I am amused by anyone on #MedTwitter who thinks I can be easily intimidated. Chile.. first I am Gen X. Then, I have lived through having gas masks distributed in case chemical war happened (when living in an oil compound). Then I have lived in places you hear gunshots routinely.
I experienced a ton of bullying, including (but not limited to) racial, as a child back when teachers told you the problem was you not being tough enough and they were not there to solve “your problems” for you. If a kid stole something, why’d you “let” him?
I have navigated the outspoken WOC in the workplace such that (despite folks who attempt to spread rumors otherwise) I have a perfectly “clean” record. No dark web searches will uncover “dirt” cuz there is none to be found.

Yes, some will resort to manufacturing instead.
While my head has remained attached I have seen MANY others’ head roll. And having been in compliance and an expert fraud and abuse investigations for public sector, including for AG’s office, I take extra precautions to keep my nose clean.
That said, I have seen how much “the rules” are flouted by some yet others get nitpicked and penalized.

So, I am anti-policing behaviors. Anyone who advises to be polite, as well, is not being anti-racist or anti-sexist. “Polite” is subjective and invites biased judgements.
As a child and in early career I internalized the idea that certain things were my own fault.

I know better now.

And I refuse to watch another generation told wrong things or told others’ “control” over them is for their own good.

Most often the issue is that one has stumbled upon something that maps to revenue. Even when “prestige” or “reputation” or “optics” is mentioned it is straight from marketing concepts on “brand.” Companies with strong brand often do not serve all, segment

That’s fine if you are selling smartphones. The problem is when academic medicine defines itself by “brands” as these are often the self appointed leaders on “#equity” - there is an inherent mismatch of the #revenuecycle or market segmentation and stated #DEI goals.
The way #healthcare, on #hospital side, makes 💰 is procedures. “Good” payer mix is considered to be more private insurance. Recall one place I considered in the Bronx (I withdrew my candidacy) was ramping up varicose vein procedures (not maternal health)

How many live in this kind of fear...

no, no, you can’t

Fear of getting in trouble

I see clinicians told we don’t understand business or operations or doctors told we are the source of bad quality.

Which doctors, tho?

Some doctors are the source of quality, including for BIPOC patients.

Is it about the degree/training?

Or is it about who is listening to ALL patients and driven by incentives other than purely financial and not full of cultural hubris?

I hate that this is so, but in part BIPOC, especially Black

may be delivering measurably better/superior care

because we have been told all our lives the bad things that happened to us were our own fault

and we had to be that much more perfect to get half as far
Look at this response put out about Dr. Moore. Her knowledge is being described as “intimidating” by her nursing team?

This is administrator speak, coded language that

Black + female + doctor = bully


Don’t flip the script

indystar.com/story/news/loc… Image
This is a super skilled dance by the institution to use “empathy” sounding words, an administrator describing being “hurt”

Yet is invoking the “scary” Black woman stereotype/trope by using “intimidating” as if nursing is not used to patients with knowledge + social media access ImageImageImageImage
You hear empathy talked about. Many administrators are using “tactical empathy” to disarm, give a *feeling* of control or being heard to actually keep control and to win negotiations favorable to selves. It is an FBI interrogation/influence technique.

What is needed is for institutions to actually be authentic for a change.

Worry less about “optics” of your too “knowledgeable” (and credible) doctor-patient sharing her experiences on social media.

Tolerate some dirty laundry being aired. Do the work to improve the system.

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with Umbereen S. Nehal, MD, MPH

Umbereen S. Nehal, MD, MPH Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @usnehal

28 Dec
We need more doctors who speak up.

Yes, I know we have worked hard to get where we are and are regulated/monitored in so many ways it is scary to deviate and take a risk of censure or discipline. It feels like we are vulnerable, not strong.

Speak up anyhow.
We can’t let our reputations or achievements become reasons why we stay silent.

Opposite, what is it all for anyhow?
What does your title mean?

They say you can’t take it with you in regards to money. But you aren’t going to take your CV with you either. Image
We can’t be telling the most vulnerable to speak up, like those early in career.

While I have yet to understand the details of what went on here, what is reported is deeply concerning.

Even with a good lawyer, this can derail an entire career right at its start.
Read 25 tweets
28 Dec
It is not about being "woke" per se as some people claim. It is about caring about measurable results & caring about human life. If you don't care about such things and are in #healthcare, if #equity is merely a hashtag or for "reputation management", you are part of the problem
I understand some people feel those at the margins can be written off or just are not part of their consciousness, irrelevant. That position of privilege goes away in a pandemic. Those people you may disregard most of the time become highly relevant to everyone's wellbeing.
It is very attractive to break problems into little, manageable parts and to isolate yourself to a silo. Too much of science operates this way. Too many of those rewarded within #STEM go narrow and deep. Then the messiness of the real world is not addressed in solutions.
Read 14 tweets
28 Dec
"Died at the scene"?

This was a suicide bombing & terrorism where someone filled an RV with explosives, parked it in front of key infrastructure, while he was inside. They were not initially sure if the "tissue" found was human or not to ID him.

Why not call it what it is?
I am feeling SO exhausted this morning.

Add the media coverage of Dr. Moore describes her as "complaining" as opposed to "reporting" or "identifying." Then the hospital's response is to describe her as "intimidating" to nurses as "knowledgeable"

The words we use matter. How much caution do we use, with whom, when? What tropes or associations are invoked? How does that populate the "data" in our brains that fill certain "buckets"? Who "complains" or "intimidates" vs "we don't know all the facts"

Read 10 tweets
27 Dec
Nothing captures structural racism better than this as has been put out by many including @QaaliHussein1

Knowledge + Black (+ woman) = scary?! (“intimidating”)

This is the type of implicit bias to racism spectrum communication I had identified this summer as well. #MedTwitter
These dynamics is partly why I have been wary of any subsequent executive roles I have been offered.

I made it past the glass ceiling. In many institutions this is exactly what you will find.

Why many BIPOC go off a #glasscliff

Your job: Be token.

To be clear, I have the privilege of choosing to be so called “model minority” or to be anti-racist.

Black women and men never get that choice.

Executive incentives and rewards often are to generate revenue for an institution per the existing system, NOT to be a change agent.
Read 4 tweets
27 Dec
This is very important. I had been preferably using Black gifs for representation.

The nature of #communication is that how you intend it and how others may receive it will pass through many other filters as well as sources of trauma.

When in doubt err on side of caution.
While I have not received any feedback that my gif use is inappropriate one should not wait to be told. Going to be sure to apply an additional lens and filter.

Caution: Some who call themselves #communication “experts” may be about promotion rather than reliable #DEI or results
In particular, when you look at who to trust or emulate on #SciComm or #MedTwitter, take note of who is effective at communicating their point, does not need to delete, can post on important topics with least misinterpretation, while maintaining the broadest audience.
Read 10 tweets
27 Dec
The world (specifically healthcare) is not giving me good feels right now.


I miss my cat

I miss NYC

I want bubble tea
Well, bubble tea has been ordered.

Puritan territory New England does not have the flavors I want at 10:27 p.m. but I realize that at least I do have bubble tea access in the first place.

As much as I now call Boston a village... it isn’t really.
It’s here!!! Image
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!