Ep 46: Representation in Medicine: Removing the Code-Switch

with Kimberly Manning, M.D.

September 15, 2021

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Kimberly Manning, M.D.
Associate Vice Chair of Diversity, Equity, and Inclusion, Department of Medicine at Emory University School of Medicine

Kimberly Manning, M.D., F.A.C.P. is an Associate Professor of Medicine, Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine. A passionate clinician-educator, she divides her professional time between teaching pre-clinical medical students and training medical residents, primarily at Grady Memorial Hospital. Manning’s academic achievements include numerous teaching awards in both the School of Medicine and the Internal Medicine residency program, and her work has been published in such prestigious journals as the Annals of Internal Medicine, Academic Medicine and the Journal of the American Medical Association (JAMA.) An avid writer, Dr. Manning authors a blog that was named in 2010 by ‘O’ The Oprah Magazine as one of “four top medical blogs you should read.”

 

My mission is for people to be able to be their entire selves. Not to hide it and only bring it out when you're around people who look like you. Shake up what is normal, and squash what we call 'other.'

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Sanjula Jain  0:03  

Women make up 70% of the healthcare workforce but only 20% of its leadership. On Her Story, we’ll explore the careers of bold and influential women from Silicon Valley to Capitol Hill and learn how they’ve overcome the odds. I’m your host, Sanjula Jain and this is Her Story, a program where we explore what’s beyond the glass ceiling.

 

It’s my honor to welcome Dr. Kimberly Manning, Professor of Medicine and Associate Vice Chair of Diversity, Equity, and Inclusion for the Department of Medicine at Emory University School of Medicine. In addition to her faculty role at the University, Dr. Manning is also the co-host of The Human Doctor podcast and has a very popular blog called Reflections of a Grady Doctor. Kimberly, thanks so much for spending some time with us today.

 

Kimberly Manning  0:49  

Thanks for having me.

 

Sanjula Jain  0:50  

Let’s start with the origin story. You have built a phenomenal career for yourself and have carved out this niche of a medical influencer. What inspired your interest in medicine?

 

Kimberly Manning  1:02  

I just have an interest in people. I’ve always loved people. I tell students of all ages all the time that it’s not like a little cherub flies out of the sky strumming the harp to tell you, “This is what you’re destined to do.” I knew I like people, I’m good with people, and I had great influence from my parents to see what servant leadership looks like, so I imagined wherever I ended up would be something involving serving people and using those connectedness skills to help people feel safer and better and to thrive.

 

Sanjula Jain  1:40  

As part of that path, it kind of makes sense now— the people, the interest in medicine. A big part of the niche you’ve carved out for yourself has been in communication. A piece that you started early on was with writing. It’s hard enough to train to be a clinician and just focus on patient care. What inspired the path to say “I’m gonna actually start writing as well?”

 

Kimberly Manning  2:03  

I always liked writing. It really started in middle school when I had a teacher affirm me as a writer and really challenged me. I remember writing an essay for this teacher and I remember her marking it all up with this red ink pen. And she had this like very particular cursive and I got like a b minus on it. And I remember really being offended. And she told me that she thought I was a much stronger writer than what I had offered her on a piece of paper. Over the course of the eighth grade, I would be pushed by her to become a stronger writer. What happened by the end of that is I knew I could write. That is half the battle for a lot of people, this idea that you can do something, but it got put on ice for many years. When I joined the faculty at Grady or the Emory, a Grady faculty in general medicine, I did a faculty development program in my first year on faculty. And as a part of that faculty development. We were asked to write longhand, something called a critical incident report. And I wrote this thing longhand, and we read them in our faculty development group. The person leading the group was my division chief who pulled me aside later and said, that was really, really good, you should type it up, and you should submit it somewhere. I had never heard of anybody submitting an essay to a peer-review journal. He’s like, “Oh, yeah, you could do that.” And so my first piece, that piece that I’d written longhand, nearly verbatim. I typed it into a Word document and sent it. I was planning to send it elsewhere. Where do I send it? And he suggested I aim high. And so I sent it to JAMA, escaped peer review, it went straight, I got an email straight from the editor-in-chief that said, “We want to publish this. We were really moved by what you wrote.” It took me back to middle school, those very first moments of affirmation from my teacher, this combination of this faculty development, and then writing something and having another external party for my writing. It told me something that I knew already, but just in a different way. There are people out there who have these sort of dormant talents and potential things that they can do in them. But they’ve decided that because I do medicine, or because I do this thing or that thing. There’s really not a place for that. That’s something from this prior life. But I’m always interested in finding ways to genuinely intersect the who of who we are into the now of where we are.

 

Sanjula Jain  4:45  

That’s a great perspective. On that affirmation piece, was it after that Jama piece that you said, “I’m going to do this on a more regular basis?” Your blog has become a household name in the industry. It’s won several awards. Was that a little bit of the push to pick that back up, or how did that process unfold?

 

Kimberly Manning  5:04  

I’m a nerd, so starting my blog harkens to this book called Peak. A part of this book is all about how you master something. The way we master anything is through deliberate practice, so when I had that piece accepted, I submitted a couple of other pieces to journals. I found that journals have parameters like you need, not more than 1500 words, and you can’t use slang. If you’re trying to express something a particular way, you may need to adapt it to their needs. I really wanted a place to start practicing writing without rules. And if everything that I wrote was something that I was submitting to a journal, I felt like it was holding me back, so I started my blog not because I thought anybody would read it other than my mom but because I wanted a place to write without rules. I wanted a place for deliberate practice. When I was most prolific on my blog—which was probably up until about 2017—I was writing twelve to fifteen hundred word essays a couple of times a week. I could use slang, I could describe dialogue in ways that were authentic to my lived experience as a black American caring for many black Americans. There were things I could express that I didn’t have to wait for somebody else to approve. The neat thing about blogging is that you hear back from people. It’s interactive, people would read it and then comment and say things so I could get a sense as to what things really grabbed people or what things people were hungry to hear more about.

 

Sanjula Jain  6:50  

That’s so powerful. As a bit of a failed academic myself, I have so much respect for those who not only can write but write in the context of juggling multiple priorities. How do you hold yourself accountable given all the different things you’re juggling on your plate to make sure you were carving out the time to write all of that?

 

Kimberly Manning  7:09  

I’m a work in progress and I never like to come across like I have it all together. I forget things that are on my calendar. I look at my phone and realize that somebody has an orthodontist appointment and I double-booked myself. The first thing I do is be kind to myself and I realize that I’m a human being, and I try to show that to other people, particularly those I mentor so they don’t try to aspire to perfection because, the closer I get to people that are successful, I don’t know anybody that’s perfect. I wish I had learned sooner that I’m really surgical with my no’s. When I say no, I say no. Not “no” with a bunch of explanatory commas on the end where it becomes a dialogue. If I don’t believe that something is something that I can do to the best of my ability, or if I don’t want to do it, I say no. Sometimes I say no and there’s somebody I can sponsor for the position, but sometimes I don’t even have the time to do that. I believe that surgical no’s make way for complete yeses. I’ve learned how to say no and also to value relationships because I love people. If a person with whom I have a connection, or somebody that I’m working within a professional capacity, asked me to do something, even if it could be a little bit inconvenient, and my schedule, because I value our longitudinal relationship, I will make the time for it. But you get asked as you get more senior and particularly if you are you have a lot of intersecting identities, you hit the mark for a lot of things like oh, black female, senior faculty, oh, like, let’s, and I’m aware of that, but I have to take care of me, I have to avail myself to my children, to my friends to my partner. Time is not a renewable resource. It’s not. I’m really, really clear about my no.

 

Sanjula Jain  9:05  

That’s such an important reminder for all of us, so thank you again for spending some time with us today because I know how precious your time truly is, but I think that’s a great reminder for all of us. On this show, we like to ask all of our guests a little bit about their early origin stories. In some ways, you probably didn’t envision the day-to-day that you’re living right now in those early days. But do you consider your foray into healthcare leadership to be more accidental or intentional?

 

Kimberly Manning  9:31  

I have to say probably both. I try to operate with intention. Most of the time I heard somebody speak once and this leader was talking about trying to learn how to do the things that only you can do and that you are the best one to do. And then to delegate the things that the other people could potentially do, but then just kind of keep track. And I think one of the things that I used to do wrong is that I would just try to take on everything at one time. And then I started to look a little more carefully about what’s for me to do. And what can happen sometimes I think is that you see another person’s trajectory, and you feel obligated to follow that trajectory. So the part that was intentional is that I know that I have effective leadership skills, and I have a unique leadership style. I know that. And so I knew that as a person who is a connector of people and loves people, I imagine myself in some leadership role, but it took me some time to appreciate what role would be for me? Right now, I do not aspire to be the dean of an entire medical school. I don’t, but we do need people to aspire to do that. It is just not what I aspire to do because I realized that there are some things that I need. I need a certain amount of clinical time with my patients, I need a certain amount of FaceTime with learners that is intimate, I need a certain amount of time with my family. With leadership comes a lot of sacrifice, and you can’t do everything. There has to come to a place where you take a few steps back and you say what will fulfill me, what will make me happy, and when I’m gone, what with my talents, what would make the most impact. And I think I’m sort of a boots-on-the-ground person, I sort of need to be in the mix with the learners in the educational environment and in the clinical environments. But I know some leaders who do an amazing job, not in a clinical environment, but who are truly essential. So we need all different types. And I think for myself, I started to appreciate where I fall in that hierarchy and, and not feel bad for not wanting to do what some other person is doing.

 

Sanjula Jain  11:50  

That self-reflection you’re talking about is a strength leaders should have and can have. You’re really setting the tone that there are so many different paths and career options that you can have. And for some during the dean path and academic medicine is in fact their calling. But for others, to your multiple interest pieces, there are ways to put those pieces together. And so I think it’s exciting to see that our industry is more welcoming of that and appreciative of some of these different cross-functional ways of thinking. To that point, you’ve been a really big champion of elevating underrepresented voices in medicine. To borrow one of the questions you like to ask others, what is your why?

 

Kimberly Manning  12:28  

I like to be comfortable in my skin. For a lot of people who look like me, or who come from historically excluded backgrounds, the way that you succeed in majority environments is through code-switching and becoming somebody other than who you are when you are in professional environments. And I learned when I was a resident and when I got to the end of my residency, I learned that you often get rewarded for it. And because of that, keep doing it. I also realized that it’s a thing that can burn you out and exhaust you and exhausts you because you are using up a lot of cognitive and emotional energy on being somebody other than who you are playing a role. What does that mean for somebody like me? I’m from Inglewood, California. The neighborhood I grew up in is predominantly black and Mexican. I went to a historically black college Tuskegee University. From there, I went to a historically black medical school. I was 25 years old and it was the first time I stepped into a space where I was the only one like me. It was hard work for me to start to assimilate with all my mind in this environment while trying to become a doctor at the same time. I figured out how to do it and was rewarded for it, but would come home mentally tired. I would feel lonely. I will go through all these things. I decided when I got ready to leave my residency program, I was not going to do that anymore. I was gonna try really hard to break this habit of morphing into somebody else every time I came to work. And to be clear, my residency program did not demand this of me. This was a cultural thing. This is a cultural thing that happens to a lot of people who are not assist had white individuals. So I said my first language is African American vernacular. Instead of me dividing people into black and white, I’m going to divide people into formal and informal. If I’m in a formal environment, I won’t be formal. I’ll do that with my mother’s friends. As I get to know you, if I afford you the opportunity to relax some and speak about and make reference to the things that are sort of a part of your culture, I am not going to hide that about me. And the more senior that I get Angela, the more I know how critical that is. Because if I present as my entire self, as a leader, a full professor at a place like Emory, what is that saying to this 21-year-old first-year medical student, I don’t want you to do what I did. I want you to just figure out how to be a doctor. I don’t want you to try to figure out how to be a doctor and how to get you a Ph.D. in a simulation. No, that’s a waste of your energy. So you learn the Krebs cycle, please, and then be yourself. And if that means for whatever whoever you are. If that means you telling me about the valley, you’re telling me about what happened when you and your family celebrated he, if you’re telling me about how on your birthday, your family from Mexico scenes, you last-minute details, whatever it is, I want you to be able to do that too and not have to hide that and only bring it out when you’re around people who look like you. That’s really my mission, for people to be able to be their entire sales. And for us to shake up what is normal, and to squash what we call “other.”

 

Sanjula Jain  15:46  

One of the things I was thinking about when you were talking about formal and informal is we’ve had a couple of guests on the show share very similar sentiments but from a gender perspective. How many of us women, particularly women of color, hide the physical attributes of how we dress or how we do our hair or whatever that may be to conform to what we maybe have historically believed to be the norms of a leader? How do you think about some of the cultural pieces that you just talked about, but also just the nuances of being a female in the industry?

 

Kimberly Manning  16:18  

This goes back to intersectionality and how it is tough. I think a lot about being a woman in medicine, but probably the most urgent of my identity is being a black American and a descendant of slavery. Whenever I think about one, I have to think about it in the context of the other, which is different from some of the other guests that have probably been here because it may not be their lived experience. The double whammy of being a woman and a woman of color at the same time pronounces people’s biases even more. They get a sense of who they think you are. If I disagree with you, what biases do you have about an assertive black woman speaking to you? Do you think that this is a tantrum? Do you think that I’m angry? What do you think this is? Then, if I present it in a way that is traditionally feminine, like dresses, and I like some things that meet a sort of traditional what people think of when they think of girl stuff. We know that we are in a space now where gender is such a fluid thing, and that is divided. But regardless of that, people still have their biases because of what we see every day. With each thing comes some idea that somebody has, a woman in a dress and lipstick, I think this woman who is black, who is disagreeing with me, I think this and what I have to do is know that that is going to happen. I walk into spaces knowing that’s going to happen, so I try my best to be prepared when I come into settings, but also have a soft place to land when I find myself being treated not in ways that are framing to me, so I make sure I have women on my team that supports me, that I have other people who come from historically excluded backgrounds who noticed lived experience, who can come and talk to me and support me and that I shadowbox some more and I come back out swinging. That’s the way I approach it. But regardless of how hard you go, sometimes there will be people that have this fixed idea of who you are and who you’re not. It will come out in behaviors and you’ll be like, what was that? The older I get, the more I’m honest about it. I call it out.

 

Sanjula Jain  18:52  

I love that you’re leading by example and you’re bringing your authentic self to all the work that you do and back to where you started around loving people and really communicating. What’s really unique about what you’re doing is you have this multi-medium approach. So we talked about the writing, but you’re very active on social media, you have a podcast, talk a little bit about how these different mediums inform your ability to communicate and amplify some of these voices. What do you have in mind in terms of the audience you’re trying to reach?

 

Kimberly Manning  19:20  

I’m a very big fan of Toni Morrison, particularly her writing but also as a human being. And she wrote her first book, The Bluest Eye when she was 39 years old. When asked why she wrote it, she said, “So I could read it. It was the book I wanted to read.” So I try to tell the stories that I would have a hunger to hear as an intern or as a medical student. I try to write stories I’m not seeing anywhere. And I try to paint a picture of a safety net hospital-like gravity or black people who come not from privilege or who have low resources. You’re not trying to humanize those entities. vigils, because I get to see that every day, but the pictures that are painted of us don’t ever look like what I get to see. Most people who see what I write on social media as it relates to a patient that I take care of at Grady Hospital are almost always from a positive slant. It is almost always countering the narrative that is painted about poor black people and descendants of slavery. Because there’s so much beauty involved, we are not all slow saying and flower bringing, there’s a lot of laughter, a lot of joy, and a lot of people who are delighted to be who they are, even with all the hardships. I’m just always hungry to tell the story that I don’t read so the podcast Dr. Ashley Mcmullin and I started together was something I hadn’t heard. I want to hear two black women physicians just talking to each other in a relaxed way. And being comfortable in their own skin. Ashley is younger than me, she’s identifies as a queer black woman. I’m a 50-year-old married mom of two, married to a man and we have very different lived experiences. So also showing that black women are not a monolith, we can be very, very different from each other, even though we’re all in this space. So I’m always hungry to show the thing that people haven’t seen, but that I get to see, and then hoping to permit more people to bring their authentic selves into spaces so that we all stop code-switching. Just stop it.

 

Sanjula Jain  21:35  

This big thing I’m picking up is, in some ways, whether it is writing and submitting to journals, you’re creating these avenues and platforms. When you don’t see it already exists, you just create the opportunity for yourself to elevate your voice and other voices, so thank you for creating those spaces for all of us. A little bit about you wearing multiple hats, you mentioned being a wife, a mother, you’re a podcast host, you’re a teacher, you’re playing many different hats. What advice do you have for other women who are juggling unpredictable clinical schedules and personal and family responsibilities?

 

Kimberly Manning  22:12  

Number one, be as good a friend to yourself as you are to the other people around you. I step outside of myself often and I do not say things about myself that would offend me if somebody said about my friend, I don’t call myself fat. I don’t call myself dumb. I don’t call myself a Dodo. I don’t do things like that. We do that a lot. I crack jokes with my best friend about our COVID-19 pounds that we feel like we gained between us but in a tender way that doesn’t mean to myself so that will be the first thing be a friend of yourself next women need women to beware of the woman who does not have women in her camp but she got in and Vinnie Aurora will tell you that our text thread is probably one of my primary wellness activities. It is always it’s funny. It’s academic One moment, it’s asking questions, it’s getting advice, and all of us are kind of at different stages. But women absolutely need women. So get you a street team of women in your corner. And nourish those relationships. be intentional about them. The woman that nourishes your spirit that you realize, “Oh man, I have not talked to her in three months.” You need to text her and say, “Hey, how are you doing? Checking in. How are you?” You have to be very intentional about that when you become busy and then have a mentor or two? Absolutely. I don’t care how senior you are, you absolutely need people mentoring you. And that is because to be surgical with the No, you need people to advise you. So there are things that people ask me to do. I just don’t feel like doing it. But my mentors, and depending upon who they are, I have about three, but I told one of my primary mentors, “Hey, I got asked to do this, but I don’t feel like doing it.” She will say to me, “This opportunity is bigger to you. I doubt very seriously they’ve ever had a black woman come into this particular visiting professorship. I know you don’t necessarily feel like going there or spending the time, but you have to think about the pipeline and what this will do for other people around there. What will it mean for you to come and present yourself in that space?” Then sometimes I’ll be like, “Do I have to do this?” And she’ll be like, “No, no, no. You don’t have to do that.” Be kind to you and be a friend to you intentionally, and with fervor and then to get you some women in your life and really make sure that you nourish the relationships do make sure that if that you aren’t doing all the talking that you do some listening that you check in on people that it’s not always them initiating everything. Then lastly, have you some mentors because your mentors will be the ones that will help you when you cannot be objective and you cannot always be objective.

 

Sanjula Jain  25:00  

That’s very well said. Kimberly, this has been phenomenal. I have so many more questions for you, but maybe I’ll wrap this up to be mindful of your time. As you think about the fascinating career you have and will continue to have, what advice would you give your younger self?

 

Kimberly Manning  25:16  

I would tell my younger self that you are enough, that you are the best you you can be. Nobody can be a better version of you than you, that a delay is not a denial for you. I grew up with great parents who really affirmed me, so I knew I was dope. I did. I applied to Emory for medical school, and I did not get an interview. I applied to Emory for residency, and I did not get an interview, but I knew I was dope. I’m not trying to be funny. I’m not. I knew I was a good leader. I knew I’d make a good doctor, and I knew that I knew that, so I would tell younger me, if you know who you are, don’t let somebody unravel that. Don’t let the imposter syndrome voice talk you into revising what you already know. What I knew about myself back then, but forgot a few times, is that I’m dope. I’m different. I have a good speaking voice, I have something to say that’s worth listening to. And my last piece of advice would be one, not just for younger me. But for everybody. I asked my students to do this one day, take a moment and step outside of yourself and talk about you as you would talk about somebody you admire. What would you say? They couldn’t do it. And this is a practice that I do so it’s probably really probably like, really a weird thing to hear somebody saying something like this about themselves. But don’t wait for somebody to write a letter of recommendation for you for you to be affirming yourself. And I’m not saying get on stages and say it everywhere. But you will not try anything. If you do not think you are equipped to do it. If you do not think you are dope enough— being dope is my highest compliment. I’d be like, “Girl, you dope.” Emory missed out. Now build my whole career at Emory. I love telling people around me that I didn’t get in twice because I knew it was there. I still knew it was in me.

 

Sanjula Jain  27:12  

I love that. We are our own advocates. That’s such a great reminder. Let’s close with our signature question. You are actually a writer, so as you think about the next chapters of your career and the legacy you want to leave behind, what would be the title of your autobiography?

 

Kimberly Manning  27:33  

One of my favorite hashtags that I use on social media is “love is the what.” It probably will be that: Love Is the What. If you ask me why I’m doing what I do, what am I up to, what’s important to me— love is the “what.” Why am I writing about patients? Because I love them. Why am I going to get off of this call and get on another call with a college student who’s trying to go to medical school? Because love is the “what.” My story is a story of love. It started with love with my parents and it has continued with love through the women I work with, my husband, my children, my sisters, my brother, and I continue to move in love. Love is the “what.”

 

Sanjula Jain  28:21  

Beautiful.Thank you so much, Kimberly. Your story is unbelievably inspiring and is playing a huge role and helping all of us in our career, so thank you for all that you do.

 

Kimberly Manning  28:31  

Thank you, Sanjula. I enjoyed talking to you.

 

Sanjula Jain  28:34  

Her Story is a podcast produced by Think Medium. For more leadership stories from inspiring women across healthcare, tune in every Wednesday. Please subscribe to Her Story on Apple Podcasts, YouTube, or wherever you’re listening right now. You can also view Her Story episodes and video and access exclusive content on our website at ThinkMedium.com. Be sure to rate and review Her Story so we can continue bringing you insights from influential women across the country. If you enjoyed this episode, we appreciate you spreading the word to your friends, family, colleagues, and mentors who might be interested. For questions and suggestions, please contact us at herstory@thinkmedium.com. Thanks for listening!

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