Isolation in Medicine: Embracing Your Individuality

By: Kelly M. Pennington

August 16, 2021

I still remember my first day of medical school. My classmates appeared so polished and were so articulate when they spoke. I felt different from them, and this intimidated me. As a first-generation college student from a rural community, I worried that my admittance to medical school was a mistake, and any day, it was going to be rescinded. I had a thick Appalachian accent that I knew was going to be my “Scarlet Letter.” I was quiet throughout medical school as I learned to minimize my accent and broaden my vocabulary. Many of my preceptors and professors would comment on my quietness in evaluations. One I particularly remember said: “Too shy for the dynamic nature of medicine.”

As my postgraduate medical training ends, I reflect on the efforts I made to blend in as a physician. I dropped “y’all,” clearly enunciated, and used a vocabulary that no one in my home community would ever understand. I tried to hide that my background was from a less-educated, blue collar family. By doing this, I failed to be a complete representative for my community—for both patients and aspiring medical students.

For some patients, having a doctor that reflects some of their similarities, values, and culture can make a difference. It has been previously shown that patients have increased satisfaction and trust when being evaluated or treated by physicians from similar ethnic or racial background,^1,2 or by gender concordant physicians.¹ Studies have likewise shown that increased satisfaction and trust between physicians and patients leads to improved outcomes, increased adherence, and higher rates of preventative care.³ By making efforts to homogenize physicians (either self-inflicted or imposed by formalized training), we devalue the needs and trust of our diverse patient population.

Not only does representation matter for patients, it challenges the stereotype of the “traditional physician,” thereby promoting aspiring medical students and health care professionals from diverse backgrounds. While efforts are being made to diversify medical school classrooms, medical school matriculants still do not reflect the diversity of the United States’ population,⁴ and anecdotes of institutional and individual discrimination against medical students and trainees are shared on social media too often. By trying to blend in and accepting unvalidated feedback, such as “too shy for the dynamic nature of medicine,” I contributed to maintaining a homogenous, nonrepresentative medical community.

Being a physician is more than a collection of knowledge and experience acquired in medical school and postgraduate training. We are individuals with diverse backgrounds and experiences. I invite you to embrace your individuality: Speak with an accent, wear clothes that signify you, use language that represents your community, use pronouns that identify you. Equally as important, only give and accept feedback that will truly enhance patient care; stop giving and accepting feedback that tries to fit us all into a traditional physician stereotype. By celebrating our own diversity and individuality, we will tear down the barriers between us and the communities we serve.

(For tips about effective patient communication, visit my blog from last year: https://www.chestnet.org/News/Blogs/CHEST-Thought-Leaders/2020/06/Patient-Communication-Tips-for-a-Successful-and-Open-Dialogue.)

References

1. Takeshita J, Wang S, Loren AW, et al. Association of racial/ethnic and gender concordance between patients and physicians with patient experience ratings. JAMA Netw Open. 2020;3(11):e2024583. doi:10.1001/jamanetworkopen.2020.24583
2. Alsan M, Garrick O, Graziani G. Does diversity matter for health? Experimental evidence from oakland. SIEPR. 2019. https://siepr.stanford.edu/sites/default/files/publications/18-030.pdf 
3. Birkhäuer J, Gaab J, Kossowsky J, et al. Trust in the health care professional and health outcome: a meta-analysis. PLoS One. 2017;12(2):e0170988. doi:10.1371/journal.pone.0170988
4. Lett LA, Murdock HM, Orji WU, et al. Trends in racial/ethnic representation among US medical students. JAMA Netw Open. 2019;2(9):e1910490. doi:10.1001/jamanetworkopen.2019.10490

Kelly M. Pennington

Dr. Pennington is a lung transplant fellow at the University of Toronto in Toronto, Ontario. She completed her pulmonary and critical care medicine training at Mayo Clinic in Rochester, Minnesota. She is a native of southern West Virginia and a proud Ramp connoisseur. Her research interests are in pulmonary infections in immunocompromised hosts.