Umbereen S. Nehal, MD, MPH Profile picture
MIT Sloan fellow, consultant, frmr Chief Medical Officer & Medicaid medical director, “Top Voice” 4x, advocate, educator, Tweets personal, RTs not endorsements
28 Jun
So much to unpack here

Thankfully I experienced the opposite in my own residency
BUT then I was unprepared for this after residency

When described this way by faculty, then can a woman really choose to describe herself similar to men without invoking backlash and social cost?
The word choices here are signaling values

difference in what valued by gender and it predicts this later

expected of women:
special favors
emotional labor
friendship behaviors
constant availability
leniency

can women hold others accountable?

insidehighered.com/news/2018/01/1…
This extends to direct reports too. What if one stops bringing snacks, being maternal (the giving tree)?

Is it fair to make it a women’s job, already overburdened and underpaid, to support other women?

Or can there be accountability & standards?

qz.com/work/1722398/w…
Read 33 tweets
24 Jun
This is the single best advice for any doctor at any stage: listen to nurses. In particular, listen to Black nurses

Also, protect nurses. In healthcare the terminology is “writing orders” - if that is not power imbalance, I don’t know what is

#MedTwitter
#NurseTwitter
#MedEd
One thing I have noticed on social media is: even at pre-med stage, the condescension & disrespect towards nurses sometimes is already there

Much of recent #MedTwitter drama I engaged in was because, though I knew it would be wise to “look away” could not

not if vs Black nurses
Across the board, regardless of race, when nurses, or anyone, is bullied within in clinical practice settings - setting that already have high rates of error

unsafe
on many levels

it is anti-#safety and #quality for patients & staff

#safetyculture

medcitynews.com/2015/04/nurses…
Read 10 tweets
21 Jun
This, today, would be considered flat out torture

First, women’s health was not studied. Even when women’s health was studied, it was by harming black & indigenous women

When women talk of safe spaces I look at race

We know this has existed throughout history ...and now
In modern society, how does a woman with education and privilege seeking career success “lean in”?

She likely has someone else - often a low wage dark skinned woman - looking after her kids, cleaning bathrooms, cooking meals.

ethicalsystems.org/women-can-no-l…
What I have come to realize at midcareer & reading history more deeply

privileged women’s advancement requires exploitation of the disadvantaged, especially low income women

It is partly why election results in 2016 *was* voting for own interest in fact

vogue.com/article/white-…
Read 21 tweets
16 Jun
In recent years have started to question the traditional approach to #narrativemedicine. Who owns a story? What lens is applied? I get it is seen as important for “joy of practice” to tell these stories as doctors. Except, these are actual lives and bodies of human beings.
As in, I don’t know the right answer but I also don’t think we are asking enough questions of ourselves, our profession, our peers, our professors/attendings.

Ours is a profession that labels
>age 35 as “geriatric pregnancy” after all

My pinned tweet:
Or: #nyc writing class, read “The Laugh”
by Tea Obreht:had never been yet wrote story in Subsaharan Africa

Vivid descriptions of wild animals
Black male=passion

WOC in class had to point out to instructor: WOC characters were flat, one-dimensional, silent, passive
=White gaze
Read 18 tweets
14 Jun
In all places, particularly, in #Pakistan, extremely important for mothers, female role models & #HeforShe men to encourage young women and girls to be expressive, out of box, push boundaries, and never go silent.

Admire you on so many levels @ayesha_mian1
#womeninleadership
The only way to advocate for the voiceless and marginalized is to use any source of privilege one may have to create space, amplify others, and be willing to be told one is “too much” in myriad ways. What is the standard to measure too much, tho? If measure is status quo...
Who designed the metrics of “just right” vs “too much” and who defined “good” vs “bad”?

What gender, ethnicity/tribe, religion, etc wrote “the rules” - overt & unspoken?

What cultural triggers are there to invoke, anger, disgust, shame?

Who is in/out group?

Are others silent?
Read 11 tweets
12 Jun
It’s an interesting approach at @MITSloanFellows - placed into teams rather than allowed to select own team. The teams are formed so there is likely to be misalignment and conflict. And then we have to work together for grades. We cannot do usual bonding activities via Zoom
Teams are being coached & cautioned that it is easy to create “in” and “out” groups to exclude, marginalize, label some in group. Instead, keep open communication and pause prior to forming any conclusion.

mindtools.com/pages/article/…
“Identify where on ladder you are.

Are you:
-Selecting your data or reality?
-Interpreting what it means?
-Making or testing assumptions?
-Forming or testing conclusions?
-Deciding what to do and why?”

Vet, verify, listen, consider

(This seems especially relevant for biases)
Read 19 tweets
10 Jun
First week of class at @MITSloan for @MITSloanFellows has been intense. Lots of learning on #mindst to move into or affirm #growthmindset - one of the videos we watched was on “Thinking Fast and Slow” or two systems in our brain.

m.youtube.com/watch?v=PirFrD…
A few pictorial representations and some humor. In our fast-paced world it is easy to rely on mental models or trusted individuals instead of verifying facts or being thoughtful

Interestingly I found that some scientist can be living in system 1 based on trust in own expertise ImageImageImageImage
That seems particularly relevant now given how blindsided so many institutions were by the #pandemic, with healthcare excutives & policy makers

seeing familiar patterns

not staying aware of the expected but rare event

#COVID19 #coronavirus

nytimes.com/2020/03/19/us/…
Read 8 tweets
8 Jun
Thread for allies on #BlackintheIvory

Be this kind of a person. We know the existing level of power differential between faculty & students or trainees.

Now add #BlackintheIvory

Step up. Be an ally. Report on behalf even if not asked. If you see power abused, speak up.
As a doctor, need to be able to do one’s job. Also, a doctor is in a position to protect others, *if* role is recognized. #BlackintheIvory

Those prestige/hierarchy oriented, treat some people poorly

(I get mistaken for cleaning person or receptionist)

Reporting on black student, trainees, & faculty #SoMe and #SciComm posts is higher - due to #implicitbias or overt racism

Black culture often offends

Institutions need to screen OUT frivolous reporting on black ppl - NOT assume fault

#BlackintheIvory

Read 20 tweets
7 Jun
Let’s talk #safetyculture

@TheIHI

It’s a framework for a harm reduction towards all: patients & families as well as all staff

Important:
growth mindset
instead of
fixed mindset

to have needed uncomfortable conversations

#MedTwitter #AcademicTwitter #MedEd #NurseTwitter
This framework has been applied to reducing harm, mostly through medication error (though intended to achieve population health)

Then was expanded to patient experience

Also, cost of care

More recently we have added clinician wellbeing

=quadruple aim

ihi.org/communities/bl…
What has not been clearly stated in any of these #safety framework is disparities, structural inequity, or racism

The acute care side of the hospital - money maker - thinks of this as type of safety & #quality

but not #populationhealth

#Implicitbias elicits 🙄😡😴 response
Read 13 tweets
7 Jun
Much debate on #SciComm. Little formal guidance exists. Those on academic committees that oversee ethics & professionalism are unfamiliar with social media. And now we are in a crisis and #pandemic of many levels. #publichealth very different from industry (1st vs rest).
In #publichealth one, the 1st points are be first & be right

There is an inherent tension between these two

With disrupted public health coordination, like cutting off from WHO, changing guidance from CDC (masks only for clinicians, no everyone wear them) how to be accurate?
In comparison, industry guidance #SoMe guidance. Industry has a lot more experience with this and uses it for marketing, market share, customer outreach, customer brand recognition, brand management. The focus is prestige, optics, reputation - there are monetizable traits.
Read 13 tweets
6 Jun
A word to you ladies & femmes who are looking to advance equity:

Highly recommend studying cultures were women have historically held power, to understand use of power

I found this extremely informative, both on power & for my own cultural roots

m.startribune.com/daughters-kept…
A key attribute was that these women were daughters in tribal culture, therefore more trusted than an outsider

That can mean your university or company network, even religious group. For instance, Dr. Birx is evangelical as are current health advisors

khn.org/news/religious…
You still have to be qualified.
But final cut: usually “in group” gets in + staying power

“Group” can be defined in various ways. Options for me: #publichealth, #pediatrician, #communityhealth etc.

Know which groups have internal competition & dysfunction (Doctors, Academics)
Read 20 tweets
3 Jun
Putting this here

To be effective, get out of the petty fights

STOP with the call outs, doxxing
(Yes, I hold whose entire brand is “call out” to facts & standards)

Activism that is entirely composed of call outs does NOT work to achieve system change

Let’s stop with the high school level thinking of labels, cliques, and lack of independent or factual thinking.

There is never any “us vs them.”

If you think that way, your identity and agenda is likely lacking complexity or scope and is too small.

I don’t give a flying fiddlestick who you are friends with or follow or whatever. Irrelevant

Show me IRL results

I don’t care what you did in the past cuz if I did I would NOT be anti-racist

Puritanical thinking is great when you are Asian or white, NOT if this your reality
Read 11 tweets
31 May
This - not only the social structure of South Asian culture, whether India or Pakistan, but the experience of Colonialism. We understand this in implicit & explicit ways used for re-establishing positions of dominance in the U.S. as "model minority" - use that for social justice
Colonialism layered over social hierarchy in South Asian culture, not erasing social structures. In chattel slavery stolen African bodies were all the same - former king now a slave. We kept our names, not taking masters' names. We accessed education.

When we think we get places in America only through hard work that is self-serving narrative and myth. Yes, there's hard work, but hard work that gets rewarded. We also get places because we know how to "work it" - work the system like systems that worked for us in the homeland.
Read 11 tweets
26 May
If you are a woman who is not making others uncomfortable, if you are not pushing or disregarding boundaries, if you are waiting for permission, you are perpetuating status quo. Instead, be the change that is needed. Speak up. Be messy. @techreview

mitsloan.mit.edu/ideas-made-to-…
"Battling workplace bias requires deliberate strategies, including learning to say no, getting comfortable talking about uncomfortable topics, and helping others behind you." @techreview @MITSloan #womeninSTEM #womeninleadership #WomeninBusiness #womenintech #womenentrepreneurs
This week I heard that some do not ask for "consent" prior to tweeting

Having worked in insurance, am curious, where do I submit this prior authorization form in order to tweet?

Who is the decision maker? What is standard used for permission granted? diversitywoman.com/speak-up-and-d…
Read 9 tweets
26 May
@threadreaderapp please unroll
@threadreaderapp please unroll (trying again)
Read 2 tweets
25 May
For “not sure who needs to hear this” trend
here is mine:

As a #SciComm doctor if:
-several nurses flag something
-POC/WOC bring up overt or implicit bias
and/or
-patients are concerned

Pause, listen, & self examine
Course correct

right thing to do
+
protects you
#MedTwitter
I listen *very* carefully to nurses

I went to a residency where I singlehandedly admitted 22 patients + crosscover as an intern, no night float. It was excellent nurses who were protecting patients & families, the institution, & me

Listen to nurses

To be anti-racist must “see” color
If have less melanin &
there is a lot more melanin in the side asking you to pause, consider, self examine

listen

If find yourself blocking POC of #MedTwitter, are you simply creating a new Jim Crow?
=bias in action

rollingstone.com/politics/polit…
Read 10 tweets
23 May
Thank you @ColleenKraft for being consistently vocal 💪🏼💪🏿💪🏽

Let’s work on #tweetiatrician #advocacy training by @AmerAcadPeds to have more robust & effective strategies vs increasing backlash & #bullying
as experienced by @NicoleB_MD @DrToddWo, worse for #minoritiesinmedicine
From @bfrist on #LinkedIn: concerning loss of scientific #integrity by political agendas

#scicomm teaching has been to “avoid politics” = sitting in sidelines

why engaged #tweetiatrician were a separate species apart from other #STEM professionals

linkedin.com/posts/activity…
We need to be multidisciplinary like work with school nurse leader @RobinCogan

When I have taught official @AmerAcadPeds guidelines to trainees in hospital settings & staff member has walked by, they assumed “political” & “unprofessional” when per AAP

https://t.co/1ktvts1Fuu
Read 20 tweets
10 May
Marketers hired by hospitals can be new source of exploitation

They know that the most credibility is with nurses & doctors

So will use employees for marketing & extension of hospital brand

But quick to penalize same employees for own, personal use of #SoMe

=Value extraction
I mean, personally, I built my reputation outside of hospital activities

I created, as volunteer, used no hospital or university resources, paid my own travel or obtained community grants, then yes, was recognized internally after creating external success, like this:
Or like this - I do all of this on own. No one trained me. I pay membership fees to LinkedIn

If I were to mess up, I’d need to deal with consequences from hospital, licensing bodies, etc

Wherever I go, I contribute to good optics & metrics

massgeneral.org/news/article/m…
Read 30 tweets
9 May
Love, LOVE @NicoleB_MD for doing this. Shout out to @DrToddWo & @DrJCoftheDC too for their savvy outreach to youth patients- am especially impressed with @DrJCoftheDC of @OHSUNews as a role model in communities of color. @AmerAcadPeds #TikTok #tweetiatrician #Pediatrics
*This* is what it means to create “safe space” - no shaming or judgement, only encouragement, kindness, affirmation from a #tweetiatrician who shares that she too was a #teenmom.
Meet patients where they are.
Be a role model.

@NicoleB_MD @AmerAcadPeds

https://t.co/iwJFeCfwsG
Am learning so much from @DrJCoftheDC of @OHSUNews - on engaging youth through new forms of #socialmedia like #TikTok and being a role model for #BlackExcellence here in partnership with @NFL players @NFLPA
@AmerAcadPeds #blackmensmiling

https://t.co/LMXf6ZwcC0
Read 16 tweets
7 May
Yes.. and more than offended, I would reframe to respond with: your obvious bias reveals you are not a person who can be trusted to apply standards fairly for good outcomes.

Bias = unsafe.

Not about anyone’s emotional or intellectual reaction.

About #safety & #quality.
Discussed w/ that frame w/ @becker_sbecker

Look, I’ve got “grit” & resilience & can manage my emotions just fine

But are *you* safe or able to provide quality results? Using my former #Medicaid medical director lens, low quality = low value, waste, harm

go.beckershospitalreview.com/scott-becker-i…
“Safe spaces” emotionally, yes - but safe for whom?

Is safe space code for protecting your fragility when hard, complex problems are identified & you must confront some unpleasant realities?

Hard problems are... hard
Hard things are uncomfortable

https://t.co/xsx50fEbSl
Read 9 tweets
6 May
Did you post about the black man hunted down?

Are you yourself black or a minority where you have felt unsafe around authorities because of how you look, race, religion?

What outcome do you expect from the share?

nytimes.com/2016/09/11/fas…

A thread on “performative allyship”
“But where are these white allies when the problems are less explicit than Nazis parading through the streets?”

Where are you when things that represent black culture are censured/shamed as inappropriate or unprofessional? A dancing TikTok or hairstyle

columbiaspectator.com/opinion/2017/1…
Is this you? (In private, offer “empathy”?)

Would you use your position to protect? Would you go to bat? Would you accept risk or harm to yourself? Make others uncomfortable? When someone criticizes a POC do you assess for #implicitbias?

https://t.co/f3NT23CQTj
Read 14 tweets