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.
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.
I don’t intend to end up in court

..except at an expert witness again like I was for the AG’s office...

However, I do know that if I were to engage in any kind of action or have an action taken against me, my record is squeaky clean and I have credibility built over two decades
A lot of us get into medical school, thru medical school & into leadership positions

through high standards, often perfectionism

becomes our Achilles’ heel

sometimes we seem powerful

but we live in


(maybe of public controversy tarnishing our reputations)
I get frustrated with the constant battles that I see play out between doctors and nurses

but I do often find that nurses understand the experience of being disempowered

are intentional in having allies/support

doctors come from an individualistic culture, feel alone
Leadership of any kind is often a very lonely experience.

It does entail sacrifice

It is hard to know went to navigate around versus when to take a stand. When to sacrifice the title/role itself. What kind of loneliness to accept?

There often isn’t any single right answer for how to lead or when to make certain sacrifices or not.

What I do know is if your need for achievement is driven by #impostersyndrome as opposed to courage, your ability to be an ethical leader is compromised by your insecurity.
Traditionally physicians were self-employed (outside of the military context) and this created a balance of power with administration.

Nurses were employed but many had the protection of a union.

Now, I worry about loss of physician courage.

What was not okay in that paradigm was the way in which nurses & many members of care team were bullied by physicians.

There also was an undervaluing of outside of a hospital care of that was community-based.

As we are shifting the system, I’m seeing less physician courage tho.
Outside of medicine and there was this high profile case, and a dispute over whether @timnitGebru was fired or resigned. What is clear is the irony of departure of an #AI ethics researcher over an AI research paper. These are exactly what leaders face.

Those of us who are physician leaders often lack the training for these kinds of ethical dilemmas that we are going to face.

Unlike physician leaders in the past, we depend on, often non-clinical, healthcare administration for our jobs (and paperwork needed for next job).
Granted, repeating these parts of the slide deck that I shared earlier

where there has been a shift of priorities from revenue generation to #populationhealth and #quality

I can’t say that I disagree with the system change though I see new weak spots on #ethics
I post about this often

and it is something I hate about how

women are socialized
rewarded at work

but the rise of the woman leader (doc or nurse)

sometimes can result in greater focus on compliance that translates into controlling other people

We hear about shattering the glass ceiling

yes, it is a barrier


shattering is violent
glass shatters in “riots”

one is not rewarded as a “rebel” or contrarian

rewards go to the compliant
politely knocking on the door to be let in

often means being quiet/agreeing
After the glass ceiling, the glass cliff awaits a woman and/or minority

another experience in insecurity & loneliness

If only token, should you stay for “you can’t be what you can’t see” & representation matters?

If you fall: “she could not do it”

Women who get these roles often have more courage than our peers. We disregard labels. We do not respect “boundaries.” We breach the barricade, shatter the glass ceiling. More common in WOC. “Women of color are the biggest professional risk-takers”

But is a WOC allowed to navigate spaces same way? Her communication is constantly scrutinized: “rude”, “intimidating”

Women often not seen as a physician in the first place

Classic sexist responses to women who speak up, holdover from Victorian gender roles: “shut her up”
I post this often as well, but often successful c-suite women need to be “tough” and fit into the “old boys club” & characterize harassment/bullying as something they had enough “grit” to overcome.

= Personal advancement but cultural status quo.

So which leaders can invoke images of Knights of the Round Table to fall on his sword? (or sacrifices to not comply with wrongdoing)

Who falls off a glass cliff, is “weak”, she could not cut it” (gif)

How does this affect ability to take an ethical stance?
One of the best sessions on how to be an ethical physician leader was this CMO Academy by the AAPL. Yes, is a pretty non-diverse group in that room, but sometimes when you can remove identity topic and isolate ethics, you can learn really useful things.

I still don’t agree with this @nature article being retracted, cuz, frankly, it is from male mentors that I have learned the most about courageous and ethical leadership. Women, too often are precariously perched under a glass ceiling or on a glass cliff.

Those of you who follow me likely see me posting the same things over & over again.

No leadership class or coach has the answers: not for the changing system, for interplay of identity and leadership.

Who is a leader? How to lead?

It is like trying to solve a Rubik’s cube.
That’s also why I unroll my own threads. I’m iterating on my own thoughts looking at the same things from new perspectives and trying to fit familiar pieces with new ones. Or deconstruct the existing structure to built it differently. How else to dismantle structural inequity?
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More from @usnehal

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
27 Dec
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.
Read 16 tweets

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