Last Updated on June 27, 2022 by Laura Turner
“Knowing yourself is the beginning of all wisdom.”
Even at the time, I realized it was an exquisitely simple task: I had to walk into the exam room, introduce myself as a medical student, and ask the patient what brought her in today. I didn’t need to take notes, didn’t need to come up with any follow-up questions, didn’t need to make any clinical decisions. It was the first week of our course on doctoring during my first year of medical school and they were easing us into the patient interview by having us elicit the chief complaint. Yet the prospect of actually talking to a patient terrified me. If you think I am exaggerating and being hyperbolic exclusively for literary effect, I am guessing you are an extrovert. You can ask my mother. I considered dropping out of medical school over my anxiety about talking to patients. I loved the science and physiology behind the illnesses, just not the patients they inhabited. I remained fairly terrified throughout my first two years of medical school, “generously” allowing my fellow medical students to practice on patients while I hung back. I was actually fairly certain I would end up in anesthesia or radiology just so I wouldn’t have to interact with patients (I intensely dislike looking at slides – even more than talking to patients, as patients don’t give me migraines – so pathology was out). But it’s more than just interviewing patients that we introverts can find taxing. Medical school seems stacked in favor of the extrovert, what with group activities, rapid fire questions, and all that talking. However, you too can do well in medical school as an introvert. And you don’t even have to become an extrovert to do it.
• Practice, practice, practice: Extroverts appear great at just winging it. When I took this approach the first few days of my medicine clerkship, I turned quickly into a blubbering idiot once in front of a critical attending and resident. I knew something had to change. What ended up making the difference? Preparation and practice! First, take time to memorize the first line of your presentation – your one-liner about the patient. If you need to, practice it in front of a mirror. This may seem silly, but it will help to give you a confident start to your presentation, and sometimes the appearance of confidence (and competence) is half the battle. Next, try to write out your SOAP note each morning before rounds. I found it was worth it to get there a little bit earlier if that meant I had time to write out exactly what I wanted to be reporting on rounds. Ideally, I would have it mostly memorized and only refer briefly to the note for reference if asked more questions, but having it there in front of me in black and white helped greatly with my ability to confidently report what I needed to. If you are given the chance to prepare, take it! While pimping can throw you off your guard, if your attending requests that you look something up and report back, take this as your opportunity to shine. I was able to do well when my attending would ask me to investigate something and teach the team about it later. Again, I took the prep and practice approach, often creating a short outline of the key points I wanted to cover that I could pass out to the rest of the team.
• Give up a bit of the perfectionism: While I’m not sure perfectionism is officially part of being an introvert, we do certainly overthink things before we speak. I tend to be in favor the philosophy Better to remain silent and be thought a fool than to speak and to remove all doubt. However, remaining silent can prove problematic when there are multiple medical students and pimping is involved. If you’re an extrovert, it comes naturally to speak up on rounds. Sure, you get a few questions wrong, but on a whole you are seen as active and engaged. We introverts are inclined to hold back, answering only when we’re 110% sure we know the answer. This can give the impression of being uninvolved. Let yourself speak up even if you are hesitant about your answer. It can help to set yourself an objective goal – like “I’ll answer x questions during rounds.” If you’re wrong, you are probably the only one who will actually remember the incidence. I painstakingly remember so many wrong answers from med school. However, as a resident now, I mostly notice when a med student gets a question correct and am impressed; if he or she offers a wrong answer, I tend to hardly notice and see it as a teaching opportunity (and pat myself on the back for having learned something since medical school).
• Use your keen observations to integrate into the team: Yes, I know interacting with people all day can be exhausting, particularly when you are trying to figure out how you fit in. Take advantage of your abilities as a quiet people-watcher to observe how the team dynamics work and fit into them. As a resident, I have had the occasional extroverted medical student who ends up trompling over team hierarchy and rubbing those higher up on the totem pole the wrong way. If you take time to see how you can fit in, you will avoid being a bull in a china shop. You can also learn a lot by observing!
• Turn small talk into big listening: In my everyday life, I tend to avoid small talk with strangers. Heck, I even sometimes avoid small talk with people I know. Lumping patients into the “strangers” category, I used to dread trying to make conversation with them as well, medical or not. Really, though, patients need you to talk less and listen more and that is what introverts excel at. Ask a question and then let them talk. What if it’s not the perfect question? It doesn’t need to be. Just be pleasant and curious. Then listen. Talking can help to relieve your patient’s anxiety and boredom, but it also enables you to know the patient better and make you a better advocate for his or her needs. One of my more introverted medical students who tended to be very quiet on rounds went back in the afternoon, having an extensive conversation with her patient. When she had to be gone during rounds the next day, the patient asked about her and the attending noticed. Those little things can make a difference, for both the patients and your grade. Sometimes it can be hard to think of anything to say. You can talk about their kids, shows on TV, the weather, questions about the plan for their care and, if you are truly at a loss, simply ask if you can get them anything. You’d be surprised how much patients appreciate a glass of water and graham crackers you snatch from the pantry. It builds rapport and it gives you an excuse to leave the room. . .
• Recharge: Extroverts love to party, their energy bolstered by interactions with lots of people. If this does not sound fun to you, let yourself off the hook. On your one night off, don’t feel like you have to please everyone else and go out. Invite a friend over for Netflix and popcorn. Or take a walk. Or read a book that doesn’t involve electrolytes and EKGs. Days on the wards are taxing for anyone, but when you’re particularly drained by personal interactions, it adds an extra layer of exhaustion. Recognize this and give yourself a chance to recharge when you can.
Medical school poses unique challenges to introverts, as we must spend our days interacting closely with complete strangers and competing in an environment that often favors the assertiveness of the extrovert. For me, through continued exposure and positive interactions in third year, I overcame much of my terror surrounding interviewing patients, making a 180 on my specialty choice and picking psychiatry of all things. With preparation, morning rounds improved and I eventually mustered the courage to respond more freely to questions. While I did just fine in terms of grades, I never really became comfortable as a medical student. As a resident, though, a certain level of confidence comes with being able to introduce myself as a doctor. Still very much an introvert, I have found it to be a strength rather than a weakness. Just don’t expect to find me at the bar on Friday night. My dog and I are headed for the trails.
Megan Riddle, MS MD Ph.D., is board certified in both adult psychiatry and consult liaison psychiatry. She attended Western Washington University and received a Bachelor of Arts in Spanish with minors in Latin and English before deciding she wanted to pursue a career in medicine and research. She received a Master’s in Biology at Western Washington University with an emphasis in genetics and then went to Weill Cornell Medical College where she earned a medical degree as well as a PhD in neuroscience. She completed her residency training in psychiatry at the University of Washington, where she was chief resident, before completing a fellowship in consult liaison psychiatry, also at the University of Washington. She is currently a Courtesy Clinical Instructor with the University of Washington Department of Psychiatry and Behavioral Sciences and enjoys teaching and supervising residents.