The Difference Between Reputation and Character
On reputation, projection, and the people who remember who you are
One of the strangest parts of getting older is realizing how much of adulthood is learning to tolerate being misunderstood. Not dramatically misunderstood, not publicly destroyed, just subtly, quietly interpreted through someone else’s lens in a way that makes you stop for a moment and think, Wait… is that actually who I am? Am I gaslighting myself or is this reality?
Years ago, moments like that would have consumed me. I would have replayed every sentence, every facial expression, every interaction. I would have spiraled trying to determine whether I had accidentally become cruel, arrogant, insensitive, intimidating, or “too much.” It could be my ADHD, or maybe it’s just part of being human, accepting life experiences, knowing people, and trying understand those who are different than you.
Healthcare trains many of us to do this. We are conditioned to constantly evaluate ourselves through external feedback. Patient outcomes, Press Ganey scores, peer review, administrative perception, productivity, tone, body language, emails, metrics etc. We become hyperaware of how we are received because in medicine, perception often carries consequences. Every time I am contacted by anyone, I assume I will be reprimanded, because that is how it has always been - at least since I’ve been in healthcare.
Somewhere along the way, many of us lose the ability to separate our character from other people’s interpretations of us. A number of people can confidently hide behind a fancy name of the hospital, such as Mayo Clinic, John Hopkins, the Cleveland clinic, Cedar Sinai. Healthcare is such a paradox that we rely on these academic institutions for innovation, life-saving healthcare, but at the same time there is a darker side too it all.
Over the last fifteen years in healthcare, I have worked with some of the most brilliant, compassionate, self-sacrificing people imaginable. I have also worked within systems that quietly train people to survive through performance, politics, emotional suppression, and image management.
Academic medicine especially can create this strange emotional dissonance where everyone is extraordinarily accomplished, but many people are simultaneously deeply insecure. You learn quickly which opinions are safe to say out loud, which personalities are rewarded, which people hold power socially versus clinically, and how quickly a narrative can shift depending on who is telling the story.
When I was younger, I thought reputation and character were the same thing. Now I understand they are entirely different currencies.
Reputation is fragile. It changes depending on the room. Character is much quieter than that. Character is the pattern of who you have consistently been over time, especially when nobody benefits from defending you.
