Thread by @usnehal

My ongoing career dilemma is as follows:

Many people tell me to be less perfectionist or aim lower.

However, a plethora of data reveal there are different standards for different people for gatekeeping/recognition of merit.

I don’t feel comfortable fudging. Others do, tho.

First, I wonder if everybody is given this advice that they should aim lower & have lower standards?

Seeking to do something different than the status quo or “realistic” is generally considered #leadership and #innovation.

Why not push boundaries?

onlinelibrary.wiley.com/doi/abs/10.111…

For many populations

our pushing the boundaries is the only way they get out of “the margins” or are no longer outside the walls

physical walls
policy walls
payment walls
definitions
access
etc

Those of us w/ identities not mainstream or of marginalized populations see it

You can’t judge by looking, necessarily, who has an experience of being marginalized

because there are many “invisible” disabilities

My concern is that if we tolerate mediocre quality on average, what happens to those 2+ SD from the mean?

My time working in the Medicaid program was personally & professionally transformative.

Up until then, all of my experience was in a single institution & I had been within children’s hospitals.

(People in my family have generally been employees of institutions.)

Eye opening.

When you work within a single population, field, institution, type of setting

you really don’t have any way of differentiating what is narrative, culture, assumption

and what is factual

despite having an MD & @HarvardChanSPH MPH, my thought processes, looking back were simple

It’s possible I never would’ve left that situation

if it weren’t for a disruptive style of leadership within my group, leading to constant shift schedule changes

while I was also doing more volunteer policy work

-> 2 ED visits, getting more & more migraines & asthma flares

Compared to people who go into #policy for power, control, fame, prestige

Got pushed into pursuing that path

as my worker bee doc role
became toxic to my health
+ I was really good at it, I learned while volunteering

Stayed clinical
At heart a frontline doc
Like my grandfather

Well, like so many other relatives

Growing up, my younger cousin, whose mom was an ob/gyn, & I

used dolls to do pretend surgery

alternating who was doing & getting the c-section

I did not realize this was not normal, to pretend to be a surgeon as a little girl

what barriers?

Recently realized

..while all of my relatives in #Pakistan had teaching appointments at academic centers

..they had their own private practices

=independence
I grew up hearing that medicine was a “good profession for women”

because you never had to answer to a (male) boss

Except despite the last GIF

the idea was that by not *needing* a man

you were much more secure

you never married a man

nor worked for a man

out of necessity or dependency

always own yourself
enter situations on your own terms

even Muslim marriage is a negotiation

“khudi”

I got a steady diet of American feminism in high school going to the oldest institution for higher learning for women in the United States @EmmaWillard

I spent my first year of college at @Wellesley

then left US to go to Pakistan for med school @AKUGlobal

then #pediatrics

This is what I have had my head & heart filled with ever since I can remember. Be a pioneer.

My @AKUGlobal @HarvardChanSPH or any degree has never been framed or hung up.

These are baseline, tbh, not exceptional in my family & circles.

Plus, what you DO w/ it matters.

My parents are down to earth frugal types, as were my grandparents, a necessity immigrating countries every generation, leaving behind land (property confiscated by new governments yet we remain a family of civil servants despite that past trauma/loss). Save for education.

I tend not to dwell on my past suffering. I’ve had plenty.

It is as Khalil Gibran or Rumi describe. It increases your capacity for the opposite: joy, generosity.

One should seek to alleviate suffering whenever possible. At the same time, some “right” actions do cause pain.

In formative teen years, when other girls were becoming small, literally (eating disorders) & figuratively, I was surrounded by this at my idyllic girls boarding school (pics from reunion). Walking past Thomas Jefferson’s words daily: feel you can go into any space & be “valid”

Except, every space I “grew up in” (well the spaces I choose to remember, some things I have put into a back closet of memory) I was without limits and/or pushing limits.

Deadline to turn in homework? That, to me, was a suggestion. LOL.

But in some adult spaces, sometimes:

Well, ok, I have had to be VERY circumspect & perfect.

There are some places I lived as a child I was afraid (warned) if I said the wrong thing the police would take my father away & I would never see him again.

I spent YEARS being VERY quiet, contained.

I value 1st amendment

So, I see/have experienced both sides of many coins: privilege & oppressed, free & suppressed, empowered & powerless, limitless and contained.

So when I am in positions of power, this resonates.

But as an American citizen, academic, now self employed ... don’t I have power?

Am at @MITSloanFellows, meant to be a transformative year. I already had started that transformation prior to starting. This has been an intense year for all humans on the planet. Where do I go next? Stay working for myself, consulting? I never “own” any system outcomes. Clean.

It is akin to the ED & hospitalist doc work. Circumscribed time, clear objectives, hand off, advise.

Never say never but do not see myself a CMO again - I think too much like a front line doc and EVERY patient matters to me. When you have 85,000 tho?

Something’s gotta give.

I feel like everybody is forever talking about “#empathy” especially in #MBA - because most DON’T HAVE IT. Whereas I want to rescue every mewing kitten in a tree. But also, if you read Voss, empathy helps selfish people seeking to extract things from others, manipulate & control.

There is the corporate route for scope & impact. Certainly lucrative & given, I am a single woman with chronic illnesses (reasonably managed now) it would be REALLY good to have solid health insurance & security.

But then, ethics - I may have too many.

cnn.com/2020/12/16/tec…

My professors at Harvard to friends and colleagues see me as a #government and #policy person. Maybe I could run for office ..but dealing with donors? Yeesh.

Appointed role? I call it a “doc on a leash.” I resist being controlled. I can’t do this: msnbc.com/msnbc/watch/dr…

Missing from this is ethics, quality, system. How much must I stick to talking points vs be authentic and accurate? When am I letting my credentials be leveraged for someone else? Where can I find people who match my intensity, pace, “unrealistic” goals, belief we can do better?

Been a roller coaster. I do really love that @MIT has this approach to “no boundaries” off of which I based this thread that I add to many subsequent threads.

Per one @MITSloan faculty to me: “You’ve crammed 5 years of work & accomplishments into 2020–👍🏽👏🏽🙌🏽 well done!”

https://twitter.com/usnehal/status/1265425020551077888

Most days I do great.

When I do not manage “balance”, this happens, tho. For most of my life I had developed an ability to suppress even extreme pain.

It got to a point I was putting myself in danger, lacking warning signals.

Am better at “feeling” after mindfulness training.

https://twitter.com/usnehal/status/1317266690078609410

So, am planning to try for #entrepreneurship - a bona fide start up & am working on something in #sdoh space for seniors, especially senior #loneliness. But a lot is up in the air. Have to build out a team & business model for #socialenterprise

wgbh.org/news/news/2021…

Am also considering taking leave given I again almost pushed to burnout. Write more formally

I have many #ADHD traits, common in many successful at #Entrepreneurship - have to be #creative & out of box, disrupt status quo, not stop at others’ boundaries.

Neurodiversity in women is extremely understudied. When I got self-driven neurocognitive testing, they held a conference on my results. It was not quite neurotypical but not fitting any diagnosis either. I got thru med school & can do detailed work so 🤷🏻‍♀️

sciencedaily.com/releases/2017/…

Likely have a mild, atypical version. I overcompensated socially, a “pleaser” to preempt social fallout. I had parents & some teachers who created psychological safety - countered bullying/shaming from peers & some teachers most girls commonly experience.

childmind.org/article/how-to…

Some people advise me that I should not talk about such things

opposite

yet again, the #business world is advancing faster than staid, risk-averse, ableist #healthcare in recognizing “superpowers” of #neurodiversity

different = competitive advantage

hbr.org/2017/05/neurod…

Having to be on the payer side where I had to deny sign denials of care, I had to “get over” being a pleaser, to an extent. I had to tolerate a lot of negative feedback, get called awful names, & disregard manipulative uses of empathy by certain lobbyists. If required almost this

However, given we know that there is an overabundance of psychopaths in the highest levels of leadership, how do I know “the rules” are driven by public good & NOT desire for power?

Once I started to be “in the room where it happens”, many SO questions

forbes.com/sites/jackmccu…

Friendships have been easy for me, unlike the stereotype of ADHD, myriad ways I don’t fit that mold. I’m grateful to have had some friendships spanning more than 20 years. I’ve been getting increasingly MIA tho, living in my head. Am thankful friends make sure we still connect.

Watching this video is a recognition, yes, this is me. I can’t check out. I can’t say “not my problem” - not keeping within a silo my issue. I am always breaking down walls/barriers to collaborate more. I care too much about EVERYTHING. #Entrepreneur

The advice I have gotten from mentors & peers on how to survive government or corporate jobs is to carve out an achievable goal about & ignore everything else. Latter is mh struggle.

Arguably as an entrepreneur I would still have to carve out a specific business idea and market.

#Entrepreneurship is lonely. I find myself going into hyperfocus modes, intensely wanting to solve certain problems. I run around reading, learning, hearing stories..

...then go into my head to try to fit the pieces together over & over & over & over..

news24.com/citypress/care…

That is another reason to take leave: take a semester off while my own cohort is around, continue to work on projects/teach/consult, unrelated to any MBA classes, then join a new cohort so as not to lose the community while I am pursuing this “lonely” path entrepreneur.com/article/254641

But it does not feel lonely tbh. It feels like this (minus the quasi child abuse - dear God some stuff is disturbing). You CAN create it. Change the world, or part of an industry.

Yes, something like 80% or more fail. I am leaning into risk. But why not?