Umbereen S Nehal, MD, MPH Profile picture
Sep 8, 2020 8 tweets 4 min read Read on X
To clarify, yes, aware there is a legislative battle going on. When at work, need to be effective in a team - be careful on escalating “us v them” narrative. Outcomes are driven by systems & culture. Neither newer entrants nor old guard have full answer to access or quality.
No matter what I tweet, also, am sure some term or phrasing will offend. Am in b-school right now so using b-school terms. Medicine and nursing are both old and noble professions but also fraught with scandal and controversy, sexism and racism. No one has moral superiority here. ImageImageImageImage
Access has a lot to unpack, as does quality. Does patients (us all) a disservice when these bandied about for escalating emotional reactions as trigger words as opposed to being thoughtful on policy, frameworks, systems

Sadly politicians respond to the so-called “Karen” approach
We have a fragmented system without coordination or whole person care. We all are burnt out. So much of healthcare is about 💴 power, turf, ego, false narratives. The main divisions I see on access and quality are by race, disability, LGBTQ, insurance status, undocumented, etc.
As a former CMO of 14 center, $100m FQHC, was a daily struggle to staff for safe care & access. I had grandiose ideas of building community programs, addressing burnout & morale, writing grants. Instead, daily fire drill of just keeping centers open and not canceling appts.
I was coming from Boston, @harvardmed @HarvardChanSPH and also @The_BMC and @EBNHC but was massively unprepared for the difference between FQHCs in #Boston vs #NYC and different culture of healthcare. At EBNHC was still working with former colleagues from @BostonChildrens
It changed my ideas on what is needed for staffing. If you are NOT living the daily fire drill, literal at times (manhole explodes in Harlem & smokes out adjacent buildings, including a clinic), if you are not doing the work, stop talking down to the WOC clinicians doing the work
It is easy to sit in your ivory tower or private practice & issue “commandments” or proclamations or create an army of online warriors or play mind games with “optics” as to who is a victim. Just get in the trenches. Get your hands dirty. Get bloodied. Accept liability. Be real.

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More from @usnehal

May 29, 2023
This. When I had experiencing #bullying towards myself, I had just walked away or been silent, keep moving forward.

Once I had some degree of “rank”, felt others should not “just deal”

I did speak up on behalf of those less powerful… which only set me up for this mislabeling.
That is not to say that as faculty you should not speak up for or defend students are trainees

but you should be aware of this.

If the #bully is a woman, then she can always claim that she is being “attacked”… “as a woman”

That narrative aligns with a common reality.
False narratives spread quickly

if they align with something that people recognize as a truth (& may even have experienced themselves)

This is particularly why Machiavellian types are strategic/smart to utilize/promote a female bully while they stay more quiet/behind scenes
Read 13 tweets
Jun 24, 2022
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte All of this was already tested out vs American Muslims - the country was just fine with it. Regardless of what you think of the dad, killing/executing American citizen children by drone, along with father, should have been a big red flag on due process.

theatlantic.com/politics/archi…
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte ~Half of Americans approve of/support torture. The idea is you can use profiling/bias to assume someone is a terrorist or sympathizes with terrorists, assume has information, torture them first, then retroactively justify violation of human rights.

pewresearch.org/fact-tank/2017…
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte Loss of Civil Liberties happened after 9/11: even if go white water rafting, spied on

pandemic killed >1 million dead but CDC has removed mask mandate & FL just refused to order vaccines=no interest in saving lives/prevention 9/11 killed 3K➡️police state

gothamist.com/news/nypd-spie…
Read 5 tweets
Jun 23, 2022
I think I need to go to law school. It might be a bit late to be #RBG & make it to SCOTUS… but seriously, it is all about the courts, the law, legal precedents.

Or maybe I just need to make myself small/silent enough to be able to fit into a government job again?
As hard as it is for me to stay in government long term given all the regulations that box you in/tie you up

plus needing to be a public servant to serve every taxpayer, even the ones you don’t agree with/like

Despite that, you *can* have an impact…small things at scale matter
There are times like this I want to be a cat & have 9 lives because there SO too many things I want to do…

…even though other times I am like, okay, how long exactly am I supposed to serve in this life because I am exhausted. (Albeit I did just recover from anemia.)
Read 5 tweets
Jun 23, 2022
For the first time in my life I felt unsafe doing #GOTV & got personally targeted & my photo posted on a QAnon type site.

More appalling was how many on #healthcare & #academia, if you are connected on social media like FB, are pro-violence & anti-rule of law & support J6.
If you are a Black, immigrant, LGBTQ, chronic illness, Muslim, etc person, patient, #HCW, teacher, heck yeah, is scary

Thing is those who have been safely tucked in cocoon of suburbia, worried about junior making the cut for the bball team
now feels suddenly scary

Us: not new
We *need* the ppl who typically enjoy more safety to step up. It feels “ick” to report, like you are an informant in Nazi Germany or something, but it is opposite: being “nice” & “not controversial” & “let’s all get along”
➡️empowers bullies

Be a true ally
Not bully ally

Cuz:
Read 5 tweets
Jun 22, 2022
Anyone who did not see this coming does not understand #tech…(which includes people who design #AI).

“Important nuances were lost in translation when a rule commonly used to measure disparate impacts on protected groups in hiring was codified for easy-to-use tools…AI fairness”
Every time I see “our #AI will solve bias! Give us your #DEI budget!” win an #innovation award, accelerator, #hackathon I feel exhausted…

institutions would rather purchase ineffective & worsening-the-problem #tech than hard work of holding ppl accountable or change culture
And this is how #DEI - how currently approached - is ineffective & wastes money because a small amount of money is thrown at it with zero/minimal real hard work & unwillingness to be uncomfortable. Hence these bills: amp.cnn.com/cnn/2022/01/19…
Read 5 tweets
Jun 21, 2022
When will we admit that “clash of civilizations” of Islamophobia narrative is not only false but dangerous. “War on Terror”=waging war vs Muslims but #J6 & #BuffaloMassacre reveal terror is not one religion. When Muslims are “legit” targets…that supremacist hate spreads further. ImageImageImageImage
Who was it “okay” to torture? (assumed is a terrorist?) Whose civil liberties disappeared 20 years ago? Muslims.

“But you all ‘deserve’ it” we’ve heard &: Why didn’t you stop terrorism? Why haven’t you apologized about x & y?

Now: consequences of that

vox.com/2016/3/31/1133…
The “Great Replacement” is an extension of “Clash of Civilizations” that conflict/war is “inevitable” between “different” humans defined by race or religion. It dehumanizes some humans as “less than” or “threat.” Once you label as such, violence follows. vox.com/science-and-he…
Read 22 tweets

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