Thread by @usnehal

Dear #MedTwitter please, please, if you are a licensed medical professional and/or in school to be, do NOT delete your tweets or comply with anyone telling you to do so. It will harm you far more than leaving them up and explaining. Nothing is ever deleted. Can be used in court.

When I was at Harvard Med School and at an esteemed children's hospital, a case against an esteemed professor, that NO lawyer would touch cuz this was someone who had WRITTEN the textbooks and trained every expert, was won ..based on "a document was deleted" - creating suspicion

"Sunlight is the best disinfectant" you will hear me say OVER and OVER - wins & losses *should* be on data/standards but unfortunately wins & losses are in the court of public opinion. So be reliable, credible, and trustworthy. Transparency is one way to achieve that reputation.

The tweets I delete typically have a typo or the link did not populate the image as I wanted and I *immediately* repost THE SAME tweet, corrected. That way if anyone with "dark web" capacity were to try to "find dirt", ain't none. What you see is what you get.

I have been around the block enuf times, been a public servant w/ strict COI & scrutiny of my every word, & have been "in the room" when we have been deciding billions of dollars of state funding in Medicaid

You can decide whether you trust my advice/PSA

In fact, in any job interview, I have now learned I need to *warn* any potential employer: I take ethics, safety, quality, transparency VERY seriously. Take it or leave it. If that ain't how you do business, this ain't gonna be a good fit. I limit my choices, but sleep just fine.

I mean, no, I don't sleep a lot, but that's another issue. LOL My conscience is pretty clean apart from the things I realize were secondary harm from my trust in the system & being, what I now know is the so-called "model minority." That being complicit DOES keep me up at night.

Many of us come from cultures of shame - medicine, nursing, religion, "family name", regional culture (say a culture of "grit")

Shame will whisper to you "delete, delete..hide it..be ashamed"

NO

WRONG knee jerk reaction from when we were living in primitive conditions.

This matters on SO many levels. Most on #MedTwitter #NurseTwitter #AcademicChatter #AcademicTwitter want to have an impact in the world, want to build relationships, want to do #SciComm

First step for ALL of that is trust

Be trustworthy
Do NOT react to your reptilian brain

If you get past "reptile brain", can pause.

Think it through. What is your purpose here? (see above)

What is in your LONG TERM best interest?

Hiding/deleting only makes you look not trustworthy, poor judgment, unreliable.

amnh.org/exhibitions/br…

psychologytoday.com/us/blog/where-…

Not to be reverse ageist but please consider the life experience & matched professional experience of anyone from whom you take advice.

Now that I am at @MIT & @MITSloanFellows the classmates who "get it" are engineers who must maintain licenses.

Is a #mindset: accountability

If ANYONE tells you to delete, and EVER uses an "or else" threat..just listen to the recent recording of Trump to GA governor. First, even POTUS cannot seem to hide what he does so exactly how do YOU expect to succeed?

Most importantly, NEVER be goaded into being unethical.

Personally, my brain is SO fully of SO many more important things that, long ago, as a child, I realized lying/hiding was just a recipe to fail - I am transparent. Plus, my mom? OMG...NOTHING got past her. Plus am Muslim so a belief I can hide anything would make me delusional.

I'm old school, with my paper chart experience from having worked in community hospitals that were slow to onboard to #EHR as well as my having been an intern a while ago.

You all training on electronic only may feel it is easy to just hit "undo"/delete.

https://twitter.com/usnehal/status/1340733792617717763?s=20

Please know that hospital-employed NON-LICENSED HR or communications people will give you BAD advice. I have seen it SO many times. A relative of mine, was asked ("asked") to delete her EHR note documenting the processes to led to a patient discharged from care service.

I can't go into more details and have enough relatives in my extended family in healthcare that I have left that sufficiently vague. That said, this is a CLASSIC example of how a business/communications person will tell you something AGAINST ethics - what attorneys DREAM about.

Never, ever, EVER protect an institution's "reputation" or any boss's/faculty member's pressure on you at the risk of your own credibility. You have tremendous power as a licensed professional that others WILL use for themselves AND leave you to go under the bus when 💩 hits fan.

I know life is complicated & you get a ton of mixed messages. There are people with clear COI who are selling their advice either directly to you and/or to administrators who buy "reputation management" services (in house or consultants). I don't envy today's students/trainees.

Stay very clear in your own head. You are here for your patients. Your credibility & your license are YOURS. Employment or student status, institutions, do NOT define you (you are a mere cog in their system).

YOU define you.
Your credibility is based on consistent data points.

The last needs to be unpacked. You can and will make mistakes. Leave those mistakes up.

The data points I mean are of being factual, using vetted/verified/validated facts, leaving UP when you make a mistake.

Have a "paper trail" that shows transparency & honesty.

Not that we should be here for the "clicks" but if you need a metric of success of documenting failures, this is probably my single most popular tweet > 7K likes. You can look at the metrics yourself. I'm kinda a numbers shmumbers kinda gal tbh.

https://twitter.com/usnehal/status/1278087408412696579?s=20

Meaning, numbers not what excite me. Impact does. Metrics are important but we all know they are not the whole story yet we overfixate on numbers/metrics, often withOUT questioning their value, definitions, or true impact.

That is the other thing, please refocus on impact.

If you follow me you likely already are a "change the world" type and/or seek to have an impact & likely seek to destigmatize. You also likely are trying to show some kind of leadership. Leaders MUST lead by example. Be the leader who can leave any error up with confidence.

You can always respond, retweet with an explanation.

Will some people do "gotcha' screenshots? Yes.

It is impossible to avoid all misinterpretation or bad faith misuse.

If that worries you, then just post less or not at all. No one *has* to have a social media presence.

I know there is a lot of talk these days on #cancelculture. Everyone hates it (yet people who are most vocal about it seem to be super inconsistent with their words & actual actions).

That is just the world we live in.

It's not easy.
Titrate your exposure/risk to your comfort.

Personally, being Muslim, if I breathe = a "terrorist." I will ALWAYS be "gotcha" vilified by immutable things about my identity. This has made me more risk tolerant.

Gave me A LOT of practice early in life about navigating these complexities prior to social media screenshots.

I think some others did not have this experience of constant bullying from your earliest memories like I do. Bullying affects people in different ways. I finally saw thru it - it is about the other person's insecurity, fear, need for power, manipulation.

I would not wish the multitude of experiences that give me "grit" on anyone else, tbh. I would LOVE you all to spend your energy/time on not just surviving but going out and making this world better (not developing chronic illnesses from chronic stress).

https://twitter.com/usnehal/status/1343007640755036161?s=20

It has made me skilled effective in high profile, high risk roles: where I when I am an expert witness in a Grand Jury trial for the AG's office, when enforcing quality standards going toe-to-toe with another CMO, when I negotiate out of a bad employment situation, etc.

In ALL of these types of leadership & many others, they WILL try ad hominem

If you lose your cool, you lose
If you get nervous about an "error" or by an overt or an implied threat, you lose
If you doubt yourself & backtrack (delete), you lose

Don't set your own self up to lose

Failing fast & failing often is different from setting yourself up to lose/fail. First is driven by #improvement #mindset of #engineering and #systemsthinking to identify vulnerabilities and correct. Latter is poor #strategy, preparation, or poor decision making under pressure.

The #narrative is taught as the goal by so called #SciComm or #communications or #marketing folks who are bad at what they do. Those good at this do #valuesbased "marketing." A non-negotiable must be ethics, credibility, reliability. elegantthemes.com/blog/marketing….

The #narrative, in fact, is how you tell the story of the #data points that are REAL of your consistent commitment to your #values. The other thing you find with low ethics/bad at their job people is manufacturing "evidence" posthoc to craft a fake narrative. Don't be that.

I am intentional on what "record" I create. This had value on many levels. I do genuinely want to provide a free resource, vetted & validated by @AAMC standards to #MedEd

these are my values: marginalized populations, multidisciplinary, #mentalhealth, etc mededportal.org/doi/full/10.15…

This is another intentional use of my time/talent for #AI #futureofwork #diversity #policy #healthcare #innovation

If I get one tweet or a few tweets wrong, will it end a career? It is possible. Anything is possible. Unlikely, given my track record.

mitsloan.mit.edu/press/mit-sloa…

I worry about you all, tho, in early career

often getting bad advice from:

non-clinician “consultants”
or
faculty from this era of old boy network where they *could* delete, erase, and make inconvenient people disappear (kill someone’s career or professional reputation)

None of them will face the accountability that YOU face
“growing up” professionally in an era of high accountability & high transparency

You aren’t a gray-haired professor w/old boy network who can leverage contacts to do #MedBikini types of ethics shortcuts & gamble not caught

I know because I don’t get those kinds of passes myself

I have to check off every single box in exactly the right order = 100+ edits

if I don’t, my high-quality publication that gets glowing reviewer comments

still rejected/delayed

many women experience this @JulieSilverMD

The system IS full of inequity

some ppl get, frankly, harassed
by the system’s non-stop demands of more evidence to stringently meet standards, gatekeeping

while others pass thru w/out scrutiny

is neither fair NOR going away anytime soon

so get used to addressing questions

This is some thing I am used to from “traveling while Muslim” all of my life - I will always face 10x more scrutiny

Some of you may not have that skill set already

There will always be unfairness in life, line jumpers

Blame game & #leadership failures

latimes.com/opinion/story/…

It is very unfortunate that means:

even when you are in a vulnerable, low info access position

of being a student or a trainee

you will be put into very difficult positions

of not knowing when to comply with the rules & listen to leadership
versus self protect

#MedTwitter

From @Docbasia on the market share of.. #marketing by hospitals

Your schools and your employers ARE pushing you out there to use YOUR credibility for THEIR revenue generation

will often give you BAD advice cuz they themselves don’t understand how to do this ethically

https://twitter.com/Docbasia/status/1286623063707131904

Your institution may push you to bear risks including of physical violence.

#pediatrics has been dealing with this for decades from anti-vaxx mobs
=Risks to your family, health, #mentalhealth, livelihood, license.

@NicoleB_MD @DrToddWo #tweetiatrician #vaccineswork

If you are of a reviled and marginalized group like I am (Muslim) you will even face this kind of directed targeting of you

One step shy of crosshairs on my face

This is vs my #Covid19 #publichealth #education & GOTV volunteer work

This is just ugly reality of #SciComm today

More screenshots of what is being mislabeled as “terrorism”

when in fact am
-educating a marginalized population with distrust of authority

on how to engage thru valid civic processes to be highly engaged members of society

+economic justice

All #STEM mislabeled similarly now

Many #STEM, previously enjoying a respected ivory tower position within mainstream society as “expert”

don’t understand how to navigate a complex external facing role

where most benign things that you do become mislabeled

leading even to death threats

= #SciComm dilemma

Look at institutional response to WOC, often Black women

mislabeling BY institutions of VERY work that they claim that they want

blame patient

Respond to #diversity/#equity as“threat”

@COCoQC schema: HR processes start FOR doing as asked to silence (“erase”/oust employee)

Am outspoken too w/ inconvenient transparency

on #healthcare “leadership” failures, #revenue model

poor/ #quality, #ethics
inconsistent standards

on cue, non-clinical #SciComm faculty, w/ her own flagrant COI
& history of threats

when held accountable:
did retaliate/mislabel

What is cited as “evidence” was manufactured:
@ me by anon accounts
my response “counted” as “my” harassing
= smoke & mirrors game

common template for distraction & manipulation

My beef was with @USC’s standards. If charging tuition, preparing for reality & accountability?

My expectation is that my future #MedTwitter colleagues, current students, taught by #STEM #MedEd institutions across country

adhere to SAME STANDARDS I am held

when:
I go thru peer review
or
my license renewed

This affects BIPOC to do #advocacy & #community work safely @USC

I had no “need” to get involved in any of this

But I have been around the block a few times

For state (MA) I disciplined clinicians, including for for social media use

As CMO, signed terminations

As licensed doc, navigated complex situations while maintaining a “clean record”

My “need “is my mission which is a shared mission with anybody

attempting to work on #equity, #diversity, #communityhealth, #publichealth, marginalized populations, dismantling structural inequity

driving a culture of #accountability, #safety

I need you to “stay alive”

Ironically, highlighting the work of that Professor... had major issues w/ way he taught his class & I left for myriad reasons

even if I don’t agree w/ methodology

issue he highlights is true

#Leadership is fraught with danger
Some advisors will harm you
Don’t take bad advice

Which brings me back to original tweet. Some of you are getting some very bad advice (getting threats, frankly) to delete things *others* do not want in public sphere

Your “brand” needs to be reliability, credibility, transparency, ethics

#SciComm & #STEM need to regain trust

https://twitter.com/usnehal/status/1346133718365298693

Please understand that you are entering, not a “profession” but an industry that is 1/5 of the country’s economy/GDP.

Students: I wish you could enjoy an intellectual playground to grow. Sad you are entering into all this.

You have to question EVERYONE, including me. Be wise.

There is so much profit, channeled through various means so as to still meet the definitions of “nonprofit”,

that when people talk to you of “professionalism” as if this were not an industry, they are not being honest with themselves and/or you

Investigate/question ALL

https://twitter.com/usnehal/status/1345787012729741313

I am not suggesting you become so cynical or bitter that you are paranoid

I am saying that
-it is extremely complex
-there is a lot of uncertainty
-people in #leadership may not always know what they are talking about

Be wise
If you are really worried, retain an attorney

Always, ALWAYS diversify your mentors & advisers

If anybody tells you you should only trust them or prevents you from having other trusted relationships, RUN

Isolating, ostracizing, controlling your access or communication are hallmarks of abuse/manipulation

Trust yourself

https://twitter.com/usnehal/status/1342532370277216258

All of you who have licenses are the financial backbone of the healthcare industry

Almost every other salary depends on YOUR work

This industry can exploit you - is the nature of badly run businesses

Stay aware
Ask questions
Don’t get bullied
Be known for ethics

“Stay alive”

Not communicating this in order to make you paranoid

rather to empower you with an understanding that you are a #revenue generator in an industry

It took me half my career to recognize this paradigm

You are a (future) revenue producer in this

(Unlabeled images from NPR)

To med students (also attendings harassed by constant “performance” metrics) recognize:

med school experience is one of constant anxiety & fixation on numbers/scores
+
#impostersyndrome

=will make you vulnerable to social media validation/metrics

hijacks your reward centers

My own addiction is a voracious curiosity....OMG what am I missing?!?

Of new or useful knowledge - why I post long threads with LOTS of links

regardless (low) interaction

=is how I learn & share simultaneously

high “Input” in my “top 5 strengths”

gallup.com/cliftonstrengt…

I’ve been grateful/blessed on mentors.

I’m pretty sure that Dr. Feigin @bcmhouston @TexasChildrens also was high input.

He fiercely protected bear cubs (students & trainees) & the marginalized.

I do my best to honor his & other mentors’ legacy.

alchetron.com/Ralph-Feigin

@threadreaderapp please unroll