Who Are You Trying to Please?

Nobody tells you the question exists. You discover it slowly, through the way rooms shift when you walk in, the way feedback changes depending on who's giving it, the way the same performance lands differently on different days.

Early in training, I thought the answer was obvious. Your consultants. Your seniors. The people who held the pen — who wrote the reports, signed off competencies, decided whether you progressed or stalled. I had watched enough ward rounds by then to understand that approval from those at the top was not incidental. It shaped everything.

So I adapted. I learned to read people. What they valued, what irritated them, which questions to ask and which to swallow. I adjusted how I presented cases — more confident here, more deferential there. I noticed the subtle differences in what each consultant called good surgical thinking, and I tried to produce whichever version seemed required.

This felt, at the time, like professional intelligence. Like learning to read the room.

What I didn't see was that the room kept changing.

There were peers to satisfy, too. Competition in surgical training is rarely declared openly, but it is constant. You feel it in how people respond when you get a good case, in the silences after an operating list that went well for you and less well for someone else. Unspoken hierarchies form early and move slowly. And so alongside the performance for your seniors, there runs a parallel one — the management of how you appear to those moving through the same system at roughly the same speed.

By some point in my registrar years I was performing simultaneously for several audiences, each with different criteria and different biases, and those criteria were never entirely aligned.

Some wanted confidence. Others found confidence presumptuous. Some rewarded initiative. Others called it overstepping. I would get direct, encouraging feedback from one consultant on a Tuesday and contradictory feedback from another on a Thursday, and in the middle there was me, trying to synthesise the noise into something coherent.

The exhaustion that comes from that kind of performance is not the exhaustion of working hard. It is the exhaustion of having no stable ground to stand on. You cannot be consistent when consistency means different things to different people. And so you adjust, and adjust again, and at some point you notice that you are no longer quite sure who you are in theatre when no one particular is watching.

The question that cuts through all of this, when it finally arrives, is not strategic. It is almost embarrassingly simple.

Who actually matters?

The answer, when you arrive at it honestly, is the patient.

It had always been the patient. That is what medicine told us from the beginning. And yet in the daily mechanics of training — the assessments, the ARCPs, the interviews, the quiet competitions — the patient had somehow become the background of a performance that was really about something else.

Once I understood that, other things became clearer.

Exams matter. Interviews matter. Colleague opinions have real weight — they open and close doors, they shape what opportunities come near you. I am not saying any of that is irrelevant. But they are the framework that surrounds the work, not the foundation of it. If you build your sense of professional integrity on what other people think of you in any given moment, you have built it on ground that shifts too easily.

The difficulty — and this is the part that nobody says out loud — is that those processes are not as objective as they appear. Structured marking schemes. Standardised questions. Defined competencies. On paper, the system looks fair. In practice, it is operated by human beings, and human beings carry bias whether they are aware of it or not. The data from broader society tells us this clearly enough. It would be naive to assume that surgical training exists outside that reality.

I became aware of this gradually, not through a single dramatic incident but through patterns. How similar behaviours were read differently depending on who was demonstrating them. How mistakes were contextualised, or not, depending on who had made them. How success was received with warmth in some directions and with something more complicated in others.

As a Black surgeon, you carry this awareness into every evaluation. You operate within a system that is assessing you, while also understanding that the assessment is not entirely neutral. That tension does not resolve. You learn to hold it.

What I found, eventually, was a way of working that made the tension manageable. I focused on what was within my control: preparation, decision-making, conduct with patients, the quality and defensibility of my clinical reasoning. I tried to make my work clear enough and consistent enough that it could stand on its own, regardless of who was observing it.

And I learned to contextualise feedback. Not to dismiss it — some of the most valuable things said to me in training came from people who challenged me directly, who pushed me to be more precise, more considered, more technically demanding of myself. That feedback was worth a great deal. But some of it was not. Some of it said more about the person giving it than about the work being assessed. Learning to tell the difference took time, and it required a certain steadiness in my own sense of what I was doing and why.

The question I had not anticipated was this: where does professional harm come from?

We are trained to think of patients as a source of difficulty — frustrated expectations, complex presentations, emotional interactions. And those moments exist. But in my experience, the more enduring difficulty came from within the system itself. From colleagues.

Rarely through overt hostility. More often through something quieter — a comment that sat wrong, a decision that didn't add up, a pattern of interpretation that ran consistently in one direction. The reason it carries weight is proximity. A difficult patient is a moment. A difficult colleague is a constant. Constants shape environments. They accumulate.

That is why the question of who you are trying to please becomes, eventually, a question about survival. If you give equal weight to every opinion — if you allow the system's shifting assessments to be the measure of your value — you will lose direction. Not gradually. Quickly.

The anchor I kept returning to was the work itself.