Episode 59: A Social Dilemma? With Dr James Thambyrajah

Social media helps us create and maintain connections. It also provides us with information — often too conveniently — in just one click. Because of this, a social dilemma arises: we keep using it without realising we’re glued to our screens longer than we ought — or want — to be.

In this episode, Dr James Thambyrajah joins us to talk about social media’s subtle yet profound effect on our daily lives. We discuss the perils of being unaware of how our online decisions are influenced. James also shares his insights on how we can improve how we stay informed and inform others.

Tune in to this episode if you want to learn more about how to go beyond your digital echo chamber.

Here are three reasons why you should listen to the full episode:

1. Discover how social media affects our online decision-making processes.
2. Learn how screen time impacts your mental health and well-being.
3. Identify some tips on how to solve this social dilemma.

Resources

• Skin Lesions: What’s the Diagnosis? by Dr James Thambyrajah
• The Social Dilemma on Netflix
• Indistractable: How to Control Your Attention and Choose Your Life by Nir Eyal
• Dad Tired Podcast Episode: Developing A Tech Plan For Your Family by Jerrad Lopes featuring Arlene Pellicane
• Guides by the Royal College of Paediatrics and Child Health

Episode Highlights

[06:34] The Social Dilemma

• Our electronic devices have become an extension of ourselves in performing our daily tasks. Hence, we spend most of our time staring at the screens of our devices.
• James and Rachel find the Netflix documentary The Social Dilemma an eye-opener.
• The documentary delves into our online social dynamics. It also tackles how tech companies manipulate information to keep us hooked on our devices.
• Tech companies deem online users, as well as their personal preferences, as their main product.
• The adverse effects of social media are seen through how quickly misinformation spreads. As a result, it’s become more challenging to control.

[12:15] Shifting Social Norms and Why We’re Hooked

• Intimacy is vital in relationships. However, due to the convenience of social media, it’s becoming less common in personal interactions.
• Tech companies use algorithms to learn more about their users and how to keep them hooked.
• Social media has the same addictive mechanism as slot machines — tech companies identify the triggers that make you pull the handle. Before you know it, it’s become difficult to stop.

[18:08] Learning to Adapt

• We often focus on the benefits of social media as a tool, so we often overlook our addiction to it.
• You can start by gradually building good habits and practising self-control.
• James reminds us that tech companies design social media not to look after your well-being but to keep you clicking on the ads.
• Set yourself as an example for your kids and family.

[26:07] On Screen Time and Mental Health

• If we can reduce our screen time, we can have healthier lives and interact better with our families. Studies have shown there is a correlation between screen time and depression.
• According to the Royal College of Paediatrics and Child Health, there are four screen types: social media, TV, video games, and computer usage.
• Due to the pandemic, James’s children have been doing remote learning, which means longer screen time for them.
• He reminds parents to look out for their children and limit their social media use accordingly to avoid risking their mental health.

[29:52] Digital Vegetables vs Digital Sweets

• According to a Dad Tired podcast episode featuring Arlene Pellicane, social media usage may be regulated by identifying whether a particular activity is a ‘digital vegetable’ or a ‘digital sweet’.
• Digital vegetables are healthy and helpful screen time usage. They help us foster connections by building you and others up.
• Digital sweets, however, are bad and addictive. If they are not consumed in healthy amounts, it may lead to problems.

[33:02] Tribalism and Political Polarisation

• We consume information which further feeds our biases.
• Such information builds up our respective echo chambers, keeping us stuck and uncritical. From this, polarisation and tribalism arise.
• James advises us to expose ourselves to various perspectives by following content we often disagree with. Truth is not a partisan issue.

[38:24] The Importance of Fact-Checking

• James recognises his responsibility as a doctor to spread relevant and evidence-based information.
• We can help each other out by correcting misleading and false information online.
• Twitter has recently introduced a feature where people are encouraged to make sure they’ve read the article before sharing.
• James urges us to practise validating the information at hand before disseminating it, even if it came from people we respect or admire.

[44:36] James’ Top Tips

• Be aware of your screen time usage and acknowledge the problem.
• Prioritise what is essential for your family. Think about how you use your devices.
• Look after your well-being and mental health and be mindful of your device usage.
• Misinformation is prevalent, so take the time to fact-check your information before sharing them.

[47:35] Rachel’s Top Tips

• Turn off your phone and notifications. Put it somewhere out of reach.
• Put a limit on your screen time.
• Help each other out and avoid ‘phubbing’ people..

7 Powerful Quotes from This Episode

[9:00] ‘To summarise, I think it’s [the social dilemma] the effect social media and these tech companies have on our lives. And we don’t realise it’s having an effect on our lives’.

[16:52] ‘The last couple years, I realised I was too addicted to my phone. . . and I realised the phone had become part of my hand. And so I made these little steps in my day to day life’.

[20:22] ‘I think it is really important that we lead by example’.

[30:24] ‘There’s good screen time and helpful screen time, which kind of builds you up and builds up others’.

[35:29] ‘I think we all have a responsibility to look at what the other side is doing, you know, because unfortunately, we don’t all look the same, we don’t all think the same. And so I think it’s important that we realise there are differing viewpoints, but unfortunately, our social media feeds tell us otherwise’.

[36:52] ‘I think you have to look at all different sides, and then make your own decision’.

[47:27] ‘I think it’s important that we take time for ourselves to make sure that we know what we’re sharing and how we’re using our social media platforms’.

About James

Dr James Thambyrajah is portfolio GP, a South West Thames RCGP Faculty Board Member and the outgoing South West Thames Faculty RCGP First5 lead.

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Episode Transcript

Dr. Rachel Morris: Welcome to another episode of You Are Not A Frog: A Social Dilemma. On this episode, I’m joined by Dr. James Thambyrajah, and we talk about a powerful documentary on Netflix, which we’ve watched recently called, ‘The Social Dilemma’. Now this was recommended to me by a friend who’d watched it, he was becoming increasingly concerned about the amount of time that she and her family were spending on their phones. And the documentary features interviews with some of the founders and some of the early workers in these technology companies such as Twitter, LinkedIn, and Pinterest. And the documentary is all about how they made the tech addictive.

Did you know that your focus attention is what they’re after? You are the product, they just want more clicks, and they’ve used very advanced psychology to get this. And as a result, we’re more addicted than ever to our phones. We waste so much time and attention on social media going down rabbit holes, and more worryingly, we are becoming much more polarized as a society, and the mental health of our teenagers is really, really suffering. So I talked to James about all of this, and we discuss how tech has been so divisive and has been so addictive to us. We talk about the difference between digital vegetables and digital candy, and we talk about how we can get out of our own digital echo chamber. I hope you enjoy it.

Introduction: Welcome to You are not a Frog, the podcast for GPs, doctors and other busy professionals in high stress jobs. Even before the coronavirus crisis, many of us were feeling stressed and one crisis away from not coping. We felt like frogs in boiling water, overwhelmed and exhausted. But this has crept up on us slowly so we hardly noticed the extra long days becoming the norm. And let’s face it, frogs generally only have two choices, stay and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your own destiny, and to craft your life so that you can thrive even in the most difficult of circumstances.

I’m your host, Dr. Rachel Morrison, GP, and executive coach, and specialist in resilience at work. I work with doctors and other organisations all over the country to help professionals and their teams beat stress and take control of their work. I’ll be talking to friends, colleagues, and experts, all who have an interesting take on this. So that together, we can take back control to survive and thrive in our work and lives.

I’d like to give a big shout out to all the GPs, physios, practice nurses, pharmacists, and practice managers who attended the recent Salfords-London Training Hubs Shapes Toolkit course. And just to let that I’m now taking bookings for the autumn, spring, summer for my Shapes Toolkit programme. Now this is a breakthrough resilience training program, which will help you and your team to increase your productivity, take control of your well being and your workload and really empower yourself and other people to take control and design a life in which you can really thrive at work.

We’ve been delivering this for various GP training hubs, and for GP fellow training schemes. We’ve also had people in the additional roles in primary care, such as paramedics, physios, we’ve had practice managers attend the course, nurse practitioners, anybody who is in a high stress job and facing some of these issues, this course is suitable for you.

So if you are part of a PCN and STP Workforce Planning Committee, or you’d like to investigate some training for your GPs and primary care teams in the training hub or health board, then do get in touch. And of course, this isn’t just for healthcare, we’re also been providing courses for other high stress organisations. So I’d love to talk to you just get in touch with me to find out about how we can work with you and your organisation.

I’m a GP myself, I know what it’s like to work in an environment where you feel overwhelmed and overloaded with work. And the Shapes Toolkit will help you take back control and thrive in your workplace. All our training can be delivered online, and it’s a really great way of holding a team away day, which encourages interaction, which gets really deep conversations between team members and just encourages people when they may be feeling a bit isolated at home. So here’s today’s episode.

Rachel: It’s really great to have with me back on the podcast, Dr. James Thambyrajah. James is a portfolio GP, he’s also on the faculty of the RCGP Southwest Thames area. So welcome back, James.

James: Thank you. Thanks for having me.

Rachel: We were just saying it’s been about a year since we last had you on the podcast and since then, you’ve had a baby.

James: Yes, thank you. Yes. Last time I spoke to you on this platform, my wife is expecting any day of that time. Now my son, Peter’s, now is going to turn one in about 10 days time. It’s been a bit crazy but fun year.

Rachel: Gosh, and having a baby in lockdown. That must have been, gosh, challenging, I think, I would say.

James: Yes, it has been a struggle. But the same time that I’ve been more, I suppose, invested with the baby, because I’ve been around more so that’s been helpful. So, I mean, work has carried on to GP, as you know, for me it’s been very busy. But at least, I’m not distracted by other things I would have normally done in the evening, because I’ve been at hand.

Rachel: Yes, I think that’s one thing. We have all connected more with our families, which I think for my teenagers, kid thing, like, ‘I’m so sick of my mother and my father, and I just need to be out of the house right now’. Talking of teenagers, one of the big battles we have with teenagers is of course, phone use, and screen time, and social media.

And we are getting together today to talk about social media screens, all those sorts of things off the back of a brand new documentary—it’s not been out for long, has it—on Netflix called, ‘The Social Dilemma’. And I watched that the other day with my kids, it’d been recommended by a lot of my friends and said, ‘You must watch it and get your kids to watch it’. And I thought, ‘How on earth am I going to get my kids to watch it’? So I basically—I bought a massive tub of Celebrations. And I said to them, ‘I’m gonna watch this Netflix documentary, this is what it’s about. I’m not gonna force you to watch it. I’ve got the chocolate. You’re not having any unless you’re in this place watching it with me’. And they were like, ‘Do I want to see that’? But they sat down and they had—I think my son ate about 20 of those small Celebrations in about five minutes. He’s 14. So he’s growing, hollow legs, but they watched it. And they watched it all the way through, all hour and a half of it. And they were like, ‘Oh my’, at the end. So when did you get to see it?

James: I think shortly before—I think maybe last week or a few days ago, and I rewatched it again, in preparation for this as well. Yes, it hasn’t been out for a long time. I remember reading a review about it in the New York Times when it came out in September. I thought, ‘Oh, I’ll put that on my list to watch’. And I think I hadn’t got around to it. And then I watched it recently. And I thought it really struck me I think in many ways, which we’ll probably go into obviously, this—but just the scope of the issue, the scope of the problem, regards to screen time and social media. And not only has it affected our social lives, but has affected our politics, and our news feeds, and how we interact with one another. So it was really an eye opening—eye opener for me.

I mean, some of those things I knew. But in a more, let’s put it this way, the documentary was really well put together. Because they advertised it as a documentary slash hybrid drama. So there was a bit of drama inside, which I liked. I mean, Netflix is very good at doing these things. So for me, I felt captivated that I was watching a film, as well as a documentary. And I’m a film buff. So for me, it ticked all the right boxes. But yes, I thoroughly enjoyed it, even though the message was very serious.

Rachel: Yes. So James, for those listeners that haven’t seen it, could you summarize it in three sentences? What was it about?

James: Well, I suppose it talks about, The Social Dilemma. It talks about how social media, and these tech companies have an influence on our lives—day to day lives. And how we access social media, whether it be leaning through our phones, or through computers.

And it talks about how, it talks about—at one point, it talks about the goals of these tech companies talking about their engagement with us, and how they want to grow as companies, and basically how they get advertising. And to kind of monetize our kind of data, and how they can manipulate us to kind of click on that or search for that like or self cater off news feeds. And so essentially, it’s just the effects of these tech companies and how it’s grown to a point where it’s very difficult to control.

And you see that with misinformation in politics. You see that with interference with elections, for example, at the moment, the US elections and the Russian interference. Misinformation about COVID, which has been a big problem in the last few months as well. And that’s been through WhatsApp and social media feeds. So it talks about that as well. To summarize, I think it’s the effects of social media, and these tech companies have on our lives, and we don’t realise it’s having an effect on our lives.

And that’s what really scared me, the fact that it’s so subtle, it’s not a stretch. It’s a gradual kind of infiltration of your lives through kind of, and using kind of, they call it data mining, which I don’t like that word, but it’s kind of data mining your mind about what you want to see and what you want to do. So I suppose, does that make sense?

Rachel: Yes, yes, that’s a really good summary. They talked about the fact that any product, any company has a product that they make money from, and the products that these tech companies make money from is us and it’s our attention. I’ve read a lot of really good books about this recently in terms of our attention and people saying exactly the same thing.

There’s a really good book called Indistractable by Nir Eyal. And Rangan Chatterjee, did a podcast with him about this, about how you focus. And he says, ‘Yes, our focus and our attention is the product’. And of course, these companies have to make money somehow. They make money through advertising. And the more time they can get you to spend on their product, more attention, then the more exposure they get to the advertisers, the more money they make. So what they’ve developed to see is details, algorithms, to keep you clicking, and to keep your interest. And the problem is because we are human beings, is that our interest is piqued when it’s, someone might like us or other people, like, so if we’re tagged in something, or someone’s liked something, that’s dopamine, so that keeps our interest.

Also, our interest is piqued by sort of novelty, and sort of extreme stuff as well. And so these machine algorithms, and they’re in other AI as well, so they learn, they learn how to keep your attention, are feeding us stuff constantly, that’s gonna keep our attention, not stuff that they think is good for us. It’s purely stuff to keep us looking at our screens, as opposed to focusing on other people, talking to people in the room.

And I think the documentary illustrated this really nicely. What it did, it had a mock up family, a couple of kids, a teenager, a mum. And then they had some sort of avatars that were behind the scenes thinking, ‘How can I keep this person’s attention’? The particularly important scene for me was, they had two boys, probably 13, 14 year old boys sat together in the canteen at school, and they were talking to each other. And then these avatars behind the scenes going, ‘Hang on, he hasn’t picked up his phone for five minutes, let’s just poke him with something’. ‘Oh, I know, there’s a girl sitting near him that he looks at quite a lot on social media. So we’ll just poke him and say, give such and such a way’. So he then gets an alert on his screen and he goes, ‘Oh, oh, she’s liked something that I’ve put up so I’m gonna comment back’. And meanwhile, while he’s saying that, because his friend sees that he’s on his screen, his friend just picks up the screen. And then you just pan back to both of them just sat there on their phones not talking to each other when they were before. And that for me, it just seems like, ‘Oh, how often does that happen to me when I’m with people, when I have my kids or my family’? I don’t know what you thought about that.

James: Yes, absolutely. I agree. I think it’s just the social norms have changed so much in the space of 10 or 15 years, where I think we’re finding it more and more difficult to interact with one another. Intimacy is becoming a big problem. Everything is online, even dating is not a problem. But everything is now online, on your phone. And so we are losing those skills that were passed down to us or taught to us by my parents, for example.

It becomes a problem really, if our kids can’t look people in the eye. I was listening to this podcast, this parenting podcast the other day. Where there’s a family—were talking about their kids going to a restaurant and kind of making sure that they order from the menu themselves, and they ask the waiter and say, ‘Please, and thank you’. And they went to a restaurant and they looked around, all the kids were on their phones or their devices.

And I remember that kind of really rang true to me is that we went to Bushy Park about a year ago. And we do have devices that are tied when my children were a bit younger. And I had to buy some [013:16 inaudible] but the battery was dead. So what, we’ll just take some books, [13:19 inaudible], or whatever. And we went to Bushy Park and lovely Bushy Park Cafe. So we’ll get a coffee and some cake. My son and I were the only people without a device. All the other kids were on devices or iPads and Kindles. And we have a book and I found that really shocking.

So I think—I suppose that really kind of hit home for me as well, their interaction with one another. And it talks about—I think in the documentary, I made a note where our primary connection now with others is through online connections. And that made me really sad, and I just think and I don’t know when that’s going to change, or that’s something we have to adapt to. You can’t arrest kind of advances in technology or AI but I think we need to learn how to do both.

And what you said about AI was really interesting because it said something about the Terminator in the documentary. When we think of AI we think of probably kind of the TT from Terminator Two coming back at being really angry and being really kind of evil and kind of killing and all that kind of stuff. Well actually, AI is very subtle, it’s more kind of getting into our newsfeeds. For example, I was looking for trainers the other day and I was googling trainers. And then I was on Instagram and my feed’s full of kind of SportsDirect and JD Sports ads for the latest trainers. And that scared me because I think, ‘Okay, I looked at it a few days ago, you’re still showing me ads of something that I want and something that I feel like I need and something that perpetuates that kind of’, that we talked about dopamine that dopamine hit, ‘oh, I need to have that’. So I needed it and that’s a shocking thing.

And so I found the addiction side of it very interesting as well, so I think yeah, we’re talking about that it was nice to see that family in that documentary because it kind of made it more real, I suppose.

Rachel: And that thing about dopamine is really interesting because, and they talked about this, and I’ve been reading about this somewhere else. So they did an experiment with chickens, where they got them to one group of chickens, if they pecked on a button, they got a piece of grain that they got, they got reward. And every time they peck, they got a piece of grain. There’s another set of chickens, where they peck sort of a button, they might get nothing, they might get a piece of grain, they might get loads of grain, but it was completely random. And so the chickens that were in the random group pecked much more at the button, than the chickens that knew that they would always get what they wanted.

It’s this slot machine type mentality, it is much, much more addictive. So when you pick up your phone, ‘I don’t know, if I look at my phone, if I’m going to have three WhatsApp messages, none or, how many likes am I gonna have on Facebook’? It’s this sort of random thing that keeps us addicted. And the really interesting thing is that, this isn’t like, hasn’t just arrived like that by chance. Like they had courses—they had courses at Stanford, on how to make people addicted to your products.

James: Yes. It’s interesting, because you say that because they will go into the algorithms because very much like this, like you said, the slot machines in Las Vegas with the casinos, and they will kind of those things that keep on wanting you to pull that handle. They use that same kind of technology, and that same kind of algorithm for our news feeds. And they talk to the guy who makes the light buzz and they talk to the guy who—when you see someone typing a reply back into all their typing. All those things kind of trigger something inside of you thinking, ‘Oh, I need that, I need that’.

And for me, this is, I think it’s been a personal journey the last couple years. I realised I was too addicted to my phone. I think I realised that when my kids come home, and I was on my phone, I’ll be talking to them. And without even thinking I’d be checking an email or checking up—because I’ve been at work all day. And I realised actually, it’s obvious that the phone have become part of my hand. And so I made this little steps in my day to day life. For example, just putting my phone away, when I come into the house. We have a little basket with keys, we should probably shouldn’t put it near the door. But that’s another story.

So as soon as I come into the house, I just put the phone down, I just go upstairs and talk to the kids or whatever because I think for me, it’s out of sight, and I can’t touch it. Similarly, I just think putting my laptop away or kind of switching off or being in airplane mode, it helps me. And I think, otherwise now, just as I was talking to you, my phone just buzzed and it’s there, and I’m very tempted to kind of reach out for it. [17:46 inaudible] because that’d be hypocritical while we’re talking about it.

Rachel: Good self control.

James: Yes. But I want to know, ‘Oh, did someone sent me a message? Oh I got a notification’. And it’s just one of those things where I think, it is a continual process of kind of learning how to adapt to these kind of devices and social, dare I say addiction.

Rachel: And it’s really hard, isn’t it? Because these things are—I mean, they’re really good tools. And that the guy on the documentary has started this thing called the Centre for Ethical Technologies. A really good guy, wasn’t he? But he said that, actually, ‘A lot of this tech is absolutely brilliant. It’s really great that I can click on where I am and order a car to come and pick me up within five minutes. Brilliant technology and we need to use it as a tool’.

So I think it’s great to be able to be in a group chat with my family where I can sort of share articles and talk and catch up with them. And I’m in touch for much more than I used to be when all you had was a phone call. So it’s really good. And the problem is, like you said, if I’m in the kitchen, I use my phone to listen to podcasts through the speakers. I use it to find out music. I use it to listen to radio, to the news. I use it to find recipes. And I use it to reply to all the school email. So actually, often I was just trying to think I’m spending time with kids. And I’m looking at a recipe or listening to music so I’m not even doing work, but to them, how do they know what I’m doing? How do they know I’m not just on Facebook or Twitter or doing emails?

And some constantly say we have this within our family that we do try not have our phones out and we put them away for meals and all that, ‘I’m just on it because’…. ‘I see you on your phone. Why is that’? ‘I’m just’… And that phrase, ‘I’m just doing’, such as ‘I’m just, I’m just’, ‘I’m just responding to someone because he’s had a bad day’. ‘Well, you need to do that now because I’m sitting here having a cup of tea with you’? Ordinarily it’s very insidious how it creeps into our lives isn’t it?

James: Yes, I think like you said, I think getting into good habits. Your children can only follow your example, I think. So if I’m on my phone or on a device, I think it took my son saying, ‘You know Dad, you’re always on your phone’. This happened about a year ago, two years ago and I was like, that really hurt me. I was just like, well, I feel like I’m doing this, I’m doing that. And so that kind of prompted me to kind of put my phone aside. And sometimes I would just joke with him, ‘Look at my hands, there’s nothing in my hands’. I just show it to him. And to me, that helped me. I know, that sounded really silly, but so he now knows. So, I mean, that’s a funny side.

But it’s kind of more, I think it’s very important that we lead by example, because we think, it’s not just our children, but us as well. We can be addicted to social media or kind of sending that email and like the documentary said, Google Gmail, and there’s an addiction to email. So kind of reading an email, what’s read, what’s unread, the colors that they use, everything has been designed so that you can see them. Even social media send you email. So social media would say, ‘Someone has put a picture that’s tagged you’. But that’s not even the picture, it’s not even there. It’s like a little thumbnail to the big picture. So you have to go into email, read the email, then go into your social media. And so I think that these tech companies, they’re not designed to—I think that it says in the documentary, they’re not designed to look after your well being, they’re designed for you to click on that, and then see that ad. Sounds manipulative, but that’s the truth, really. They’re not there to look after your well being or to your mental health.

And then that becomes dangerous when we start thinking about, you mentioned that family in the documentary talks about these preteens. And the statistics was shocking. I’ve talked to my sister about this. And she’s a perinatal psychiatrist, and we talk about the mental health issues, I always used to think, which is teenagers, and then I was shocked to see self harming gone up 160% in preteens, that’s 10 to 13. And then and suicide have gone up by, just a little bit less 150%, since, like 2010, or 2012. And that’s all that can be correlated with social media and preteens, and teenagers, adolescents having phones.

And I think, it’s really good in this country in the UK, where we are, the Royal College of Paediatrics brought out some excellent guidance last year, about screentime. Talking about how it affects your family, how it affects the activities that you do, and I think that’s been really helpful, actually how it interferes with your sleep. So, I found that guideline really useful. And I try to share it when I can in my practice, because I think it’s really important. They came out in January of 2019. I think that’s really important. It gives you good advice, and there’s good infographics, and good PDFs, as well.

Rachel: Okay. We’ll put that link in the show notes. I think that’d be helpful. And we struggle. And I think these preteens I think they’re particularly susceptible because they don’t have any of the filtering mechanisms. They don’t have any of the, well, [22:44 inaudible] older teenagers. They have even less, my daughter is obsessed with TikTok. At some point, she was walking around this funny jerk, she was kept going like this. I said, ‘What are you doing’? and she said, ‘TikTok dances’.

James: And you talk about how influential that’s become, especially in America with the coming election as well, and all that company. And so—but it’s interesting, because when I was growing up, we didn’t have social media. So mobile phones would—were just coming in, and I had my first mobile phone when I went to university, I was 18. So I never had a phone until I went to uni. And now I’m terrified for my daughter who’s eight, the fact that, normally when you go to school, there, I said, when I was growing up, all the stuff at school was at school, when when you get home, you had your safe haven there.

And now the fear for me is for my children. And for everyone’s children, I suppose, it’s just that when you come home, it carries on. The pressures—the social pressures, the anxieties from school, and looking at Instagram, looking at likes. And so suddenly, there’s pressure at home to kind of put up this facade or this filter of what your life should be like. Whereas, when I was growing up, but just going home and just dealing with my family, which was—so I think that is the biggest change, really, and I think that’s why we’re seeing so many increased risk of depression and mental health issues in our preteens and adolescent teenagers.

Rachel: Yes, I’m sure that’s true. Because you’re on your phone, you’re single, your friends are missing it without you or there’s a conversation going on and yet anything is difficult. And I think I want we’re all we always had in our houses, no phones in the bedroom. And that has been really good actually means that kids actually sleep. And I know so many kids that got into real mental health problems, because they have been up all night on the WhatsApp. Well, that’s when online bullying goes on. That’s when all the really difficult stuff goes on.

But I think, you know when I do my resilience courses, when we talk about sleep, the one thing I say to adults, and it’s always, like at least 50% of the room have their phone next to their bed because they use it for an alarm clock. And my other half still does this and I wake up in the morning and he’ll be on his phone looking at stuff. And I think it’s so bad for you. And I just—because the problem is you get to set your alarm in the night and think, ‘Oh, hang on what if I got tomorrow? Let’s check my diary. And oh, I haven’t replied to that text or email’. Suddenly you’ve spent half an hour of work. And it’s all going through buzzing through your mind. It’s really—quite apart from the blue light and the melatonin disruption.

What I always say to people, the one thing you need to do is just buy a really simple alarm clock. So I have a digital alarm clock next to my bed. It’ll only play one crappy radio station that wakes up every morning with the traffic news. But that’s it. That’s it. And honestly it’s that, it’s [25:37 inaudible] me.

James: Yes, I think that’s really important. I think we put a new Alexa. Other smart speakers are available by our bedside and so it has an alarm, and it wakes up to whatever artists I like, that kind of be quite nice for us. So otherwise, yes, because the phone will know ‘Oh, you were asleep between this time and this time’, it’s almost as though the phone is like that documentary is kind of monitoring. If we can reduce that, that we have healthier lives, and sleep more, we’ll interact with our families more.

There’s a study in kind of, I think, journal American Medical Association pediatric last year. And it talks about the correlation between, not just screen time and depression, but there are four types of screen time. So there’s social media, TV, video games, and computer usage. And it talks about how each of these different screen times can increase rates of depression. And I just thought, sometimes you don’t realize how many screens are in our lives. And I never read that study. And I’m just thinking, ‘Oh, my goodness, yes, not just one screen. There’s multiple screens of our lives’. So it’s kind of be at the computer screen or be at the TV. We don’t have a computer games console in our house at the moment. But that’s something that I’m talking to my wife about.

I talked to my wife about it, because I can only think about what I went through. So I had a Nintendo and Super Nintendo when I was eight, or nine, and my daughter is getting to that age now. And I know a lot of her cohorts are having PlayStations or Nintendo Switches. So for me, that’s a new hurdle. But I’ll have to navigate—of course, unlike my day, these games are online now.

Rachel: Yes, I say it’s really difficult with this whole games console thing because my son has an Xbox. And he is 14. And that is how he communicates with his friends. Because he sits there with a headset and chatting to them. So through lockdown, like, we were trying to limit his screen time, no more than this amount per day. But that actually meant we were limiting his interaction with his friends as well. So if you can be—it wasn’t about being addicted to the video, it’s about well, they will be having conversations and I’m not going to be there and they talk around the game that they’re playing.

And I think girls is not quite as much like that. Girls tend to be more on the chats and things like that. Whereas the boys, actually, that’s the way they do their social interaction. So it’s not quite as straightforward as going, ‘Right, blanket ban on screens’, or there’s this much because you’re stopping them. And we felt incredibly guilty. But we did in the end have to say, ‘You know darling, it’s really not good for you to be on the screen for 12 hours a day’ , he wasn’t quite that bad. But it got pretty bad during that time. Because actually, what else? What else can he do? , you’re gonna have two hours of exercise.

James: Also does that dilemma of that? And also, Rachel, well, we’re going to a second lockdown in this country at the moment. But the first lockdown, there was no school. So a lot of the kids were doing homeschooling, and they were doing homeschooling through a device, through screen time. So suddenly, now I was reading articles about what do we do now? Because all this time, we’ve said, I think the Royal College Paediatrics said, ‘No more than two hours or one and a half hours or whatever screen time per day’, I can’t remember, I have to look at it up.

But now we have children who are remote learning on the screen for several hours. So how do we kind of—and I don’t know the answer to this—but how do we regulate that? How do we make it healthy for them? Can we kind of put incorporate breaks? Can we go outside? But now it’s gonna be tricky, because it’s winter, it’s going to be darker. In the summer, we were able to go out but now it’s—today was a very chilly morning. So it’s the kind of thing where it’s definitely more challenging moving forward throughout the winter. Thankfully, kids are going to school. So that’s one less thing to worry about.

I do think we have to re-navigate the goalposts regards to screen time because we have to think about what to do. And also depends on what they’re looking at. So again, I was listening to this parenting podcast, aptly called Dad Tired, which says what I feel like as a father of three and a one year old. And he talks about—the guest, he was a child psychologist, he talks about digital vegetables, and digital sweets, or digital candy.

Rachel: Okay. Oh, I like that.

James: It talks about the challenge, especially during lockdown as with your children’s, what are you feeding them digitally? Are you feeding them digital vegetables such as FaceTiming your grandmother or kind of learning an instrument or learning a language? You can do that for YouTube and things like that. Or is it kind of digital candy, for us digital sweets or chocolates? Is it kind of going on YouTube? Or is it going on Instagram or social media? Or is it kind of going on Facebook. And I just thought that was really interesting, because there’s good screen time and helpful screen time, which kind of builds you up and builds up others for our children and ourselves. Or is there kind of digital sweets, where it is that constant addiction, we want it and that immediate hits and some of that dopamine, but it doesn’t really kind of fortify our kind of soul or mind, I think that’s really, really struck me. I just think that’s important.

So it’s about kind of encouraging what our kids gifts are and what they want to do. And similarly with me, I learned a lot from that as well. So for example, I’m trying to FaceTime and call my friends more, as opposed to just talking to them through social media, which is easy to do. You can just talk to them through a messaging app. And so I’d rather kind of just call my friend the other day, he’s a GP and like, ‘How you doing? How’s it going’? Yes, so thinking about how we consume digital information, and how we can use that digital information to kind of improve our daily lives. Does that make sense?

Rachel: Yes, absolutely. Because we cannot say screen’s bad. But I love that idea. Is it a digital vegetable? Is it digital candy? And it’s okay to have a bit of candy, isn’t it?

James: Oh absolutely.

Rachel: So that’s interesting. So there’s—we’ve talked a lot about the effects of screens on our well being and our children’s well being. And I think that’s a good enough reason to try and sort of cut down on the digital candy.

I think there’s another really important thing that we’ve sort of touched on already, talked about in The Social Dilemma. And that is the effect on polarizing society and extremism and our points of view, because we’re right in the middle of the American election at the moment, and I’m looking at some of the voters and thinking, ‘How can you believe that? How can you think that I do not understand’?

But as it was shown really helpfully in the documentary, if you start looking at certain things online, and you click through to certain things that the machines will learn what you like to look at. There’s plenty more of the same stuff. And what do we like to read? We like to read stuff that reinforces what we believe, and our values, and all that sort of stuff. So you start to read more of this, and then it feeds you more of this. And very soon, you’re stuck in this complete bubble, where the only stuff that you’re reading or seeing is stuff that agrees with your points of view. And then, so you can actually see how someone might get stuck, and I can see it myself. I’ll read from The Guardian. And eventually I’m thinking ‘How can anyone else not have this point of view’? but of course it’s because they’re not reading that. They’re reading something else. And it’s shown, they show how divisive it is in America, so it’s more polarized, society is more polarized than it’s ever been before. And it’s terrifying.

James: Absolutely, I think that is a real danger. Because we’ve become so polarized. It talks about in the documentary, tribalism as well, to the point where individual studies published—especially in the States where Democrats can’t stand Republicans and vice versa. And suddenly you look at your social media feeds, it becomes an echo chamber of what you want to see and what you want to process. And that’s how a lot of people these days get news. I say the olden days before Facebook, we used to get our news by getting newspapers and my dad used to get the Times and I used to read my dad’s Times at home when I was a teenager. Now in the Times, they have all sorts of commentators, all sorts of opinion pieces, and news and everything about sports.

Now, like people get their—So, if you look at my feed, even my Twitter feed, there’s things that I like and there’s things [34:01 inaudible] and I tried. One thing I like in the documentary, one of the things right at the end was kind of follow people that you disagree with. And I thought that was really important. So what I’ve done recently was follow the opposite side. So I kind of follow in, I suppose, more liberal. And so I’ve kind of focused kind of right wing politics as well. And I follow Fox News, for example, and just see what the other side was. So it’d be interesting to see how the other’s take and also looking at—I don’t know about your family, Rachel, but my family will be sending all sorts of things through WhatsApp and sharing things and I’m like, ‘Whoa, how did you get to that’? And then rather me just being dismissive and just saying, ‘Oh, that’s rubbish’, or ‘I don’t understand you. That’s wrong’.

For me, another thing that the documentary was actually take that time to Google it, to fact check it. And that that’s not just about, disseminating information that’s receiving information. So if I received something, rather than just me being dismissive, it’s like, ‘Well, actually, okay, let me just have a look at it’. I think one of my friends have sent me something, I just was so tempted to say, ‘Oh, this is really bad, why are you reading it’? I actually took a day or two, I kind of took some time, read that article, and kind of looked at the background articles. It’s formed from conspiracy theory, this was like COVID actually. It’s about vaccines and corporations and all that kind of stuff, and actually reading around it. And there was some elements, like many of these things, there’s elements of truth there, but then someone kind of just blows it up.

And then, so I think we all have a responsibility to look at what the other side is doing, because unfortunately, we don’t all look the same, we don’t all think the same. And so I think it’s important that we realize there are differing viewpoints, but unfortunately, our social media feeds tell us otherwise. So we just look at, and in that documentary saw that teenage boy just kind of going deeper and deeper into his own echo chamber, and listening to his own blogs and not—and then shutting out the world, which is very sad. He was shutting out going to football practice, or his family,and things like that. And I thought, it’s very easy to just go down your own rabbit hole.

And I’ve done it myself with social media. Even simple things like sport. I would be following—I’m a massive cricket fan. So I love England cricket, and following cricket sports, I mean, for years of test matches. And for years, I’ve just followed the English journalists and read their stuff. And I thought, ‘Well hang on a second. There’s lots of Australian writers that I know are really good’. And so I kind of follow them or read their books. And I just realised that a simple, simplistic way of looking at things that I thought that really helped me kind of articulate my views on cricket, and English performances, because I’ve just seen it through an English lens. Whereas I’m looking through an Australian lens, I’m looking through a kind of international lens of how other journalists can have—saw that performance. And so I think the same can be said about the way you look at news, I think you have to look at all different sides, and then make your own decision.

Rachel: Yes, I think and you made a good point earlier that when we were reading things in newspapers, do you remember the olden days in the doctor’s nest, where they subscribed all the newspapers? In your brain, can you reckon you could get through The Sun in about seven minutes, but you’d read this story. And you know it was in The Sun, so take it with a massive pinch of salt, but you know where the biases are? The Tory Graph, and that that’s what it is. And so you take that pinch of salt, you read The Guardian, but you know where the Daily Mail is coming from, you know where other things are coming from, and, you know what their biases are.

On social media, you generally—it’s not always obvious, is it? I mean, you can follow the different newspapers, and you could have got some idea, but a lot of these articles, it’s very, really insidious. And maybe we need to take more of an approach that we would be taking with the sort of, we would with medical evidence.

And I remember when we were teaching medical students about how to look things up, because we look things up these days online all the time as doctors. But actually what we need to be teaching—so teaching students not so much about remembering facts anymore. It’s about knowing where you’re getting your facts from and evaluating where they got those evidence from, so that we’re not applying that to the other stuff that we’re consuming as well.

James: Well, yes. And I think that that’s a really good point, because I think getting all the facts is so important. Now, for example, obviously, we’re doing a pandemic. Remember in March when the French Minister tweeted about ibuprofen, you remember that?

Rachel: Yes, yes, yes.

James: And so that spread like wildfire. I remember all the parents, Whatsapp groups, everything came on about, they were all—because I’m the resident GP in the Whatsapp group. And so, ‘James, what have you heard about it’? ‘I haven’t heard about it’. And suddenly now it became an issue where BNF and NHS England had to release a statement about it, but it all came from a tweet from a French Minister, unverified, about ibuprofen.

And there was a great piece by Sue Llewellyn in The BMJ in March of this year about the importance of spreading misinformation, and the importance of being careful of what seems to be expert advice. I think we as doctors have responsibility, or health care providers, whoever, have kind of passing on information. I think it’s really important going back to what you’re saying about getting all the facts before kind of sharing something. But it’s so easy, isn’t it, on these, like, especially Facebook, where you have to see a link and but one thing I’ve seen in Twitter, for example, recently, which I think is quite good, I think it’s a fairly new thing, correct me if I’m wrong.

I see an article from journalists, which I admire and respect. My immediate thinking is to share that article. But now it says, ‘Do you want to read the article first’? I’ll see the headline and like, ‘Oh, I’m really busy. Or,I’m kind of on the bus or whatever’. And I think that’s really good, because I have a tendency, and I know, I should put my hand up. ‘Oh, that Gemma, she’s really good. I’m just gonna share it anyway’. I know that just a bit. And I know that sounds awful. But I think we have a tendency just to kind of share something without reading the whole page. So you can read the topic. So I think that’s important. I think that’s a good feature that they’ve added to Twitter recently. So I think to kind of summarize your point is that I think it’s really important that we think—because as a doctor, I think about evidence-based all the time. And I think it’s really important that if we’re looking after our patient with evidence-based medicine, why are we not talking about information that we spread ourselves without kind of look at all the evidence and kind of look at all the facts?

Rachel: Yes yes. Because that’s what there is a dearth of in our societies is truth. Social media is full of alternative facts, and alternative news, which, like calling out lies, these are lies there, there is truth, and there are lies. And we are responsible for checking.

James: And I know one of my favourite news presenters on CNN, Jake Tapper. And he said, which I think really struck with me, he said that, ‘Truth is not a partisan issue’. And that sounds crazy saying it. But he’s got to the point that our politics both across the Atlantic, and here, where saying something which is the truth, people say, ‘Oh, you’re just kind of—you’re being—you’re Labour or your left wing or right wing’. ‘Actually no, this is a fact’. It has become so—and you talk about alternative facts, which kind of from the States, and that’s a lie.

So, unfortunately, we open that point where we don’t know, and unfortunately, with our social media feeds, we don’t know what is truth, and what is fact. Because a lot of these videos, which I saw—I think a video was sent to me, which was so well put together, Rachel, so well produced and graphics, and it was about COVID. I just thought, ‘This is false’. It just, it was all false. It was all kind of conspiracy theories. And like it was a homemade remedy for treating COVID. And I just, it was done really well, I can see that. If someone read that, I can see how they would think that was the truth. And they would think that.

And then sometimes patients come to me and say, ‘Oh, Doc, I saw this video, what do you think about it’? And I think it’s important, as I see it as my duty to kind of think, ‘Well, let me have a look at it. Let me read it. Let me kind of digest it. And I’ll get back to you on that’. Because I don’t think—sometimes in a 10 minute consultation, especially on telephone we don’t have time to do that. I do think that’s another obstacle. And that’s another skill we have to acquire as—with me as a GP, especially, as doctors, well, we have to kind of assimilate information in real time, and try and kind of relay the truth to our patients, especially when it comes to their own health.

Rachel: Yes, that’s interesting. And I think when you talk about sort of, truth isn’t a partisan issue. Absolutely not. And there’s truth, and there are opinions. And of course, you can have alternative opinions. And what maybe the difficulty is separating out what is truth and what is opinion. And that’s how we need to be quite canny and realize, ‘Ah, that’s an opinion’. That’s not the truth. That’s an opinion. The truth is factually what happened, like, did I walk across the road or not?

James: Yesh, absolutely. I think this is the problem that was social media were so polarized, and it’s becoming so tribalistic, as it says in documentary. It has become a real problem now, really, that we saw in Brexit a few years ago in this country, where families were kind of—I don’t wanna say torn apart. But families were arguing about different points of Brexit, meaning Brexit and remain and and I think that was a real—you saw it, then. And then obviously, I think I sort of feel with Brexit sign Benedict Cumberbatch again, that was using algorithms and using kind of Facebook again, and so I think there is dangers here, that it affects not only our social lives and what we like on Facebook, it affects our politics, it affects the way we view news, and also kind of the way we assimilate information.

And I think that’s—I mean, like you said before, it’s not all doom and gloom, Facebook and social media’s been amazing. The fact that you can raise money for charity really well, through Facebook. You can connect with others, you can sell things over Facebook as well. I sold one of my old CD players. It’s just one of those things where it’s, it’s great. You can connect with people, and it’s a real gift. Unfortunately, it can be used for ulterior motives, and we have to be aware of that.

Rachel: So, we’re running out of time, James, we could talk about this for ages. But if you have some top tips for people listening to this podcast about what they can do to manage it for themselves, their family, their own well being and also to avoid getting sucked into these echo chambers to sort of try and stop what’s going on, what would you say?

James: It’s good question. I think being aware of, kind of screen time usage and actually realizing there is a problem. I think many people don’t want to admit that there’s a screentime issue in their lives and that they’re using too much screen time. I think, for me, it came back. I recognized about a year ago or a year and a half ago, I realised I was too addicted to my phone and screen time. So actually recognizing it as a problem, I think first of all, for me was a big thing. So that would be my first top tip.

Second thing is try and prioritize what’s important for your family, especially during lockdown is whether my kids don’t have phones, but they have Kindles, and making sure that they’re not reliant on that kind of cutting down at times. And there is safeguards on these devices where you can kind of reduce the time as well. So there’s ways of doing it. But thinking about how our kids interact with one another, and whether that is through phones or social media, and especially for teenagers as well. I think it’s difficult, I think. I don’t want to say to stop it altogether. But I think, think about how you use your devices.

So we were talking about digital sweets and digital vegetables. I think that is my second tip. I think that it’s really important. For example, okay, if you don’t want your kids to go down to YouTube, kind of social media rabbit hole, why don’t you ask them, ‘Do you want to learn the guitar’? for example, and that you could do like a YouTube class did that. And I think that you’re still using the same platform, but you’re using it for something incredibly more productive. And I think that’s important. So thinking about how we use our devices properly. So that’s the second thing.

The third thing is just making sure that you’ve look after your well being and mental health really and ask yourself, ‘Are these devices really helping you with that’? Ask yourself these questions. And if you see, either yourself or family member becoming too reliant on it, or becoming an issue, I think that’s something that we need to recognize early on, really. We need to protect one another. Oh, I think he said three.

But the fourth thing I say, sorry, very quickly. The fourth thing I would say is that misinformation is a big problem amongst social media. So realizing, if you get something or you share something, making sure that you take that extra second to Google it, or to fact check it. And so I think we have incredible responsibility to guard the information that we share. And that the information we receive, we can’t do much about the things that we share onwards and forwards. I think that’s really important that we kind of, we talked about evidence-based making sure that we do our own fact checking, or we make sure we check the evidence. There might be bits of it that are right. But I think it’s easy to be dismissive. I think it’s important. If that means taking a bit longer to kind of make that decision or share that article or forward on that link that your cousin has shared with you. I think they can wait, I think it’s important that we take time for ourselves to make sure that we know what we’re sharing and how we’re using our social media platforms.

Rachel: Yes, thank you. My top tips are, well firstly, just turn it off. If your phone is outside, if you can charge it downstairs, when you’re upstairs, then you can’t actually get it, you’re not just going to reach it for it, when you want your quick bit of digital candy, you’re not going to be able to do that. So put it somewhere out of reach and turn it off.

Turn off your notifications as well. And I talked about this in the thing. If you’re constantly getting notifications on the front of your phone or on your computer that people have tagged to you, you’ve got a new message, or people like stuff, or then you’re going to keep going. So if you just turn off everything, then you can only, you’ll only go on social media when you want to when you decide to go over there and look at it. So that’s a really important thing. And I think putting a limit on your screen time. You’re saying, ‘What’s I want to spend the day’? It’s not necessarily bad, but how much time you spend on that digital candy is important. And then lastly, I would say, I think, help each other out. Me and my husband are trying to, and I can’t say it’s not really irritating, but trying to avoid ‘phubbing’ each other. So phubbing is phone snubbing.

James: I didn’t know what that was, okay.

Rachel: Phone snubbing. It’s quite difficult to challenge people and I was listening to a podcast that gave some good advice that has a challenge. So literally just say, ‘I see you on your phone, is everything okay’? That’s like, ‘I’ve noticed you are, but is everything okay? because I want to just like, check. You might be on it because there’s a crisis or something’. And I must say, it still irritates me. But it’s—when I know when he says it’s good intention, it’s saying, ‘You know I’ve noticed is everything okay? It’s just flagging up but I’ve noticed’, and I think that’s really helpful, though.

James: Yes, and I think that there’s a really good tip, Rachel. Thank you. I think it’s kind of putting it out of, out of sight is really important. I think that’s what’s helped me as well putting my phone away. As soon as I come into the house, I think I mentioned earlier before, that’s really helped me. I charge my phone and I make sure the charger is furthest away, or upstairs so I can—because if I have chargers all over the place, I know that I can see it and I can hear notification. So I think making sure that you put the charger strategically placed far away where you’re going to be. I think that’s really helpful for me as well.

Rachel: Yes. Great. So James, thank you so much for coming on the podcast. If people want to contact you, you’re on Twitter, and I’ll cite you.

James: Yes, so yes. These are good social media [49:56: inaudible]

Rachel: You can use it for good.

James: Yes. Exactly. So I’m @J and my surname JThambyrajah on Twitter, @JThambyrajah. Yes. And also do a lot of our faculty board member for Southwest Thames. So we do a lot of stuff in that area as well. So yes, that’s two ways to get hold of me.

Rachel: Brilliant. Great. Well, thank you so much for being on and we’ll have to get you back soon for another interesting topic. So have a great day. Thank you.

James: Thank you very much. Take care now. Bye.

Rachel: Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You Are Not A Frog email list and subscribe to the podcast. And if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this!

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