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Arghavan Salles, MD, PhD Profile picture
@arghavan_salles
Aug 18, 2019 • 15 tweets • 4 min read • Read on X
Observing Twitter over the past few years, I’ve been concerned about how quickly people jump to judgment and condemn others. I did it, myself, with that doctor in Texas who said unfortunate, embarrassing things about women in medicine.

1/
Then I listened to a podcast from @NPR on call-out culture, and it really changed the way I view these moments. This op-ed from @LorettaJRoss has some important insights that I want to share.

2/
“Call-outs are justified to challenge provocateurs who deliberately hurt others, or for powerful people beyond our reach. Effectively criticizing such people is an important tactic for achieving justice. But most public shaming is horizontal...”

3/
“... and done by those who believe they have greater integrity or more sophisticated analyses. They become the self-appointed guardians of political purity.”

4/
This, to me, is the heart of the problem with pouncing on people the second they say something gauche:

“Call-outs make people fearful of being targeted. People avoid meaningful conversations when hypervigilant perfectionists point out apparent mistakes, feeding...”

5/
“...the cannibalistic maw of the cancel culture. Shaming people for when they “woke up” presupposes rigid political standards for acceptable discourse and enlists others to pile on. Sometimes it’s just ruthless hazing.”

6/
Honestly there are times I don’t contribute or respond bc I don’t want to say something “wrong.” I’m about as liberal a person as there is in the US. But I also only have my own perspective and experiences, and these are limited. I am so afraid of offending unintentionally...

7/
That when I’m not quite sure, I just stay quiet. Of course, who cares about whether I get to chime in? That’s not the point. The point is then I don’t learn, understand, grow.

8/
That is the true cost of call-out culture. Sure, there are people who are racist, sexist, transphobic, etc. And maybe they do deserve to be held to task. But this culture also prohibits the engagement of a far larger group of people, I think: those who want to...
Contribute, learn, grow, do better. The potential allies. But call-our culture freezes them out. So, I agree completely with @LorettaJRoss that we need to welcome conversations, especially uncomfortable ones, if we are to make any progress.

10/
Some of you out there are doing this. You are gifts to the world. I’ve had convos in DMs with some of you and we have tag teamed lowering the temperature of a convo to prevent it from boiling over. Thank you.

11/
Please also hold me accountable. Call-ins, done with love as @LorettaJRoss says, are a gift. I’m here for it.

In our search for social justice, let’s help each other push forward rather than climbing up, shoving others down as we go. 🙏

12/12
Here is @LorettaJRoss’s article:

nytimes.com/2019/08/17/opi…
And this is the @NPR @NPRinvisibilia podcast:

npr.org/2018/04/13/601…
Here is an interesting opposing view:

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More from @arghavan_salles

Arghavan Salles, MD, PhD Profile picture
Sep 26
I’m seeing a lot of med student match posts, so I might as well share what I wish I’d considered when I was a student.

1. One of things I loved about general surgery was that we were the ones people called when they didn’t know what else to do. This felt very badass. What +
…I didn’t consider was that being needed means being available. When you do a month or two of general surgery call as a medical student, it’s impossible to extrapolate how that will feel month after month, year after year. It is exhausting and can be demoralizing +
…depending on the context and the support you have (or lack thereof).

2. 7 years is a long time. At that point in my life there wasn’t anything I’d done for 7 years. I’d never even lived in the same place for that long. I had no concept of what I was signing up for. +
Read 13 tweets
Arghavan Salles, MD, PhD Profile picture
May 28
I signed up for the "n0n-w0ke" impl!cit b!as training. Follow along if interested!

It looks like Part 1 is about 42 mins or so and starts with an overview. Notice there are no references for the bold assertions on the right. Screenshot of a slide that says "Key points: Part 1 -Requirements for Michigan implicit bias training -"Implicit bias" defined -The Implicit Association Test 9IAT): what does the evidence say? -"Health equity" and "equitable access to care" -How Critical Race Theory (CRT) relates to implicit bias in healthcare a box on the right says, "Did you know? Politicized healthcare means more discrimination, less personalized care, and less innovation that saves lives."
Lol off to a great start as they say "Do No Harm" was established to "restore merit to healthcare," a phrase that is problematic for many reasons, including the implication that healthcare was ever meritocratic (it was not).
Their stated goal is to keep "identity politics" out of healthcare, which is 1 way of saying they want to pretend everyone is treated the same and has the same opportunities even though that's not true.

I know this is petty, but there's an extra space before "renewals" Screenshot of a slide that says "Michigan Implicit Bias Training Requirements": New applicants: 2 hours of implicit bias training in the 5 years preceding your application; Renewals: one hour of training for each year of your license cycle
Read 18 tweets
Arghavan Salles, MD, PhD Profile picture
Apr 9
The problem isn’t false accusations. It’s that men refuse to acknowledge rape. “They [rapists] had absolutely no sense of themselves as rapists and were only too happy to talk about their sexual behaviors.”

Based on a study of rapists, as described in Missoula by Jon Krakauer.🧵 The participants in the study had no qualms about being research subjects, Lisak told me, "because they share this common idea that a rapist is a guy in a ski mask, wielding a knife, who drags women into the bushes. But these undetected rapists don't wear masks or wield knives or drag women into the bushes. So they had absolutely no sense of themselves as rapists and were only too happy to talk about their sexual behaviors." Most of the student rapists interviewed by Lisak were regarded by their peers as nice guys who would never rape anyone, and regarded themselves the same way.
They are too entitled and self-centered to see the harm they cause. The serial rapist hidden in plain sight among us, isak explained, "harbor all the usual myths and misconceptions about rape. Adi. tionally, we now have data showing they are more narcissistic than average. So they are caught up in their own worldview. They lack the ability to see what they do from the perspective of their vic-tims. It's not like they've spent any time thinking about what it would be like to be passed out and wake up to someone raping you. It's not like they've ever asked themselves, 'How would I feel if I fell asleep, someone climbed on top of me, and penetrated me wit...
“It pissed me off that she played along the whole way and then decided to squirm out of it…I mean, she was so plastered that she probably didn’t know what was going on, anyway.”

It’s sad this has to be said, but if she doesn’t know what’s going on, she can’t consent.
She was really woozy by this time. So I brought up another drink, you know, and sat her down on one of the beds, sat down next to her, and pretty soon I just made my move. I don't remember exactly what I did first. I probably, you know, leaned her down on the bed, started working on her clothes, feeling her up. ... I started working her blouse off. ... At some point she started saying things like ... I don't want to do this right away, or something like that. I just kept working on her clothes, ... and she started squirming. But that actually helped, because her blouse came off easier. And ...
Lisak's interview with Frank was typical of the interviews he did wich other rapists. In a part of the interview not included above, Lisak told me, Frank "actually described two other rapes he did, under almost exactly the same circumstances, except the two other victims were unconscious from alcohol at the time. And Frank had no idea that what he was describing to me were acts of rape." Predators like Frank get away with it over and over, Lisak explained, because most of us are in denial. We're disinclined to believe that someone who's an attentive student or a congenial athlete ...
Read 4 tweets
Arghavan Salles, MD, PhD Profile picture
Dec 16, 2023
The pandemic has been so badly bungled that people don’t know if they have Covid, don’t care if they have Covid, don’t know when to test for Covid…what are we doing here??

My mom just tested positive for Covid and wouldn’t have known if I hadn’t told her to test again… Photo of a positive Covid test and a text message that says “positive”
…She had tested the first day of symptoms and was negative. I told her to test again, and bam, positive.

A family friend got Covid around Thanksgiving. I told her she should keep testing even after she feels better bc of rebound and how long some people stay positive…
…She had taken paxlovid and started to feel better. Then, symptoms came back and bam, she was positive again.

These are smart people who follow the news. My mom didn’t know to test again, family friend didn’t know about paxlovid rebound…
Read 5 tweets
Arghavan Salles, MD, PhD Profile picture
Aug 25, 2023
We don’t talk enough about coercion in healthcare. I just had a procedure I did not want to have because I was forced to do so in order to move forward with IVF. I stated multiple times I would accept the risk of foregoing the procedure. (The risk, as far as I can tell, is…
…perhaps slightly lower success rate for implantation.) I invoked shared-decision making and bodily autonomy to no avail. I was reassured, in the classic paternalistic medicine way, that this was in my best interests.

I am a 43-year-old physician. If my doctor doesn’t think…
…I am competent and capable of making decisions about what’s in my best interest, do they think anyone is?

So today when the PA wanted to confirm that I wanted to move forward with the procedure, I told her the truth: No, I did not want to have the procedure, but…
Read 11 tweets
Arghavan Salles, MD, PhD Profile picture
Jul 19, 2023
Did you know up to 200 women at Yale’s fertility center were forced to undergo egg retrievals without narcotics? These procedures are typically done under heavy sedation, but these women were awake enough to talk; one even told them she was alert enough to drive. These women…
…were in pain, and they were brushed off. A nurse in the clinic had swapped out fentanyl for saline in hundreds of syringes. So for FIVE MONTHS women had these horrific experiences. They told their doctors, but nothing was done. One of the women recalls her doctor saying…
…only that he was “perplexed” and “surprised.” Without another explanation, some of the women were convinced it was their own fault; they must not be sensitive to fentanyl.

The patients weren’t aware of the fentanyl swap, but they knew something was wrong. One of them said…
Read 10 tweets

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