Dear Introverts in Medicine

Early on in medical school, I realized that what intimidated me most about medicine wasn't having to memorize stacks of notes or work 24-hour shifts; it was how I'd get by as an introvert in a culture that seemed stacked in my extroverted colleagues' favour.

From the emphasis on group learning to the design of our videoconference lecture hall (where a camera would zoom in on you if you turned your microphone on to ask or answer a question) medical school seemed like exposure therapy for us "quiet" folk (and not systematic desensitization, but full-on flooding).

While others may have fretted over remembering the steps of the cardiac exam during a clinical skills session, I had the same baseline concerns, with the added anxiety of performing in front of my peers. Seeing an afternoon's worth of back-to-back family practice patients left me flustered. Socializing with physicians at our medical society dinners was inordinately stressful. Everything just seemed a little bit harder than it should have been.

Starting third-year hospital rotations provoked more anxiety yet. Being put on the spot during rounds, granola-bar-for-lunch days with zero down time, and the unpredictability of a pager-dependent schedule are struggles for anyone, more so us who appreciate quiet time. As someone whose ideal workspace would be isolated and silent, it was a struggle to learn to write and dictate consults while ignoring the chaos of staff, patients, and machine beeps, and trying to minimize my desk real-estate on a corner of the unit clerk's counter. Suffice it to say that hospital work spaces are not designed with introverts in mind.

But somehow I got by. Uprooting myself every few weeks to switch hospitals, staff, and specialties became less unnerving. Hearing my pager go off induced a lesser degree of tachycardia. And presenting patients on rounds became something I tolerated, rather than dreaded. I guess I'd say I mellowed out.

Even though I learned to function, I went through medical school considering introversion to be a major hindrance. Particularly so, in the CaRMS residency match -- three weeks of interviews and social events, on a tight travel schedule, with people you've never met -- the stuff of introvert nightmares.

That I came through all right in CaRMS should have given me some confidence that I didn't have to act like someone I wasn't to get by. And I think it did, on some level, as I got through my first year of residency without too much distress. But even so, there have been times in the past year when my introversion has been brought to light. One such occasion was on my Emergency rotation, when the staff doctor I'd been working with for the past eight hours told me that at the start of the shift he'd thought I'd seemed disinterested (unfortunately that's what being quiet on the periphery sometimes gets you). He fortunately went on to say that as the shift progressed he saw that I really wasn't...but our conversation got me to think about how my quietness may be (mis)perceived (and all this on a night when I didn't even think I was being that quiet!).

This month I'm working on a ward with a couple of phenomenal doctors, who are also the most gregarious people and could honestly quit medicine and support themselves as comedians (rounding with them is like watching stand-up). While I wish I had wittier rebuttals, we get along well and the patients just love them. In contrast, the other day I wasn't particularly chatty and was asked by three different people whether I was unwell, sad, or tired. My outgoingness fluctuates and it's good to know how I come across (evidently not too well!) at quieter times. Most other days I've been all right and, while no one would pay to watch me at a comedy club, I'd like to think that I get along well enough with our patients by being myself.

It's taken me the better part of the past five years to realize that the medical world isn't as extroverted as I'd initially thought. Introverts can be found across the spectrum -- surgery, emergency, you name it. And I've met plenty of extroverted pathology and radiology residents on my rotations through those specialties, so let's just throw that stereotype out the window too. Basically, if you are an introverted medical student don't let yourself be pigeon-holed because of it.

There's no need to change your personality to succeed in medicine. Sure, portraying confidence when you're not feeling it is one thing, but there is no advantage to forcing yourself to act extroverted. I've realized that some degree of introversion can be an asset in medicine. When I think back to physicians I've worked with, the modest, unassuming ones who took time to hear their patients out often made more meaningful connections and more insightful observations than their louder, brasher colleagues -- who were also more liable to get themselves into trouble.

I think my biggest (ongoing) hurdle has been developing confidence in my abilities. I know I underestimate myself, which only begets anxiety and lost opportunities. My advice for introverted medical students is to not let yourself be intimidated by extroverted colleagues -- there are a lot of big personalities in medicine who risk their confidence surpassing their ability. You just have to trust that you will develop a quiet confidence and learn not to doubt your own abilities!

And for more inspiration than this rambly rant, you may want to watch Susan Cain's TED talk :)