Umbereen S. Nehal, MD, MPH Profile picture
MIT Sloan fellow, fmr Chief Med Officer & Medicaid med director, Top Voice 4x, activist, MedEd, data nerd, humanist, contrarian,Tweets personal, RT🚫endorsement
22 Apr
Word “racism” silenced, actively, by #MedEd #MedTwitter #healthcare#professionalism” & “communication” labels

Saying “racism” offends or “hurts feelings” > actual #BLM deaths

If #professionalism itself is racist -makes sense that word suppressed
@FutureDocs
What @ayshakhoury experienced pushes out & silences many

If the editors of @JAMA_current resist hearing word “structural racism” then they certainly are not publishing papers using that word

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Journal gatekeeping: men
Behavior gatekeeping: women/HR

#accountability only for white men
-> we miss “Amy Cooper” in #academia, #HR, #professionalism #compliance

insidehighered.com/advice/2020/06…

@DrAlethaMaybank @RheaBoydMD @FutureDocs @TIME #BlackintheIvory #MedTwitter @bmj_latest
Read 18 tweets
22 Apr
The only feelings to center on are those of black community
Wrong use of this quote during the week of #DerekChauvinTrial

Some people “feel” things if a white male faces accountability
Amy Cooper’s feelings: call cops
Racism & racism lite has always focused on “feelings” #BLM
When @ayshakhoury or @uche_blackstock were authentic in their feelings: ended careers

Black female physician #DrSusanMoore having “knowledge” or a “voice”
while DYING
made others
*feel* “intimidated.”

This is part of a known pattern for WOC
@COCoQC
#BLM #BlackintheIvory
This is a repeating pattern of “feelings” used against tellers of uncomfortable truths that #MLK described in the letter from the Birmingham jail.

Seeking order > justice or overpolicing are all to protect only certain “feelings” of “security” while those like #adamtoledo die.
Read 13 tweets
20 Apr
Important perspective below

When I was a foreign grad & trainee I bought into idea: I just needed to work 3x as hard to get 1/2 as far

At mid-career, my health gave out trying for:
“be the person you needed when you were younger”
& to protect students

this system does not work ImageImage
Editors of elite journal @JAMA_current question if medical racism is real

the business world gets it
@HarvardBiz
published this on #minoritiesinmedicine #blackexcellence #blm #BlackLivesMatter

#MedTwitter needs #transparency & #Accountability

hbr.org/amp/2018/08/re…
why can’t elite journals that define #EBM & #datadriven #healthcare
like @JAMA_current

focus on OUTCOMES
as experienced by PATIENTS

Why focus on LABELS certain physicians don’t like to hear?

Am a former regulator
we need quality #data by gatekeepers

medpagetoday.com/publichealthpo…
Read 8 tweets
20 Apr
Evidence online “#vaccine research” by @Illinois_Alma drives anti-#vaccine #SoMe
=prolong #pandemic
=mortality

@KateClancy’s study: periods in perimenopause “after” vaccine
by 15-minute survey
= bad #data = #misinformation

American feminism has a long history of harming WOC Image
Best practices of #community engaged #research involves
LISTENING
to all important stakeholders

American feminism
frequently believes that it
✅box of the diversity
therefore
no need to listen to anybody else

Women & WOC deserve good, not bad #data.

ncbi.nlm.nih.gov/pmc/articles/P…
Theories of infertility “by” vaccine
Draw upon past government sterilization programs
Fears are never unfounded
even if not the case now

Being out of touch with these realities + poor #studydesign
= research that adds harm without adding knowledge

ihpi.umich.edu/news/forced-st…
Read 7 tweets
20 Apr
#MedTwitter influencers show hypocrisy (advice vs actions on masks). Agree:

“unpleasant comments are ‘the nature of social media’ and holding public figures accountable is critical when they are setting an example for their ‘millions of followers.’”

insider.com/coronavirus-sh…
#tweetiatrician have even gotten death threats for pro-#vaccine #SciComm - most #MedTwitter influencers did nothing to protect vs these personal safety threats to #clinician & #doctor colleagues

@ZDoggMD & @DrToddWo did step up to help @NicoleB_MD

medpagetoday.com/special-report…
Compare above to Dr. Mike:
when medical influencers are “caught”

adds to public perception:
“doctors cannot be trusted”

“Another fan posted on Reddit: ‘I know it's your life and you can do what you want, but you have chosen to be a public figure.’”

mirror.co.uk/news/uk-news/w…
Read 11 tweets
18 Apr
Accountability

Flowers, I will go see she said.

Headed to Esplanade (cuz this photo alone would check a box but would actually be cheating - the power of “optics” or manufactured data whose lives & careers are Twitter).

Question everything you see
See like a #pediatrician Image
I shall see from a new perspective she said - I will cross on the other side.

(Actually, I wanted to be on the other side but would have to walk a block to cross so, fine, I’ll cross on this side. Bah humbug). Image
I shall admire the barely born green hope unfurling into the crisp Spring air, fragile yet #resilient, she said

(Yay #Science and @museumofscience #BostonStrong #Boston ... and yes, and requisite monuments to male anatomy and war as well) Image
Read 25 tweets
14 Apr
I would say that society is at fault. The government was not behind Jenny McCarthy, Oprah, Dr. Oz, etc.
#vaccine #VaccinesSaveLives #VaccinesWork #MedTwitter #ScienceTwitter
What the government DID do wrong: “#security” & espionage via vaccines Frankenstein monster unleashed on Muslims

If the US government does do things like this it’s not a “#conspiracy

...all while what led to #CapitolRiots was brewing 🤦🏻‍♀️

@PeterHotez

npr.org/sections/thetw…
If Prius-driving Whole Foods-consuming suburbanites would STOP #misinformation #disinformation to #trauma ridden #refugee populations

(trauma->fear)

the jobs of minority & Muslim doctors would not be so hard

This is lack of *societal* control
of the most privileged
who HARM
Read 21 tweets
14 Apr
In light of the Boston police Union leader child abuse, this is very plausible, even probable. I have 2x, on behalf of someone else, reported, via Title IX - the woman or gay man was not feeling safe enuf to report. Yes, there is blowback when one reports. But we can’t be silent.
I am a mandated reporter as a #pediatrician. I *must* report for my patients or face legal consequences. Am same for staff, students, trainees. But in #EmergencyMedicine who do I call if a child may be unsafe at home? Sometimes, cops. Are cops safe?

boston.com/news/local-new…
I have seen #mentalhealth and entire life paths destroyed by abusers preying on children like: This happened to too many people I know. I have seen institutions intimidate, mislabel, bury stories of the victims. (Some predators wait until 18th birthday.)

nytimes.com/2017/08/07/nyr…
Read 29 tweets
14 Apr
This is why I am outspoken when #MedEd or #Education faculty and/or administration and/or HR falsely label a POC, BIPOC, WOC.

People end up dead.

Verify identity and do not spread rumors, innuendo, threats. Refer cases to appropriate authorities or #ethics committees.
Am learning about social network analysis.

As an American Muslim I have always been looked at with suspicion or been under surveillance.

Once I looked at how closely connected some faculty or healthcare ppl are to QAnon posts (or believe it selves) 😱

nytimes.com/2021/01/04/us/…
During the Trump administration, well before the #CapitolAttack, many minorities were experiencing increasing workplace #harassment & #bullying, especially for simply speaking (up). Just seeking accurate data for patients can = “threat” #MedTwitter

go.beckershospitalreview.com/scott-becker-i…
Read 5 tweets
14 Apr
Had a fun time talking about #leadership in #STEM (at any stage of career), #BlackExcellence #WomenInSTEM #DEI #DiversityandInclusion to a range of students and faculty at @tennesseetech. Thanks for the invitation @JosephCSlater. Look forward to building further on this.
Talked about ways to take on community level leadership roles to develop skills in acquiring funding, managing a budget, team building, managing people, executing.

Know what you are good at and balance the rest with your team. Don’t try to be it all.
Particularly on #Twitter, being overt about terms like #bias or #BLM or #racism can result in blowback. That does not mean what you said was wrong rather others may have insecurity or have work to do. Manage your energy as an advocate. Avoid burnout.

Read 15 tweets
13 Apr
Addressing #stigma: If you are my friend or colleague, regardless of gender, you get to know my ovaries whether you want to or not. I’m a woman with #endometriosis & #fibroid #menstrualhealth pain. Instead of seeming “flaky” I will tell you my #womenshealth reason I must cancel.
This is also a generational thing. Boomers and some GenX were “I am as tough as a guy... ovaries.. what ovaries?”

Me: “I have ovaries. They are complicated suckers. We’ll have to work around them.”

#endometriosis #fibroid #womenshealth #menstrualhealth

swhr.org/identifying-ba…
One of the things that made me 🥰is when a MAN reached out to me, because I tweet on this, for his female significant other to ask if I had resources to help her

If you hear of me being “anti-woman” I am anti-#professionalism (women) who suppress open uncomfortable communication
Read 9 tweets
13 Apr
I fired several guns recently, at a gun range. Many guns have safeties too. I don't know how things work for the police in terms of the gun safety and such, but the actual muscle memory and actions needed to use a taser versus a gun are quite different.
I fired those guns for a few reasons
1-when I get targeted (#cyberstalking) by potentially QAnon affiliated "militia" types, I am not going to show fear
2-maybe if they see a Muslim firing machine guns they'll support gun control. 🤣
3-to tweet this. 😁 =having street cred
Some guns I fired:
Read 5 tweets
13 Apr
Been busy unsubscribing from emails & deleting hundreds of emails at a time.

The loss of my mail icon on my iPhone (still have not found it but have a new way to access it) has made me realize (since I was forgetting to check my mail without the visual cue) the overwhelm in it.
I am really good at skimming a lot of stuff and going right to the thing of use. I'd been tolerating SO much spam and with the various moves, not everything is quite as relevant. Being a journalist personality, I still remain curious - what is the @nypl doing, for instance?
With #pandemic, everything is virtual and accessible without being physically present in #NYC. I *might* "go" and wanted to have the option or the easy access so had not thought to unsubscribe. But wow is my inbox CROWDED.

Perhaps I will get under 100,000 unread emails soon.
Read 4 tweets
13 Apr
My family, knowing how close I was to my #mother, is trying really hard to fill the gap

They mean well, but are wired so differently from me & see the world so differently, that it’s making it worse - I miss her more

She can’t be replaced
She’s gone

#COVID19 #grief
I am one of these circles.

I essentially want to be a circle of one right now, though.

Others’ ways of processing grief or their ideas of what I need can frustrate.

Everyone knows I was very close to Mommy.

But only I can take care of myself.
No one else can help me.
It’s not unique to grief. I accepted, a long, long time ago: only I can help myself.

I did find some sense of community in informal grief circles online. That meant a lot and helped in the first month. Now, it is just so personal, what my mother meant to me.
Read 15 tweets
13 Apr
#BLM

In the last few years I have become increasingly outspoken to the detriment of certain professional relationships & at some reputational risk - in particular holding fellow so-called “model minority” accountable on harm

we as a society MUST stop killing & harming ppl
There are 1001 ways to avoid difficult, uncomfortable change.

Those who (I’m going to be frank) are lazy, selfish or lack sufficient ability or courage, will oppose change, often also mislabeling other people either as lazy “moochers” or aggressors.

#BLM #blacklivesmatter
A culture of civility only empowers the true aggressor. It allows silencing and mislabeling of anyone who speaks up regarding system level harm or interpersonal harm.

npr.org/sections/codes…
Read 5 tweets
13 Apr
Uteri owners have it hard.
Ouch. Ouch. Ouch.
#endometriosis #fibroids #womenshealth #menstrualhealth
On a positive note. I did not pass out or almost pass out this month. 👍Last two months my mom was newly in the ICU then she had newly passed away and I could not get out of bed without syncope or near syncope. And I had just had my 2nd vaccine so was already not well.
There are all these wise people who say things about suffering but it’s honestly true..

..that the more suffering you experience the more gratitude you can have..

..because when something is not as bad as it used to be do you feel immense relief, #gratitude
Read 4 tweets
12 Apr
We live in an attention #economy & what #Tweetiatricians have known for decades (#Twitter started in 2006): importance of drawing attention to factual science-based information as compared to #misinformation & #disinformation, especially on #vaccines

econreview.berkeley.edu/paying-attenti…
You have to be fast & prolific to play catch up to this. I have 77K tweets, a moderate sized band of 6K followers interested enough to tolerate my volume but use of hashtags allows reach across Twittersphere. Trending hashtags = better for riding a way for that attention economy
If is unclear if we are now so siloed that tweets are ineffective with anti-vaxx. But not all anti-vaxx are QAnon
Read 39 tweets
12 Apr
“QAnon is ...a self-sustaining environment of #disinformation & #misinformation...

.. QAnon hijacks the architecture of social media..

..By controlling acceptable forms of information, QAnon traps its members in a downward spiral of radicalization.”

american.edu/sis/centers/se…
“As P.W. Singer and Emerson Brooking describe in.. book Likewar: The Weaponization of #SocialMedia, this phenomenon of “junk” or “fake news” is not new. In 2016, a similar, but related, conspiracy known as “Pizzagate” resulted in a shooting at a DC area pizza parlor.” #SoMe
Above is not limited to academic articles

There has been an increase in #antiAsianhate crimes
shootings
#xenophobia
targeting of #GOTV by minorities
including this attempt to intimidate me for my GOTV, by armed right wing

There was the #Nashvillebombing (with QAnon beliefs)
Read 19 tweets
11 Apr
This is why I do long threads on racism in child & education spaces (child education up to #MedEd) and on the role of women to “protect” only some kids, not others. There is focus on police without looking at the full picture of sources of harm to children of color.
It is very very easy to focus on the Boston police Union leader

but who is it that..

helps him get access to children?
stays silent?
silences abused children?
promotes him?
seeks to please him (be promoted by him)?
sees him as a “good leader”?
softens his image?
protects him?
The role of men & women who police/silence those who would speak up... who prevent identifying the abuser

=extremely important

it is all on one spectrum: if you experience being denied food by a teacher as a 3-year old, will you speak up on abuse...

vs Stockholm Syndrome?
Read 7 tweets
11 Apr
This is a form of privilege not often spoken about.

It is not “just” the money but the financial literacy, the comfort navigating certain spaces, feeling is belonging vs #impostersyndrome. It affects ability to do unpaid internships. It affects who is bullied. #MedTwitter
Women of more affluent families may not be the ones targeted by or vulnerable to slimy professors too.

Learning requires a “safe space” in reality as well as in your own head. #MedEd has a LONG way to go before #education spaces are truly open to all. #MedTwitter #equity
For instance, while my mom’s family was in Pakistan, I grew up knowing my mom had her own identity & her own money (she always reminded my dad he had no Islamic right to 😂
=the confidence of a woman who *could* leave)

She dressed simply but had the confident demeanor of a queen
Read 5 tweets
11 Apr
Is happening in the spaces I least expected (but that shows how naive I often am) #FQHC & #safetynet. Read up on Hahnemann Hospital closing & sale of assets: land, residency.... yup Medicare funded residencies among “assets” #MedTwitter

@Health_Affairs
healthaffairs.org/doi/10.1377/hl…
“The bankruptcy affected the lives of more than 2,500 employees in the city and displaced more than 550 physician trainees. The hospital’s underserved, ethnically diverse patient population was left to redistribute their own care around the city” #MedTwitter #healthcare #Medicaid
“became the institution’s first and only female professor of emergency medicine...assumed a leadership role as the associate dean of graduate medical #education. In that role, I and my team were asked to identify opportunities to improve the tenuous financial situation” #MedEd
Read 5 tweets