During the first week of my major attending work, I saw a patient with fever, sore throat, no cough, and tonsil discharge. Well trained in the management of septic shock, but not knowing how to practice in a primary care clinic, I made a ton of infection and inflammation diagnoses. My senior partner took one look and said, “Don’t you know it’s strep?”
blushing and trying to hide, I thought, “I’m such an idiot. I” I Totally kill all my patients. This is a disaster. “
As predicted, the July 1st transition at every stage of medical training and practice is the arrival of signals for the impostor within us. I don’t like “Impostor Syndrome” ” because it pathologicalizes normal human uncertainty. It’s important to clarify some terms:
- Uncertainty: A lack of certainty about someone or something. A perfectly normal, helpful emotion. For example, when a patient presents a diagnosis you don’t quite believe, uncertainty Will help you realize that you need to dig deeper to ensure accuracy. Small doses of uncertainty keep us curious.
- Impostors: Uncertainty + Shame. Imagine being a new intern or a new attending physician and seeing a clinical presentation you don’t recognize , and told himself, “I don’t know what this is. I should know this. What’s wrong with me? Everyone will know that I don’t know what I’m doing. “Impostor creates a false story about our uncertainty. It tells us that we don’t deserve it, everyone will find out, and we’ll die of humiliation.
- Systemically oppressed: Everyone/authority convinces you that you are not worthy and contributes to the impostor narrative. For example, “Women don’t Belongs to Surgery”, “Natural Hair Unprofessional” and “These new documents are just complaints. They don’t work hard enough. “These forces, through prejudice and exclusion, provide a narrative that we internalize (and believe) that we are unworthy and unqualified; therefore, we should not try or conform so that the power system is not broken.
So what are you telling yourself about uncertainty in this new PGY phase?
When you are faced with uncertainty, what narrative do you hear?
Whose voice is telling that you are the one?
Is this story true or a false narrative that you internalized over time?
Ultimately, our critical imposters are just trying to save us from vulnerability, failure, and exposure. If they could be loud, we would be small, quiet, and safe, limiting our potential, influence, and power.
Imposters can be foreseen. Predictably, Imposters can emerge during times of uncertainty and new responsibilities—career transition points, new leadership roles, new social circumstances. Of course, as you transition and take on new responsibilities on July 1, your inner Impostors will be waiting to greet you. When you look at your shiny new ID and get nervous about what’s to come, and then your critics get full mouthed, you can think, “Oh, I know you will be here. “
Please know that there is no threshold for success to eliminate an imposter. Michelle Obama famously described how her imposter syndrome followed her into the most powerful room in the world. This year, as a PGY-18, I found myself thinking, “These new doctors know a lot more than I do. I’m totally out of date. “What? Thanks, impostor. No. Not helpful.
What can you do to silence your impostor?
- Find a hype girl/hype guy.(Look at that How does this arrogant term lead to impostors? No one calls men hype boys.) Well, hype-team. Who are your cheerleaders who celebrate your strengths and accomplishments? Ask them: “What am I good at? What am I known for? What is my super power? Know your strengths and own them. It’s normal that you’re not good at everything. Your impostor wants to redefine “your growth area” as “evidence that isn’t worth it.” Don’t believe the hype.
- Keep a winning list – a list in an email folder or reminder works just fine. Write down your victories, big and small, and come back when you need proof of your accomplishments. I keep letters from patients in my drawer as a reminder that the work I do matters.
- Knowing your inner imposter is doing their job – keeping you safe. With empathy, remind yourself, “Thank you, Brain. I know this is scary. I’m learning to deeply own my own support, and I’ll do it no matter what. “
- Be present and create a healthy amount of uncertainty for your team. Tell them when you don’t know the answer. Tell them it’s normal to feel exposed when they’re new to PGY. Tell them that uncertainty is a superpower that can help them identify when the diagnosis doesn’t seem right.
You can never avoid a completely normal sense of uncertainty. However, you can decide what you let it mean What. Let uncertainty lead you to a zebra you never thought you’d see. Then add it to your winning list.
Kara Pepper, MD is a physician who can be reached through her eponymous website, Physician Instructor: Kara Pepper, MD.
This article appeared in KevinMD.