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Umbereen S. Nehal, MD, MPH Profile picture
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7 Apr, 52 tweets, 55 min read
When you want to know why
-women & minorities leave medicine
-why research lacks data to serve needs of anyone not white & male
and/or
-why different mortality rates in patients by gender, race, SES

this is why

This is #MedBikini “#professionalism” again

#MedTwitter
#MedEd
Is insidious
but highly effective
maintains
-segregation
-different access
-barriers

As women, LGBTQ, minorities, disabled enter or advance in medicine, this professor’s public stance will be cited to mislabel having #ethics as “lacking #professionalism”

bioethics.net/2020/07/medbik…
#medbikini is not one article
=attitude of many physicians
=drives this

We saw this happen with @ayshakhoury and @uche_blackstock and so many others. It especially happens at midcareer to WOC, especially black. Also if Muslim, LGBTQ, disabled, #mentalhealth

#MedEd
#MedTwitter
Let’s look at even one of those identities: women physicians

more harassed
not respected as physicians
under-compensated
fewer leadership opportunities

Now say that woman speaks up on “political issues”, like medical access to OCPs

“Unprofessional”

comphealth.com/resources/surv…
Say a WOC seeks to reduce mortality rate for black women by addressing institutional barriers, instead of defaulting to blaming the patients. She was a “diversity hire.” But the nurse manager is offended by talk of race, reports “unprofessional” doctor

insidehighered.com/advice/2020/06…
While someone like @adamcifu may make it sound intellectual but using word “debate” as to whether being black, LGBTQ, female, Muslim, BIPOC has any place in medicine as a physician or a patient, the “Amy Cooper” in HR will enforce his views to keep spaces cis straight white 👨‍⚕️
Anyone who experiences that or observes it, would consider being an ally, will go silent.

It has already been put on #MedTwitter by a full professor in #MedEd that certain identities or advocating for equitable outcomes or access is “not professional”

Latter blocks/ends careers
Look through the tweets on #GenevieveHansen: what #professionalism looks like

Or is #GeorgeFloyd too “political”?

if a woman or POC made error of believing the “be authentic” or “be vulnerable”

her emotions would be used against her credibility as a #healthcare professional.
Using one’s professional skills to save human life: get treated like #GenevieveHansen was by the judge & lawyer

When Professor @adamcifu either publicly states, or privately believes: a physician or #healthcare professional should not be “political”, =don’t save all lives
#MedEd
Who else does not believe in saving lives (some not valuable)?
Dr. Birx

Here, she was reassured that deaths were age>50 or “pre-existing conditions”

Now, she claims/implies, as a licensed physician, she was bullied by her politician boss

#COVID19 is political
#MedTwitter
Listen carefully & look at facial expression when she talks of #DNR:
derision
dismisses an EXTREMELY important #endoflife care decision
WAS essential in #COVID19
This is not first time DNR has been used in politics

Is not DNR discussion a doctor’s job?

newsweek.com/why-gop-gunnin…
Do doctors like Fauci & Birx belong in government? Or does that violate professionalism?
What made Dr. Birx, a licensed physician, seasoned #publichealth bureaucrat so easily manipulated by a politician?
If #MedEd physician training is per @adamcifu
physician training = go silent
#MedEd shames doctors into a culture of silence
Who is empowered when licensed professionals go silent?
(Political) bullies

When doctors faced w/ ethical choices that can result in life or death for individuals or at scale
per #healthcare #physician #leader @adamcifu: go silent
What else is political? #vaccine manufacture, distribution, eligibility that is budgeted & allocated by government & elected officials. Is that also not in doctors’ lane, @adamcifu? Yes, until recently #vaccineswork, was “just” a #Pediatrics issue (a lesser stepchild of medicine)
That an adult medicine doctor in #MedEd excludes #pediatrics
a field defined by #advocacy

= continuation of this from 100 years ago
not surprising

I AM surprised a doc in #primarycare still has this mindset of 1920s @AmerMedicalAssn

@AmerAcadPeds #tweetiatrician #MCH
This fragments, siloes #healthcare. The division between pro-patient & pro-family advocacy in #pediatrics & “that’s not my job” adult medicine, as defined by @adamcifu, adds risk to transition from child to adult care at a time of high risk, adolescence.

pediatrics.aappublications.org/content/142/5/…
When will adult medicine peers make their side’s #primarycare or speciality care a safe, #compassionate, supportive place for my patients? #pediatrics still seeing patients 40+ is not good #quality care - I am not best at treating an MI. #tweetiatrician

statnews.com/2017/05/01/ped…
POC, LGBTQ, disabled, docs would also like to do other things. We do not want to be mascots. Whereas @adamcifu can take off a white coat and became a “regular guy” in America, many of us cannot take off our gender, skin color, chronic illness for ourselves or our family members.
Why is there this distrust of the system such that only black doctors are trusted in black communities?

Why are we comfortable keeping this multi-level disparity in place (access issues for patients, unpaid work for black doctors in time off, etc) with “not my problem” #Covid19
In clinical medicine, am paid less than male peers & face publication barriers (see @JulieSilverMD in @JAMA_current)

Given my CV, my billing rate for non-clinical work is more 💰 than taking care of patients. Instead, I do free #SciComm to Muslims like

If I do not do this work, anti-science anti-vaxx target already traumatized communities fleeing oppressive regimes & teach: fear U.S. government

I would LOVE to take off my white coat & kick up my feet like @adamcifu

But then we cede to anti-vaxx

statnews.com/2017/05/08/mea…
Albeit, if @adamcifu went into a Muslim community saying “trust me/the system I represent” after this, he would not be believed.

He CAN’T do the work I do.

But where was #MedTwitter when CIA was using tax dollars to sabotage public trust in vaccines?

npr.org/sections/thetw…
Even as I grieve my mother, whose life was not protected by Dr. Birx or “not political” doctors

in condolence calls I receive, I am doing #SciComm with “the aunties”:
yes, #COVID19 is real
no the vaccines are not a government plot (see above)
yes, get the shot

No rest, even now
This politician: allowed to violate hospital #safety for a photo op
masks protect vulnerable patients
I was the rare doctor willing to be quoted by @MarketWatch

When I was at my dying mother’s bedside, told “the rules are the rules” & “leave, we will call you when she expires”
My area: #quality, #MedEd #disparities #communityhealth
My #publichealth #SciComm: free
Am depleted, exhausted, grieving

@USC employed @Sarah_Mojarad #Scicomm & #professionalism faculty: paid
racist & sexist tropes
mislabels #tweetiatrician
#MedTwitter

medium.com/@smojarad/onli…
Who hires & teaches @Sarah_Mojarad or others doing #hospital & University #communication?

@marketwatch had to tell hospitals: require politicians to mask for patient #safety

Who defines #professionalism?
Docs like @adamcifu?

Replying to non-factual #ScoComm = #harassment?
Ok, #MedEd faculty like @adamcifu or Goldfarb in WSJ neither want to do this work nor capable of it
Ok, take off your white coat & kick up your feet

Without your support rest of us are doing this...then arrested
Call off the attack dogs
#MedTwitter

amp.miamiherald.com/news/local/cri…
Not just a #MedTwitter #MedEd
“debate”/intellectual exercise

BIPOC physician after BIPOC
physician is stepping up in a broken
system & failed leadership
that failed patients like my mother

accused of “theft”
by GOP-affiliated DA
tho cleared by board

khou.com/amp/article/ne…
What #MedEd & #MedTwitter faculty put out on BIPOC, LGBTQ, disabled physicians
in tweets
MATTERS

No one is forcing you to do free work at margins
Just get out of the way of the way
Stop crafting “narrative” on #professionalism
Entire concept is racist

ssir.org/articles/entry…
Given this reality in #academia

added to what @JulieSilverMD identified in @JAMA_current

#BIPOC docs may even accept:
your turf, your rules

We go to open space of #MedTwitter & communities

to try to make an impact
on important things like *mortality* for WOC during #COVID19
We of so-called #modelminority” realizing: while we chase carrots in #MedEd system of barriers

no one is protecting our mothers or grandmothers
not in hospitals or on the street

Non-BIPOC #MedTwitter peers prefer to justify “opt out” w/“political”

nytimes.com/2021/03/30/nyr…
No matter level of seeming privilege, identity is a basis of targeting

For many of us, our very identity that we cannot take off like a white coat to go home and relax, is made political, criminalized. #Research collaboration depends on freedom from fear

chemistryworld.com/news/mit-facul…
Over-policing, excessive harshness has a LONG precedent of implicit bias and/or a mechanism of racism - as seems like in examples of Prof Chen or Dr. Gokal

It is why I felt safer off of campus this year: “peer policing that is prone to #xenophobia”

poetsandquants.com/2020/09/16/aft…
I followed every #pandemic rule

did not see my mother for 14 months

a mother who just passed away from #COVID19

as compared to other #MedTwitter darlings who put fun & partying ahead of #safety - yet “sexiest doc” still trusted on monetized #SciComm?

torontosun.com/news/world/sex…
None of these #SciComm #MedTwitter celebs
some not even clinicians
w/ monetized platforms
are protecting BIPOC patients in community
nor BIPOC clinicians from #MedBikini harassment inside #MedEd #AcademicTwitter, in name of “#professionalism” policing

med.stanford.edu/news/all-news/…
The only time, in the last >1 year, I touched my mother, she was sedated, paralyzed, intubated

This looks touching but it is my false “narrative” to not fall into an abyss of pain & despair

“Optics”, then emotions, are easy enough manufacture

But my mom not “there” here:
So @Adamcifu (do you feel “harassed” cuz I address your tweets, w/ frameworks, evidence, publications, & lived experience on matters that are life & death for my loved ones)

Do what you want with your free time. Stay in your lane.
Call off the #MedTwitter #Professionalism police
WOC, esp black doctors, already not believed to have the credentials we do

We already are working in “off” hours for free: outreach to compensate for the distrusted system that harms

Tweets from a professor labeling activism “not professional” harms

washingtonpost.com/national/healt…
Even in hospitals, when we are hired, it is for this paradigm to self sacrifice (self harm) to take care of BIPOC patients (at lower salaries)

#healthcare #leadership will publish a “narrative” in a journal or a chapter on #equity

in real life if perceived “political”: silence
That picture is correct: we are exhausted & depleted. All doctors are. Difference is, especially in this #COVID19 #pandemic mostly killing minorities, is BIPOC mothers dying, literally.

To rest, go silent, opt out of “activism” is to fail our own mothers. The pressure crushes.
I would love to feel able to do self care. “I worked hard, done” & not run down my health this way, but if WOC rest, our mothers & children die. BIPOC, especially black, still die from preventable harm, but our every action, word, might save someone else’s mother or child.
So we do this - in my case I saw enough & experienced enough in #Academia that I left that as a career

tho still publish @acgme-compliant #curriculum on #communication, #traumainformed care, #advocacy, #refugee #health

unpaid, as adjunct
to fill #MedEd gaps
while a student
My mom raised me to be self sufficient, not a “drama queen” or “victim”, to hold myself VERY accountable

so-called “model minority” is why so many Asians never report harm
We “take it” for ourselves

But it our mothers defenseless, harmed, alone

as have been black women, always
Barred from my mother’s bedside for #COVID19 #pandemic safety - tho Pence had been allowed to walk around @MayoClinic w/OUT a mask or gown - I did not sleep

I know how much #MedEd has wrong information still in #medicine & #nursing textbooks
#MedTwitter

insidehighered.com/news/2017/10/2…
So yes, if #MedEd fails to teach facts, basic #humanism, many of us are breaking from the narrow confines

“boundaries”

of how cis, straight, white, non-disabled male #MedTwitter faculty define “#professionalism”

(Below tweet was quoted as “harassment” by @Sarah_Mojarad btw)
Cis, straight, white, non-disabled non-pediatrician male #MedEd physicians should refrain from mislabeling, misdefining #professionalism

so they are not quoted by non-clinicians (monetizing #MedTwitter #SciComm in violation of @ACGME #ethics)

My field:
psmag.com/.amp/social-ju…
No one is asking you to care about ppl at margins in hours you’re not paid to work, in ways that do not add lines to your CV on peer-reviewed publications

But why label those contributing per #MedEd @AAMCtoday @acgme standards withOUT support, pay, or title “not professional”?
...because we take this work outside the ivory tower or peer reviewed literature

to make a real world impact

via #SciComm, #policy and #community #outreach

Why is any of this not professional?

If you don’t wish to do it, simply refrain from commenting
stay out of the way
The heads of hospitals, who are not WOC, are sitting right next to those elected officials. Same heads of hospitals that tell VP Pence no problem on potentially exposing patients to #COVID19 during a hospital visit while their policy bars families of patients dying from visits.
Yet hospitals muzzle clinicians, with #cyberstalking #HR mechanisms, hired “#Scicomm”, made up “#professionalism”

fire clinicians
for speaking up.
Dr. Birx was not speaking up.
Then who speaks?
Who protects most vulnerable during #COVID19 #pandemic?

businessinsider.com/coroanvirus-ho…
Stay protected if you prefer, stay silent, let the death toll rise, it’s not your mom, right?
Take off the white coat, kick up your feet, relax.
Fine.
Stay out of OUR lane of taking care of the most vulnerable.
Refrain from mislabeling a fuller scope of physician care.

/Fin
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More from @usnehal

Umbereen S. Nehal, MD, MPH Profile picture
7 Apr
@adamcifu - the idea that doctors should not be political is why the entire field of #pediatrics walked out on the rest of #medicine. Children don't have the luxury of "every man for himself" mindset. Also, Muslim patients' or atheist patients' autonomy at #endoflife : political
All of us are trained, in residency, on "political" dollars from #Medicare and much of our #EBM is funded by tax dollars from #NIH and elsewhere. Tax dollars are public money, managed by elected officials, who are put in place and held accountable by the political process.
Then there are seemingly extreme examples, but are they so extreme given how often horrific things happen in history & even uptick of violence in the U.S.? Should doctors opt out of protecting vs this? These camps, if formed, may utilize doctors/nurses

time.com/4574680/muslim…
Read 5 tweets
Umbereen S. Nehal, MD, MPH Profile picture
6 Apr
#MedTwitter showed me the dark side of this, of all times, during a #pandemic. Turns out some who are employed in supposed #SciComm actually stalk patients on behalf of doctors & administrators. Sadly, #bullying patients has gone from "just" in hospitals to dark web.
There is a type of doctor, not all, who believes self a "victim" of patients.. "I am a victim" is used to do mental gymnastics to "justify" #bullying patients who seek answers, report error or harm, initiate lawsuits.

Yes, there is too much litigation. But this is America.
#Tweetiatrician training is for #advocacy on #vaccines #VaccinesWork #VaccinesSaveLives

This has been our lane for well over a decade. As long as I've been a pediatrician we've been using every form of #communication and #SciComm, the sillier the better

pediatrics.aappublications.org/content/141/1_…
Read 9 tweets
Umbereen S. Nehal, MD, MPH Profile picture
6 Apr
Further, suboxone has required special training and certification, adding an administrative barrier and creating an added fear barrier among risk-averse clinicians whereas oxycodone can be prescribed easily with the DEA certificate we all have.
Because doctors/prescribers are definitely lacking in administrative burden and CME obligations, we're just twiddling our thumbs eager for someone to ask us to get MORE educated, taking time off from patient care to get this:

medpagetoday.com/psychiatry/add…
The law enforcement side sees doctors through this lens. So doctors seek to limit their risk and liability. I'm all for taking down those who harm patients. I've testified in cases like the ones below for the AG's office as a medical expert.

medscape.com/viewarticle/91…
Read 7 tweets
Umbereen S. Nehal, MD, MPH Profile picture
6 Apr
This happens not uncommonly. Sadly, it means being Muslim-American means that you never know who has been targeted, "converted", especially via #mentalhealth targeting

Need to fulfill metrics of "terrorists caught" to report to superiors... meanwhile, Jan 6th happened....
If you work in refugee health, are an activist, seek to empower the marginalized or targeted, this has either happened to you directly or happens to people you know

The person you are supposed to pick up from the airport arrives hours or days later with no info where they are
"Go back to your country then" does not work if you are
1-born in the U.S. thus are in "own country"
2-drones kill grandmothers in their own homes across the world too

#Safety for whom?
Look at #CapitolRiot, etc
How's that #security going, America?

pri.org/stories/2016-1…
Read 7 tweets
Umbereen S. Nehal, MD, MPH Profile picture
6 Apr
This is where a "culture of civility" enables abusers & predators. If you do not say something to inappropriate behavior in a professional context, maybe you feel it will draw negative attention to yourself oor associate you with the harm

you are complicit
you teach "this is ok"
What I find with "civility" culture

is it will punish action - like even smiling too much, identity (natural hair) or things of a non-European culture

while rewarding suppression, silencing, & inaction as "not making people uncomfortable" called #professionalism.
A prime example is how "comfortable" Dr. Birx made us on ongoing harm. Per her recent interviews, she knew was going to happen, she carefully documented (like the bureaucrat expecting later accountability and protects self) but did not speak

businessinsider.com/dr-deborah-bir…
Read 5 tweets
Umbereen S. Nehal, MD, MPH Profile picture
6 Apr
This is VERY important because we already have a mistaken belief that being "a good person" or "having empathy" can erase or mitigate racial bias or disparity when study after study proves opposite. Now we're encoding bias into #algorithms and #AI that will be called #DataDriven
This is the new frontier of #systems driven #bias. Look at the demographics of who is in #technology and #BigDataAnalytics and #AI. Look at the reputation of culture of these spaces. This puts everyone at risk even if you think you "benefit" from the bias. Inaccuracy is harm.
Just look at the #COVID19 #pandemic. Who correctly predicted AND took correct actions for good outcomes?

The risk of the most vulnerable became YOUR risk

if your #sytems and #bigdata and #BigDataAnalytics fail to capture reality

your real life results will be failure.
Read 4 tweets

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