Thread by @usnehal

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.

https://twitter.com/shesinscrubs/status/1328017296498036737

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
😨😣😖

As if turf wars and “Mean Girls” gossip and competition among clinicians were not bad enough, add in the new entrants. Typically new entrants disrupt. But in #healthcare they are non-clinician administrator amplifiers hired to take more turf/power and control/monitor clinicians

It is called the great healthcare bloat. Kinda like how after a tick feeds on an animal and the body gets bloated and may transmit disease? That it is what certain types (not all) of administration hires do. Meanwhile clinicians are increasingly burnt out. nytimes.com/2019/06/08/opi…

This may seem extreme

It IS extreme when ~400 doctors kill themselves every year

We can’t do anything
without resources
if turned into inhumane cogs
shamed & exploited
...AND some “colleagues” are “Mean Girls” petty & gossipy too & are the ones who rise

nytimes.com/2020/07/11/nyr…

This tweet is popular but is it feasible? They say “culture eats strategy for breakfast.” The old school culture of American healthcare is toxic and many of the new entrants also bring a toxic culture of “narrative” for “brand” and “competition” instead of humans are or quality.

https://twitter.com/usnehal/status/1001789736414007296

If you are producing a new luxury car, go for it with pricing and niche markets.

But if you are a hospital?

Overcharging minorities and uninsured?

These are not signs of an ethical, humane, fair industry culture

Culture change needed

fiercehealthcare.com/healthcare/pri…

I rarely call it a profession anyone. I thought if that way

It is an industry that is 1/5th of the GDP and you know that is going to attract people interested in 💰💰

The ones with social mission may become clinicians. Altho many doctors choose “challenge” aspect & prestige

There’s this culture war within med schools & hospitals. Snarky poking fun at people’s very identities, written after retirement. That’s the thing, when in positions of power, majority are passive aggressive making the equity posters false advertising.

wsj.com/articles/take-…

Physicians are mostly a low trust (near paranoid), risk averse bunch preparing for the worst case scenario & afraid of malpractice + used to vicious competition in med school. Do not show the authentic selves. See “woke” as a risk to prestige & a liability. “ Unprofessional”

Read through ALL of it. Passed IRB. Passed peer review. Published. Fake accounts used. Database accessed w/out permission. Women trainees, in particular, spied on. BUT also note women’s health issue or safety issues also were deemed “unprofessional” How is spying “professional”?

Meanwhile you want to know the gatekeeping of this multi-disciplinary #traumainformed educational resource on #refugee #health? 100+ edits. 1.5 years. Slide color critiqued as well as if valid frameworks used (latter feedback I respected) #MedEd mededportal.org/doi/full/10.15…

There is layer upon layer upon layer of barriers to unpack in just juxtaposition of those 2 examples. Publication is currency in academia. Authorship on unethical, sloppy #Medbikini authorship & review by men = to careful, framework-based multidisciplinary #MedEd on refugees.

Frankly given we are a revenue-generating industry willing to exploit and price gouge, not a “profession”, what *is* “professionalism” anyhow?

It is merely control

of those who might be activists or not like these portraits

= don’t be authentic

npr.org/sections/healt…

So of course we get these outcomes. And the same people who are printing the diversity posters are pushing out BIPOC, LGBTQ, religious minorities, those with disabilities.

Trending hashtags used while enforcing rigid “brand” marketing optics but calling it “professionalism.”

So what @shesinscrubs is experiencing & what she described is not a rare occurrence - it is systematic, intentional, strategic, incentivized, rewarded on an institutional level to “defend” “professionalism” when real target is industry/market share, revenue, control over staff

Now am quick to sniff out who is the power-aligned type with surface optics and manipulative narrative versus the mission driver reformer and activist. I had great mentors in administration. But after training, learned that is NOT the norm. Naively believing narrative leads to

Well, not so quick, still, I still make the error of engaging then being puzzled, then investigating, then being both outraged and puzzled, until I realize, oh, I wrongly assumed authentic interest in growth mindset or improvement mindset in an educator or administrator

Now that am in #businessschool understand what I’ve been seeing inside of #hospitals all this time... which is #marketing - marketing need not be a bad thing at all. But how it plays out in many hospitals is not authentic, collaborative or promoting equity gmrwebteam.com/blog/hospital-…

Yes “customer acquisition” is a term that is used in business but “patient acquisition” sounds like a new way to dehumanize & objectify patients which is the very thing that we are trying hard to undo in healthcare - so some #digital #health #marketing may oppose #humanism

I may not be practicing this year but I put in a solid ~15 years as a clinician. I open & unapologetic on: if someone wants in on this turf/industry they had better be humanizing patients

It is possible in #digitalhealth - why I did this #hackathon mitsloan.mit.edu/press/mit-sloa…

Do I love business culture or hacker culture? There are good parts & not so good parts. Coming from a family of service oriented physicians - for instance my great aunt, an ob/gyn surgeon, provided free care to refugees in Pakistan - I was slow to see American physician culture

What I do know is on the #business and the #technology side I can be a #disruptor in a good way

as opposed to how a “disruptive physician” is treated when following the narrative that’s described in equity posters on the wall but is opposite to leadership values (in some places)

Frankly if what happens to @shesinscrubs or @ShrimpLingSoup or @uche_blackstock or @choo_ek or to #blackmensmiling or to #blackintheivory is the way it is, please leave the pictures up - optics only of “safe space” is less safe IMHO. Culture change needs more than images or words

“No more hurting people”

like “first do no harm”

If you teach, provide care, have oversight, discipline, and are in any way in a position of authority, then be sure your are vetting, verifying, & taking judicious actions

I will take direct action, after verifying facts

These days, while I am still submitting on harmful “professionalism” & “the hidden curriculum” that grows out of my #patientcentered care and #communication work - must fix #MedEd culture & #systems before can expect results at scale, focused on #diversity in #STEM & at @MIT

We know that had we had diversified #SupplyChains & correct #safetystock we could have prevented some #PPE shortage

That is #operations
where I find great folks as well as my nemeses in #healthcare

Now am on their turf now & shaking things up #womeninSTEM #womeninbusiness

#Diversity is more than a checkbox for HR documentation. If we truly embrace diversity in every sense we will be stronger and safer and more effective. Am not holding my breath on medical culture. Focusing instead on being a disruptor from the business side. #WomeninBusiness

@threadreaderapp please unroll