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Umbereen S. Nehal, MD, MPH Profile picture
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30 Dec 20, 12 tweets, 12 min read
Yes, the #vaccine rollout is slow, uneven, not matched to need. "Botched"? That is a bit too strong. Much blame to go around.

American #healthcare is built for silos, turf, acute care, reactive..not #populationhealth #publichealth #prevention. It shows. Why is anyone surprised?
And #MedTwitter, despite your hashtags & publications, when it comes to real life actions inside departments, hospitals, or even on Twitter, all you all do is turf, ego, cliques, us vs them, etc. I am unimpressed. Build *systems* Yes #impostersyndrome makes you crave validation.
I am a #pediatrician and if you need validation, I've got a whole box of stickers for you. I will even let you choose your own sticker. How is that? Because, yes, you are special. You matter. You are wonderful. Happy?

Then after that, could we get 💩 done?
We need a bit more Deming and a bit less hastily rolled out #AI or tweet wars on who is at fault for bad analyses. #systemsthinking is what we have always needed. Everything we are seeing and experiencing is perfectly logical for the systems in place.

deming.org/quotes/10141/
My reference too #AI and #COVID19 #vaccine rollout btw is in regards to this in case you missed the news.

I'm at the @MITSloanFellows at @MITSloan and @MIT because I *do* believe in the power of #technology and #HIT #healthtech - done correctly.

statnews.com/2020/12/21/sta…
A while ago with @ETSshow he joked on how much he uses the term #ecosystem. Well, now I might win that contest Mark. LOL. We need to fix the system itself, though, all the perverse incentives. We need to detox our brains from this conditioning too, tbh.

explorethespaceshow.com/podcasting/umb…
I wanted to say we have no system but a "jungle" only even jungles make more sense than our #healthcare "#system" - I was talking here on #valuebasedcare & #populationhealth. Applies to #vaccine rollout too. We are designed to fail, frankly.
@Ned_Arick

anchor.fm/the-state-of-h…
A jungle *is* an ecosystem in fact. It is designed to promote symbolic and collaborative life forms, yes, with some competition and some survival of the fittest. (Yeah, there are some gruesome things too.)

Versus: nytimes.com/2020/05/15/us/…

All we have is acute care silos.
Even tho, arguably, I could have seen some bizarro tweets on #MedTwitter and just ignored/muted/blocked them like others have done, the dynamics of Twitter this year has been fascinating, educational, & more representative of hospital politics that most people may want to admit.
This was known pre-pandemic. We gave the same leaders & the same (academic) centers that have given us these results the #vaccine. I have a love/hate w/ academia personally. (I've seen too many centers publishing on #equity refuse some Medicaid patients.)

commonwealthfund.org/publications/i…
So, we gave acute care centers where the #revenue cycle depends on surgeries and that glorifies tech, responsibility for public health of vaccines where the best practices are actually found in the developing world and @WHO.

who.int/immunization/c…
Again #technology and #healthtech and #HIT are all awesome. Love #AI & #ML. Let's make sure these things are brought into #healthcare thoughtfully, with appropriate stakeholders at the table and an eye on #ethics. Let's discuss/debate (not snark) gh.bmj.com/content/3/4/e0…

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More from @usnehal

Umbereen S. Nehal, MD, MPH Profile picture
30 Dec 20
Believe women

The gf was taken to a #mentalhealth facility

The man she was afraid of, the future TN suicide bomber, was assumed to not be a threat enough to get a warrant

Hers *could* have been a normal response to living with someone violent

apnews.com/article/ap-top…
There is no way of knowing w/out additional details

But as long as

-we do not believe women

-we do not see fear of a “regular guy” as valid enough to investigate (like if he had been Black, brown, or Muslim)

-we are soft on domestic violence

then: we will fail on prevention
Not uncommon for men who have difficulty dating (socially awkward? short?) or experience social rejection

to date women who need some kind of financial security from them but may have troubled lives, have own #mentalhealth issues

Few women call for help

usatoday.com/story/news/nat…
Read 28 tweets
Umbereen S. Nehal, MD, MPH Profile picture
30 Dec 20
1- If we knew terrorists looked like the "average Joe" we might see things right before our own eyes

2- If we believed women we could prevent terrorism

"She related that the guns belonged to a 'Tony Warner'..she did not want them in the house any longer," -MNPD spokesman"
There is a clear link between prior examples of violence towards women (wife, gf, mother), domestic violence, violence towards animals or elderly or "other" and later public violence like mass shootings or terrorism. bloomberg.com/graphics/2020-…
No, the TN suicide bomber did not kill anyone and took measures to reduce deaths similar to what is reported the IRA would do in Ireland. (I grew up watching a lot of BBC News at home and all they ever talked about was this IRA bombing or that).

wkrn.com/news/local-new…
Read 6 tweets
Umbereen S. Nehal, MD, MPH Profile picture
30 Dec 20
These #vaccine battles get fought in hospitals and #healthcare. This is not going to be easy. #communication #strategy and skill will be critical. Anti-vaxx fearmonger to already traumatized groups or those who distrust authority. @JAMA_current

linkedin.com/posts/usnehal_…
jamanetwork.com/journals/jama/…
Anti-vaxx target grieving mothers then spread #misinformation through women's online groups and social networks. #vaccineswork @AmerAcadPeds #tweetiatrician @DrToddWo @NicoleB_MD

That billboard is fear mongering. (I debated whether to post this at all)

nbcnews.com/tech/social-me…
Read 7 tweets
Umbereen S. Nehal, MD, MPH Profile picture
29 Dec 20
It is not like the information was not there.

I recall having Twitter exchanges in early 2020, telling someone who was reacting to seeing hazmat suits, to trust the public health officials. Nothing to worry about.

We must now restore integrity of & trust in #publichealth
Apparently, there were doctor mom groups on Facebook that were tracking this in December and January and trying to raise the alarm while everybody was telling them to “calm down.” Back then I was trusting we would be alerted through government mechanisms.
In fact, I recall a friend of mine, whom I have known for years, who is very active in Facebook doctor women’s groups, when I kept suggesting she should avoid posting certain unverified messages, told me I was “mansplaining” her. I was like, but I am a woman.

Now I get it.
Read 13 tweets
Umbereen S. Nehal, MD, MPH Profile picture
28 Dec 20
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.
Read 25 tweets
Umbereen S. Nehal, MD, MPH Profile picture
28 Dec 20
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

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