This 🧵 resonated. Trained in Houston, #asthma central, I was in this scenario SO many times.

I had the best #pediatric training at @TexasChildrens & @bcmhouston - you see it all.

Amazing that mere tweets can transmit humane, quality #MedEd teaching across the globe.
After moving to Boston I found myself surrounded by highly anxious doctors. We have an over abundance of resources and a healthier population. I saw people quick to overreact and manage (poorly) their own anxiety & need for control, with harmful aggressive overintervention.
I also do get being “Harvard” makes one a target. Juries are not going to understand “at the brink of death” and not intubating or the equivalent action in another scenario. “Jury of peers” is not present in a malpractice case. Good care can seem negligent, paradoxically.
What that means, when life saving treatment, counterintuitive you, is *less* aggressive, instead, overanxious doctors & hospitals, who react out of fear & need for control …will kill their patients as a way to protect self from liability & to protect own/hospital reputation.
If you are a “how will it look” or “optics matter” type, in this scenario you may cave to the judgment from your own trainees. “What if the patient dies & they testify against me” is a thought you could have instead of managing own anxiety well to do what is best for the patient
The most prestigious places with most resources and fear of loss of face or reputation or liability do too much to the point of harm.

To not be ableist, do need to recognize #emergencymedicine has a high rate of giving doctors #PTSD. Denial➡️impairment.

physicianleaders.org/news/traumatiz…
Having #mentalhealth issues itself is not the “impairment”, the denial is - if focus is “control”, not honest transparency & sensibly managing these professional hazards like being damaged by the practice of medicine, medical culture, litigious culture. aamc.org/news-insights/…
I am a huge patient advocate yet recognize some well intentioned & needed patients protections or access to doc information now violate doctors’ needs as patients/humans which then makes patients less safe, as the norm is to hide to avoid licensure issues. statnews.com/2017/10/16/doc…
Doctors at breaking point. #Mentalhealth is needed
as is culture change

@drbreenheroes does great work.
Personally, want to stop hearing #HealthcareHeroes or “hero”

We are human
Budget resources accordingly

(& reduce bias to “heroic” action)

nytimes.com/2020/07/11/nyr…
As a CMO, I was guilty of bringing the #emergencymedicine personality into situations. It did not help that #NYC #FQHC is an intense place. I also am a fan of the “No *sshole rule” - cut out toxicity if you want good culture & morale & low HCW turnover.

hbr.org/amp/2007/03/wh…
While as a clinician I was trained VERY well & had TONs of experience via a VERY busy residency (15-22 admissions, solo, a night + crosscover + codes as an intern was normal).

But #healthcare management is a different skill of managing self among business non-clinicians.
Dr. Breen was getting an MBA as a medical director in a pandemic.

This is a resource issue.
When value extracted, lack of protection, exploitation, exhaustion, bad things happen. People’s normally good judgment gets flawed/impaired.

@drbreenheroes nytimes.com/2019/06/08/opi…
I am DEEPLY concerned by the erosion of physician confidence in service to hospital brand/optics. A lot was wrong before too. There ARE humanistic quality forms of #MedEd that DO teach to put the patient first. Hospital lawyers & communication ppl too often block/harm good care.
I am genuinely torn - I do see what many nurses & patients have communicated to me, and I experienced as a patient, of doctor/hospital ego, harm, hubris. Yet, when a patient satting 30s & about to die but intubation is *harm* but few know that… unsafe if mislabel doc actions.

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More from @usnehal

12 Dec
At every critical step past the early life & career stage (then rewarded for just delivering)

when protecting loved ones from harm
or #leadership

listening to #BlackExcellence/Black women gave me the framework to understand & the tools to be effective.

time.com/5869662/black-…
“Model minorities” chase impossible standards? Then let’s try to match of achievement level set by Black women

…who accomplish so much while mislabeled, hated, un-/underpaid, killed, losing their children to violence of others’ fear/anti-Blackness

wbur.org/cognoscenti/20…
This is NOT the standard:
-keep your access/proximity to power via a politician
-stay in spotlight
-use your credentials (& frowns/soothing tone) to gaslight a nation that deaths occurring not a concern to you

known for a collection of Hermès scarves…& now >700K American deaths
Read 32 tweets
11 Dec
Those of us with immigrant backgrounds have NO idea what debt we owe these women for risking their lives so some of us can shop at Whole Foods with other suburban moms, then drive a Lexus home to ride on a Peloton, & think only our own hard work created this access to success.
Those of us who are Muslim have a partial experience of what it is like to be made the face of threat and danger and vilified.

…But “the West “still wants to “save” Muslim women… make us a token or mascot of saviorism & evidence of being a shining city on the hill.
In comparison, the black woman doesn’t have that opportunity to be paraded around as the most recent woman “saved” & celebrated - the tropes are universally harmful & exploitative/pejorative vs Black women in society/media + centuries of economic barriers/being exploited.
Read 47 tweets
11 Dec
When I see this, and think of how a Muslim woman was denied a soda can given other passengers on the flight, out of fear of her look & belief she would harm people…

then look at this & school shootings

the double standards are SO clear.

These ppl likely were violent before
Is a question of who is given a pass?

what kind of violence is “acceptable” to American society?

towards whom violence is “acceptable”?

We already know who is dangerous. It’s just that “domestic” violence (vs women) is “acceptable” in American society

bloomberg.com/graphics/2020-…
The same is true about maternal mortality

Judging by outcomes, compared to peer nations, we’re a nation where women’s lives are not valued

This is indirect societal violence vs women

Still surprised Americans get violent vs flight (female) attendants?

npr.org/2017/05/12/528…
Read 4 tweets
11 Dec
"defendants…willfully destructed the evidence by deleting the webpages and social media accounts," Hanna wrote. "Plaintiffs cannot continue to be blindsided by the defendants by having to search for what evidence is being destroyed or altered”

LinkedIn is personal, not school’s
This is a really fascinating case as a lot of what I see happening in #MedTwitter (Twitter presence of the legal minefield that is #healthcare #MedEd, etc):

faculty, consultants, #hcw deleting content & accounts

My prior 🧵 on this & potential legal implications.
Read 11 tweets
11 Dec
Anybody who says “the #data don’t lie” either is ignorant or manipulative or both. The data are merely a tool that must be used responsibly & ethically to try to approximate “the truth” …some of which is unmeasurable (yet?). There are MANY #datascience methods & varying results
Everybody gets super excited about this new #AI #ML #machinelearning technique or that

You cannot build a RELIABLE house with low #quality bricks

First, look at the building blocks… meaning, how the #data fields are even defined & how the data are obtained

Who defined them?
I can’t tell you how glad I am that I have done coursework at both @MITSloan AND @StanfordGSB - Former immerses you in a ton of hands on analysis & options for analytic techniques useful in a #datascience job. Latter steps back to frame questions, assess missing data, biases.
Read 13 tweets
11 Dec
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 🧵?
Read 15 tweets

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