"I have no idea what I'm doing, and it's just a matter until they all find out". Sound familiar? Certainly that's how I felt for much of my own career.
Imposter syndrome is a collections of feelings of inadequacy that persist despite clear evidence of professional success. It happens when the individual has the skills, but gets trapped in thoughts that they are not competent. Those thoughts generate a lot of anxiety. This can then lead to confirmation bias, when every knock-back is interpreted as further evidence that they are not competent, despite the fact that everyone else faces exactly the same challenges. Even worse, not feeling confident can actually negatively influence your performance. Those with imposter syndrome are not able to accurately relate their success to their competence, instead attributing it to luck. It may co-exist with anxiety or depression, and is also associated with burnout, low job satisfaction and poor workplace performance.
Surely humility is good?
Humility and imposter syndrome are two very different things.
Humility is a good characteristic to have. Humility results from an accurate appraisal of one's capabilities, meaning that one has a good idea of what they are good at and where they need to develop.
In contrast, imposter syndrome is about an inaccurate appraisal of one's abilities, so that despite being competent, the person is convinced that they are not. Clearly this is problematic for the individual concerned, who spends all their time battling feelings of inadequacy. Further, the person's career may not progress as well, because the individual doesn't value their own contribution, and may in fact sabotage their own successes in acts of self-confirmation of their incompetence.
Imposter syndrome is also problematic for the organisations and our patients, because the doctor with imposter syndrome doesn't actually perform to their full abilities.
How common is imposter syndrome?
Imposter syndrome is common in high-achieving and highly-successful people. Initially it was described in professional women, but it affects men also. It is probably more common than we recognise. One review found it in 75% in clinical nurse specialists and in 44% of internal medicine trainees, whilst another found it in 22% to 60% of doctors and medical students.
As healthcare professionals, we are expected to know everything, be certain, and supremely confident at all times. We rarely talk about our worries, feelings of inadequacy, and the anxiety of having to get it right. Imposter syndrome isn't a medical diagnosis, but it is a common thing that affects many of us.
Sometimes imposter syndrome shows up in the classical form with doubting own abilities despite evidence to the contrary. But sometime it may be more subtle and show up as perfectionism, controlling behaviours, inability to delegate, or hyper-vigilance.
What can you do about imposter syndrome?
Imposter syndrome is complex, and there isn't one simple fix. Here are some things to explore.
What are you expecting of yourself? Are your high self-expectations realistic?
Evidence of competency
What does objective evidence about your performance say? What do others think? What are your outcomes like?
Our work is challenging, even more when you constantly feel that you are not up to the job. Some humility is good, but constant worry may lead to burnout. Yet worrying about patient care is also a characteristic of a doctor that cares. Be kind to yourself, and acknowledge that things are challenging. Have a look at self-compassion.
By thinking about your values, it is possible to convert worries about what outcomes there might be, and instead focus on doing what you think is the right thing to do and being the kind of person that you want to be. This shifts from future worries about what might be, into present-day behaviours that reflect the person you want to be. None of us can completely control future outcomes, but we have much more control about how we behave in the present moment.
In imposter syndrome, the individual's ways of thinking and how they feel contributes to problems. Emotional intelligence is about recognising and managing your emotions. Paying attention to this can help you manage imposter syndrome.
Instead of focusing on the every-day ups and downs at work, it can help to see the career as a life-long journey of learning and development. Have a look at growth mindset.
Imposter syndrome is common. Humility and worrying about our patients are good characteristics, but they need to be grounded in reality rather than in an inaccurate appraisal. Hopefully the tips here are useful.
Finally, many of us will have colleagues with imposter syndrome, yet we may not know what they are experiencing. It's good to be kind to others at work, for often we have no idea what the other person is going through.
Share the knowledge
If you have any questions about anything in this article or about coaching, please don’t hesitate toget in touch.