Umbereen S Nehal, MD, MPH, MBA Profile picture
Dec 11, 2021 15 tweets 8 min read Read on X
Doing a 🧵 of @EM_RESUS’s thread with screenshots.

We see a lot of screenshots of what is wrong in #SciComm.

What went right here? How can one doc transmit knowledge & confidence to another so well via a series of tweets?
First: what was the outcome of the #SciComm? Intention matters little as communitarian happens on the terms of the listener/reader. How was your #communication received/understood?

A doc:
recognized similar scenario
calmed team
avoided overaggression
achieved a similar result
The fact that the #MedEd teaching allowed an EQ & #leadership outcome (staying course despite others’ anxiety), not merely medical knowledge/journal club, is striking. How was this achieved? Let’s look at the thread. How do you transmit courage AND knowledge via tweets in a 🧵?
How does he start?

NOT with #data
NOT with a diagnosis
NOT a journal club

With a human being
A visual description
A family
Emotions

If in #emergencymedicine you recognize this right away
It triggers a memory or few
You will recognize it when you see/feel it

#SciComm
Next set of tweets. More visuals. Emotional tension, the pressure to “save” (via intervention).

You are still in the room in this scenario. This is masterful narrative medicine without violating patient privacy.

Only one data point.

Walks you through YOUR emotions, reassures.
After acknowledging what you’re feeling & your human reaction or bias to action, slows down your brain to “System 2”

Now, physiology

Engages your intellect & memory of how lungs work & what positive pressure ventilation does (in this case, harm/death)

Then: correct action
This is boom, boom, boom actions. Meds.

But still, human acknowledgement of nurses.

And where he wants you to remember, says it several times. Doses given of individual doses & total.

And explanation is why combineb or why give steroids early

This aids retention.
Same as above
This is a turning point clinically and you see the descriptive nature come back. What are you seeing, hearing, & why?

You transition out of only “do” mode

and because you did NOT overreact, did NOT paralyze & sedate & intubate

you can observe mental status
connect as a human
This is SO important. A busy #emergencymedicine doctor could leave at this point and the patient could crash then the doc blamed for not intubating. Instead, you are reminded that mental status includes anxiety that could affect clinical status.

Then reinforces the main point.
Given that 🧵, yes, it achieved success as #SciComm to communicate high quality, compassionate, humane, family-centered care that helps the doc (feeling the need to play hero) to manage self & stay logical, aware, make good choices under pressure & despite dissent/disagreement.
To summarize what @EM_RESUS did well in 🧵

-describes human aspects
-walks you thru your bias to action to “take control of the airway”
-activates System 2 thinking to engage on physiology/mechanisms
-repeats critical points
-clear precise med/BIPAP instructions
-end with human
Entire tweets in the 🧵with no/limited data ➡️get you to focus on what important.

Any parrot can memorize. An octopus has dexterity ..so ok..you can intubate? Whoopdidoo. None of that saves lives.

Being able to *see*, *hear*, assess, consider & respond (not react) saves lives.
& when others around you have anxiety & want heroic action, resisting bias to action or need to feel in “control” is HARD

stay confident, stay aware of the physiology/anatomy, calm others

➡️don’t kill the patient with aggressive over intervention/your anxiety

=#quality care
As I’ve been asked, yes, please do share & use this 🧵 based off a 🧵 in any way that you see fit

Tweets are public property
Can be used by anyone

If this helps you teach attendings or senior residents how to teach interns/juniors, go for it. I’m adding to @EM_RESUS #MedEd🧵

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More from @usnehal

May 29, 2023
This. When I had experiencing #bullying towards myself, I had just walked away or been silent, keep moving forward.

Once I had some degree of “rank”, felt others should not “just deal”

I did speak up on behalf of those less powerful… which only set me up for this mislabeling.
That is not to say that as faculty you should not speak up for or defend students are trainees

but you should be aware of this.

If the #bully is a woman, then she can always claim that she is being “attacked”… “as a woman”

That narrative aligns with a common reality.
False narratives spread quickly

if they align with something that people recognize as a truth (& may even have experienced themselves)

This is particularly why Machiavellian types are strategic/smart to utilize/promote a female bully while they stay more quiet/behind scenes
Read 13 tweets
Jun 24, 2022
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte All of this was already tested out vs American Muslims - the country was just fine with it. Regardless of what you think of the dad, killing/executing American citizen children by drone, along with father, should have been a big red flag on due process.

theatlantic.com/politics/archi…
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte ~Half of Americans approve of/support torture. The idea is you can use profiling/bias to assume someone is a terrorist or sympathizes with terrorists, assume has information, torture them first, then retroactively justify violation of human rights.

pewresearch.org/fact-tank/2017…
@ErinMarieMHCMEd @danpreston @JoshuaMZeitz @AmandaMarcotte Loss of Civil Liberties happened after 9/11: even if go white water rafting, spied on

pandemic killed >1 million dead but CDC has removed mask mandate & FL just refused to order vaccines=no interest in saving lives/prevention 9/11 killed 3K➡️police state

gothamist.com/news/nypd-spie…
Read 5 tweets
Jun 23, 2022
I think I need to go to law school. It might be a bit late to be #RBG & make it to SCOTUS… but seriously, it is all about the courts, the law, legal precedents.

Or maybe I just need to make myself small/silent enough to be able to fit into a government job again?
As hard as it is for me to stay in government long term given all the regulations that box you in/tie you up

plus needing to be a public servant to serve every taxpayer, even the ones you don’t agree with/like

Despite that, you *can* have an impact…small things at scale matter
There are times like this I want to be a cat & have 9 lives because there SO too many things I want to do…

…even though other times I am like, okay, how long exactly am I supposed to serve in this life because I am exhausted. (Albeit I did just recover from anemia.)
Read 5 tweets
Jun 23, 2022
For the first time in my life I felt unsafe doing #GOTV & got personally targeted & my photo posted on a QAnon type site.

More appalling was how many on #healthcare & #academia, if you are connected on social media like FB, are pro-violence & anti-rule of law & support J6.
If you are a Black, immigrant, LGBTQ, chronic illness, Muslim, etc person, patient, #HCW, teacher, heck yeah, is scary

Thing is those who have been safely tucked in cocoon of suburbia, worried about junior making the cut for the bball team
now feels suddenly scary

Us: not new
We *need* the ppl who typically enjoy more safety to step up. It feels “ick” to report, like you are an informant in Nazi Germany or something, but it is opposite: being “nice” & “not controversial” & “let’s all get along”
➡️empowers bullies

Be a true ally
Not bully ally

Cuz:
Read 5 tweets
Jun 22, 2022
Anyone who did not see this coming does not understand #tech…(which includes people who design #AI).

“Important nuances were lost in translation when a rule commonly used to measure disparate impacts on protected groups in hiring was codified for easy-to-use tools…AI fairness”
Every time I see “our #AI will solve bias! Give us your #DEI budget!” win an #innovation award, accelerator, #hackathon I feel exhausted…

institutions would rather purchase ineffective & worsening-the-problem #tech than hard work of holding ppl accountable or change culture
And this is how #DEI - how currently approached - is ineffective & wastes money because a small amount of money is thrown at it with zero/minimal real hard work & unwillingness to be uncomfortable. Hence these bills: amp.cnn.com/cnn/2022/01/19…
Read 5 tweets
Jun 21, 2022
When will we admit that “clash of civilizations” of Islamophobia narrative is not only false but dangerous. “War on Terror”=waging war vs Muslims but #J6 & #BuffaloMassacre reveal terror is not one religion. When Muslims are “legit” targets…that supremacist hate spreads further. ImageImageImageImage
Who was it “okay” to torture? (assumed is a terrorist?) Whose civil liberties disappeared 20 years ago? Muslims.

“But you all ‘deserve’ it” we’ve heard &: Why didn’t you stop terrorism? Why haven’t you apologized about x & y?

Now: consequences of that

vox.com/2016/3/31/1133…
The “Great Replacement” is an extension of “Clash of Civilizations” that conflict/war is “inevitable” between “different” humans defined by race or religion. It dehumanizes some humans as “less than” or “threat.” Once you label as such, violence follows. vox.com/science-and-he…
Read 22 tweets

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