Woah..that was freaky but familiar. Was lying down & decided to get up to take pain meds for #endometriosis and #fibroids and it felt as painful to get up as the day after surgery. In kitchen, sweating, lightheaded. Quickly squatted to avoid passing out holding onto fridge door
..which swung open..but I did not fall. Then once head feeling better, stood up long enough to take meds...then walked, wobbly and lightheaded to chair. I can't quite feel my palms but that will come back. This probably gets to be called 10/10 pain..but maybe really an 8/10
Great..and a migraine too..scotoma.. taking a migraine med and lying down. Man, when it rains it pours.

Mother Nature is such a misogynist.

SO glad I did not decide to rent a car and try to go Finger Lakes this weekend to see peak foliage.
Wow...I've got some great friends. I'll be ok. I know the drill. This happens sometimes. I always have my meds. Drank water. had a few bites to eat. Drank more water. I'm in a doorman building so if anything worsens I'll call down. My phone is more than half charged and charging.
One of my best friends has what should be debilitating illness. She combines self care with powering thru certain times. The key is she runs her own business and controls her own deliverables, delegates what she needs to. I've learned a lot from her on self care + accomplishing
This is 💯% true

The antifragile & resilient mindsets/skills developed when cannot rely on own body


Prepared for anything
not fazed by sudden crisis

“Dealing with health concerns can prepare you for the ups and downs of business ownership”

Medications are such wonderful things.

The pain is much more tolerable.

Actually got some sleep.

Am hoping to go back to sleep. But since my tweets resulted in at least one concerned call, documenting that I am ok.

Appreciate the care/concern/check ins! 🥰
When one feels terrible physically, the relief from pain or return of normal senses is such a relief, blessing, generates incredible gratitude. I admit I went thru a few years with anger at limitations from pain and such. Now grateful for the good days. practicalpainmanagement.com/treatments/psy…
Many non-pharma practices are ridiculed by certain folks in mainstream medicine

That said, we have had an opioid crisis destroying so many lives

Yes, I do deep breathing and positive imagery along with the strongest non-opioid NSAIDs available to cope

Also, mindfulness has helped me feel what is going on and admit to myself and others when I need to step back & take care of self.

My professional training taught me to take a day off was to betray colleagues and patients
= a source of shame.

In fact:

The toxic shaming in #healthcare culture - wrongly telling workers that taking a day off is “lacking professionalism” or “not caring” enough about patients or “dumping on” colleagues, is, in fact, unsafe.

#MedTwitter @_HarryPaul_

It is one of myriad ways “professionalism” and those whose job it is to define & enforce it make #healthcare & #hospitals unsafe for patients and staff alike. It is why I have become increasingly outspoken on weaponized professionalism.

Recently submitted these:
In med school, I never was at risk of passing out in the OR, but I often almost passed out on long rounds in not air conditioned public wards in Pakistan (blood pooling in dilated vessels my legs and not making it to my brain).

We are taught to be embarrassed @vivek_soi
So yesterday, when felt like was about to pass out, had these types of practiced ways of dealing with it

Lower self to the floor (before hitting floor)

And when a med school buddy calls “Are ok? Can I call anyone?”

Hang tough, “I’ll be fine”
I rarely/never accept help
There is so much hazing & #bullying within medicine, that “showing weakness” (meaning acknowledging human needs or any illness) is seen as “whining”

it does attract the brutes and victims to brutalize you when you are down, often in name of “professionalism”

#MedTwitter #MedEd
To the extreme, this outcome, when
1-the system resources are overwhelmed
2-impossible load is put on an individual doc
3-when monitoring self/health or asking for help is shamed

The way professionalism taught, often anti-#mentalhealth & pushes to this

I fight fire with fire

Those who teach professionalism who make “cases” & public examples of doctors & nurses for showing humanity

like in this thread when @DGlaucomflecken was targeted

I do respond in public with evidence

I have contacted universities teaching thru shaming
We have to stop toxicity actively taught within #MedEd #medicine

Nurses & doctors are human. We are safer & offer higher quality care when allowed to admit to being human. Smiling, dancing, taking a sick day: all ok & healthy

If making an allegation vs someone, use standards
When holding behavior police accountable to their own standards, can be seen or called “bullying”...but if enforce it on others, same can be done to you 🤷🏻‍♀️

if non-clinicians make “cases” of practicing clinicians, w/out consent
= “case” of “professionalism” & “ethics” as harm
I have held multiple clinical leadership positions with disciplinary authority over fellow clinicians, from Chair of state “Provider Review Committee” to Chief Medical Officer. I have gone out of my way to only take an action if there is credible evidence based on a standard.
This pinned tweet is very popular

If we want this to be true, we need reform of #medicine #healthcare #meded #AcademicTwitter #AcademicChatter #MedTwitter

We need to hold accountable, re-educate, and/or remove the faculty who are teaching thru shaming, anti-#MentalHealth etc
It is easy to characterize clinicians as “whiners” which then activates the bullying of the Angelou quote above.

In fact, having been in more than one room where medical affairs budgets decided, I can verify this is true @danielleofri #MedTwitter

There are myriad reasons I am in b-school, not least is that this is not acceptable - it is not only unsafe for patients & clinicians, is unsustainable as a business model.

When people can’t do their jobs (boards, CEOs), I get above them


No, NOT a “beautiful” #business model - depleting your most credentialed workers w/ high #PTSD & #suicide among #clinicians yet is what I see in @LinkedIn

I may be a “Top Voice” x 4 & in top 1% as an #Influencer in #healthcare per #LinkedIn’s #SoMe score

who signs budgets?
Yes, some of my @LinkedIn posts get >12K views. But the ones on physician suicide? ~200

How effective are we being on #SoMe or with @NEJM perspectives?

Are decision makers listening?

I’ve felt as powerless to prevent harm as #NYC physician leader Dr. Breen who died of suicide
Thing is, my chronic illnesses have been a blessing to protect against the God complex many doctors have. Had to admit am human. I have had to accept there are some things I cannot accomplish myself & times I will “fail” - I have gotten over being shamed

Yes, have moments of extreme pain. I have exited clinical medicine. I have been shamed for my self care choices by fellow physicians. Have fought hard to protect my & others’ ability to work vs wrong definitions of professionalism as @_HarryPaul_ describes explorethespaceshow.com/podcasting/har…
Yes, I identified non-factual, unverified “professionalism” policing by @USC @KeckMedUSC faculty @sarah_mojarad vs a Black male trainee

This non-factual hit piece written as retaliation by faculty “obsessed” with her “narrative” - “evidence” from 2013?

I recognize by being factual again, I will again draw this kind of retaliation w/ implications I am unfit to practice medicine thru innuendo

while I plainly state facts, standards

I do things in the open rather than by private messages or gossip or manipulate facts

Be factual
I invite you to look thru my threads & what I publish on to understand the source of my very deep concern

When I am up all night

am not obsessing over what others say/optics

have debilitating pain

I think hard about how to fix this system of harm

I write curricula like
In the hit piece on me by @USCViterbi @USC faculty @Sarah_mojarad, I was misquoted on boundaries just like someone else’s actions in 2013 was part “evidence” used vs me

This is what I have to say on boundaries: break those gendered behavior police impose #WomenInSTEM
I seem be a popular target - just called a “terrorist” by equally non-factual right wing “patriot”

this is how I responded
I don’t delete
I document factually, w/out innuendo

clear evidence
offer references & proofs from external authorities & standards linkedin.com/posts/usnehal_…
Am curious why schools like @usc @USCViterbi - my father’s alma mater - engage in the same repeated online #SciComm behavior against minority physicians as above

Do schools intend to use non-licensed clinicians to start witch hunts vs licensed clinicians

Am I really the enemy?
I can’t tell you how many such messages I get in private from doctors & nurses

non-clinical & non-licensed “professionalism” police harm/abuse clinicians daily

thru disciplinary actions via a license

Gossip & innuendo harm individuals & the system when clinicians leave
For years, I hid illnesses

I proudly touted stats: I trained pre-work hour restrictions, admitted 22 patients + crossover with no team or night float. All me💪🏽
Or: LP on no sleep x 1 week, hand shaking but got it 💪🏽

Really? 💪🏽?
Things to brag about?
Yes, if ableist culture
Given how outspoken I am in identifying fellow faculty (ones building career on image & “professionalism”)are not factual & use no standards

even taking on these part of healthcare that gets doctors & nurses fired for exactly what I am doing

yes, lots of attempted retaliation
The infamous #Medbikini study used med students & residents reviewers, including ones who were minority

in same way that compliance is full of women, often policing other women based on rules written by men

Hiring a woman is not enuf if system the same chicagotribune.com/opinion/commen…
This remains true. The system needs to either be dismantled or thoroughly reformed.

The results we have are a logical result of resource allocation, systems, incentives, processes.
Let’s obsess less over what “people say”
Let’d not teach “optics” to the next generation of doctors or #STEM
Let’s not craft “narratives” to avoid accountability on harm.

Let’s start to care about real things like life, death, harm, waste
Let’s admit when we fail to improve
I have been in many jobs, many roles, many states and countries.

I am deeply, deeply concerned by the state of healthcare in America.

I won’t defend the walls of harm from the inside and perpetuate harm.

Let’s “hack” healthcare
Failure is manifest

I break a lot of the rules on how to hide parts of myself to be “popular” or per professionalism, marketing, or reputation management types

Yet, I broke the glass ceiling, am a 4x Top Voice, 230K followers, top 1% in #healthcare

=authenticity respected

In a #pandemic I achieve this reach along with @DrTomFrieden or @sandrogalea to disseminate facts-based engaging posts on #COVID19

able to communicate in a way that gets thru to #business #leaders, where risk-averse #STEM & #SciComm often fail

It is not uncommon for a woman + minority speaking unapologetically about facts to be called impolite or even “a bully.”

Others must experience this cuz this post got >12K views.

We need more real talk, less narrative, reputation management, or optics

Nursing is primarily women and we need to be able and willing to hear women say things we don’t want to hear.

We need doctors and administrators to be real, hear/respect nurses, students, cleaning staff

We know this is coming. We saw what this looked like.
Yes, this was a mammoth thread.

But I am lying flat to avoid a repeat of last night.

I am awake and have been for many hours.

I keep hoping if I keep trying to fit the puzzle pieces together I will figure it out.

I don’t feel as much pain when I focus on problem solving.
A bit afraid to try getting up. I am okay when horizontal. But I have SO much to do!!! The “firehose” does not shut off just cuz one has an #endometriosis flare @MITSloanFellows @MITSloan @mit
So much for leaf peeping...
Please read this thread

Being an #ally to #BlackintheIvory is chat on Zoom, yes

as well as system level

If you are an ally making changes at a system level you are then changing resource allocation, asking quality for 💰spent
you may make enemies, not get trophies
know this was meant in a very different context

Nonetheless nature of social media is that context lost

To be an effective ally one must reject any talk of manners

@FutureDocs & I had a robust convo on the context she heard this is in vs coco-net.org/wp-content/upl… @COCoQC
#Medicine has a problem
#MedEd has a problem
“Professionalism” has a problem

When you work w/in an organization, when are *you* part of the problem?

(While I respect the written materials & framework, did not agree w/ methods of this class, particularly in an all online world)
I have worked in compliance myself. I have seen the mindset

Make self the “savior” and (as often is women) “policewoman” of those big bad bullies/cheats

Yes, there are bullies

amplifying fear = job security

Anyone who works in compliance has their own COI - who polices them?
One example of compliance types using fear & anger to expand their business model: drug testing food stamp recipients

7 states spent over $1,000,000 & failed at finding “illegal” behavior among welfare receipts

If reason is no tax $ for “illegal”...

... then why $50m for opioid use recovery?

Why the inconsistency?

Is there a difference in demographics between those who are on food stamps vs opioid?

Given what we know of bias, is there a role of bias by race, poverty, gender on who we police?

My beef is w/ the ENTIRE compliance “industrial complex”

No, can’t have anarchy

Yes, good resource stewardship

exactly why I ask questions about compliance creep including in #SciComm controls

“I can control this too! pay me!”

show me results
prove “first do no harm”
Hospitals & universities spending 💰 to train faculty & students to be free sources of this 💰💰💰marketing for them

A dark side: after encouraged to go online, will be policed on nebulous professionalism standards #Medbikini @JAMA_current #MedTwitter

I only *just* understood expansion of training of students on supposed “#SciComm

while those same people doing that training are are policing clinicians & getting them fired for speaking up on #PPE

Crisis = Reputation management?

not facts, optics?

>210 Americans dead yet:
Those of us who used to toe the line

thinking could make a difference by staying “in the game” & “polite”

now quitting

no, don’t get to use our identities, licenses, credentials, reputations, credibility

for optics

is my read on this
especially BIPOC leaving in #pandemic
Some people take a “leave of absence”

or temporarily deactivate account

after they act unprofessionally or start to have “narrative” unravel

usually these are the ones suppressing scientists & activists

Others get fired - typically whistleblowers like

How many healthcare workers lives have to be lost

before lives matter
more than
“reputation management”

When will #hospitals put slashed #pandemic budgets towards caring for & protecting

not protecting “reputation”?

I used to be on side of compliance. I know that mindset. I used to hide my own illnesses. I was a self-shaming ableist doctor

No more

In UK context, not all lives are being lost at same rate. #BAME dying at much higher rate

No more


Even now, despite my often feeling alone as “a Cassandra”

I have been SO slow to see it

Once your professional society @AmerAcadPeds is issuing guidance on #BLM

=it has bubbled up
gotten thru:

that is hardly the leading edge
Who is speaking up on #safety? (Clinicians)
Who is silencing? (Non-clinician administrators)

Who does frontline work?
Risking own lives?
btw who is generating the revenue?

Yet who
..has authority?
..held accountable?
Who manipulates “narrative”?

Please notice how painstakingly this #blackexcellence doctor explains how polite he was & his compliance with expected “manners” while he is doing work that public officials should be doing for marginalized
Should “manners” really be most important thing?

Why is it “his side”? These are verifiable facts documented in video

Why must #blackexcellence defend self against non-factual assumptions?

I place responsibility on the city that a police officer could not recognize #pandemic necessary #publichealth by a licensed professional
It is not okay
This, repeatedly done, harms
It breaks spirits
It makes people afraid
Licenses can be terminated if one is arrested or has a charge

Hospitals focused on reputation management

Will distance & push out employee if controversy

We need #blackexcellence to be whole
I take courage from #blackqueen examples like this

No more hiding
No more pretending everything ok or “under control”

No more being on side of shaming myself or policing others

No more worrying if..
..my hair is frizzy & “ethnic” so “unprofessional”
..admitting I get sick
As a Chief Medical Officer I had this up on my wall. My only art on walls was made by patients @ArtLifting to be uplifted by their strengths, not get into any “savior” mindset. I was open that I am a doctor & a patient. I love this #blackqueen expanding past boundaries of picture
Over & over, maters most for making a sustainable difference is 💰💰💰

like how @ArtLifting does not just use “poverty porn” (stolen pics without consent)
to get money itself

but it gives artists living with medical conditions jobs selling own art

I speak up now
This year I left the bedside
& no longer afraid of power of non-clinical administrators over my job/license/reputation

I can be honest & open - sad that as long as we see patients must hide
My peers live in fear tho

Am writing curriculum w/ two #backqueen deans:
I have stopped trying to be this

..am human
..feel pain
(Sometimes almost pass out from pain if try to stand)

My father is not Zeus
I have no magical shield/arm bands
Those from trenches are fighting own battles
Cannot provide back up

I must be realistic & honest
I take it one day at a time

I define courage by moments

I define success by liking myself as I am in my gloriously messy imperfection

I don’t worry what people say

And somehow my #authenticity outpaces the paid marketers

I am still strategic - must gatekeep communication
What makes some marketers🤯😡

I have no training
yet outpace them
in they get paid to do/teach

thus I may make them look bad by default (they are paid for ....what?strategy w/out facts or authenticity)

in hospital, their salary paid by clinical revenue
=should work *for* us
Well, those NSAIDs kicked in. Feel functional. Not lightheaded. I just need to plan ahead & start taking NSAIDs 1-2 days before

Thank god in recent years have had amazing PCPs. Non-shaming whole person care

Primary doctors & clinicians do NOT get paid enough

Time to pack...
I have had ppl reach out to me particularly young women doctors

particularly WOC doctors

for advice

I don’t know what to say

given my authenticity comes after leaving the bedside

I don’t have good answers
You feel unsafe
You are

You are not crazy
That is gaslighting
I did many “establishment” things

More than any #endometriosis pain
Is pain of knowing my “do gooder”, “follow the rules”, “model minority” past was part of this #system of #harm

women in compliance today mean well too

yet drive out exactly who we need in #healthcare
After learning to update my beliefs on patient autonomy to current standards

back on the patient side. 👀 Wow

Sad, took my experiencing it to see it
Why “empathy” fails - talk of “empathy” is way to exclude other stakeholders from table (“I got this”)

No, need lived experience
It took others seeing this & saying “no you are not okay”

friends not accepting my internalized self-gaslighting I’d learned from a gaslighting system of harm/exploitation

b4 I started to accept: “I am in pain”

yes, shift change but not okay to wait 60+ minutes in extreme pain
They call us #healthcareheroes invokes military style conformity without questioning authority

I made such a “good little soldier” cuz as a child, been treated badly over & over so that was “normal”

the best policer of others is the person abused & lacking sense of normal
I don’t know what to tell the emerging generation of clinicians

I can tell you
I was harmed as a child
I accepted “be tough”
was a “good little soldier” in a system rife w/ harm

Until I was harmed again & again, did not (refused to) see it

I kept “lean in” mindset w/in system
Right now, I have set myself free

The only lawsuit I was named in was where family did not recall I existed but lawyer named every physician who signed any order
(I was an overnight doc)

I was dropped from case, no payments made
Will always still have to report it tho
If I had been the way I am now as a student, trainee, young faculty, would not have this “clean” record

Believe me, folks have tried to find ways to smear

The best that could be done in hit pieces is:
“she is Muslim”
messages from someone else dated 2013
this on “boundaries”
I have been humbly learning from #blackexcellence like @DrDaniJackson

it has been taking years to re-educate myself and I often still misstep or identify a gap and have to commit more time and effort to learning. I am grateful for #blacktwitter
@QaaliHussein1 is someone who is at intersection of #blackqueen Muslim surgeon podcaster mother - I learn so much from her and am grateful for her courage and her voice. #WomenInMedicine #womeninSTEM #womeninleadership #phenomenalwoman
I often quote tweet @DrOmolara who has courage to identify as having chronic illness as a #blackqueen

I let myself get driven out by this anxiety & stress
yes, flares my illnesses
felt easy prey for professionalism policing
afraid of losing a perfect record, I’ve left clinical
I understand that is a privilege: to choose “model minority”, align, be rewarded
choose to speak up

Others are born with a level of melanin that does not give them such options

Even an a Muslim, I know I need to address anti-blackness
within my community
stand up for:
The so-called social media experts talk about “narrative”

Personally, am fan of verified vetted facts

When others who fear/are intimidated by honesty use hit pieces to try to control any narrative
write about yourself

(I write about others’ actions when they go after trainees)
I can’t undo things I did when I did not know better

I can’t go back in time & make other choices about many things

I can try to support those trying to maintain their faith, dignity, integrity

Yes, I do act like an experienced woman > 40
I still have so much to learn
I think I’ll call this done.

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More from @usnehal

16 Oct
Agree. There is a lot more to unpack and there are not simple policy or regulatory fixes. If you think the feds coming down hard on what the population uses to connect and communicate, you’re not a student of history, sociology, psychology, etc.

@sinanaral in @HarvardBiz
I hear all the old, harmful ideas repeated by many who should be at cutting edge of technology. Whereas what @DrvanTilburg describes, if merely digitized to “control” social media, will not work, will harm #SoMe #AI #SciComm #professionalism
From the #healthcare lens there are these potential issues of #AI and #bias including as relates to #COVID19. Yet 30% of business are now using #ArtificialIntelligence in some form. Horse out the barn.

So what is the answer? Ban? Control?


@JordanBazinsky @HealthITNews
Read 14 tweets
14 Oct
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?
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?
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)
Read 14 tweets
14 Oct
This 👇🏿👇🏼👇🏾

Women in medicine have choices on how to consume attention and airtime. If women wish to be counter sexist stereotypes that depict us as petty, maybe the causes we care about and invest the most time and attention in should reflect well on our priorities and values.
Outrage is easy to manufacture. Is the level of outrage matched to the issue?

As some have tweeted, don’t like a company? Don’t buy their products. The market will take care of @wearfigs whose advertising ridicules both women & DOs. Ridiculing customers is a bad business move.
The market is not a factor that will address these issues. With most physicians employed, other clinicians also employed, penetration of Wall St & PE into healthcare, and evidence of higher mortality rates for Black and minoritized populations, many things to be outraged over
Read 14 tweets
13 Oct
I know some doctors like to say “don’t confuse your google search with my degree” -personally, given errors made by peer review, from Wakefield to #MedBikini (cyberstalking = scholarship?), I don’t consider a patient’s Google search something to ridicule news.bloomberglaw.com/pharma-and-lif…
In fact, I prefer to “Don’t confuse...”

“...your ivory tower ignorance...”
or “...your PhD in leadership....”

“....with my actual experience”

like of being a CMO of a $100m 14-Center FQHC in neighborhoods where a Black woman is 12x more likely to die of maternal mortality
I am not interested in how many books you have read or written or leadership programs you started at non-diverse institutions

until you show me you have done the work & have immersed yourself in the settings you study...

..with TRUE partnership and humility, not just photo ops
Read 5 tweets
12 Oct
Absolutely true @askdrstephanie - in fact, I have seen that seeking fairness, accountability, accuracy can even result in a vicious backlash if the other person is will be willing to manipulate a narrative and play the victim to distract from harm to others or exploitation.
Anyone who talks about "optics" or "reputation" or deletes a lot of things is already signaling they care about image, popularity, and what others think. That often is a barrier to ethics, fairness, accountability, or accuracy. We can't solve messy problems by being prissy.
That's honestly why I am so glad I am moving out of #MedTwitter spaces and the actual hospital spaces represented by them into #STEM and #hackathon spaces. Instead of judging people and gossip, roll up your sleeves and get 💩 done, whether with high school students or retirees.
Read 4 tweets
11 Oct
Please start to do this. If you find something not factual, take the time to highlight, cross out, write notes on the image. We are highly visual creatures and the red X will communicate much better than your facts or words.

Make the “wrong” or “not factual” a clear visual.
Further, think of unintended consequences. Will what you put out there take a life if its own?

I have seen too many of those paid to instruct #STEM professionals on #SciComm & #MedTwitter professionalism

fail to understand this aspect of #SciComm - how will others repurpose?
How often in re-sharing a conspiracy theory post are you merely driving traffic to that site or person? It is a numbers game. In your “OMG look at this!!!!” are you contributing to this?

Please stay away from those who share a new “look how bad” example

Read 11 tweets

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