Discover and read the best of Twitter Threads about #Pediatrician

Most recents (24)

Beth Steckler (she/her)

@purplemamabear

Thread 🧵: Reflections of a Parent/Caregiver After Six Years Implementation of CDC Guidelines (warning long but I am very interested in feedback)

Since babies, my kids, have intimately known #pain. At one time their #pain was intermittent & #acute. Sadly, they now struggle 1/

#chronicpain & are young adults. Our kids 1st 13/16 years of life, our family had a #safetynet, their #pediatrician. He was highly intelligent, compassionate, he challenged the system & in the most authentic sense #partnered with families. #Pain was not a major concern when 2/

the kids were under his care. The nature of their disease often brought us to the ER & hospitalizations. The hospitalizations resulted due to inability to manage #pain, dehydration, & other issues caused by a flare in their #disease. My husband & I attempted to minimize the 3/

Dr. Venky Soundararajan

@DrVenkySoundar

High levels of an #infection in #Massachusetts is causing both gastrointestinal (#diarrhoea, #vomiting) & respiratory (#cough, #sinus, #headache) symptoms WITHOUT typical fever or runny nose - School children & parents/guardians across #boston suburbs affected for last 3 weeks.

Note the CDC data suggests very little SARS-CoV-2 (Omicron) or influenza (flu) at this time in Massachusetts or Connecticut or New Hampshire. So diagnostic tests being used are not catching this circulating pathogen, or a seasonal coronavirus/norovirus/adenovirus is the culprit

According to the data on SARS-CoV-2-positive PCR tests there is very low levels of COVID-19 over last 3 weeks in Massachusetts, CT, NH, RI & VT. Yet there are several #school #children, #teachers and #parents with gastrointestinal & respiratory #infection symptoms in these states

I got home this morning after an overnight shift in the pediatric emergency department.

I rarely share personal reflections based on my clinical work as a #pediatrician via @twitter, but I'm allowing myself this exception.

#omicron #COVID19Qc #N95sForAll

A thread 🧵 1/21...

2/ I started my winter holiday stretch of shifts by working on #Christmas evening and finished it by ringing in the #NewYear last night while taking care of sick & injured children with a phenomenal (but overworked & somewhat demoralized team) at the children's hospital.

3/ Let me re-iterate at the outset that I've always been opposed to @francoislegault @coalitionavenir's imposition of the #curfew because of its harmful impacts on many of the most marginalized people in society.
cbc.ca/news/canada/mo…

Umbereen S. Nehal, MD, MPH

I am trying to understand this response. Yes, #mentalhealth access is very limited & victims of abuse or domestic violence are at risk: ~3 women are killed daily by domestic violence.

Generational trauma can create perpetrators in subsequent generations. #GhislaineMaxwell

https://twitter.com/wolodya/status/1476704417676156932

As a #pediatrician I have one signed papers & worked with authorities to evaluate a family situation, even remove children from a home.

Working in #emergencymedicine we also had children boarding for days due to lack of access.

Access *is* limited.

wbur.org/news/2021/02/0…

As I learned more about disparities & social justice & bias, I began to understand that *the system* is the source of “broken” Black & brown families, criminalizing certain parenting while much worse is *not* identified in privileged families.

time.com/5946929/child-…

Umbereen S. Nehal, MD, MPH

Those of us with immigrant backgrounds have NO idea what debt we owe these women for risking their lives so some of us can shop at Whole Foods with other suburban moms, then drive a Lexus home to ride on a Peloton, & think only our own hard work created this access to success.

https://twitter.com/docrocktex26/status/1469523289248780290

Those of us who are Muslim have a partial experience of what it is like to be made the face of threat and danger and vilified.

…But “the West “still wants to “save” Muslim women… make us a token or mascot of saviorism & evidence of being a shining city on the hill.

https://twitter.com/repbowman/status/1466516209864695818

In comparison, the black woman doesn’t have that opportunity to be paraded around as the most recent woman “saved” & celebrated - the tropes are universally harmful & exploitative/pejorative vs Black women in society/media + centuries of economic barriers/being exploited.

Umbereen S. Nehal, MD, MPH

I only became certified as an executive #coach as I experience SUCH bad coaching...I can't even begin to describe all the levels of wrong. But this is one of those times (a lot of my life) when someone harmed (on my dime no less) then I was motivated to create something better

A part of me was like yeah, yeah, yeah..I know this stuff...hurry up and give me the darn certificate. But.... I have to say, I see myself changing in practice sessions: able to not tell/be a consultant but open up space, listen, reflect THEIR words, then get them to go deeper.

I see SO many bad...like harmful bad..coaches out there...who beat you up to try to motivate you while also talking of compassion. *sigh*

I am learning that I care SO much about #safety (which I knew) - it is the trigger when I fail to be a coach and become ED doc/pediatrician

Dr. Katharine Smart

@KatharineSmart

1/ With #Vaccines approved for 👧🏽👦🏾 5-11 yo parents have a decision to make. #Omicron reminds us we aren’t through this yet.

As a #Pediatrician I have spent my career helping parents make health care decisions about their kids. This🧵is about #risk and the decision to #Vaccinate

2/ The decision to #Vaccinate means you believe the benefit outweighs the risk - so let’s break it down starting with- what #risk does #Covid19 pose to our #kids?

3/ Acute risk in 5-11 yo from 🇨🇦 data:

Hospitalizations 🏥 in 0.2%
Death in 0.002%
#LongCovid in 2-5% (still learning)
#MIS-C 1/3500 cases (most common in 5-11 age group)

Let’s remember kids rarely die so this is on par with other diseases we prevent with #vaccination

Rebekah Diamond MD

@rebekah_diamond

I keep seeing hot takes on how covid affects kids + if it’s dangerous for them.

But amazingly there’s still a striking shortage of pediatrician voices given the opportunity to provide our nuanced and expert opinion.

What would we say if you asked us?

A thread 🧵

Pediatricians have a lot to say about the covid in kids, how to balance the risks and benefits of exposure, and how to make personal + public health decisions that prioritize the needs of children.

What would we say if asked how dangerous covid is for kids?

We’d ditch glib mortality statistics that dress up data as science + paint a more complicated picture.

We’d reassure you that children continue to mostly do well with acute covid. We’d then explain that deaths + hospitalization from acute covid are just part of the equation.

Umbereen S. Nehal, MD, MPH

Word “racism” silenced, actively, by #MedEd #MedTwitter #healthcare “#professionalism” & “communication” labels

Saying “racism” offends or “hurts feelings” > actual #BLM deaths

If #professionalism itself is racist -makes sense that word suppressed
@FutureDocs

https://twitter.com/FutureDocs/status/1385228009473515523

What @ayshakhoury experienced pushes out & silences many

If the editors of @JAMA_current resist hearing word “structural racism” then they certainly are not publishing papers using that word

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest

Journal gatekeeping: men
Behavior gatekeeping: women/HR

#accountability only for white men
-> we miss “Amy Cooper” in #academia, #HR, #professionalism #compliance

insidehighered.com/advice/2020/06…

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest

Umbereen S. Nehal, MD, MPH

Accountability

Flowers, I will go see she said.

Headed to Esplanade (cuz this photo alone would check a box but would actually be cheating - the power of “optics” or manufactured data whose lives & careers are Twitter).

Question everything you see
See like a #pediatrician

I shall see from a new perspective she said - I will cross on the other side.

(Actually, I wanted to be on the other side but would have to walk a block to cross so, fine, I’ll cross on this side. Bah humbug).

I shall admire the barely born green hope unfurling into the crisp Spring air, fragile yet #resilient, she said

(Yay #Science and @museumofscience #BostonStrong #Boston ... and yes, and requisite monuments to male anatomy and war as well)

Umbereen S. Nehal, MD, MPH

I would say that society is at fault. The government was not behind Jenny McCarthy, Oprah, Dr. Oz, etc.
#vaccine #VaccinesSaveLives #VaccinesWork #MedTwitter #ScienceTwitter

https://twitter.com/peterhotez/status/1382355746147467267

What the government DID do wrong: “#security” & espionage via vaccines Frankenstein monster unleashed on Muslims

If the US government does do things like this it’s not a “#conspiracy”

...all while what led to #CapitolRiots was brewing 🤦🏻‍♀️

@PeterHotez

npr.org/sections/thetw…

If Prius-driving Whole Foods-consuming suburbanites would STOP #misinformation #disinformation to #trauma ridden #refugee populations

(trauma->fear)

the jobs of minority & Muslim doctors would not be so hard

This is lack of *societal* control
of the most privileged
who HARM

https://twitter.com/usnehal/status/1255218923529744387

Umbereen S. Nehal, MD, MPH

In light of the Boston police Union leader child abuse, this is very plausible, even probable. I have 2x, on behalf of someone else, reported, via Title IX - the woman or gay man was not feeling safe enuf to report. Yes, there is blowback when one reports. But we can’t be silent.

https://twitter.com/shades_dirty/status/1382159562980143105

I am a mandated reporter as a #pediatrician. I *must* report for my patients or face legal consequences. Am same for staff, students, trainees. But in #EmergencyMedicine who do I call if a child may be unsafe at home? Sometimes, cops. Are cops safe?

boston.com/news/local-new…

I have seen #mentalhealth and entire life paths destroyed by abusers preying on children like: This happened to too many people I know. I have seen institutions intimidate, mislabel, bury stories of the victims. (Some predators wait until 18th birthday.)

nytimes.com/2017/08/07/nyr…

Umbereen S. Nehal, MD, MPH

If you study #vaccine + #sideeffect... you automatically cross into #healthcare & #medicine regardless of what other label applied

I'm a #vaccineswork #vaccinessavelives #pediatrician & #tweetiatrician careful on #data #quality particularly for women, WOC, POC

This is my lane

Every seeming kind of "not a big deal" thing related to #vaccineswork blows up in our faces like death threats via online mobs against #pediatrician #SciComm

May seem extreme but take a look at the escalation of responses to my identifying "bad #data"

medpagetoday.com/special-report…

We can't wait for yet more false "vaccines affect (THEY DO NOT) fertility" trope to circulate

anyone who is generating data on #vaccine "#sideeffects" needs to think about clean, quality, meaningful data. Junk data: common, but this actually matters

healthline.com/health-news/no…

Umbereen S. Nehal, MD, MPH

Peak Twitter. Woman w/ stage 4 #endometriosis, #fibroids, latter condition more common in WOC, post 2 gyn surgeries

identifies online #womenshealth #vaccine #survey as poor #data #quality

instead of improving, response ~ "not to attack... but am glad you are not my doctor"

Indeed, I engage patients & families 1:1 without forcing them into fields I've pre-created for my #data collection, based on assumptions I have from personal experience

Respecting women & WOC allows people to not be forced into leading questions or pre-created fields

Measuring needs to be #quality to deliver quality. Your #results will never be better than your #studydesign or collection methods. Wrote this cuz we need less measurement & more humanity. I'm in b-school & everyone sends a new survey every 30 sec..
journals.sagepub.com/doi/abs/10.117…

Umbereen S. Nehal, MD, MPH

When people who seek control
and who monetize fear

are faced with evidence their narrative of control is false

rather than embrace reality
(or develop courage)
they double down

At times of high stress you see bizarre overpolicing & bullying increase over petty non-issues.

There is a gender difference in bullying tactics.
Men: physical
Women: social (exclusion)

Later looks/sounds like
“Don’t talk to her”
“Club”
“No one likes you”

(Yes, really adults resort to grade school tactics)

Faculty/teachers need to stay aware:

apa.org/topics/bullyin…

Whereas adults are taught “just shake it off” or “ignore it”, students or children are especially vulnerable to faculty or teacher over-policing.

This over-policing starts not just in preschool but in the cradle.

“The police” in schools: teachers.

txicfw.socialwork.utexas.edu/4-things-you-n…

Umbereen S. Nehal, MD, MPH

"As QAnon influencers and their followers are pushed off mainstream platforms.... There, they may be exposed to more extremist content, like that of white supremacist and neo-Nazi groups."

So what is the right approach? No right answers.

npr.org/2021/01/31/962…

..soooo.. usually seek facts & ideas ...rather than go down rabbit holes of others’ 🤯

..but wow, some remaining QAnon-posting accounts are within 1-2 degrees of separation..

To FB’s credit, misinformation/disinformation posts get covered with a grey filter & this warning:

Since I am a Muslim woman on the highly armed alt right’s radar myself now

am curious to understand what kind of 👹 they perceive me to be - tho prefer to only a quick peek, not a deep dive

(Obviously @IlhanMN was not actually at any such training camp)

usatoday.com/story/news/fac…

Umbereen S. Nehal, MD, MPH

Frankly every single person has some kind of privilege. If you have sight or two functioning legs you lack certain barriers

Acknowledging the same about structural racism is not insulting

unless you have cultural chauvinism/superiority & believe your own culture faultless

https://twitter.com/jerrysoucyrn/status/1345093301465214978

Personally, as someone Muslim, what I was taught about my purpose on this earth is the every single thing I “have” is only loaned to me and nothing I am entitled to.

You have to pay interest on loans.

More you have, more you must give (back).

Of course I face barriers too.

I don’t talk about religion a lot. I am deeply spiritual. I do believe Islam is “a way of life.”

I am less worried about reciting the exact right dua/prayer when stepping in a room with the correct foot.

Hadith can be disputed but this one is beautiful. Mercy matters most.

Umbereen S. Nehal, MD, MPH

Yes, the #vaccine rollout is slow, uneven, not matched to need. "Botched"? That is a bit too strong. Much blame to go around.

American #healthcare is built for silos, turf, acute care, reactive..not #populationhealth #publichealth #prevention. It shows. Why is anyone surprised?

And #MedTwitter, despite your hashtags & publications, when it comes to real life actions inside departments, hospitals, or even on Twitter, all you all do is turf, ego, cliques, us vs them, etc. I am unimpressed. Build *systems* Yes #impostersyndrome makes you crave validation.

I am a #pediatrician and if you need validation, I've got a whole box of stickers for you. I will even let you choose your own sticker. How is that? Because, yes, you are special. You matter. You are wonderful. Happy?

Then after that, could we get 💩 done?

Umbereen S. Nehal, MD, MPH

Hear, hear

As a confident WOC willing to enter male dominated, non-diverse spaces (women >20% of my class & rare in tech)

I hear from men and women:
I take up too much space, I talk too much, etc, etc.

If invited 6x to podcasts in 2019, is that "too much"?
Who decides?

https://twitter.com/DrvanTilburg/status/1316390019578368001

In the marketplace of ideas, lack of women o BIPOC in a space, what is the metric of too much/little? A recent thread on leadership coaching specific to #WIM: importance of having manners if one wants a seat at the table

How about results as the metric?
nehalgroup.com/news

I'm successful as an advocate, having been a Health Advocate of the Year in 2012 by @Drsforamerica in 2012. Part of being an advocate is bringing issues to the forefront that may not be the priority of decision makers. One communicates on it (albeit, at times, relentlessly)

Umbereen S. Nehal, MD, MPH

This

@bruce_y_lee succinctly says what I lay out in multi-tweet threads

This is it in a nutshell

Divide and conquer is as old as time. Ask anyone whose history includes being colonized

#Healthcare is 1/5th of the U.S. economy. You bet non-clinicians want a piece of that

https://twitter.com/bruce_y_lee/status/1303690214817386499

If you are someone who touches patients, has ever touched patients, provides direct care, has any clinical background, I'll be totally frank, I respect your role. If your salary adds to the 30% administrative overhead of #healthare in America, then I have questions about #value.

This is a framework my coauthors and I offered on how to assess value and cut waste. Let's start with administrative burden. What exactly do you get paid to do in #healthcare? (we should be asking) What does your job do to deliver on the quadruple aim?

journals.sagepub.com/doi/abs/10.117…

Umbereen S. Nehal, MD, MPH

Wish me luck!!! Taking my financial accounting exam today. Though am taking the class pass/fail, the exam is a large part of my grade. Thing with exec education: you do have to try hard to fail. But having realized that, I cut it closer and closer

Okay, have always been this way

My whole life is game theory. I end up figuring out the rules and the winning strategy and then I put just the right effort needed to "win", unless I just adore the subject cuz once I focus, OMG, it is laser focus and intense and deep. That's the way I've always been.

Which basically is the description of a high functioning woman with ADHD and why I tend to violate expectations of women, be out of box, innovate, strategize, rather than be linear in ticking off boxes in the right order and staying within boxes others draw. Nope. Not me.

Umbereen S. Nehal, MD, MPH

A word to you ladies & femmes who are looking to advance equity:

Highly recommend studying cultures were women have historically held power, to understand use of power

I found this extremely informative, both on power & for my own cultural roots

m.startribune.com/daughters-kept…

A key attribute was that these women were daughters in tribal culture, therefore more trusted than an outsider

That can mean your university or company network, even religious group. For instance, Dr. Birx is evangelical as are current health advisors

khn.org/news/religious…

You still have to be qualified.
But final cut: usually “in group” gets in + staying power

“Group” can be defined in various ways. Options for me: #publichealth, #pediatrician, #communityhealth etc.

Know which groups have internal competition & dysfunction (Doctors, Academics)

Sapna Kudchadkar, MD, PhD 👩🏽‍⚕️

Every summer my heart is heavy with memories of a time when I even came close to leaving #medicine-when career & motherhood collided and I didn’t ask for help.

I want to share that story in case it helps even 1 person.(Thread) #medtwitter #meded #womeninmedicine #TipsForNewDocs

I share this now because July is full of #tipsfornewdocs but August comes & we all get swallowed up in the hustle & bustle of heavy clinical loads- when orientation ends and the real work begins.

I had just finished #pediatric residency and started #anesthesia residency with a 6 month old baby. Orientation was over & we were deployed to do our first cases in the OR without an attending always in the room with us.

Marguerite Duane

Another true #DPC for the win story... Friday morning I saw a @MMMedCare patient at a school event. “I’m so glad to see you as I need to talk to you about my 5yo. For a month he has been complaining of increased thirst, so I checked his blood sugar an hour ago & it was 289!” 1/?

Child has no history of #diabetes & generally is in good health. Only other sxs -increased hunger & bed wetting. No vomiting, no confusion. Mom had checked own BS & a siblings & both were normal so it was unlikely machine error. Normally new, random BS of 289 =trip to ER
#DPC 2/?

We were at school to watch our children in a performance & her son appeared well. Still with a blood sugar of 289 after fasting all night, I knew he needed immediate follow-up so I said I should see him right after. As we left school his only complaint was “I’m hungry” #DPC 3/?