Dr Yvette Low is an ICU Fellow and was recently awarded the Don Harrison medal for the CICM Fellowship Exam.
I volunteered to write a blog piece on being heard, but I think what I’ve done is write a piece on speaking up. To be heard is to have a voice in the first place, and finding my voice has been one of my challenges in life and in medicine.
I have always been an introvert. Quiet, shy and sensitive, I have also long had a fear of speaking up for fear of being wrong or being judged negatively by my peers.
In medical school, I felt like I was constantly surrounded by smart, confident people. I enjoyed what I was learning, but my fear of being wrong often stopped me from participating. My feedback was often that I was too quiet and needed to contribute more. This paradoxically made me more self-conscious and more tentative.
In my early clinical years, I started to feel like I was finding my feet. I enjoyed my job and was fortunate enough to work in a hospital with a great culture. With the added responsibility that came with being a registrar, however, were renewed anxieties about speaking up for fear of being found out, for being an ‘imposter’. My inner critic was flourishing. I found ways to cope, including adopting the ‘fake it til you make it’ mantra, but it was emotionally and physically draining.
Additionally, I was beginning to feel like my gender was making things worse. I was a quiet, short, Asian female. The common things happened – being misidentified as a student or nurse, ignored in preference of my male colleagues, slowly edged out of the circle when discussing a patient… in isolation I could shrug them off, but over many years they insidiously fed my fear of not being ‘worthy’ of speaking up.
I became frustrated that who I was, was making work challenging. It felt like there were parts of my nature and personality that I couldn’t change. I certainly couldn’t change my height or sex. I sought advice from others. Be more assertive, speak with more command and volume, have a greater physical presence, don’t wear scrubs, wear makeup, be more masculine… then people will notice and listen to you. Well, it is exhausting being someone that you’re not.
Thankfully, there have been two pivotal moments that have been real game changers for me.
Firstly, I made an appointment with a psychologist. Exam-related performance anxiety is what led me to her, but the ground we’ve covered, issues we’ve unmasked and lessons I’ve learned have gone way beyond that. One of the key lessons has been the importance of a small shift in focus and the huge impact this can have.
Let me explain.
Refocusing my thoughts from the fear of being wrong and judged, to the desire to always do the best for my patients, has given me the courage to speak up. Whether the best for the patients is offering an opinion or advice, confidently introducing myself and my role, leading a resus, or gaining knowledge as I prepare for an exam, using this as my motivator has helped me to find my voice and direct my attention away from my inner critic.
Secondly, a fellow introvert lent me the book “Quiet” by Susan Cain. If you are an introvert (or if you’ve ever sought to understand one), I cannot recommend this book enough. Cain explores introversion through interviews and research, and the challenges and strengths that it entails. Reading this book, I felt like I was having a lightbulb moment every couple of pages. I started to see that what I perceived as my own negative personality traits could be viewed in a different light, and in fact could be used to my advantage in the workplace. I learned a lot about myself, why I think and act the way I do, and realised that I didn’t necessarily have to change who I was to be effective and thrive at work.
I still find speaking up is often a struggle, and there are still many frustrations that come from being a quiet, female doctor. But a psychologist and quiet moments reading a great book have given me so many more tools to work with. I am finding my voice, and I am noticing that I am being heard more often when I speak. But perhaps best of all, I’m starting to believe that I have the right to be heard just the way I am.