Thread by @usnehal

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

engadget.com/2010-10-02-app…

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)

nytimes.com/2020/05/15/us/…

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?

hbr.org/2018/08/resear…

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

NO

Don’t flip the script

indystar.com/story/news/loc…

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

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.

blog.blackswanltd.com/the-edge/how-t…

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.