Dr Kimberly Manning on Twitter Teaching, Vaccine Deliberation, and Her Own 'Secret Sauce’

; Abraham Verghese, MD; Kimberly Manning, MD


November 09, 2021

This transcript has been edited for clarity.

Eric J. Topol, MD: Hello. This is Eric Topol with my co-host Abraham Verghese, and this is our podcast, Medicine and the Machine. For this edition, we're privileged to have Dr Kimberly Manning from Emory University. Welcome, Kimberly.

Kimberly Manning, MD: I'm so glad to be here.

Topol: Much of the medical community has gotten to know you in recent years, but let me give our audience a bit of background. You are board certified in medicine and pediatrics, a professor at Emory University, the associate chair of Diversity, Equity, and Inclusion (DEI) in the Department of Medicine at Emory, and one of the great mentors and teachers in American medicine today. You've written a lot and, in fact, your Reflections of a Grady Doctor was recognized by O, The Oprah Magazine as one of the top medical writings of today.

Although you and I converged in Cleveland for a number of years, because you were at Case Western Metro when I was at the Cleveland Clinic, I didn't meet you until the Gold Foundation gala 8 months ago. Tell us about growing up in Los Angeles and your father telling you that you would never be able to be a doctor.

Manning: It was not my father who told me I would never be a doctor but my father who was told he couldn't be a doctor. I'm originally from Inglewood, California. That's a suburb of Los Angeles. During the time I grew up, it was a working-class town made up of predominantly Black American, Mexican, and Asian Pacific Islander families. Like many Black Americans you meet on the West Coast, my family was from the South and came by way of the Great Migration from Alabama. My dad and mom met at Tuskegee University, as did my grandparents; my great grandmother went there too. So we have a family tradition at Tuskegee.

My origin story in medicine starts with my dad because my dad is one of 11 children and was the first to go to college. When it became apparent that he was headed in that direction, he met with a college counselor and told the counselor that he liked science and liked people and thought he wanted to be a doctor. The counselor, who really was well meaning, said, you know, you're the first in your family to go to college. You need to be able to help your family and so you need to major in engineering because that is where you will get a job as a Black man. If you do not get into a Meharry or Howard University, then you are left with fewer options. My father took that to heart. As a terrible math student, he decided to go to Tuskegee. It took him 6 years to graduate. Fortunately, during that fifth year he met my mother, so I'm glad it took him so long.

The day I told my father that I thought I might be interested in being a doctor, he pounced on it and pretty much told me that I was going to be a doctor. So it's neat: My dad had only these two options for medical school in 1961 in Birmingham, Alabama, and then here I am, just one generation later. It never even occurred to me that I couldn't be a doctor. I declared that I wanted to be one. It was tough, but I didn't grow up in an era where I thought I couldn't. What a difference a generation makes.

Abraham Verghese, MD: You have emerged as such a wonderful voice in medicine. You are especially a voice of reason in encouraging people to take the COVID vaccine and for addressing the racial inequalities of medicine. Was there a moment that galvanized you into the role you're in now or had you been doing this all along? The George Floyd moment changed a lot of things in America. Can you look back and talk about that?

Manning: I have to push back a little and let you know how much I admire your voices in medicine. What happens over time is that, as people get to know who you are, you feel a responsibility to think about what you should do with your influence, especially in a time such as this. I found myself feeling, more than ever, an urgency to do that.

On November 15, 2012, my older sister, who was 20 months older than me, died of sudden cardiac death at age 44. One minute she was here, and the next minute she was gone. She hadn't been sick. She was at my house the evening before, helping my kids with a school project. She was hilarious, she was fun, and my family is very close. She, too, went to Tuskegee, so we are all thick as thieves. Something about her passing gave me such urgency about what I'm supposed to be doing. The murder of Mr George Floyd was horrific, but when I was a freshman at Tuskegee, I was talking about the Central Park Five; when I was graduating from Tuskegee, I was talking about Mr Rodney King; then it was Mr Amadou Diallo. And so, George Floyd really wasn't anything new for people who have lived life through my life lens as a Black American. What was different was that the whole world was now paying attention too. But I have this unique space where I interact in many communities — in the Black community and in the medical community — and I just felt an urgency to authentically say what I could say as me.

Topol: You are literally a dynamo. Have you always been this way? Would you describe yourself as an extrovert?

Manning: Have you ever read Quiet (Quiet: The Power of Introverts in a World That Can't Stop Talking) by Susan Cain? I read that book and I had an "aha!" moment because I do get a lot of my energy from within, which is why I like to write and run by myself. I tend to like intimacy and interactions with people rather than crowds or things like that. I call myself an ambivert. The world would probably describe me as an extrovert, but I grew up cherished, with parents who listened to me. When I had something to say, they listened to what I had to say. They still talk to me in ways that show me they want to hear what I have to say.

I was fortunate enough to have parents who protected my innocence as long as they could and then created a space for me to believe that what I have to say is worth somebody hearing. Then I was brought up in my emerging adulthood in two historically black institutions, so I never really thought a lot about my race or my identity as a Black American, because everybody around me at Tuskegee and Meharry looked like me. It wasn't until I got to Cleveland, as an intern, that I was like, yo, I'm other. So that has a lot to do with who I am. I think a lot of people have things inside them that they want to get out, but they haven't yet found the courage or felt the permission.

Verghese: That's a wonderful story of how you evolved from childhood to becoming a doctor. I read something you wrote with Vinny Arora and Shikha Jain on how you were holding a virtual protest over George Floyd, and it was an awakening moment in the sense of the amount of people who Zoom-bombed your event, and you were made to feel the vitriol that was out there. I thought your response and the article you wrote were just brilliant.

Manning: Thank you so much for mentioning that. Vinny Arora and Shikha Jain are two amazing women in medicine who I met virtually. They contacted me and we agreed to work together on this virtual White Coats for Black Lives rally following the murder of Mr George Floyd. Part of it was because none of us could physically go to any of the marches. Vinny had just had a baby, Shikha had some childcare issues, and I had some conflicts as well. We had this ambitious plan and somebody put the link straight out onto Twitter. As the person from probably the most marginalized group, I was like, Are we sure we don't want this to be webinar-style where people have to sign up? We were sort of naive about it. We started the Zoom rally and right away, perhaps the most hateful images you could imagine came across the screen. I don't even want to describe it. It was bad. We stopped the recording because there were about 300 people on with their children. But I thought to myself, this is not the first time I've seen something like this, and we still have something to say. We have to keep going forward, right? So we decided to just go ahead and rerecord it 15 minutes later. We jumped onto Zoom and recorded it again and put it on YouTube and then posted that to Twitter, which got way more interactions than we would have ever gotten from the live event.

When we wrote that piece for The New England Journal of Medicine, it was about our unique identities and what we were able to learn from each other, because immediately Shikha and Vinny came to protect me, right? They were like, oh my goodness, we brought this Black woman here who is a mother of two Black sons and married to a Black man, and then we traumatized her further. I was trying to explain to them that this is nothing new under the sun. If you think this is the worst my people have seen but kept on truckin'... This is what we do. Let's keep it moving. Let's get our eyes on that prize. And that was to amplify this important mission. So we leaned on each other and showed what it looks like when you push on, but at the same time, think about your wellness.

Topol: That's extraordinary. Kimberly, you came to Emory in 2001. That's 20 years ago, and you look like you're in your 20s.

Manning: When a cardiologist tells you that you look young, I'm going to take that. My new secret sauce is sleep. I have spent my entire adulthood without enough sleep. I'm the person who argued that 6 hours of sleep for some people is plenty. In my late 40s, I started realizing that sleep is something you really need, and now I'm pretty maniacal about exercise and sleep. So hopefully that's coming across in my youthful glow.

Topol: You wrote an amazing tribute to your colleague Carlos Del Rio. He, like you, has a big presence on social media and is one of the great humanists at Emory. Tell us about him. Has he been a mentor to you?

Manning: Carlos is a mentor and a friend to me. You have these pivotal moments with people and sometimes they don't even remember, or somebody tells you something that you did that changed their life and you think, Really? Did I do that?

When I had been about 3 years on the faculty at Emory, I had written an essay on faculty development, and my division chief at the time saw it and said, "This is really good. You should send it to a journal." But I had never heard of journals accepting essays. I thought he meant the lay press, like the Atlanta Journal-Constitution. He suggested that I send it to JAMA. I sent it to JAMA and it got accepted right away. I was like, wow. I had something else I wanted to submit so I sent that out, and it got accepted by the Annals of Internal Medicine. As it turns out, these pieces came out a week apart.

Now, mind you, I am an assistant professor. I have never seen my name in lights in those types of journals. I'm so proud of myself. We were at a function and my chair was there and, bless his heart, I know he did not mean to hurt my feelings, but someone next to him said, "Kimberly was published in the Annals and in JAMA within 2 weeks." He'd seen my pieces and he said, "Yeah, they were essays, right?" And I said, "They were narratives." He said, "That's great. So now they know your name. Now you have to do some research, get your research in there, too. That'll help you with your trajectory to be promoted."

Carlos was there. I was so proud, but it burst my bubble so bad. At the time, Carlos and I weren't close. But as my chair walked away, Carlos looked at me and said, "You know what you do? What you do is write and publish so damn many essays that eventually nobody can say anything to you. You just keep sending your essays to those journals and eventually they're going to see them all over your CV and they're going think, Well, damn, we're going to have to figure out what to do with this and count it." And that is what I did. If Carlos had not said that to me, my impostor syndrome probably would have been amplified even more and it would have trivialized what was a proud moment. What should have been a moment to affirm me as a writer was made to seem like it was some silly side hustle that I'd done. Carlos shut that down. He was like, I don't know anybody here who does that, so just write so damn many.

Topol: What a great story.

Verghese: That's wonderful. I'm struck by the way you use your Twitter feed as a dialogue between you and people you meet. It's a unique use of Twitter, almost as though you're bringing a narrative into Twitter in a way I haven't seen before. I also want to ask you about Twitter education. There's a lot of medical education that, frankly, I was learning by following some of the links that you have on your site. Talk about the role of Twitter in medical education, because that was new to me, other than reading my wonderful cohost and his links, which keep me sounding like I know something about COVID.

Manning: Dr Topol is definitely part of my microlearning. For sure, I love that feed. Over the past 3 years or so, people have become a lot more intentional and creative with ways to teach on Twitter. Initially I was mostly listening to podcasts that were focused on medical education. But there are a few people who started this trend of creating what they refer to as tutorials. Tony Breu is one person I admire. He was writing these medical education–based tweet threads that just taught a lot of medical concepts and would be about 12 or 13 tweets long. I would walk away thinking, Okay, now I understand iron deficiency anemia. This is great.

I feel like I say this on every podcast, but it bears repeating. I think a lot about how Toni Morrison said she wrote her book The Bluest Eye because it was the book she wanted to read. It was the book she hungered for. I think for myself as a teacher on Twitter, I try to write and share the things I wish I could see or that I want to read. Now more and more, people are teaching in a way they wish to teach. Since we know the human attention span is so short, bring the teaching where the people are, and the people are on social media and other devices. I think it's just evolved with the times.

Topol: It's such a great contribution. You have a unique perspective, both as an internist and a pediatrician. Can you integrate that with your views of the pandemic now that we're getting to the 2-year mark of this mess?

Manning: My training is in internal medicine and pediatrics. The majority of what I do now is general internal medicine and hospital medicine with adults. But once you've trained in pediatrics, you're always a pediatrician. And I'm a mom. I think the special piece about my pediatric training is the communication skills you learn and the things that aren't spoken, because kids can't always talk to you. This heightens your communication skills. I found that once I became a parent, the things I knew in pediatrics combined with that experience made me realize how ignorant I was before I had kids. I pull all that together and think I know what it feels like to be scared as a mom. I know what it feels like to be scared that something can happen to my loved one. I know what it feels like to have somebody pull my husband over and ask him to get out of the car and get on his knees in our neighborhood. I know what all of that is like, and I just try to be courageous about taking my identity and transparently sharing with people things they may not be seeing.

For example, if your husband got pulled over in your upper-middle-class neighborhood and was told to get out of the car he owns, get on his knees, and asked if he has a weapon, it's plausible to think that the same community where that happened might not be people who are thinking about your best interests. That's plausible. I think about all of those things when I get ready to talk to patients. I believe my pediatric background helps me with a level of patience and understanding the fear. Anybody who's been a parent knows that is a whole uniquely vulnerable space to be in and a love you've never felt, and you need to be handled with kid gloves but still told the truth.

Verghese: You've written a lot about vaccine hesitancy and vaccine resistance. I'd love your insights on how you see the fact that we are so poorly vaccinated as a country compared with some other countries. What do you see, and what is the breakdown of how that works at a personal level when you deal with people?

Manning: I'm an optimist and have been since childhood; somebody once told me I was annoyingly optimistic. I give you that disclaimer. I'll focus on historically excluded and minority groups; I think some of the labels have missed the mark. I tend to not use the term "vaccine hesitancy." I tend to say "vaccine deliberation." I think of people as on a spectrum of deliberation. Some people may be on a spectrum where they're like, no way, but I found that even those people, many of them have not had any conversations with anybody. Their level of conviction about where they are may not be as strong as people think it is. You just need somebody to plant a seed and open a door. That's one place where the mark was missed.

There was this initial rush to get a playbook for how to talk to the minorities about this, about their vaccine hesitancy, when no group is a monolith. Every single person has a unique reason for why they feel as they do. I think the secret sauce is humanism, being kind to people, listening, and not having a playbook to plan what you're going to say while the person is talking. I think that's a piece where we miss the mark.

I also think there's a little too much friction in the ability to get a vaccine. While we do have them everywhere, the friction that I speak of is something as simple as, "Here — you have to go fill out this form." At Grady now, if you want to get vaccinated, I'm walking you over there. When they hand you the form, I ask you, "Do you want me to fill it out? If you don't want me to fill it out, fine." But I'm finding that there are a lot of points where we could reduce friction for people all the way through the process, particularly in groups that are undervaccinated.

Topol: That's really insightful. I wonder if you could extend this to age 5 to 11, because that's beginning now. I have a 7-year-old grandson who's about to get vaccinated, which I'm thrilled about. But what is your sense about that? I know you convert a lot of people, you're persuasive, but tell us about children. That's even more tricky than these adults deliberating, right?

Manning: I generally always say in my head, "Convey, don't convince." To the parents, I say, "May I share information with you based on what I know that might help you in your deliberation process?" That way, we can co-create a plan. I just tweeted about this. I was in a car wash a few days ago and this lady was watching the news and she was saying, "Oh no" about the children's vaccines. And as we began to chat, she told me that she was vaccinated, but there was no way she was going to let them do that to her kids. I told her I had vaccinated my children already. But she told me I was the first person she'd met who had vaccinated their kids. She started asking me, was I scared, and what did I think? And why had I had my children vaccinated? Now, my children are teenagers, but the questions still relate to what I would do if my children were younger.

With children, though it's possible that they can get sick, we know that's more rare. But they still walk around and see people, and hug people like their grandparents. My children are around my parents and other people. My son works at a fast-food restaurant and he's interacting with the public. So I told that lady that sure, I was a little nervous about it, but I'm more nervous about the idea of my kids coming in contact with somebody and doing them harm. Also, what if my child is in that tiny percentage of kids who gets COVID and ends up in the ICU on ECMO? I don't know how to predict if that's going to happen. Everything is fine until it's not. So if I could prevent that, then I want to.

We parted with her saying, "You know what, I'm really going to think about it." And she had started with, "Oh hell, no." I think all of us have had experiences with people who were a firm no, but then we run into them 2 weeks later and they're wearing a button that says "I got my vaccine." Well, what happened? Sometimes people just need more time to deliberate on their own.

Verghese: We've had many conversations with wonderful people like Uché Blackstock and others, talking about how you bring about racial equity and inclusion in academic medical centers and corporations, and many academic centers are playing catch-up. But they're doing it a lot more now. Do you have any general advice for how academic centers go about this? What have you observed over the years?

Manning: I'm fortunate to be here at Emory in my role as associate vice chair for DEI in the Department of Medicine. A lot of that has to do with our chair, who didn't only call for leaders in this role; he made it a line item. There has to be a budget. You have to protect people's time to do this. That's a big area where people are currently missing the mark. They're forming task forces and councils, which we all know translate to no protected time. If you are already feeling racial battle fatigue and then somebody tells you, "Oh, and I want you to make a strategic plan for us on DEI," that is a set-up for burnout. So one piece is that leaders, and department chairs and deans, have to put some money on it, provide administrative support, protect time, give them the resources they need to go to conferences and to grow and learn. I quickly found out that being Black and having gone to an HBCU (historically Black college or university) is not enough for me to be a subject-matter expert in diversity, equity, and inclusion. I had a lot to learn, and thank goodness, I've had the support to do that.

The other piece is the reporting structure. Often, DEI leaders report laterally. They don't report at the same place where other leaders are reporting. We report to our chair, and our DEI leaders in the School of Medicine report to the dean. That's important, because over time, people get tired of a subject. People got tired of talking about quality improvement or patient safety or whatever they were talking about. If you have a vice chair of equality, then you can be tired all you want. That vice chair is still at the table and the subject is going to remain relevant because it's a line item in a place where we have goals in our strategic plan. You have to put some treasure down on it. If you think it's important, you can't just form a task force. I know I'm probably stepping on somebody's toes.

Topol: It's important that you do. I don't know how the DEI efforts can go forward, as they typically do, with someone in charge of that but without any resources.

Manning: People agree to do this because they feel urgency. As Black Americans and descendants of people who survived slavery, there's an urgency for us to get this done. When you ask me to do it but say, "Oh, but we have 5% time for you, or we will build up to that," because I feel the urgency, I think, Well, if I don't do it, nobody's going to do it. People all over the country are in that position, and it's sad.

Topol: We've been so lucky today to have had time with one of the great American medical teachers, mentors, humanists, dynamos. You are a treasure and you're going to continue to have a big impact in American medicine. We'll keep following your career. Thanks so much for joining us.

Verghese: Kimberly, what a wonderful interview. Thank you.

Manning: It's such a privilege for me to talk to both of you. I deeply admire the work that you do, and I appreciate you giving me the space to bring my whole self into this conversation. I appreciate being seen. Thank you.

This podcast is intended for US healthcare professionals only.

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