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Wednesday, February 20, 2019

Introversion and Hospice & Palliative Care: Insights from ‘Quiet’ by Susan Cain

by Ben Skoch (@skochb)

I made some interesting observations during my first ever trip to the AAHPM National Assembly in Boston, almost a year ago. It seemed to me that I was not the only one favoring my phone screen over introducing myself to hundreds of new people. My new Twitter follower to friends IRL ratio (‘In Real Life,’ for those wondering) was about 25:1. I noticed people often trying to find seats in a lecture hall at least a few spaces away from others, to a point where some rooms looked like those old science problems involving the diffusion of a gas.

I wondered to myself how many people here are introverts like me? Some months after that conference, I decided to poll the #HPM Twitter family to see if I could get a sense of how many identify as introverts. While 72 responses may not seem like an overwhelming sample size, I couldn’t help but feel at least partially validated with three-quarters identifying as introverts. Does the field of Hospice and Palliative Medicine naturally attract introverted people?

It wasn’t until I read “Quiet: The Power of Introverts in a World That Can’t Stop Talking” by Susan Cain, that I discovered some potential explanations. At one point in the text she describes her interviews with Harvard Business School students who learn best in “learning teams” and describe socializing as “an extreme sport (47),” situations that would make any reserved person naturally uncomfortable. I recognized some of her sentiments seemed to overlap significantly with my years of medical training, and I couldn’t help but think that she was describing so much of my life. I sure did not use my first trip to AAHPM’s Annual Assembly (in Boston no less, just minutes from the entertainment enthusiasts that Cain describes) as a chance to socialize as much as physically possible.

But what really piqued my interest was later in the book when some parallels between the natural tendencies of introverts and the work required in the world of Hospice and Palliative Medicine started to become more apparent. A few examples:

Introverts might be wired to handle the emotional ups and downs of Palliative Medicine more naturally. How often have those in Hospice and Palliative Medicine heard, “That must be so hard,” or “Isn’t that so sad all of the time?” Cain describes an interview with Janice Dorn, MD PhD (Psychiatry and Neuroscience) who counsels people involved in the trade market. Dorn says “introverts…are more successful at regulating their feelings…they protect themselves better from the downside (158).” She suggests that this may be in large part due to the way we are wired, as extroverts are more excitable and are more likely to “find themselves in an emotional state we might call ‘buzz.’” So perhaps introverts are better biologically equipped to handle sad and tough conversations.

It’s an introvert’s natural tendency to let others talk. I am confident that one of the most important things I do for my patients is to listen as they tell their stories. By providing “therapeutic silence” and “active listening,” I offer them a chance to explore their emotions. This is how I build trust so that we can work together to make personalized decisions. In her book, Cain presents the findings of psychologists John Brebner and Chris Cooper, “who have shown that extroverts think less and act faster…introverts are ‘geared to inspect’ and extroverts are ‘geared to respond (166).” Many physicians find it difficult to simply sit and listen, as evidenced by a study from 2018 that showed a median time of 11 seconds before physicians interrupted their patients.1 Perhaps this is a system flaw. As students, we are continually encouraged to be more extroverted; then during residency, we are trained to ask specific questions and document succinctly to be as efficient as possible. By the time one becomes an attending physician, we unconsciously adhere to this learned sequence. Or perhaps some of us are just wired to listen longer and let others talk, and we simply need to find a niche where this is useful.

Maybe the most compelling connection between Quiet and Hospice and Palliative Medicine is when Cain describes how introverts might get the most out of life. “The secret to life is to put yourself in the right lighting…Use your natural powers – of persistence, concentration, insight, and sensitivity – to do work you love and work that matters (264).” When people who work in Hospice and Palliative Medicine are asked to describe their work, common answers are rewarding, satisfying, gratifying, etc. I think this is likely because many in Palliative Care are introverted and they have simply found the “right lighting” for their natural abilities: an unflappable personality in the face of a wide range of emotions, listening intently to their patients, and using persistence, concentration, insight, and sensitivity to help patients and families struggling with some of life’s greatest challenges.

We all have special gifts that make us unique, and it is up to us to figure out how to use those gifts to help others and make the world a better place. As Cain details well in Quiet, it may be that extroverts have an advantage in utilizing their gifts in our modern society. Maybe our culture inhibits some introverts from recognizing their strengths and talents until later in life when they discover pastimes, relationships, and work that enhance these traits. Perhaps the world needs introverts to flourish like those examples Cain highlights: Dr Seuss, Rosa Parks, JK Rowling, and many others. Once introverts find their “right lighting,” they can build a life that is fulfilling and do work that matters. Maybe they will even wind up in a field like Hospice and Palliative Medicine where there is a connection between the strengths of introverts and the nature of this sacred work. I think if you are an introvert looking for work that is abundantly rewarding and can be a natural fit for your God-given abilities, perhaps Hospice and Palliative Medicine is worth your consideration. It might be the dream job that gets you excited to start each day, even if you have a hard time showing it.

Ben Skoch, DO, MBA, is a Hospice and Palliative Medicine physician at the University of Kansas Medical Center. Outside of Family and Palliative Medicine, he enjoys most sports, black coffee, and most especially spending time with his wife and two adorable children.

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1. “Quiet: The Power of Introverts in a World That Can’t Stop Talking” by Susan Cain

2. Ospina, NS et al. Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters. Journal of General Internal Medicine. January 2019; 34: 1: 36–40.

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