Discover and read the best of Twitter Threads about #SDOH

Most recents (24)

Thank you @ColleenKraft for being consistently vocal 💪🏼💪🏿💪🏽

Let’s work on #tweetiatrician #advocacy training by @AmerAcadPeds to have more robust & effective strategies vs increasing backlash & #bullying
as experienced by @NicoleB_MD @DrToddWo, worse for #minoritiesinmedicine
From @bfrist on #LinkedIn: concerning loss of scientific #integrity by political agendas

#scicomm teaching has been to “avoid politics” = sitting in sidelines

why engaged #tweetiatrician were a separate species apart from other #STEM professionals…
We need to be multidisciplinary like work with school nurse leader @RobinCogan

When I have taught official @AmerAcadPeds guidelines to trainees in hospital settings & staff member has walked by, they assumed “political” & “unprofessional” when per AAP
Read 20 tweets
Personal news: after 6 unforgettable years, I am stepping down from my leadership role at @NYCHealthSystem. Mixed emotions to say the least! But most of all I feel grateful to have served the mission of this extraordinary organization.
Please indulge me as I recount some of our proudest accomplishments on behalf of patients. Far and away the most important one was forging this amazing team—
Our vision was to build a better health system, one with a more proactive approach to addressing avoidable human suffering. More on what that means here:…
Read 16 tweets
Marketers hired by hospitals can be new source of exploitation

They know that the most credibility is with nurses & doctors

So will use employees for marketing & extension of hospital brand

But quick to penalize same employees for own, personal use of #SoMe

=Value extraction
I mean, personally, I built my reputation outside of hospital activities

I created, as volunteer, used no hospital or university resources, paid my own travel or obtained community grants, then yes, was recognized internally after creating external success, like this:
Or like this - I do all of this on own. No one trained me. I pay membership fees to LinkedIn

If I were to mess up, I’d need to deal with consequences from hospital, licensing bodies, etc

Wherever I go, I contribute to good optics & metrics…
Read 30 tweets
Umbereen S Nehal MD MPH: who is this person? Several people have been asking

A thread

Where am I from? Hooboy.
Let’s say, citizen of the world, human ping pong ball. Third culture kid. Genetic mutt

Born: 🇺🇸
🇵🇰 parents - when my parents born colonial rule, pre-Pakistan
To thoroughly annoy my Twitter bestie, @DrvanTilburg

Am an ENFP - a cross between Snoopy, Robin Willians, Ellen Degeneres, Dr. Seuss, Charles Dickens, Upton Sinclair

I border on ENTP - love new info and love to challenge in order to break through barriers or limitations
My great-grandfather was given title "Khan Bahadur" (brave). As a judge, a brown man under Colonial rule, he threw the book at a British attorney. "Learn the law" if in his courtroom. Hence my stiff moral backbone

My mom & me:

(She loves this song)
Read 52 tweets
“Dude. Is that old VW making your left leg bigger?”

Wait what?

Before my teammate pointed it out at cheer practice that day, I’d never noticed. But there it was. A defined, asymmetric bulging of my left quadriceps muscle compared to the right. It was undeniable.

Oh snap.
I was 16 and that ’69 VW Beetle was my 1st car. On the outside, it gleamed with a new candy-colored paint job. But on the inside? It was old and manual as manual could get. Only 4 speeds. And a clutch so tight that it called for herculean leg effort when shifting.

In those first few months of driving it, my left thigh would throb in pain every day. But the more I rolled around southern California in my bug, the easier it became. And eventually, the musculature of my nondominant leg would bulk up and adapt to that clutch.

Read 17 tweets
As an academic not caregiving for humans*, I'm stuck on how to offset this trend. I have a few below, curious what others think.…
1. An offer to women in my general area (#SDOH & #epitwitter, #macrosw, #gerontology / aging, LGBTQ health) to recommend me as a reviewer and I'll commit to doing quality, constructive, & timely reviews.
2. Respond to any review request with a link to this article and say that I'm willing to review for women 1st authors. This might unblind the review a bit, but <looks around> does that *really* matter right now? Maybe offer to do two for the price of one ask?
Read 8 tweets
1/Many of my colleagues and I have not been redeployed to the hospital during the #COVID pandemic. We have been doing the ambulatory care of pre/non hospitalized patients, helped w admitted pts and starting to see post discharge pts.

Many thoughts/advice points:

2/ First our #primarycare triage function in this process is crucial.

Workflows/teamwork/infrastructure have to be worked out and optimized.

An updated list of daily follow up #telehealth covid pts must be kept. Day of illness, daily update notes and tracking has to happen
3/ Key points:

Age, comorbidities matter. And yet, there are those healthier patients that get sicker, hypoxemic/stormy as well

Don’t completely know (like so much in this illness) the grouped likelihood ratios for the following but these are things to ask to be complete ..
Read 20 tweets
Nine homeless shelters in Toronto have outbreaks with 69 known cases. Public messaging has told us all to stay home. But what if you have no home? We are told to stay 2 metres away from people. But what if you sleep less than 2 metres away from other people every night? #COVID19
These are just the cases we know. While people in shelters are considered high risk for transmission and therefore a priority to test, people exp homelessness are also the least likely to be able to go to an assessment centre, stand in a long line, and await results. #covid19
People staying in shelters are more likely to have mental illness, cognitive concerns or use substances and at baseline have negative experiences with the healthcare system. If we really want this population to be tested, outreach is the only realistic way. #Covid_19 #topoli
Read 11 tweets
I'm a #LatinX physician, taking care of #LatinX patients with #COVID19.

I've been so surprised at how people are surprised by data showing #COVID19 is disproportionately affecting marginalized communities that till now I didn't know how to respond.

Some thoughts:

2/The implications of these #disparities run far deeper than simple differences in rates of morbidity and mortality. I applaud all of those shedding light on these #inequities, but we need action, and we need it now. @valstonemd @drlouiseivers #COVID19 #SDOH
3/A majority of our #EssentialWorkers, our #FrontLineHeroes, come from minority communities; these are the individuals putting themselves at risk to do the invisible work without which our society would collapse. @JoiaMukherjee #COVID19
Read 12 tweets
1/18 So. I just returned from working at an ED in Queens on the frontlines of the COVID response. I have so many thoughts and feelings that it seems impossible to summarize, but here are a few initial musings:
2/18 This shit is real and it is scary. COVID is taking patients down, and we do not know how to stop it. The images of overflowing EDs, overworked providers, patients who cannot breathe—these are real and it is happening. Do not let anyone tell you its not.
3/18 These are the lungs of a person who cannot breathe. We do not know (yet) how to fix these lungs. The not being able to breathe is terrifying. The not knowing how to fix it is terrifying.
Read 18 tweets
1 of my revered premed profs @HowardU once said to me and my classmates:

"Biochem without Genetics is $%#!; and Genetics without Biochem is $%#!"

I am now declaring that "A medical (& nursing, pharmacy, etc.) education without #SDOH & Racism/Bias in medicine is $%#!"
It doesn't matter if your 1st yr med student aces the test on how hemoglobinopathies are transmitted and result in the sickling of cells if you don't teach them that SC pts are victims of bias and racism in ERs across the country
3/ Nor does it matter students memorize the Krebs Cycle and how energy production in the presence of oxygen is more efficient if U don't help them realize that myocardial cells in Blacks vs White pts are more likely to die due to longer door-to-balloon times in "Black" hospitals
Read 9 tweets
COVID-19 is causing 2 (not 1) public health crises, and what we can do about the 2nd one (thread)...

The number of confirmed cases and deaths from COVID-19 is shocking and the growth rate is alarming.

But its clear now there is a 2nd global public health crisis developing.
The first crises - the COVID-19 pandemic. Caused by an infectious respiratory disease that is passed from person-to-person.

The second crises - the response to COVID-19 pandemic. Caused by changing the conditions in which we work, live & (the social determinants of health)
These two crises are inherently linked, yet the differences between them are stark.

COVID-19 results in physical illness that is apparent over a course of days or weeks. Its effects on health are direct. It can be measured. There is currently no vaccine.
Read 11 tweets
What Is to Be Done, Now?

“With #Coronavirus bearing down on our economy, we must mobilize all our resources now to survive—so that one day we may thrive.”… #SDoH #HiAP #Interdependence #COVID19 Image
Protect the vulnerable, advance the democratic economy...

“By standing together, in our work and our values and our communities, we are not alone.

From isolation but in solidarity...” #COVID19
“...this crisis also underscores another truth that only the left is willing to acknowledge & confront: The coronavirus is a tragedy not because the intense suffering it will cause is so exceptional, but because it isn’t.” #COVID19 #Interdependence #SDoH
Read 231 tweets
10 tips for caring for #immigrant & limited Eng prof pts during #COVID19. Created w physician experts in #languagebarriers. Full recs:…. 1- No shortcuts with interpreters. This is not time to “get by” w limited lang skills. Reinforce confidentiality. 1/7
2- Interpreted conversations often less #patientcentered. Ask about pt concerns & feasibility of recs. Dispel rumors. Inquire abt medicines/herbs or high-risk contacts (e.g. elderly parents at home, etc). If #COVID19 #isolation advised, explore open-ended❓about concerns 2/7
3- Highlight #publiccharge suspended for #COVID19 testing & treatment. Spread the word. #Greencard eligibility not jeopardized by seeking #COVID19 testing & treatment… 3/7
Read 7 tweets

Him: "I need to leave."
Me: "Can we talk about it more? I'm concerned that you aren't well enough to go yet."


Me: "Sir?"
Him: "I hear you. But I need to leave."
Me: "There's
some things happening with your body that could be life threatening and--"
Him: *interrupting me* "Listen. I know I need some more tests. And I know y'all think it would be best for me to stay."

*wipes face with his hand and sighs*

Him: "I get that."
Him: "But away from this hospital? I got a WHOLE LOT going on. And you know what? That shit is life threatening, too."
Me: *listening*
Him: "'Scuse my language."
Me: "It's ok."

He sighed again. Hard. Then he started looking around his bed.

Him: "I got to go, man."
Read 18 tweets
Feb @Health_Affairs is out!

We did a formal return on investment (ROI) analysis of the IMPaCT community health worker program using randomized controlled trial evidence.

Each dollar invested by Medicaid returns $2.47, annually.

@threadreaderapp unroll
This paper is important because most estimates of ROI from #SDOH programs are likely exaggerated because they are based on pre-post studies.
It’s important to note that IMPaCT is highly structured with fixed caseloads, clear hiring protocols and good supervision. I think those program elements are key to seeing this kind of financial return. So #hclrds, resist the impulse to skimp!
Read 7 tweets
Hey #medtwitter and #medstudenttwitter! A while ago, I gave a #dermatology presentation on the intersection of derm and #trans health.

I learned a lot. So here's a #medthread on some of the takeaways I found most valuable.

Let's start with our transfeminine pts.

Derm can provide a number of facial feminization procedures (FFP): e.g. botox, soft-tissue augmentation.

These FFPs can be more affordable/less invasive than feminizing surgeries such as forehead or mandibular contouring.

Note: tho traditionally considered "cosmetic", these interventions have MATERIAL psychosocial benefits – studies show that facial feminization has a demonstrated positive impact on QoL + mental health outcomes.

Read 10 tweets
A thread on some quotes from @gautambhatia88’s “The transformative constitution “In equality jurisprudence, the approach of focusing on the disproportionately exclusionary impact if politics rather than their formal character or motive is known as disparate impact”
“It is based on the premise that inequality and discrimination result not (only) from individual hostile acts, but from structures and institutions.” @gautambhatia88 Only in brackets important & added by me.
An test for entry may be “neutral” but yet exclude by aligning with exclusionary institutions; if an physical entrance test for firefighter includes activities not necessary for fulfilling duties and unintentionally poses #gender-barriers, deserves to be struck down. #NoteToSelf
Read 95 tweets
1/ So, today was a big day for @DrJRMarcelin and I. We've been developing curricula on "Structural Challenges & Inequities in Healthcare Delivery" for the @UNMCCOM M1 students as part of the Health Systems Science coil.

Thread on this #MedEd project + today's capstone 👇🏾
2/ With inspiration from @JonathanMetzl & Dr. Helena Hanson's work on #StructuralCompetency, we wanted to assemble a pilot set of experiences that would give @UNMC students a glimpse into local health inequities, from historical & community perspectives:
3/ We gave the M1s several introductory lectures & assignments focused on big-picture issues like #SDoH & disparities, creating a "structural DDx" for patients, unconscious #bias & #microaggressions, developing structural humility, and #racism in medicine...
Read 11 tweets
BEFORE READING THIS THREAD, do you think this statement is TRUE or FALSE?

Despite being a documented #epidemic for decades, @HHSGov's #CenterForDiseaseControl(@CDCgov) intentionally obstructs its collecting #statistics on what causes at least 10% of deaths NEEDLESSLY every year.

HINT: You already know of these systemic #DataScams due to #PublicCorruption & #RegulatoryCapture:

🤥#UScensus is maliciously biased

Thread coming soon about #CauseOfDeath #DataFraud

#AmericanSwamp #MedicalControlFraud

ANOTHER HINT: My inability to escape intrahospital, interhospital & health/disability insurers’ #ConspiracyAgainstRights using #MedicalControlFrauds exposes motive of the right answer.

Watch this video later to understand #PublicCorruption by example📽️
Read 43 tweets

I love to provide structure for my learners. A couple years ago I adopted a set of rules for rounds and ward teams. These continue to evolve.

I share them on day 1, and refer back to them frequently while on service.

#TeamRules #MedEd
What are your #teamrules?
Rule 1: We treat patients, not diseases or numbers.

Always always put the disease and number into context for that specific patient. And get to know the patient.

It’s good medicine, and makes the job so much more interesting.

#SDOH #IllnessInContext #EBM
Rule 2: Rounds are done by noon.

Come prepared and we will get the work done together

Stick with the 4 Ds - decompensated, discharges, diagnostic dilemmas, the C Diff patients last. Stop wherever we are at 11:30 and finish running the list.

HT @thecurbsiders ep157

Read 7 tweets
New @NASEM_Health @theNAMedicine report “Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health” #SocialCare

full report:

Summary in @JAMA_current

My THREAD 1/18
Great committee of outstanding experts in medicine, public health, social work, healthcare financing, digital platforms, implementation sciences, nursing, law, gerontology, health equity #SocialCare cc: @djmasonrn @KedarMate @LisaCooperMD @KBDeSalvo (2/18)
Why this topic?

⬆️ healthcare spending, but outcomes lag

⬆️ focus on healthcare value

Social factors ▶️ health, but not necessarily addressed in healthcare

⬆️ activity integrating social care into healthcare -> need framework to design/evaluate/improve #SocialCare (3/18)
Read 19 tweets
The recognition of the political nature of health & appreciation of the political determinants of health are key to better understanding despair & health inequality, as well as our shared responsibility to ensure the conditions under which people can enjoy hope & health equity. Image
The decline in life expectancy is occurring in part due to deaths from despair. From 2007 - 2017, the mortality rate from drug overdoses increased 82% while suicide rates increased 24%.

Many problems associated with poor health stem from lower incomes.
“ is essential to rethink the hegemonic discourse of the right to health so that it becomes a first-class human right intrinsically coupled to the other social, political and economic rights.”

Benach, et al. 2019 #SDoH #HiAP…
Read 175 tweets
#TRIBECON begins #Pravara; felicitations to #AbhayBang @SearchGad & #sudarshan #VGKK for their inspiring work on #TribalHealth; @DrLahariya @whoindia among others felicitated
#abhayBang #healthsystem design for tribal communities need to be relooked for #UHC; strategies & schemes must adapt with local social & cultural context; recollects #Brainstorming with @DesirajuKeshav at @SearchGad leading to #ExpertCommittee #tribalhealth @TribalHealthIND
#TRIBECON #AbhayBang notes with happiness increasing interest in #tribalhealth research, yet this continues to be “off the beaten path”; congratulations to #pravara medical college in bringing this together; the proposed #Bandardhara declaration to improve #tribalhealth research
Read 81 tweets

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