. I was very excited to build something new within the program that trained me, and my first job was like a “first baby.” I put in a lot of planning, learning, effort, and endless hours of work, because Georgetown didn’t have a formal IBD center, and I spent several months at the Hopkins IBD clinic in my third year of fellowship. Several years later, Hopkins asked me to build the IBD service line in their DC hospital, Sibley Memorial Hospital. So, in some way, I came full circle. I was very proud of the work I did at Georgetown. I had established a good team of medicine, surgery, and radiology faculty with interest in IBD, and had made great friends there. I just loved my fellows and had patients I was following for years, they were like family to me. So it was really a long process to reach the decision to leave and start something new, but at the same time it was very liberating and something I knew I needed to do if I wanted my professional and personal life to move in the direction I wanted it to.

I think reassessing now my first job out of fellowship, there are a lot of positive things that came out of it, and several mistakes I have learned from. What I absolutely don’t regret and what carried me forward were the relationships I built with fellows, colleagues, nurses, staff, and my GI/IBD patients. Connecting with people, having a sense of community, is my saving grace from burnout.

The reason I love IBD is that it really gives me the opportunity to connect with my patients on so many levels. To be able to improve the health and quality of life of someone is so rewarding, but it’s really beyond that. For me, it’s really making sure my patients’ concerns are heard and understanding what goes through their mind when we’re talking about disease, plans of care, procedures, but also what is going on in their lives outside of their disease. Working with patients at all stages of life, understanding how IBD affects their lives, and how life affects their IBD care, doing my best to make a difference and teach that to my GI fellows and nurses, these are really the best experiences and where I find joy at work.

What I regret about the early part of my career is how much I allowed work to take precedence over other things in life, and the lack of direction for my professional growth. I was over-working, but not necessarily in a smart way. I wanted to prove that, as a young woman, I could do it all and do it as well as my male and senior colleagues. I was putting in long hours, and completely ignoring myself and my family needs, missing some of my kids’ events at school. With my first child, I had struggled to get pregnant, did IVF, and had complications from IVF. After that, I had more miscarriages and struggles before my second pregnancy. So, you would think in that situation I would be prioritizing more personal time and working reasonable hours, but I think there was so much pressure on me to prove that even as a young mom and a young faculty member I could see a high volume of patients, scope, and meet high RVU targets, work late, and never stop. I was even on call the week before my due date, and it never occurred to me to say “No, this is ridiculous, I can’t do that!” I wish someone had said, “Stop; you need to work smart, and you need to ask for what is important for you, and do what is right for you—at work and outside of work—and take care of yourself and your family.” And when someone said it—my Chief at that time, Stan Benjamin—I didn’t listen because I didn’t think he shared the same experience!

This is one of the reasons why women mentors are so important, to be available, and to advocate for and mentor junior female faculty—and you, Jill, sharing the experiences of women in GI with others is so critical. Receiving mentoring and advice from someone who understands what is going on in our head and life has such great impact and value. What I also wish I had was guidance on how to build a career outside of clinical work; get protected research and admin time, join national societies, work with hospital or national committees, etc. I discovered the importance of all of this much later; that is why when I mentor fellows or young faculty, I ask them first to define their interests and plan their time accordingly and get involved early in professional societies like ACG.

So, at some point, despite the professional and clinical successes I had at work and all the good opportunities Georgetown had given me in my early career, I felt I had plateaued and my mind started nagging me, “So what’s next? Where do we go from here? What are your goals? How can you get there? What are your values and your vision? Are they aligned with your institution?” It was like a mix of a professional and personal midlife awakening: who am I as a woman, as a mother, as a person, and as a physician; what do I want for my life and how can I get it; and what are my priorities?

“It was like a mix of a professional and personal midlife awakening: who am I as a woman, as a mother, as a person, and as a physician; what do I want for my life and how can I get it; and what are my priorities?”

So, it was a slow process to get to that decision point. Interestingly, it came with a self-rediscovery on a personal level, redefining my interests, prioritizing kids and family time, exercising again, doing things I enjoyed, having the time to think, and discovering meditation. So, from a personal awakening came a professional one. I realized that the value I bring to my patients is within me; it’s my knowledge, my compassion, my ethics, and this is something I carry with me anywhere. My value is not linked to a title; it is what I give as a physician, as a mother, as a friend, as a mentor, and finding joy in all that. And now, I was in a place in my life where I knew what I wanted from my work life, what leadership path I wanted to take, what to negotiate for in a contract.

“From a personal awakening came a professional one. I realized that the value I bring to my patients is within me; it’s my knowledge, my compassion, my ethics, and this is something I carry with me anywhere.”

In addition, at Sibley/Johns Hopkins Medicine, I found the culture, the schedule, the support I needed at this point of my career. The Chief of GI who hired me, Tony Kalloo, is a strong advocate and sponsor of women and minorities in medicine, building a division with a large number of women in advanced endoscopy and in leadership roles. Our new Chief of GI is an accomplished female researcher and clinician, Anne-Marie Lennon. It is very empowering to have women colleagues and be offered a leadership position when you feel you are ready for the next step in your career.

As the clinical director of the Hopkins GI Division at Sibley Hospital, I am tackling new challenges like growing the division, recruiting faculty, and shaping a positive culture in the division that aligns with the values I want to live by. I want everyone to feel part of the team, their opinion heard, their work valued, and for my team to enjoy coming to work, at least most of the time! (Laughs.) I think that is key to fighting burnout, to continue finding joy in healthcare, and to give incentive and space for everyone to thrive.

I don’t know what it means to lead like a woman or lead like a man; all I know is that as women leaders, we bring something different to the table, and it’s good! The way we approach problems and offer solutions, our understanding of people’s needs, and the importance of achieving a healthy work-life balance. I believe we can be assertive and empathic at the same time. We can be team builders and we can make decisions on our own when we need to.

JG: So, another thing that popped up when I was looking you up online was your personal Twitter page (@DCharabaty), but also your Monday Night IBD (MNIBD) Twitter page (@MondayNightIBD).

AC: Yes. I’m very excited about this new adventure!

JG: You have more than 4,600 followers on your handle and more than 3,000 followers on MNIBD. Tell me about @MondayNightIBD. What is it and how did that get started?

AC: So, I joined Twitter under peer pressure, I admit. One of my fellows said, “If you’re not on Twitter, you are nowhere and you’re nobody.” I was like, “Oh! That’s harsh!”

JG: That’s mean!

AC: The way I wanted to use it is kind of an extension of what I love doing: educating and advocating for my patients, my fellows, my colleagues. So, when I joined Twitter, I would post summaries of IBD articles I read or things I learned at GI conferences. But then, since I really like to have conversations and connect with people, I started asking questions about IBD management.

In March, after an experience with a hospitalized UC patient who got partially better on steroids and infliximab, but much better after adding Cipro and metronidazole (despite lack of an active infection), I put out a tweet, “If you have a patient with acute severe UC, do you use antibiotics in addition to steroids?” with a poll: yes, never, only if evidence of sepsis. A great discussion started and different IBD experts and gastroenterologists shared their opinions. There was a spontaneous enthusiasm to have these conversations regularly, so, I said we should turn “Monday Bingo Night”—I don’t know why I thought about Bingo Night, I guess I keep thinking that when I’m old, I’m going to be playing Bingo on Monday night—into “Monday Night IBD.” I thought it would be a great opportunity to use this platform to highlight the expertise of everyone caring for patients with IBD and learn from everyone; so, I started asking IBD colleagues to lead a conversation and poll every Monday on a topic of their choice, based off of a clinical vignette.

The question @MondayNightIBD asks is, “How would you manage a real life IBD situation?” And the conversation comes easily, because the beauty of Twitter is that you can follow a discussion and tweet at anytime, anywhere, without the constraints of time and space. And for some reason, it is less intimidating to comment or ask a question on Twitter than in a large conference room. I also wanted the platform to be inclusive of everyone involved in IBD care, like a virtual multidisciplinary team from all around the USA and the world. I wanted everyone represented and to keep it diverse: IBD experts, up and coming IBDologists, private and academic GI doctors, researchers, GI fellows, colorectal surgeons, women, minorities, dieticians, psychologists, clinicians from different parts of the world with different challenges and experience in caring for IBD patients. We can all learn from each other and lift each other up!

And finally, the inclusiveness means also bringing in the patient voice. The online patient advocacy world was new to me and I’ve seen, on Twitter, IBD advocates doing amazing work promoting good science to other IBD patients, providing support to patients, and actively advocating for IBD care. And we need that, clinicians and IBD advocates bringing the good science to our patients where they are, on social media. I really wanted to bring the patient perspective to @MondayNightIBD because we often think that physicians and patients are speaking the same language, but we are not. I think that is one of the things that makes @MondayNightIBD special: clinicians and patients learning from each other.

“I really wanted to bring the patient perspective to @MondayNightIBD because we often think that physicians and patients are speaking the same language, but we are not.”

JG: How did you overcome the technical barrier of using social media? There are a lot of women who haven’t joined Twitter because they just don’t know how or the concern that it will take up too much of their time.

AC: You need to make the conscious effort to limit the time you spend on Twitter, because it can take up all your time if you let it! But you have to enjoy it to do it. Initially, I didn’t think I was going to like Twitter. I thought Twitter was for politicians and for the Kardashians. (Laughs.) Then, for me, it turned out to be an extension of who I am and what I like doing; I’m an extrovert and I love talking to people and getting to know them, teach and learn, explore new ideas.

I encourage women in GI to build their social media presence. One, it gives you visibility and exposure to promote your work and your research. Two, it connects you with people you wouldn’t have connected with. Three, it does build your “brand”, if you want, letting the world know who you are, what you stand for, what your interests are, not just as a physician but as a whole person, independent from your institution or organization. Four, you can make a wider impact for the things you advocate for. For me, when I tweet, I tweet with a purpose—the purpose of educating, promoting women and minorities, promoting my colleagues’ work, lifting up others, and advocating for my patients. Advocacy is a very important aspect of a physician mission and social media is a very powerful tool to advocate for change, for physicians, and our patients’ access to care.

“For me, when I tweet, I tweet with a purpose—the purpose of educating, promoting women and minorities, promoting my colleagues’ work, lifting up others, and advocating for my patients.”

One thing that is great about Twitter is the connection with non-GI physicians, writers, psychologists, sociologists; it opens up horizons beyond the confines of an institution and your circle of friends. Twitter gives you the quick opportunity to see what other people are doing in their work and life. I often bring back the knowledge I gather to my personal life and my professional life. There was one post by a gentleman who does a lot of disaster relief work and he was talking about his approach to disaster victims. And I was thinking, my patients with a new diagnosis of IBD or complicated IBD, this is a trauma, this can be experienced as a disaster in someone’s life. I took some of the wisdom he shared and I applied it in my practice. Other tweets with a great personal impact are the tweets from psychologists, free advice and wisdom—we all need that in our life and when raising kids. That is priceless!

Author Note

You can follow Dr. Charabaty and join the Monday Night IBD conversation on Twitter at @DCharabaty and @MondayNightIBD.