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Umbereen S. Nehal, MD, MPH Profile picture
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13 Nov, 28 tweets, 18 min read
This. Black nurses like @mclemoremr who not only have authentic clinical and community experience, not only know the disparities data, but also are winning grants to do the studies themselves belong on the transition committee or COVID Task Force.
In contrast when I have taught medical students straight from @AmerAcadPeds policy statements on racism in a hospital with a disparities center, have been told by a division chief that nurses find me “too political” which exactly is this that @COCoQC lays out

Not safe spaces Image
Repeatedly I “break ranks” - I don’t spend my time on outrage over “scope creep” - who is serving in the communities where Black women die at a 12x higher rate from maternal mortality? Not the doctors or nurses battling on own job & pay.
Is these ppl: mededportal.org/doi/full/10.15…
And yes, when one takes on allyship as a doctor who breaks ranks from doctor crowd, then allyship with Black nurses makes one more of a target or allyship called “bullying.” Am outspoken wrong use professionalism. We are not here to protect “prestige” of a profession or “optics”
There are huge barriers to entry to med school

I left Wellesley to go straight to med school in Pakistan = no loans

Then took a few months off to just study
aced USMLEs
got into a top 5 ranked program

my success possible cuz I went outside the system
cpassfoundation.org/the-barriers-f…
I am so DONE with battles over “quality” by doctor vs nurse
What quality?

Is not your degree. Is how racist you are.

Yes, I said it. I don’t call ppl racist but that is what people hear - I talk about outcomes and people choose to take personal affront

nature.com/articles/d4158…
Zero tolerance for policing by non-clinicians hired to protect hospital “brands”or taking everything about them (all about their personal brand)

harassing ppl doing the work

posing as saviors of a profession by protecting prestige

Get out of the way

mention.com/en/blog/hospit…
Who is counting mentions & titles vs who is counting Black bodies? If your priority or, frankly, obsession is the first

I won’t mince words
I do not respect you

You have choices on how to spend your time & talent

Don’t choose ego, optics, waste

This goes for clinicians too
If I say #outcomes #quality #safety #standards & you hear “racist”.. I can’t help you if you self identify that way & choose to be offended on a personal level instead of your asking questions about why we have this - why is the system killing Black folx?

commonwealthfund.org/publications/p…
If people raise issues that affect life & death & your response is to shut people up for “reputation management” or “civility”

you are the problem

Who is at the table?
Need people willing to speak up, not shutting Black, brown, LGBTQ, disabled, etc down
harpersbazaar.com/culture/politi…
Even at @MITSloan and @MITSloanFellows the deans, professors, and my peers now know that I will raising #BlackintheIvory ALL THE TIME.

Look, I find #digitalhealth & #AI as awesome as the next #tech geek but who will be left behind or criminalized? technologyreview.com/2019/01/21/137…
I actually can go days without seeing a human or talking to anyone, happily reading or making handmade cards or trying new recipes in the kitchen

But get me outraged at harm, and I have a LOT to say
I persist
This took >100 edits.

I will NOT give up when it matters enuf
I did not experience trauma at this level by any means yet can relate to

“It was brutal to be young and already trained to sit quietly and listen to charges brought against my color with no chance of defense.”

We need Black, brown, LGBTQ, etc voices

slate.com/human-interest…
Grateful at @MITSloan has faculty like this just named to the transition team, former chief economist of @IMFNews who uses his position for those at the margins. I introduced him to #FQHC clinical leaders to expand access to #COVID19 testing in #community

mitsloan.mit.edu/faculty/direct…
Guess what, that is a cis straight older white man at the table

Do I have a problem with his being there?

No, if he is reaching to the margins to bring system resources to them, I’m all for it

Or this:
When I talk of #harm #waste #quality #safety, what is your response? Do you make the mention of system failures about you? Do you race to scrub any “mention” you find bad for your optics, delete?

Or do you respond like a problem solver?

Are you even factual?
Are you credible? ImageImageImageImage
If I highlight @mclemoremr is for her WORK + yes, her lived experience as a Black woman. NO “race card” or “gender card” played. Her persistence, grind, slog of is takes to achieve on behalf of marginalized, vilified populations while oneself devalued blogs.scientificamerican.com/observations/c…
Problem is when others *are* playing so-called gender card to grab a seat & crowding out women doing the actual work & the slog. They then assume others as empty of merit as themselves

Solution: be real, be authentic, make it about more than you

nonprofitaf.com/2015/03/are-yo…
Why was it SO hard for #MedTwitter to recognize #BlackExcellence or #blackmensmiling or pro-#mentalhealth or pro-#communityhealth in @DrJCoftheDC

when professionalism policing was inciting negativity pile on
... vs joy
...vs recruiting POC to medicine

#MedTwitter was able to correct itself and recognize merit and correctly give @DrJCoftheDC this type of platfotm@like @ETSshow did.

But why the initial judgment error and led by whom?

Are community health & BIPOC leading #healthcare #MedEd #medtwitter?

explorethespaceshow.com/podcasting/jas…
No community health leaders are NOT leading. The gender folks would just say “manel” & make it “okay” as long as a woman placed there. No. Which woman? What if the man placed there had experienced being in a wheelchair? What about Black male Experience? Gender is not everything.
If you are a woman policing others on petty details, optics, on being “polite”, wearing hair right way, the you are the problem. You have accepted the role as a barrier. “Got mine” & keep others out on behalf of who pays your salary is anti-progress

Chose to focus on real things
When at the table, can you make an actual case? Can you be effective? Do you do the work? I am not a fan of many conservative gender views but have to admit the “fainting couch feminism” has got to go - it harms the cause and makes identity, not outcomes, the focus/target
SO much bad “coaching” & “professionalism” teaching by those proving the “those who can’t do, teach” adage true. How many teach a topic they themselves can’t get right for themselves. If you care about outcomes (getting 💩 done) this advice is toxic:

If your goal is just the title, like on your CV, occupying a seat, you represent waste and a barrier.

Instead, if you have a seat at any table, utilize it to get actual measurable outcomes achieved with a sustainability plan so it can live beyond your role

Generate impact
I push boundaries. More women should. When you are at that table, if you are a mere diversity checkbox, you will be the self fulfilling prophecy and ignored. Bring & deliver value. Push the boundary of current reality. Make this world a better place.

yearlyglot.com/always-pushing…
Let’s be honest about American feminism and which women were intentionally left out. Now, women of the same mindset want a seat at the table? There are many qualified women. Pick the one who spends time slogging for those at the margins and delivers results at scale.
All this is spot on

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More from @usnehal

Umbereen S. Nehal, MD, MPH Profile picture
15 Nov
As a physician, can say this about doctor culture in the U.S.: we are a socially stunted puerile bunch easily manipulated by sales & marketing ppl or by metrics of competition, obsessed with status, prestige, ego..

...not my doctor friends...but we hang out at the margins.
The high school level drama that plays out in hospitals, then the replica, amplified, on #MedTwitter is 😱 No wonder our profession kills so many patients when we are so busy policing on pettiness & ignoring standards of quality, safety, population health ncbi.nlm.nih.gov/pmc/articles/P…
There are many reasons why I am hanging up the stethoscope, one of which is that I cannot in good faith go into any clinical setting and feel confident about “first do no harm” - The system is too misaligned, not driving quality, safe results

Then, the human dynamics are
😨😣😖
Read 30 tweets
Umbereen S. Nehal, MD, MPH Profile picture
15 Nov
Accountability is when someone takes money for a job and fails to use standards or violates standards. Referencing standards when seeking accountability, in a transparent way, is fair game and necessary. Teaching at esteemed institutions = an obligation to deliver quality.
Some info on #MedEd - the roles and responsibilities

medschool.ucla.edu/workfiles/site… ImageImage
For medical professionals, especially doctors, payment of the critical part on liability.

Good Samaritan protection relies on no payment, often.

Doctors can be served papers up to 25 years later if it was an infant.

That is level of accountability of clinicians ImageImageImageImage
Read 18 tweets
Umbereen S. Nehal, MD, MPH Profile picture
14 Nov
Are you 🤬 kidding me? My movers for the a.m. just canceled on me.

So found new movers within 3 calls. Rebooked. Now moving out on Sunday.

But dear God. Who cancels a move at 8:03 p.m. the night before?

This is why I detest moving.

I was still traumatized this from last move.
Last move: movers kept making disparaging remarks "I told you you had too much stuff. Everyone who moves from Boston to NYC does this." Okay. They mark up the ceiling. They get annoyed at my cat. Dishes they packed broken. And they kept one box "open" then charged for "packing"
Meaning they had charged "packing" time for an untaped box. Meanwhile the guy I had hired to re-assemble my IKEA wardrobe started hitting on me and I got him out ASAP but then I only had a half built wardrobe and CMO job started the next day. Every day, drained, exhausted.
Read 9 tweets
Umbereen S. Nehal, MD, MPH Profile picture
4 Nov
I literally have no election stress tonight. Met with a senior dean & a director to advocate for a peer. Wrote a 4 page executive report with 20+ references that was just emailed to 6 top brass leadership. No, it is not about loyalty. It is about correct application of standards
#MedTwitter is likely aware of my propensity to write detailed reports with a multitude of references emailed directly to deans. If there is a top, and if I am a tuition paying student or even just a concerned citizen, you’re gonna hear from me if someone is misusing rules.
My great grandfather, a Justice in the High Court, figuratively threw the book at a white barrister in Colonial times, telling him to learn the law. For standing up to a white British man as a brown Muslim man in colonial times he got the title Khan Bahadur. (Brave)
Read 8 tweets
Umbereen S. Nehal, MD, MPH Profile picture
3 Nov
I know that there is the anti-leader leader concept (not using titles, wearing hoodies and such) particularly in the tech & entrepreneurship world. At the same time, those are spaces that are not necessarily as woman or BIPOC friendly historically so the "casual" can be a trap
implicit, or frankly, explicit biases have not gone away. Except professionalism is also a trap - it is well documented in peer-reviewed publications and I've repeatedly notice with how multiple "professionalism" faculty fail to examine embedded biases & cultural chauvinism
In tightly controlled spaces there is a so-called right/wrong way to have one's hair, with "wrong" including natural hair if one is "ethnic", women must wear skirts and pantyhose automatically adding distracting details (do I have a run in my stocking? am I sitting okay?) &such
Read 18 tweets
Umbereen S. Nehal, MD, MPH Profile picture
20 Oct
I'm always amused by sales or marketing or communication professionals attempt to sell to me how I need their help, how I need their protection, etc or it could be "mutual benefit" to connect. Oh, then what is your rank for what you are paid to do and attempting to charge me for?
Why am I able to outpace, by far, sales, marketing, and communication professionals? What is it they are teaching you wrong in school and/or you are unable to apply for success in real life?

Likely, the answer is: authenticity
Lived experience
Open communication
Values
Yes, metrics matter
Yes, reputation needs to be protected
But as we see happening with Dr. Fauci, those who wish to suppress science-based information (that they find embarrassing or wish to hide) will malign the person speaking about verifiable facts. Blowback does happen.
Read 28 tweets

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