To the Bedside Manner Born

A friend mentioned to me recently that she's thought about going to medical school, but believes she wouldn't have the necessary bedside manner. I think she was referring to the fact that she's a little shy — she's certainly not rude, though she is wicked funny — and I realized that the things that are predictive of a good bedside manner aren't exactly intuitive.

For instance, a good schmoozer is not necessarily good with patients. I myself have never been able to schmooze properly. Part of this is the way I was raised; my mother never taught us many of the standard social niceties, like introducing oneself, saying hello and goodbye, shaking hands. (Truly, we didn't say hello or goodbye in my family. People are often startled by the way my mother will just get up and walk away.) I can shoot the shit with people I already know, but when I first meet someone, I have to keep reminding myself, Now you say hello and smile. Ask how they're doing. Maintain eye contact. I said maintain eye contact! It can be exhausting. (I find that meeting fellow bloggers is less of a strain, I think because I feel like I already know them.) But give me a patient to talk to, and I'm better than Oprah. Because a good doctor doesn't talk; a good doctor listens while the patient talks. I am the Queen of the Pregnant Pause. It's a rare person who can stand a silence longer than I can. On a blind date, this is death, but in an exam room, it's pure gold. And by the time it's my turn to talk and try to explain something or sell the patient on my plan, the ice is long since broken.

This may come as a shock, but in general, the people who are attracted to medicine as a profession are not the social superstars. Doctors tend toward shy and quiet; they're the sort of people who are more interested in observing others than being the center of attention. And I have often noticed that the way doctors behave socially is rarely the way they behave in front of patients. Which is a good thing, because I've met some real wackos. I am a real wacko. But I can say: "What brings you here today?" and then shut my trap. (And no, nobody ever answers "the bus.")

Of course, there are some schmoozy types who go into medicine. We call them "surgeons." I'm kidding, but only a little. We attendings amuse ourselves when meeting new medical students by trying to predict each student's future career path. Schmoozy, hail-fellow-well-met men: Surgery. Assertive women: OB/Gyn. Geeky shy cerebral types: Internal Medicine. Sweet happy types: Pediatrics. Crunchy happy types: Family Medicine. Intense oddballs: Psychiatry.

I have a meeting with each student halfway through the clerkship so that I can get their impressions of how it's going and give them feedback on what the residents and attending are too chicken to tell them to their faces. (I keep a box of tissues handy.) There are really only about three scripts that I have to remember, because there are themes that recur. One of the most common is the Shy Student. The problem with the Shy Student is almost never bedside manner; it's the interaction with the other members of the team. If you don't speak up, people think you don't know anything, but what's worse is, your good ideas about and knowledge of your patients go to waste. I myself got the Shy Student talk my first month on clinical rotations as a med student. The attending said, "I'm giving you a High Pass for this month instead of Honors, because you haven't spoken up enough." I have to say, I was furious. I thought it was ridiculously unfair. I mean, it was OBVIOUS that I knew more than the other medical students! Wasn't it? Er, maybe it wasn't. So I started being Mouthy Student, or as mouthy as I could be. And it worked: I never got anything but Honors ever again. What I tell students to do is: pretend you're someone else, someone you think is a bit of a loudmouth grade-grubber. No matter how hard you try, you won't really become one, but you'll definitely crawl out of your shell a little ways, and it's not as painful as you think.

So if all that's preventing you from applying to medical school is your quasi-Asperger's personality, I say go for it.