Thread by @usnehal

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.

https://twitter.com/usnehal/status/1469662435762188291

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.