Navigating the Downward Spiral: Managing Imposter Syndrome as a Doctor

💭 Thoughts of the week

I have used Weekly Writes as a means of reflecting on my journey as a doctor. Throughout the year, I have come to realize that I struggle with acknowledging my own abilities, despite receiving compliments from others. Even when I achieve significant milestones, I never feel satisfied and attribute my success to luck rather than my own capabilities.

This mindset may seem harmless when things are going well, but as I progress in my medical career, the number and complexity of decisions I have to make on a daily basis increase. This leaves me more susceptible to making errors. I find myself increasingly troubled by the mistakes I make, and I believe that perfectionism plays a significant role in this. I have previously discussed this in Weekly Writes #001. However, when I take a step back and look at the bigger picture, my experiences align more closely with what is commonly known as imposter syndrome.

To better understand imposter syndrome, let's explore its characteristics as outlined by Clance in the first journal article on the topic in 1985:

1. The Imposter CycleThe imposter cycle begins with a task assignment, leading to feelings of anxiety and self-doubt. Individuals with imposter syndrome cope with these feelings by either putting in excessive effort or procrastinating before rushing to complete the task. Upon completing the task, they attribute their success to luck or their own hard work, dismissing their true ability and fueling self-doubt for the next cycle.

2. The Need to Be Special or the BestImposters often feel inadequate if they are not at the top, leading them to believe they are unintelligent.

3. Superhero AspectsImposters have a perfectionistic tendency and set extremely high and unrealistic goals for themselves in every aspect, expecting flawless performance.

4. Fear of FailureThe fear of failure creates high levels of anxiety, as imposters strive to avoid feelings of shame and humiliation. To prevent failure, they often overwork themselves.

5. Denial of CompetenceImposters struggle to accept praise and attribute their achievements to external factors. They continuously try to prove that they do not deserve recognition.

6. Fear and Guilt About SuccessAchieving success can trigger fear and guilt due to potential negative consequences, such as being rejected by others.

In my experience, imposter syndrome has greatly impacted my mental health, fueling self-doubt and anxiety with each imposter cycle. This, in turn, has disrupted my productivity, making it increasingly difficult to meet my own expectations. It feels as though I am caught in a downward spiral, where I produce undesirable outcomes followed by feelings of guilt and shame.

I started this post by discussing the six different characteristics of imposter syndrome in the hope that you would reflect on your own experiences and identify actionable strategies for managing this syndrome. Here are a few methods I have learned over the years to manage my imposter syndrome:

1. Aim to be a good doctor, not the bestMedicine is a vast field with limitless knowledge. As a junior doctor, I constantly sought approval from supervisors and colleagues, which made me feel like I had to know every detail about diseases. This constant pursuit of being the best left me feeling inadequate.Over time, I have come to accept that my goal is to be a good doctor. I have realized that being the smartest or most knowledgeable physician is not necessary to be a good doctor. Keeping this in mind has helped me overcome this aspect of imposter syndrome.

2. It is normal to fail and fear failure, but always reflect and take actionAs a doctor, I often face situations that push me outside of my comfort zone and require me to deal with uncertainty. It could be a simple procedure while I was an intern like inserting an intravenous cannula or developing a treatment plan for a critically ill patient.My journey has not always been smooth, and I have made mistakes that left me feeling defeated and ashamed, triggering the imposter cycle. I have also avoided attempting certain procedures again after an initial failure due to anxiety and fear of failure.What has worked for me is stopping myself when faced with fear and asking what my next step should be and how it can address that fear. For example, I had a poor experience participating in a cardiac arrest call as a medical intern, which made me fearful of leading similar calls as a medical registrar now. Instead of procrastinating and avoiding such situations, I realized that not progressing in my job would not make me better. I chose to learn more and enrolled in courses that helped me gain confidence, such as simulation training for similar scenarios.

3. Redefine what it means to be humbleI had a misguided understanding of humility while growing up. I believed that being humble meant never acknowledging my abilities and always considering myself inferior to others. This worsened my imposter syndrome, as it made me feel guilty for any achievements and fueled my denial of my own competence.Recognizing this, I made an effort to redefine what humility means to me. Now, humility means recognizing my abilities without assuming a superior position compared to others. I understand that we all play important roles in making the world function as it does.The idea that I am no more important than anyone else, and that I may simply have more knowledge or skill in a certain field, has helped me deal with my imposter syndrome a lot better.

So what is your challenge when it comes to imposter syndrome, and how do you deal with it instead?

✍🏻 Quote for the week