Residency Diaries Series #4: thoughts on confidence
I was recently given the feedback that I was doing a great job as a senior resident BUT that I should work on being more confident. This particular feedback is one I’m familiar with. I do tend to be on the quieter side. I'm rarely yelling over others to be heard (though this is a thing I have had to do as a 3rd year leading codes and traumas). When someone asks a question, I’m almost never the one raising my hand to answer it first, much less yelling it out for everyone to hear. I’ve always resented this feedback because I feel that there seems to be more emphasis on “appearing confident” than actually being confident. Maybe it’s because “appearing confident” is something one can work on short-term but actual confidence can take years.
I do think confidence is an important quality as a doctor. Patients probably do feel better when their physicians come across certain— full of knowledge and experience. But it took me a few years actually practicing medicine to realize that a lot of times, we don’t know what we’re talking about— not even the seasoned attendings— no matter how confident we sound. In medicine, there are still so many unknowns. We may be able to quote studies or statistics to help answer questions but at the end of the day, there are so many things that are mysterious and random… and even in the realm of objective science, some things simply don’t make sense.
After receiving the feedback, I came home and started writing about how it made me feel. Then I realized that I have a very similar post from intern year:
1/16/2019 Wednesday 3:00am
I really dislike it when people mistake my quietness for lack of confidence. This is often the case in medical school, too-- where more outspoken students are mistaken as “confident” or “more competent” and the quiet ones the opposite. As an intern, being told that I need to be “louder” or “more confident” feels wrong to me. Let’s be real: I barely know anything about medicine. If anything, this residency has thus far shown me a glimpse of exactly how much I don’t know, rather than how much I actually know. I “know” things from the pure repetition of common complaints in the ED. When it comes to actually talking about it with consultants, attendings, or even other residents, I realize just how big my gaps in knowledge are. This isn’t to say that I am insecure about it (though sometimes I am) or feel bad about it (though sometimes I do). I think it’s a perfectly normal and expectedly uncomfortable place for me to be in right now as someone who literally JUST started practicing medicine. Where is the value in misplaced confidence? So my patients can falsely feel better? So I can tell the wrong answer loudly atop of my lungs? I would much rather be honest and tell my patients when I don’t know the answer to some of their questions. I am okay with the uncomfortable and somehow everyone seems to want me to just a) be ignorant or b) be oblivious to it.
What is real confidence? I think true confidence is:
knowing when you don’t know something and being able to admit it without letting it get to you
knowing the difference between irresponsible lack of knowledge vs. just a simple lack of knowledge because you can’t possibly know everything
being able to own up to your mistakes
but at the same time not beating yourself up over a bad outcome that was out of your control
and maybe one more thing is… being able to accept criticism and feedback with grace even when you disagree.