I’ve previously written about imposter thinking. I come across it a lot and the impact of it can be significant if it isn’t recognised for what it is, so here’s my most significant personal experience of it…
When I moved from Sexual Health to Elderly Care, I had essentially been out of general medicine for about 13 years – I was very knowledgeable and skilled in managing complaints pertaining to the genital area after this length of time, but my general medical knowledge was in need of a bit of a refresh.
I started off on the admissions ward and was delighted to find myself working alongside a group of absolutely fabulous junior doctors who took me under their wing. I was old enough to be their Mum, and yet they were essentially teaching me – acronyms that were new to me (AKI? ACS?), the IT system, how to take a blood gas (it had been a long time), how to find and implement the so-many protocols and guidelines that now existed, the names of music bands I might like because their Mums did (we'll gloss over that...).
Lunchtime felt awkward - I didn’t quite fit in with either junior or senior body group. Where to go? I no longer had an office and perching on the edge of someone else’s desk just didn’t feel great. Canteen on my own felt a bit lonely, I do like a chat. On the occasions when there was time to go to the mess (the other side of the hospital), the juniors were very kind in asking me to go along with them – sometimes I did, often I didn’t because I felt like I stuck out like a sore thumb.
Each time I arrived on a new ward I was asked questions by ward staff who assumed that I was the senior on the ward as I looked the ‘right age’ to be a consultant, often followed by a not-so-surreptitious sideways glance when it became evident that I didn’t know the answer.
The days of knowing the answers and not having to explain myself on a regular basis felt like a long time ago. The days of feeling confident in managing the vast majority of scenarios that presented felt like a long time ago.
Essentially those feelings of confidence had been replaced by feelings of self-doubt. Or, more accurately, thoughts of not being good enough – a fraud - which resulted in me feeling anxious and fearful, and questioning my sense of belonging.
I became so focused on these thoughts of self-doubt and the many gaps in my knowledge that it didn’t occur to me to reflect on the many strengths that I was bringing to the role, or the ‘softer skills’ – which are, in fact, not soft at all.
I had unrealistic expectations of myself, and interpreted that as others having unrealistic expectations of me. As much as life at home with two kids would permit, I was reading, reading, reading. Obviously I chose to do yet another qualification – if in doubt, prove yourself with a bit of paper. I was dotting the i’s and crossing the t’s – surely a doctor of my age and stage shouldn’t make mistakes, and so I did everything to ensure that I didn’t. I passed by on opportunities to develop my career because I thought there was a risk that I would be found wanting, so I held myself back.
Looking back, what did I expect was going to happen when I made that career transition? That overnight I was going to be working at the level of a consultant who has trained for many, many years? That I would be able to manage an acutely unwell patient as well as a registrar who has vastly more experience than do I in that situation? That, after years of not doing any general medicine, I was going to be polished in all things medicine? That I was never going to need to ask questions?
The self-doubt I was feeling was actually entirely normal given the circumstances – I had pushed myself out of my comfort zone, and self-doubt is to be expected. The problem was the judgement I attached to it, and the story that I unwittingly allowed it to turn into.
And so that is how ‘imposter syndrome’ can show up. If left unchecked, it is exhausting, feeds into unhealthy perfectionism and can result in career stagnation. Job satisfaction can be hugely impacted and it can be a significant contributor to burnout. Essentially, very negative consequences which are well worth avoiding for all concerned.
I’m aware that I have given an example from a time of significant career transition; these are a regular affair for doctors – overtly so for doctors-in-training, but also for senior doctors as they take on more roles and ever-increasing responsibilities. However, I would emphasise that imposter syndrome can occur at any time, including when you have been in the same role for a long time. And it doesn't just start after qualification - it is well-recognised in medical students. In addition, that sense of belonging that I mentioned is also very relevant, and is why it may be felt more acutely in under-represented groups, tied in with lack of diversity.
If you recognise any of this and want to take just one thing away from this article, let it be:
TALK TO SOMEONE ABOUT IT.
Trusted colleagues and mentors/supervisors at work are a good place to start – you will be surprised by how many people can relate.
Other things that can help include:
Step back and look at the actual evidence – your thoughts are thoughts, not facts. You are where you are because you deserve to be. Your inner critic may be shrieking the opposite, but it is focused on an evolutionary urge to try and keep you safe, not on facts.
Start to note your achievements daily – even the tiniest of things – it starts to switch your focus to what you’re bringing (helpful to also note what strength or skill you used, e.g. defused an angry relative – rapport-building, communication, conflict management etc)
Focus on your unique strengths and skills – by brainstorming a list, or there are various online free strengths profiles, or by asking trusted friends/family/colleagues for feedback
Self-care and self-compassion – 2 highly under-rated essentials for wellbeing
Mindset and language – e.g. moving from ‘I can’t do…’ to ‘I can’t do…yet’
I appreciate that that is a very brief overview and that recognising and managing this can be difficult to do on your own. If you would like further support with this, get in touch.