EP153: Building a Healing Narrative: Dr. Susan Hingle on Data + Stories = Change

Empowering Women Leaders in Medicine: An Interview with Dr. Susan Hingle

In this episode, Dr. Susan Hingle, Professor of Medicine and Associate Dean at Southern Illinois University School of Medicine, discusses the ongoing gender gap in medical leadership. Dr. Hingle emphasizes the importance of combining data with personal stories to drive change, shares her journey in medicine, and highlights the significance of relationships and strategic mentoring. She also explores the concept of power in leadership, the necessity of self-care, and the role of reflection and gratitude in maintaining physician well-being. Here is a link to the book, The Power Code, a recent read of Dr. Hingle's. And here is a link to an article about The Power Code.

00:00 Introduction and Guest Introduction

00:33 The Gender Gap in Medical Leadership

02:41 Dr. Hingle's Personal Journey

06:13 The Importance of Strategic Mentoring

08:33 Integrating Medical Humanities

10:45 Addressing Moral Injury in Healthcare

14:33 Empowering Women Leaders in Medicine

16:50 Prioritizing Self-Care for Better Leadership

23:34 Final Thoughts and Reflections

Transcript

Christine Ko: [00:00:00] Welcome to today's episode. I'm joined by Dr. Susan Hingle, Professor of Medicine and Associate Dean at Southern Illinois University School of Medicine. As President of the American Medical Women's Association and a past Chair of the American College of Physicians Board of Regents, Dr. Hingle has been a powerful advocate for gender equity and physician well being. She brings decades of experience in transforming medical culture and creating supportive environments for healthcare professionals. 

Welcome to Susan.

Susan Hingle: Thank you for having me here. 

Christine Ko: Thank you for being here. You've mentioned that medical school gender parity should have led to more women leaders by now. Why do you think we're still having the same conversations about this gender gap? 

Susan Hingle: That's a great question. If I really knew the answer, we may have solved some of the problems. Some of it is that, as a profession, we say that we are very evidence based, data driven, and despite [00:01:00] giving the data and the evidence, these issues remain. Nothing seems to change. So one of the things that I have learned over time is that data alone is insufficient to stimulate change. We need to couple the data with stories so that people can really personalize the information and understand it in the context of human beings. So I have this equation that I've created. Data plus story equals change. Often, because we're so focused on the evidence, we often lose the story piece. We don't prioritize that. This is not only a professional reality for medicine, it's really a reality in U. S. culture. It's a reality in world culture that women are are not viewed equally. If you look at the Equal Rights Amendment... didn't get enough to get ratified in the 70s, and it just sort of got put on hold [00:02:00] for decades. Then we got enough states to ratify it, and it never has been published. President Biden just came out and said he thinks it's the law of the land, but the legal scholars say it's not the law of the land because it hasn't been published as part of the Constitution. So we don't have equal rights. And you think about all the gendered expectations and all the policy decisions that have been made that don't level the playing field. If we know what the problems are, then we actually can address them. We thought it was something simple, just get more women in medical school, and It'll be fixed, and clearly it wasn't that simple. 

Christine Ko: I like your data plus stories equals change. Can I ask you what your story is, how you've gotten to where you are now?

Susan Hingle: I can tell you a little bit about my story. I grew up not too far from where I am now. When I finished high school, I thought I was out of here, I was moving on to bigger and better things, I wanted to go to the big city, I did [00:03:00] that. And then family is what kind of drew me back, and I've been at SIU for 27 years now, a long time. The mission of our school is to physicians to meet the healthcare needs of people in Central and Southern Illinois because it's considered an underserved area. Growing up, my mom was sick quite a bit. She had inflammatory bowel disease and had all these extra intestinal manifestations of it. Ended up getting bile duct cancer while she was getting evaluated for a liver transplant. Also got ovarian cancer, and she passed away from that. But at the time, we didn't have specialized GI doctors in the region, we didn't have specialized dermatologists, we certainly didn't do transplants; we were just getting our first oncologist in the region, and so she and my dad traveled around for their care quite a bit. Not that I had a bad childhood at all, but there were challenges. You look at [00:04:00] the SIU School of Medicine and Healthcare now in the region it's because of the School of Medicine that we now do have specialized dermatologists and gastroenterologists, oncologists, do transplants, all of that. So that mission is what has really kept me here. 

As far as kind of my evolution of my career, I'd say a couple of things. I'm a very organized person, but my career has not been that way. I haven't been one of these people with one year goals, five year goals, ten year goals. I've really sort of been someone who, if an interesting opportunity comes up, I sort of am like, oh, I'm going to try that out. And that's how I got involved with advocacy work, that's how I got involved with a I thought I was going to be a residency program director, and that wasn't working out, and an opportunity to get involved in student education came up, and then an opportunity in faculty [00:05:00] development, so I've sort of gone against advice I was given, you know, have this straight, linear path and know who you want to be and find people to help you do it. If something sounded cool, I tried it, and it's been really, it's been fun and interesting. So that was one of the big things. 

I think the second big piece that's really helped me is relationships. I just got asked to do a talk on strategic networking, and I thought, I can't do that. I haven't done strategic networking, but when I've reflected on my career, I have done it, but I just didn't know I was doing it. That's important in any discipline, but definitely in medicine. Those relationships: people who can mentor you, who can sponsor you, who can coach you, who can motivate you, who can help you know about other things that you might not be aware of.

Christine Ko: You touched on 1) having an [00:06:00] important mission that you believe in. Central and southern Illinois area being underserved, and you really have changed that for that population. And I'm sorry to hear about your mother. Thank you for sharing that story. And also these relationships. In terms of setting up strategic mentoring, what does that really mean, do you think, in your view?

Susan Hingle: Even though I told you I didn't have, like, one year, five year, ten year goals, I think strategic mentoring is based on knowing what you want to accomplish and finding people who can help you accomplish it. It's gonna be different at different points in your life. If you're early in your career, you may not know exactly where you want to go, but you may know that you want someone to help you figure out where you want to go. And so, at that point, strategic mentoring would be meeting lots of people. So, lots of people to introduce you to all the different exciting things that are out there. Getting to know lots of [00:07:00] people who can help you to reflect on what you might want to do with your career. Later in your career, when you know what you want to do, strategic mentoring may be getting outside of your organization and meeting people nationally to form collaborations. Mid career is often when a lot of women's careers stagnate because we've spent so much time sort of establishing ourselves, and then we have all of these other commitments, family commitments, things like that. We feel kind of stuck. In the mid career, a strategic mentor would be someone who helps us to get unstuck and to sort of figure out what changes we might need to make. A mentor might be someone who helps us to be brave in making those changes. So, I think really strategic mentoring is people who help us to reflect and then work [00:08:00] towards whatever it is that we want to accomplish.

With our medical humanities department here, one of the big goals is to help students learn how to be reflective practitioners. In medical school, when it's still sort of all mapped out for them, they don't get it. They're like, why are we wasting our time on this? But then, if you reconnect, you know, in five, ten years, they're like, I get it now. I know what you're talking about, Dr. Hingle. And those are the ones who have likely been successful in becoming reflective. 

Christine Ko: Yeah. How do you teach the humanities?

Susan Hingle: So all of our third year students get a week of it. All of our fourth year students get another week. They have different focuses. Then we've got a whole bunch of electives that the students can take. I'm really working now on trying to integrate it in the first and second year so that it doesn't seem like it's something separate because really, when you think about what a physician [00:09:00] does, who a physician is, it is medical humanities. We're interacting with human beings on a day to day basis. Learning how to develop those relationships, how to communicate with them, how to find meaning in that work is really important. We do a lot of things with narrative writing. We're starting to integrate some improv. We have the student's journal. They do projects, which is always fascinating, about their identities. Some of them do writing or art, traditional humanities; some of them have started cooking and bring in different elements of their heritage. Some have created music, so all sorts of really creative pursuits.

Christine Ko: It kind of also goes back to your data plus stories idea because medical knowledge is maybe in a way sort of the data and the humanities part of it is the stories. 

Susan Hingle: Yeah. When you think about the issues in our health care system now and how physicians, [00:10:00] all members of our health care team, are really suffering moral injury. A lot of it is because they're so busy, the work compression is so intense, they lose the story piece of it. All of the to dos are always there. You gotta get your notes done, you gotta get the inbox from the patient portal messages done. And we often lose the story piece. So figuring out how do we develop ways for people to make that reconnection to the meaning is really important, and that's where I think reflection, again, becomes really important. That's what I do on my way home every day. I reflect. I think about my day. What was fun about it? What was not so fun? Why was it fun? Why was it hard? 

Christine Ko: You mentioned moral injury. A lot of physicians or others in healthcare or even other jobs think that there's sort of some kind of purpose and when the system isn't allowing you to fulfill that purpose, you become quite [00:11:00] demoralized. When we feel like we're not really being able to make a difference anymore, that can become quite a problem. 

Susan Hingle: Yeah. Physician advocacy actually probably comes about because of moral injury and might actually be a part of a solution to the moral injury. Because you see a patient who needs, I'll just make it up, insulin, but they don't have health insurance, and you know that insulin is super expensive. There's this moral injury that goes along with that. You knew you couldn't take care of your patient in the way that you wanted to, in the way that you knew they deserved. If you get involved in advocating for that patient, whatever that looks like, by getting them in touch with prescription assistance programs, or by getting involved at the national level with organizations who are working with Congress to deal with prescription drug pricing, that act of advocacy then becomes part of the solution because you then are hopefully at least [00:12:00] helping to fix it temporarily for the individual patient: if it's through a patient assistance program, or perhaps your patient and more patients through advocating at a policy level. 

Christine Ko: Being able to remember that we can make a difference is something that can help with moral injury or feeling symptoms of burnout. You mentioned that often mid career, a lot of women feel like they're a little bit stuck. Do you think that there are some solutions or tools that people can use if they're feeling that?

Susan Hingle: Well, not to sound like a broken record, but I think a lot of it ends up coming back to to relationships. Early career, there's actually a fair amount of investment in women physicians. I forget what it's called. I think it's called maybe the Jennifer effect or something like that. People feel good because they're helping these promising young physicians reach their career goals, but then once you reach mid career, they become sort of competitors. They're no longer like your [00:13:00] pet project. They're someone that actually could take that job away from you, that opportunity away from you, that recognition, or that award. And so that mentorship goes away. And, if you think about imposter phenomenon, the literature that's out there on how to combat that, it's through talking about it with other people, through those relationships and recognizing that you're not alone, that others experience this. Relationships also can be helpful in having people help you to recognize that even though things can be really challenging, I mean, it's a really difficult time in healthcare right now, a really difficult time in medical education, really a really difficult time in society in general; as physicians, we remain very, very privileged to do the work that we do. Despite all of its challenges, we get to interact with human [00:14:00] beings when they're at their most vulnerable, and they need us, and we get paid for it. And so those relationships can help us to, to sort of recenter that and recognize that despite all the challenges we're still really, really blessed and privileged to do what we do.

Christine Ko: I agree. Patients are often at their very most vulnerable. It is a real privilege to potentially make a difference for someone when they're feeling that way. Coming back to your data plus stories equals change. Would you have any advice to women who are trying to, or would like to become, or maybe they already are, leaders in medicine?

Susan Hingle: So let's see. I just finished this book called The Power Code. I don't know if you've read it. It's really good. It's by Katty Kay and Claire Shipman. The premise of the book is about the potential that exists when women [00:15:00] leaders lead as women, not women trying to fit into the typical profile of a leader, which tends to be very masculine. They give all these fantastic examples around the world in different industries of how that can happen.

One of the barriers has been that when you ask women if they want power, they say no. Because the whole concept of power sounds selfish and scary. Our concepts of power, again, are male. Male power. And so they have this whole concept in the book of men view power, obviously broad over generalization, but men view power as power over. So, you reach a position of power, and then you have power over all of your subordinates. Women view power as power to, so power to change. That subtle shift [00:16:00] in language makes power then something aspirational and less scary. Women who might be interested in leadership, they need to figure out how you feel about power and get comfortable with it. I don't know if I've always thought this way, but my natural tendency is the power to. Like that's what's attracted me to leadership because I know that there is potential to change all this stuff that's really really hard and stuff that I have dealt with.

We've talked about the importance of mentorship. That's another important piece. You know within mentorship women also often feel like they don't have time to talk to a mentor, to invest in themselves. Like many women, I got to a really unhealthy point. I was giving so much to everyone, and, again, I feel very privileged in my life, but we've had lots of challenges in [00:17:00] my family's life, in my life, just like everyone else, and I got super, super unhealthy until one of my colleagues called me out on it because here I am, this supposed, uh, wellness guru, and I was so unhealthy. I was pre diabetic, and out of shape, and I wasn't sleeping, and all this stuff. And she called me out on it. I was mad at first, but then I reflected, and I was like, she's totally right. And so, I got my act together, and I'm like, okay, I'm going to take care of myself. I didn't know what that meant. I had never really done it. When I first started doing it, I felt so selfish. I was like, oh my gosh. I can't believe I'm exercising. I could be volunteering here. I could be doing this with my kids. I could be writing this paper. And it took a good few months. But I'm like, I'm gonna do this [00:18:00] every day. I finally got to the point that I was healthier. Not only physically healthier, but I started doing journaling, three good things with one of my friends. I really got healthy, and for the first time in my life, and I'm not a spring chicken anymore, but for the first time in my life, I actually lived what it meant that when you're good to yourself, you're better to everyone else. I had always intellectually believed that, but I had never lived it. And when I was healthy: physically, mentally, emotionally, spiritually, I was a better doctor, a better wife, a better mom, a better educator, a better daughter, a better sister. I was a better everything. I like really lived it.

And so, the second thing that I would share with people who want to to be leaders is prioritize yourself. It is not selfish. It's the exact opposite of selfish [00:19:00] because if you're going to be a better doctor, a better educator, a better wife, a better mom, a better whatever, that's actually the opposite of selfish. So make sure you do whatever it is that you need to be healthy and that's how you're going to be a better leader.

Christine Ko: I love those insights. Power and priority. Thank you for sharing what you did. The data of who you are, like, just like your titles and etcetera, that kind of data plus the story that you just gave. It's very inspiring to me. I like what you said about power. I've heard that. I know Brene Brown says that about power over. It's interesting that you say that women often say, Oh, we don't want any power. I do know that I want power. I would love to have more power. I don't have enough power to change the things that I want to change. Even then I just said power to change things. When you mentioned like, oh, you're exercising, which is a good thing, but you kind of felt guilty. Like I should be serving in a volunteer role or like doing something for my kids or [00:20:00] something. It's nice to hear you say those things, because once I realized that I felt like I couldn't think about myself, or I didn't know how to think about myself, in some ways, I just felt kind of silly and stupid. 

Susan Hingle: We are, particularly as women, but not only women, we are socialized to be humble. A lot of times that gets interpreted as, Don't brag about yourself. A former colleague of mine who's now retired said that humility is not thinking less about yourself, which I think is how a lot of people interpret it, but thinking about yourself less. And so, again, it's about the work. It's about the meaning of the work. It's about the impact of the work. And so if you think about that, exercising is a way of being humble because, again, you're going to be healthier and there's nothing wrong with doing it for yourself. You can do it for [00:21:00] yourself and by doing it for yourself, you're also doing it for others.

Christine Ko: Can I go back to the friend who kind of called you out on being a wellness guru and not applying it to yourself? That's a really good friend. 

Susan Hingle: Oh, yeah. At first when she said it I was just like, that is so mean. And she's like, no it's not. She said, I'm doing this because I love you, and she said, I want you to love yourself. And I said, oh, I do, and she's like, no, you don't, and I'm like, yes, I do, and she's like, you absolutely don't, look at the way you're behaving. And so I'm still so grateful that she loved me enough to do that and was comfortable enough to have that conversation rather than just ignoring it like everyone else was.

Christine Ko: How was she able to approach you about that? She was just that concerned about you? 

Susan Hingle: I think so. 

Christine Ko: Yeah. 

Susan Hingle: There's a lot of similarities for women in medicine. We struggle with a lot of the same things, and I think that she struggles with a lot of the [00:22:00] same things. And so it didn't feel that difficult to have that conversation because she had been there too.

Christine Ko: It's good to have good friends. 

Susan Hingle: Yes, it is. 

Christine Ko: Yeah. So let's see. We talked about the power question and prioritizing yourself and some daily practices. You're really saying reflect, like you reflect on your way home, you journal, it sounds like you write down three things to be grateful for every day. And it sounds like you do that with someone.

Susan Hingle: Yes. So that started during the pandemic. Which obviously was a very difficult time in healthcare to think about the good things because there was so much devastation. A colleague of mine from New Mexico, we started doing it. We would text each other every night. Sometimes it would be, I had a great cup of tea. It was like really small things, but other times it was much more substantial, like someone who had COVID survived that we didn't think would, or we had the opportunity to connect a patient with a loved one. [00:23:00] Sometimes it was bigger things and sometimes it was a cup of tea. We still do it every night. The two of us, we've been doing it since like, I don't know if it was like right at the beginning of the pandemic, but near the beginning of the pandemic. Having that um, sort of accountability partner is helpful. Because sometimes when you have a bad day, you're like, that's the last thing I want to do is look for something positive. But that text comes through from her, I'm like, oh, okay. Think about it. What was something good today? And it changes things. 

Christine Ko: Yeah, I like it. Well, we covered a lot of ground. Thank you for your insights on leadership, your story, data plus stories equals change, thinking about power, and prioritizing yourself, and having time for self reflection.

Do you have any final thoughts?

Susan Hingle: Just to thank you for doing this conversation. Learning from each other and connecting with each other is really an important part of our growth as human [00:24:00] beings. Not a lot of people take time to do that. So, just thank you so much for facilitating this.

Christine Ko: Thank you. I really enjoyed talking to you. 

Susan Hingle: Me too. Thank you.