Finishing my intern year at a program about which I've had nothing but good things to say. However, there is one aspect of this year that is frustrating and seems to be irreconcilable.

I will admit right up front that I have a "strong personality." I'm direct and very forward with opinions at time. I am enthusiastic. I am not afraid to ask questions, of anyone. While these appear to be good qualities (and are generally commended in male physicians), my type A personality has been of great detriment.

The year started off with a complaint from a nurse that I asked them what I should do for management of an issue. I did this because I was advised to ask the nurses for suggestions so they don't hate me. Yet it was a mark against me. Subsequently I stopped asking the questions and tried to demonstrate confidence. I've maintained nothing but a professional rapport with them but this seems to have backfired and now I am perceived as the devil-resident. I am direct. I am methodical. And I am a take charge person. I am also tall, thin and wear makeup. The combination of these factors has put an X mark on my back.

This has translated to what seems to be a conspiracy against me. On most ward months, something trivial comes up with a nurse and my program director is informed. When I say "trivial" it is below trivial. For example, I knocked on a patients door and was told to come in. The patient (female) was seated on the edge of her bed with a towel around her body and a shower cap on. Fully covered. They had said to come in so I started asking questions. The patient asked me to leave because she was "bathing" and I apologized and left. Subsequently, the nurse told the nurse manager that this had happened and the nurse manager told her to tell me. I apologized to the patient and she was understanding and everything was forgotten. However, the nurse manager told the chief resident who told the attending physician who told the program director (yes, this DID happen) and I was called in for "unprofessional" conduct. In all reality, I simply knocked and entered a room for <30 seconds after I'd been told "come in." The escalation was outstanding.

I was told to be "sweet" because nurses don't like type A women physicians and expect female physicians to be maternal, sweet and subdued. These are not characteristics used to describe me so I've adopted phoniness in my interactions. Previous interactions were polite and professional but not "sweet."

Yet it continues. I work hard to not irritate them but I make a small mistake (that other residents make multiple times) and I am told on and lectured and advised to work on "people skills."

I am so exasperated. I'm nauseated by the "sweetness" that I have to embody but do it for the attendings because they are my bosses and I respect their advice. Clearly my first impression was not a good one on the nursing staff and in turn, this has led to the perception among the attending staff that I am difficult to work with. How can I change this? I'm under microscopic examination so each mistake is blown up. I am not infallible. What do I do? Has anyone had anything that slightly resembles this situation?

For years I pooh-poohed information and activities designed to build communication / team-building skills, thinking they were silly and superfluous. But, I've come to feel that working in a team in the "real world" is much more difficult than I imagined it would be based on high school social studies projects - and situations that are high stress, with lots of people feeling responsible for high-stakes issues but with different levels of control and authority (ie, inpatient medicine)... it's a set up for difficulties.

I really sympathize with it feeling like it's hard to follow their recommendation for being "sweet" when you feel like it's not a natural way of interacting and comes off not feeling authentic. I wonder if there are ways you can try to build more authentic relationships with people that will feel less phony to you? For example - and this may sound really stupid, but bear with me - if you experiment with trying out little mental scripts early on in your interactions with new people, such as "in working with this new team, I'm going to really work today to periodically stop and think (1) what does this situation (not necessarily a bad situation or a complex interaction, just the everyday activity that happens to be going on at this particular moment) look like to nurse/student/attending X? and (2) what is there about this person that I like/appreciate/can relate to (be it their efficiency, their warm smile, the way they really care about patients, or even that you like their style sense or the fact that you admire their dedication to making it home to see their kids before bed or help an aging parent)?" Don't feel like you have to take any particular action based on those thoughts - I don't mean to immediately then say "Dr. Peterson, I sure like your socks!" - but for me just making sure I've thought about some of those things periodically will automatically change my interactions a little bit. I think medicine makes it really, really easy and natural to become so focused on your needs and your patients' needs that it's hard to remember much about the people you're working with - and so even though the exercise can feel sort of artificial, it can help to take these intermittent pauses to remind yourself of things that usually come up naturally in a more constant, calm working environment... and, as a result, your interactions can become more positive and more authentic feeling (despite the silliness of the exercise).

One more thought: I sometimes feel like there's this choice we're forced to make between acting self-confident and acting respectful of others. But, I have worked with people before who seem to opt out of the choice by combining very clear self-confidence with a constant, unflagging pattern of assuming that not only are they themselves well-informed and competent, but that presumably the person they're talking with is, as well. And I've seen it work *really well* for them in professional situations. I agree that it can be a harder balance for women in particular - but this is the tact I try my best to take (not that it's easy at the end of a long frustrating day when you just feel like it has to be SOMEONE's fault that everything is so HARD all the time!).

Anyways, I'm sorry it's been feeling so difficult - I'll be interested to see what ideas others have!

To me - off the cuff thought - it sounds like the whole "Confident women are &^%es, rhymes with itches" and yet - "Confident men are always leaders, self-assured, competent."

Wasn't there a Grey's Anatomy episode on this?

Seriously, though, I think the world STILL isn't ready for a no-nonsense, confident, capable woman in a power position. I'm looking forward to the responses you get, because I need to take notes also.

HAM - my personality sounds very similar to yours in working environments. Many people say I'm a very intense A personality, so I imagine I'll probably have some of the same questions you are having when I'm an intern.

My evil secret- try to remember something personal on them and then ask them how it's going... makes them think you care about their kid/mother etc and sweetens the pot more than any "niceness" apologies etc. Obviously I write this with an edge of sarcasm, but don't have it when you "deliver" the line...
Lullls them into thinking your a chatty, huggy simp, then you can run around and get your work done in peace! (Sounds very Christiniaish from grey's doesn't?!)

Laughing because yet another person referenced Grey's, yet at the same time - we all know how completely unrealistic this show is compared to real life! Yet we compare it to our real life personalities, which somehow is actually realistic - minus all that "medicine stuff"!

The irony!

Interesting- I have a quiet, subdued personality, and it comes across as lack of confidence to those who don't know me. However, I actually understand what you're going through. People do form an opinion of you within minutes of knowing you, and it is difficult to shake, especially when you work in a field in which many outspoken and opinionated people work. I find it particularly difficult to gain approval from physicians, and highly extrovert nurses who have limited experience with me. I find that being outspoken exudes confidence, and is an admirable quality among physicians. So, although the nurses may not like you, the attendings probably do, even if they don't show it yet (as long as you are respectful.) Anyway, those who work with you frequently enough should see what you're about.

Life as an intern is difficult enough, and worse if your personality is on either end of the spectrum. You do need to find a balance between demonstrating confidence without coming across as haughty or too meek. Remember that some nurses have been in that field for 20yrs, so you can imagine they do not like taking orders from someone who has been a doctor for 5 mins, especially if they perceive you as over or underconfident.

Getting on the nurses' good side may require you to do things like eat lunch with them once in a while, (if you have the time,) bring in a treat, or volunteer to bring a dish when they are having a potluck. I find that nurses are more "human" than attendings for the most part, and they want to be valued and respected. Residents, and anyone else quite frankly, deserve to be valued and respected also; unfortunaley, we are at the bottom of the food chain, since we are usually the newest members of the healthcare team. Nevertheless, you'll find that as you progress through your residency, the nurses will gain respect for you as your experience and knowledge grows, and they will appreciate your self-assuredness. You just have to make it htrough the hazing process.

Nurses can be your worst nightmare if you get on their bad side, (which isn't hard to do for an intern,) but if they like you, they can be a joy to work with, and they will look out for you. Also, don't forget there are some people who are just happy being miserable, and enjoy making others around them miserable too. Good luck!

I'm like this too but I actually get along great with hospital staff. I am not 'sweet.' Our nurses and social workers love me because I respect their expertise and value their opinions.

Warning: my post is not going to be very tactful but I don't do tactful on the internet - I save my tact for when I need it, in real life.

Here's what I think: Your 'trivial' anecdote about the patient in the towel actually suggests to me that you are not very attuned to others' feelings.

OK she told you to come in and you did - which is fine - but the fact that she was sitting there in a towel ought to have given you a moment's pause, and prompted you to ask whether it was OK to interview her *before* you started asking questions. That's just normal courtesy IMHO, and I know it gets really lost when you're on your 30th straight hour without sleep but the fact that you don't recognize it was rude *even in retrospect* is a big red flag to me.

Instead of faking an unnatural 'sweetness,' I would try to put real effort into imagining how the people around you actually feel, and working up some respect for them as professionals and as human beings. You can continue to be direct, opinionated, and enthusiastic, but if you really respect and care about others' feelings it will show. And if you don't, that will show also.

"put real effort into imagining how the people around you actually feel, and working up some respect for them as professionals and as human being"

Perhaps you are new to the forum. This is usually a supportive group lacking the judgmental, impulsive "I can say this because no one knows who I am" sort of venue. While your platitudes are useful in "professionalism" lectures in medical school, they are not really applicable to the situation.

I don't mince words. TR you are WAY off base.

You will be hard pressed to find another physician with the degree of empathy and understanding that I have for my patients. If you re-read my post, the triviality of it was the tattling, not the patient interaction. When I learned that she was offended, I returned, sat down with her and apologized for making her feel uncomfortable. She forgave me immediately following our discussion.

To me, your "warning" seems more of a cover for cowardice than anything.

So Update!

I took some of your advice during my month of night float (on the River Styx) and honestly I think it worked out really well.

I got to know the nurses a bit and learned little bit about each of them to chat with them about it. I know, for the most part, which ones have kids, the approximate ages and genders and also hopes/aspirations etc. of some of them.

I'm a free food getter with no cash so I couldn't ever participate in the food things they had but I did invite most of one unit to some shopping sites that I found. I did make cookies but they were not very good so I don't know if it was much help :-)

Finally, I learned a common complaint/issue that is getting them riled up and learned the consensus opinion. Then I made jokes supporting this opinion.

All of this aside, part of the improvement may stem from the fact that I was alone and in scrubs most of the time. Less threatening I guess.

New update.

Getting to know the nurses helped and now I'm no longer a threat. They have started laughing at my jokes (thank goodness, because for a while there, I was starting to think that maybe I'm not funny).

I am now thinking maybe last year was breaking through the territorial attitude and now that I'm in, I'm in. In fact, I was asked by one of the nursing leaders to provide an hour lecture to all of the hospital nurses about diabetes and diabetes care (ME! not an actual endocrinologist or an attending, but ME! very flattered actually because lets face it, though not an intern, I'm just above an intern who is essentially scum (not literally, just to everyone at the hospital. This may be the start of my ego restructuring. Uh oh. . .)