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'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've got some great friends. I'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'm in a doorman building so if anything worsens I'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've learned a lot from her on self care + accomplishing
This is 💯% true

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


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

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
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
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
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
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 🤷🏻‍♀️

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
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
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
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?

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
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
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
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

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💪🏽
Or: LP on no sleep x 1 week, hand shaking but got it 💪🏽

Really? 💪🏽?
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
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
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
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

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
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
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 💰spent
you may make enemies, not get trophies https://twitter.com/docpatteachone/status/1317448295896276994
You can follow @usnehal.
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