Letters to A Young Resident, II: Stop Apologizing

Okay, before you immediately start to object: this isn’t meant to be blanket statement.

There are times when you should absolutely apologize in medicine, medical mistakes being the number one reason to apologize, and well.

But for the majority of residents who are not psychopaths, and certainly among majority of first year and female residents, the problem is, in fact, over-apologizing.

Stop.

 

 

As a Canadian, and as an only daughter in an Asian household, I understand your pain. Politeness to the point of discomfort is practically the mortar of my being. I grew up differential and soft-spoken. I lived within the rules set by school, by parents, and by society. When coloring, I drew crisply within the lines. And it worked well for a while: the quiet, nice girl who puts her head down and does her work well may not be well known, but she is certainly well loved (if and when she is recognized).

 

 

I would argue that medicine is no place for this sensibility.

Intern year was hard for me, as it is with many. I was thrown into many situations I was unprepared for, worked long and exhausting hours day and night, ran headlong into that great, yawning chasm that separated my studious book learning from the practical, volatile aspects of real-life medicine. The team of residents was unhelpful, helmed by poor leaders who were alternately lazy, volatile, and occasionally downright malignant. Faced with consummate exhaustion, overwhelming tasks in numbers and difficulty, and furious and unhelpful criticism, apologetic became my baseline state.

 

 

If someone yelled, regardless of the source of fault, I said sorry.

If someone questioned any of my decision, right or wrong, I said sorry.

If someone asked why I didn’t eat earlier that day instead of waiting until now, I said sorry.

If I was reamed for one typo on a long signout list, I said sorry.

When I asked anyone a question because I didn’t understand, I said sorry.

When I begged for any help from anyone else – attending, chief, resident, nurse, even the operator – I said sorry.

Before I asked to go to the bathroom, I said sorry.

 

Sorry indeed – my life that is. It resided somewhere between subservient and groveling, even when I had done absolutely nothing wrong.

 

It got so profuse that even as I progressed along in intern year and became quite efficient and good, every other sentence seemed to end or start in apology. And one day, during an operative hysteroscopy with a lovely and patient attending, while I was correctly answering medical education questions in apology form (as though it were required, like the Jeopardy-question format), he had to stop teaching to say to me, with firm kindness, “You have to stop apologizing.”

To which I immediately responded, “Sorry!”

 

 

We had a good laugh, but that was also a serious turning point for me.

 

Why should I apologize for answering questions correctly?

Why should I apologize for asking questions when I don’t know or understand a concept?

Why should I apologize when I genuinely need help?

Why should I apologize for delays or mistakes by others that I am trying to fix?

Why should I apologize for basic bodily functions?

 

To be sorry by definition means “feeling sorrow, regret, or penitence”. And yet, we do not take hold of its meaning. Instead, we use it as a way to beg favor, to soften requests, to minimize our needs. We spread its shame on us when nothing is our fault. That is both great egotism and unnecessary abasement: to think we could be the cause of all faults, and to feel our needs are not important enough to be met without prostrate request.

Women, in particular, are prone to doing this. A recent skit by Amy Schumer characterizes it well:

 

Here are intelligent, prestigious women who have risen to the top of their typically male-dominated fields. And yet, out of fear of inconveniencing others and respect for the feeling and comfort of others, they apologize for their own requests or accomplishments or their very existence. They view others as more valuable than themselves. Sure, this is an extreme, hyperbolic example meant for laughs. But that little niggling, nugget of truth is there. For how can we expect the respect of others when we have so little for ourselves – our intellect, our needs, our abilities, and our rights?

 

Too often, apology becomes rote, a suffix to every sentence when we feel inferior or insecure or unsure. When we apologize, it should be for something. It should mean something. It shouldn’t be a mere vocal tic. And we should not, as the Chinese saying my dad is fond of goes, “grab someone else’s s&*^ and spread it on ourselves.”

 

 

We should never apologize for:

– having feelings (of anxiety, fear, insecurity, loneliness, or other negatively regarded emotions)

– having opinions, if expressed respectfully, whether they differ from those around us or not

– asking for help, when we have tried our best on our own

– reasonable requests, whether it’s taking meat off of a meal that was ordered as vegetarian, or asking that someone move their legs so that you may sit.

manspreading, it’s a real epidemic source

– speaking up when there is a wrong, a mistake, or a need

– emotional needs in a relationship, whether expressing them or asking them to be met.

– loving others with great passion

– having great passions, no matter how mundane to the world it may seem

– the things attributable to the behavior of any scientifically recognized living organism: bodily needs (food, water, sleep, light), natural bodily functions (periods, urination, bowel movements, need for activity),

 

In medicine in particular, apology is a luxury. The state of apology automatically starts from a less powerful ground, which may command less attention, less urgency, and less respect. It is automatically taken as a sign of insecurity, naivety, lack of wisdom. There are times we cannot, and should not, soften our sentences and stances with “sorry.”

When we see something wrong, we should not be so afraid to step on other people’s toes that don’t speak up forthrightly.

We should not be so afraid to go against the grain that we do not suggest a better way of doing things.

We should not be so scared to infringe on the ill-defined borders of politeness that we do not take charge of situations, make wise decisions, and gravely give a life-saving order, without apology.

Otherwise, apology will be truly and tragically necessary, indeed.

 

Perhaps we have learned to employ ‘sorry’s to soften our requests, make them more palatable.

Perhaps we now launch them as sharp, passive-aggressive missiles, a means to be assert and dismiss without superficial and societal impoliteness.

Or perhaps, like our opinions of our self-worth, ‘sorry’ has come to mean nothing at all.

Let’s stop.

 

As doctors in medicine, as women and men in the world, as human beings in life: let’s save our ‘sorry’s for when we are truly sorry. Let our apologies be worth something.

Otherwise, let us respect our rights, our opinions, and ourselves, so that others may follow suit.

 

cheers/c

 

 

 

Please follow and like us:

Leave a Reply

Your email address will not be published. Required fields are marked *