For the student who is afraid to speak up

Attending: “What is CREST syndrome?”

I know this, but something’s holding me back. My mouth won’t open. My eyes scan the room. Everyone looks at the attending yet nobody speaks. 5 seconds go by, 10 seconds. Someone shyly lifts their hand.

“Calcinosis. Raynauds. Esophageal dysmotility. Scleroderma. Telangiectasia.”

I knew that. I knew it before he even finished uttering the word CREST. But I couldn’t say it. And if I would have said it, it would have sounded shy, not confident. Why could I not be confident? I’ll try again next time.

The only reason people are afraid to speak up is the fear of being wrong.

....and an even bigger fear of everyone perceiving them as an idiot. 

This had been a problem for as long as I could remember. It started in middle school when answering a question correctly would give bullies ammunition. It was easier to shy away from proving my intelligence and let someone else get made fun of. It continued into high school and college when I was no longer the smartest in the class and there was an actual possibility I could be embarrass myself in front of an entire lecture hall. 

During first and second year of medical school it was obvious why I was afraid to speak up. We had tons of information drilled into our head every second of the day. “Oh yea I remember reading that but what was that exact pathway?” The few moments I was comfortable with the information I didn’t feel the need to be a gunner and shoot my hand to the sky before the lecturer finished asking the question.

Third year, we now had an audience. A team of medical students, interns, residents, attending, nurses, and most importantly, the patient. Speaking up risked a chance of being vulnerable in front of the entire team. Unless I was 100% positive something inside me was rarely ready to take that chance. 

The interesting thing now was I noticed the exact same behavior from all of the other students. I noticed the same uncomfortable shifting as soon as a question was asked. I noticed the same mumble that came out if there was an actual reply. This entire time I was afraid of being the weak link in the room. Unfortunately, it took me this long to realize everyone else felt the exact same way. 

My first rotation of fourth year was in the ICU, completely new territory. Before the beginning of the rotation I looked myself in the mirror and refused to continue this shy, ridiculous behavior. Next thing I knew, the attending asked about CREST syndrome and I fell into my old habits. I wanted to kick myself. In less than 365 days I was going to be a physician. There was no longer any time to be hesitant and insecure. Yes, there was a chance I could be wrong, but at the end of the day there was a patient who needed me and couldn’t afford any hesitation on my end. I promised myself this would be the last time.

....And it was.

This is motivation for every student who has ever felt nervous to speak up. Everyone else feels the same way, you are not alone. Own your knowledge. Own the fact that this is a process and you will be wrong sometimes. But you know what? You’ll learn so much more for being wrong than you will from being right.