Thread by @usnehal, Woah..that was freaky but familiar. Was lying down & decided to get [...]

Woah..that was freaky but familiar. Was lying down & decided to get up to take pain meds for #endometriosis and #fibroids and it felt as painful to get up as the day after surgery. In kitchen, sweating, lightheaded. Quickly squatted to avoid passing out holding onto fridge door

..which swung open..but I did not fall. Then once head feeling better, stood up long enough to take meds...then walked, wobbly and lightheaded to chair. I can& #39;t quite feel my palms but that will come back. This probably gets to be called 10/10 pain..but maybe really an 8/10

Great..and a migraine too..scotoma.. taking a migraine med and lying down. Man, when it rains it pours.

Mother Nature is such a misogynist.

SO glad I did not decide to rent a car and try to go Finger Lakes this weekend to see peak foliage.

Wow...I& #39;ve got some great friends. I& #39;ll be ok. I know the drill. This happens sometimes. I always have my meds. Drank water. had a few bites to eat. Drank more water. I& #39;m in a doorman building so if anything worsens I& #39;ll call down. My phone is more than half charged and charging.

One of my best friends has what should be debilitating illness. She combines self care with powering thru certain times. The key is she runs her own business and controls her own deliverables, delegates what she needs to. I& #39;ve learned a lot from her on self care + accomplishing

This is

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💯" title="Hundert Punkte Symbol" aria-label="Emoji: Hundert Punkte Symbol">% true

The antifragile & resilient mindsets/skills developed when cannot rely on own body

=assets

Prepared for anything
not fazed by sudden crisis

“Dealing with health concerns can prepare you for the ups and downs of business ownership” https://www.business.com/articles/managing-business-with-chronic-illness/">https://www.business.com/articles/...

Running a Business While Managing a Chronic Illness - business.com

Dealing with constant health concerns actually can prepare you for the ups and downs of business ownership.

https://www.business.com/articles/managing-business-with-chronic-illness/

Medications are such wonderful things.

The pain is much more tolerable.

Actually got some sleep.

Am hoping to go back to sleep. But since my tweets resulted in at least one concerned call, documenting that I am ok.

Appreciate the care/concern/check ins!

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🥰" title="Smiling face with 3 hearts" aria-label="Emoji: Smiling face with 3 hearts">

When one feels terrible physically, the relief from pain or return of normal senses is such a relief, blessing, generates incredible gratitude. I admit I went thru a few years with anger at limitations from pain and such. Now grateful for the good days. https://www.practicalpainmanagement.com/treatments/psychological/chronic-pain-psychological-stages-grief">https://www.practicalpainmanagement.com/treatment...

Chronic Pain and the Psychological Stages of Grief

How clinicians can help patients work through the feelings of grief and loss when faced with a lifetime of intractable, chronic pain.

https://www.practicalpainmanagement.com/treatments/psychological/chronic-pain-psychological-stages-grief

Many non-pharma practices are ridiculed by certain folks in mainstream medicine

That said, we have had an opioid crisis destroying so many lives

Yes, I do deep breathing and positive imagery along with the strongest non-opioid NSAIDs available to cope https://www.practicalpainmanagement.com/treatments/psychological/chronic-pain-psychological-stages-grief">https://www.practicalpainmanagement.com/treatment...

Chronic Pain and the Psychological Stages of Grief

How clinicians can help patients work through the feelings of grief and loss when faced with a lifetime of intractable, chronic pain.

https://www.practicalpainmanagement.com/treatments/psychological/chronic-pain-psychological-stages-grief

Also, mindfulness has helped me feel what is going on and admit to myself and others when I need to step back & take care of self.

My professional training taught me to take a day off was to betray colleagues and patients
= a source of shame.

In fact: https://www.ehstoday.com/safety-leadership/article/21918281/presenteeism-costs-business-10-times-more-than-absenteeism">https://www.ehstoday.com/safety-le...

Presenteeism Costs Business 10 Times More than Absenteeism

Employees take an average of four days off per year for sick time, but admitted to being unproductive an average of 57.5 days a year.

https://www.ehstoday.com/safety-leadership/article/21918281/presenteeism-costs-business-10-times-more-than-absenteeism

The toxic shaming in #healthcare culture - wrongly telling workers that taking a day off is “lacking professionalism” or “not caring” enough about patients or “dumping on” colleagues, is, in fact, unsafe.

#MedTwitter @_HarryPaul_ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947637/">https://www.ncbi.nlm.nih.gov/pmc/artic...

Presenteeism: A Public Health Hazard

"Presenteeism" occurs when an employee goes to work despite a medical illness that will prevent him or her from fully functioning at work. This problem has been well studied in the business and...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2947637/

It is one of myriad ways “professionalism” and those whose job it is to define & enforce it make #healthcare & #hospitals unsafe for patients and staff alike. It is why I have become increasingly outspoken on weaponized professionalism.

Recently submitted these:

In med school, I never was at risk of passing out in the OR, but I often almost passed out on long rounds in not air conditioned public wards in Pakistan (blood pooling in dilated vessels my legs and not making it to my brain).

We are taught to be embarrassed @vivek_soi https://twitter.com/vivek_soi/status/1316057003471577088">https://twitter.com/vivek_soi...

https://twitter.com/vivek_soi/status/1316057003471577088

So yesterday, when felt like was about to pass out, had these types of practiced ways of dealing with it

Squat
Lower self to the floor (before hitting floor)

And when a med school buddy calls “Are ok? Can I call anyone?”

Hang tough, “I’ll be fine”
I rarely/never accept help https://twitter.com/vivek_soi/status/1316065949204779011">https://twitter.com/vivek_soi...

https://twitter.com/vivek_soi/status/1316065949204779011

There is so much hazing & #bullying within medicine, that “showing weakness” (meaning acknowledging human needs or any illness) is seen as “whining”

it does attract the brutes and victims to brutalize you when you are down, often in name of “professionalism”

#MedTwitter #MedEd

To the extreme, this outcome, when
1-the system resources are overwhelmed
2-impossible load is put on an individual doc
3-when monitoring self/health or asking for help is shamed

The way professionalism taught, often anti- #mentalhealth & pushes to this https://www.nytimes.com/2020/07/11/nyregion/lorna-breen-suicide-coronavirus.html">https://www.nytimes.com/2020/07/1...

‘I Couldn’t Do Anything’: The Virus and an E.R. Doctor’s Suicide

Dr. Lorna Breen was unflappable — until she faced a new enemy.

https://www.nytimes.com/2020/07/11/nyregion/lorna-breen-suicide-coronavirus.html

I fight fire with fire

Those who teach professionalism who make “cases” & public examples of doctors & nurses for showing humanity

like in this thread when @DGlaucomflecken was targeted

I do respond in public with evidence

I have contacted universities teaching thru shaming https://twitter.com/usnehal/status/1256717930395570176">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1256717930395570176

We have to stop toxicity actively taught within #MedEd #medicine

Nurses & doctors are human. We are safer & offer higher quality care when allowed to admit to being human. Smiling, dancing, taking a sick day: all ok & healthy

If making an allegation vs someone, use standards https://twitter.com/usnehal/status/1256711372966109187">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1256711372966109187

When holding behavior police accountable to their own standards, can be seen or called “bullying”...but if enforce it on others, same can be done to you

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷🏻‍♀️" title="Achselzuckende Frau (heller Hautton)" aria-label="Emoji: Achselzuckende Frau (heller Hautton)">

if non-clinicians make “cases” of practicing clinicians, w/out consent
= “case” of “professionalism” & “ethics” as harm

When holding behavior police accountable to their own standards, can be seen or called “bullying”...but if enforce it on others, same can be done to you https://abs.twimg.com/emoji/v2/... draggable=

if non-clinicians make “cases” of practicing clinicians, w/out consent= “case” of “professionalism” & “ethics” as harm" title="When holding behavior police accountable to their own standards, can be seen or called “bullying”...but if enforce it on others, same can be done to you https://abs.twimg.com/emoji/v2/... draggable="false" alt="🤷🏻‍♀️" title="Achselzuckende Frau (heller Hautton)" aria-label="Emoji: Achselzuckende Frau (heller Hautton)">if non-clinicians make “cases” of practicing clinicians, w/out consent= “case” of “professionalism” & “ethics” as harm">

I have held multiple clinical leadership positions with disciplinary authority over fellow clinicians, from Chair of state “Provider Review Committee” to Chief Medical Officer. I have gone out of my way to only take an action if there is credible evidence based on a standard.

This pinned tweet is very popular

If we want this to be true, we need reform of #medicine #healthcare #meded #AcademicTwitter #AcademicChatter #MedTwitter

We need to hold accountable, re-educate, and/or remove the faculty who are teaching thru shaming, anti- #MentalHealth etc https://twitter.com/usnehal/status/1001789736414007296">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1001789736414007296

It is easy to characterize clinicians as “whiners” which then activates the bullying of the Angelou quote above.

In fact, having been in more than one room where medical affairs budgets decided, I can verify this is true @danielleofri #MedTwitter https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html">https://www.nytimes.com/2019/06/0...

Opinion | The Business of Health Care Depends on Exploiting Doctors and Nurses (Published 2019)

One resource seems infinite and free: the professionalism of caregivers.

https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html

There are myriad reasons I am in b-school, not least is that this is not acceptable - it is not only unsafe for patients & clinicians, is unsustainable as a business model.

When people can’t do their jobs (boards, CEOs), I get above them

@EricTopol https://www.medscape.com/viewarticle/927811">https://www.medscape.com/viewartic...

Topol: US Betrays Healthcare Workers in Coronavirus Disaster

Many US healthcare workers started this year already suffering from burnout, but the worst was yet to come.

https://www.medscape.com/viewarticle/927811

No, NOT a “beautiful” #business model - depleting your most credentialed workers w/ high #PTSD & #suicide among #clinicians yet is what I see in @LinkedIn

I may be a “Top Voice” x 4 & in top 1% as an #Influencer in #healthcare per #LinkedIn’s #SoMe score

who signs budgets?

Yes, some of my @LinkedIn posts get >12K views. But the ones on physician suicide? ~200

How effective are we being on #SoMe or with @NEJM perspectives?

Are decision makers listening?

I’ve felt as powerless to prevent harm as #NYC physician leader Dr. Breen who died of suicide

Thing is, my chronic illnesses have been a blessing to protect against the God complex many doctors have. Had to admit am human. I have had to accept there are some things I cannot accomplish myself & times I will “fail” - I have gotten over being shamed https://www.cmaj.ca/content/191/17/E478">https://www.cmaj.ca/content/1...

Ableism: the undiagnosed malady afflicting medicine

Medicine has traditionally been viewed as a benevolent discipline in which every human life is valued equally, without any form of prejudice or discrimination. Although this may remain the ideal to...

https://www.cmaj.ca/content/191/17/E478

Yes, have moments of extreme pain. I have exited clinical medicine. I have been shamed for my self care choices by fellow physicians. Have fought hard to protect my & others’ ability to work vs wrong definitions of professionalism as @_HarryPaul_ describes https://www.explorethespaceshow.com/podcasting/harry-paul-on-disabilty-ableism/">https://www.explorethespaceshow.com/podcastin...

Harry Paul On Disabilty & Ableism - Explore The Space

“We need to become aware of the spectrum of disabilities that’s all around us so that the people who are disabled themselves don’t have to do as much teaching” Harry Paul is an MD/PhD student who...

https://www.explorethespaceshow.com/podcasting/harry-paul-on-disabilty-ableism/

Yes, I identified non-factual, unverified “professionalism” policing by @USC @KeckMedUSC faculty @sarah_mojarad vs a Black male trainee

This non-factual hit piece written as retaliation by faculty “obsessed” with her “narrative” - “evidence” from 2013?

https://medium.com/@smojarad/online-harassment-death-by-1-000-tweets-731e47812625">https://medium.com/@smojarad...

I recognize by being factual again, I will again draw this kind of retaliation w/ implications I am unfit to practice medicine thru innuendo

while I plainly state facts, standards

I do things in the open rather than by private messages or gossip or manipulate facts

Be factual

I invite you to look thru my threads & what I publish on to understand the source of my very deep concern

When I am up all night

am not obsessing over what others say/optics

have debilitating pain

I think hard about how to fix this system of harm

I write curricula like https://twitter.com/usnehal/status/1307851096468131846">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1307851096468131846

In the hit piece on me by @USCViterbi @USC faculty @Sarah_mojarad, I was misquoted on boundaries just like someone else’s actions in 2013 was part “evidence” used vs me

This is what I have to say on boundaries: break those gendered behavior police impose #WomenInSTEM https://twitter.com/usnehal/status/1265425020551077888">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1265425020551077888

I seem be a popular target - just called a “terrorist” by equally non-factual right wing “patriot”

this is how I responded
I don’t delete
I document factually, w/out innuendo

clear evidence
offer references & proofs from external authorities & standards https://www.linkedin.com/posts/usnehal_friday-reflections-with-dr-umbereen-sultana-activity-6722454401052635136-nyj0">https://www.linkedin.com/posts/usn...

Am curious why schools like @usc @USCViterbi - my father’s alma mater - engage in the same repeated online #SciComm behavior against minority physicians as above

Do schools intend to use non-licensed clinicians to start witch hunts vs licensed clinicians

Am I really the enemy?

I can’t tell you how many such messages I get in private from doctors & nurses
afraid

non-clinical & non-licensed “professionalism” police harm/abuse clinicians daily

thru disciplinary actions via a license

Gossip & innuendo harm individuals & the system when clinicians leave

For years, I hid illnesses

I proudly touted stats: I trained pre-work hour restrictions, admitted 22 patients + crossover with no team or night float. All me

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪🏽" title="Angespannter Bizeps (mittlerer Hautton)" aria-label="Emoji: Angespannter Bizeps (mittlerer Hautton)">
Or: LP on no sleep x 1 week, hand shaking but got it

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪🏽" title="Angespannter Bizeps (mittlerer Hautton)" aria-label="Emoji: Angespannter Bizeps (mittlerer Hautton)">

Really?

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💪🏽" title="Angespannter Bizeps (mittlerer Hautton)" aria-label="Emoji: Angespannter Bizeps (mittlerer Hautton)">?
Things to brag about?
Yes, if ableist culture

Given how outspoken I am in identifying fellow faculty (ones building career on image & “professionalism”)are not factual & use no standards

even taking on these part of healthcare that gets doctors & nurses fired for exactly what I am doing

yes, lots of attempted retaliation

The infamous #Medbikini study used med students & residents reviewers, including ones who were minority

in same way that compliance is full of women, often policing other women based on rules written by men

Hiring a woman is not enuf if system the same https://www.chicagotribune.com/opinion/commentary/ct-opinion-medbikini-movement-doctors-professionalism-20200803-z353smu5mrfc7cno4chrsz5m3m-story.html">https://www.chicagotribune.com/opinion/c...

Commentary: Doctors and the MedBikini movement: Nebulous standards of professionalism reveal biases

Society should not allow the concept of professionalism to be weaponized against medical students and trainees who are women or of color.

https://www.chicagotribune.com/opinion/commentary/ct-opinion-medbikini-movement-doctors-professionalism-20200803-z353smu5mrfc7cno4chrsz5m3m-story.html

This remains true. The system needs to either be dismantled or thoroughly reformed.

The results we have are a logical result of resource allocation, systems, incentives, processes.

Let’s obsess less over what “people say”
Let’d not teach “optics” to the next generation of doctors or #STEM
Let’s not craft “narratives” to avoid accountability on harm.

Let’s start to care about real things like life, death, harm, waste
Let’s admit when we fail to improve https://twitter.com/usnehal/status/1278087408412696579">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1278087408412696579

I have been in many jobs, many roles, many states and countries.

I am deeply, deeply concerned by the state of healthcare in America.

I won’t defend the walls of harm from the inside and perpetuate harm.

Let’s “hack” healthcare
Failure is manifest https://anchor.fm/the-state-of-healthcare/episodes/Hacking-Healthcare-with-Umbereen-S--Nehal--MD--MPH-ehn3hi">https://anchor.fm/the-state...

Hacking Healthcare with Umbereen S. Nehal, MD, MPH by The State of Healthcare • A podcast on Anchor

How does a Sloan Fellow at MIT think about Healthcare? How about a Sloan Fellow at MIT who is a former Medicaid Medical Director? Former Chief Medical Officer of a multi-specialty, multi-site...

https://anchor.fm/the-state-of-healthcare/episodes/Hacking-Healthcare-with-Umbereen-S--Nehal--MD--MPH-ehn3hi

I break a lot of the rules on how to hide parts of myself to be “popular” or per professionalism, marketing, or reputation management types

Yet, I broke the glass ceiling, am a 4x Top Voice, 230K followers, top 1% in #healthcare

=authenticity respected https://m.youtube.com/watch?v=R4rpG-dipYA">https://m.youtube.com/watch...

In a #pandemic I achieve this reach along with @DrTomFrieden or @sandrogalea to disseminate facts-based engaging posts on #COVID19

able to communicate in a way that gets thru to #business #leaders, where risk-averse #STEM & #SciComm often fail

https://www.linkedin.com/posts/sylviaromm_linkedintopvoices-worldhealthday-activity-6653377787581259777-zU2k">https://www.linkedin.com/posts/syl...

It is not uncommon for a woman + minority speaking unapologetically about facts to be called impolite or even “a bully.”

Others must experience this cuz this post got >12K views.

We need more real talk, less narrative, reputation management, or optics https://www.linkedin.com/posts/usnehal_i-think-that-what-our-society-teaches-young-activity-6721779946743730176-9yCg">https://www.linkedin.com/posts/usn...

Umbereen S. Nehal, MD, MPH posted on LinkedIn

"I think that what our society teaches young girls, and I think it's also something that's quite difficult for even older women... is that idea that likeability...

https://www.linkedin.com/posts/usnehal_i-think-that-what-our-society-teaches-young-activity-6721779946743730176-9yCg

Nursing is primarily women and we need to be able and willing to hear women say things we don’t want to hear.

We need doctors and administrators to be real, hear/respect nurses, students, cleaning staff

We know this is coming. We saw what this looked like. https://twitter.com/epflcswccm/status/1317449607094423552">https://twitter.com/epflcswcc...

https://twitter.com/epflcswccm/status/1317449607094423552

Yes, this was a mammoth thread.

But I am lying flat to avoid a repeat of last night.

I am awake and have been for many hours.

I keep hoping if I keep trying to fit the puzzle pieces together I will figure it out.

I don’t feel as much pain when I focus on problem solving.

A bit afraid to try getting up. I am okay when horizontal. But I have SO much to do!!! The “firehose” does not shut off just cuz one has an #endometriosis flare @MITSloanFellows @MITSloan @mit https://twitter.com/usnehal/status/1316972347761590272">https://twitter.com/usnehal/s...

https://twitter.com/usnehal/status/1316972347761590272

So much for leaf peeping...

Please read this thread

Being an #ally to #BlackintheIvory is chat on Zoom, yes

as well as system level

If you are an ally making changes at a system level you are then changing resource allocation, asking quality for

https://abs.twimg.com/emoji/v2/... draggable="false" alt="💰" title="Geldsack" aria-label="Emoji: Geldsack">spent
you may make enemies, not get trophies https://twitter.com/docpatteachone/status/1317448295896276994">https://twitter.com/docpattea...

https://twitter.com/docpatteachone/status/1317448295896276994

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