Family Medicine Vital Signs

By: Anna Holman, MD

When people ask me what I do for work and hear that I’m a family medicine resident, they often follow-up with “So, are you a doctor?” My answer is usually “Technically, yes…” I still feel a little odd introducing myself as a doctor. I can’t quite own it, despite years of working toward it.

Along with many of my peers, I tend to not give myself credit for the hard work and time I put into getting where I am today. When submitting my application for medical school, I never thought I would actually get in. Then I did. I chalked this up to luck and circumstance, thinking I would never survive the first month, let alone the first year. Then, despite my doubts, I passed the first year and then the next 3, graduated from medical school, and was called “Doctor” for the first time. It was not easy by any means. I often thought I was not smart enough to be in medical school, surprising myself with each passing grade. I was surrounded by smart, compassionate, talented people and thought I had to work twice as hard for the same result. When people congratulated me for getting through medical school, I usually said “Anyone can do it, it’s just a matter of putting in the work,” dismissing their compliment.

Somewhere along the lines, I was told I had Imposter Syndrome (also called Imposter Phenomenon or Imposter Experience). When I first looked it up, I didn’t think it applied to me. The definition I saw stated that a person with Imposter Syndrome has deep-seated beliefs that they are not good enough, that they have fooled everyone to think they are smarter than they are and fear that they will be found out to be a fraud. This definition didn’t fully describe my experience. I never thought I was a fraud or that I was fooling anyone. I just thought my luck was going to run out at some point. However, doing a little bit more research, I found that Imposter Syndrome is also described as someone who is unable to internalize their own successes, someone who attributes their success to luck and has a hard time accepting that their success is due to their own hard work and personal strengths. This definition fit me a little better.

Imposter Phenomenon was first described by Pauline Rose Clance and Suzanne Imes in 1978. First, it was thought to be something only women experienced, but was later revised, shown to affect both men and women. It is not a diagnosis, but more of a description of an experience. Not surprisingly, many people experience this and there are dozens of TED talks, articles, and blogs describing it and how to overcome it.

So, what do you do when you have Imposter Syndrome?

I am not an expert in psychology or psychotherapy, so I can’t pretend to give expert advice on this or I might actually be found to be a fraud. What I can do, however, is explain a few things that I have learned along the way. The following tricks have helped me to give myself credit for my strengths, recognize my own successes, and ultimately enjoy residency with a little less self-doubt.

“Forgive yourself for not knowing what you didn’t know before you learned it.” – Maya Angelou

I heard this quotation sometime in my intern after I made a mistake I had trouble getting over. I wish I had heard it earlier. So often in medical school and residency, I beat myself up for not knowing something that seemed so simple or something everyone else already knew. Now, if I’m wrong or make a mistake, I say this quotation to myself first. This has helped me change my mindset from blame to forgiveness. When I take the blame and guilt out of the situation, I find that I am able to learn from the mistake much faster than I did before. This helps me get out of my head and learn from the facts.

Say “Thank you” instead of “Sorry”

In medical school and beginning of residency, I always entered a patient room in the early mornings with “Sorry!” I felt terrible for waking up the patients to do my exam or ask them questions about how they were doing. What I didn’t realize, was that saying “sorry” for everything I was doing was making it so I wasn’t acknowledging the importance of my role in taking care of the patient. It also forced the patient to validate or thank me instead. I started thanking my patients for their time and attention and realized how much better I felt about the interaction. The truth is, I am very thankful for my patients allowing me to take part in their medical care and I shouldn’t apologize for doing my job. I started using this in clinic as well. If I’m running late, instead of apologizing, I will sometimes thank my patient for their patience with me. I find this is a much more settling exchange and doesn’t force the patient to tell me it’s okay that I made them wait (because it’s not).

Ask for help

This is a very simple rule, but often hard to do. After all, many of us are frantically trying to show the world we are competent, and telling someone we don’t know something feels like it contradicts the effort. The best thing about this rule is that once you start doing it, you will realize how easy it is and you’ll wonder why you weren’t doing it all along. Don’t assume that you should know everything. Tell someone you’re overwhelmed. Ask dumb questions. You will be amazed at how much help is out there and how much you will learn. Part of Imposter Syndrome is feeling like you don’t belong. Talking about your experience or concerns about your performance can open up doors for positive feedback and allows others to tell you about their own experience and fears. Listen to and trust the positive feedback you hear. Learn from others’ experiences. One of my attendings once told me that when she first started practicing in an outpatient clinic, she was terrified of missing something or making a mistake, so she just scheduled all of her patients back for close follow-up. She said this allowed her to look up things she didn’t know and check up on whatever treatment she had prescribed. She said her patients thought she was a really conscientious and attentive doctor, but really she was just scared. I started doing this my own practice and I found that my patients benefit from more visits and I’m able to learn more from them too.

Be scared and do it anyway

On the first day of one of my obstetrics rotations, a patient came on to the Labor and Delivery floor, fully dilated, about to deliver her baby. The nurses quickly swept her back to a patient room and said, “We need a doctor”. True to form, I said, “I’m technically a doctor, I’m an intern.” The nurse barely looked at me and said “Perfect, the attending physician is on his way, but might not make it in time.” My brain told me that I didn’t know what I was doing, was not qualified to deliver a baby, etc., etc. I delivered the baby anyway. There are so many times when the fear of failure has prevented me from trying, but I think that this fear has also led to my success. I’m glad I fear failing, but I try not to let it paralyze me.

I’m still working on managing my own Imposter Experience and don’t expect it to go away anytime soon. Residency has taught me that you’re never as prepared as you want to be, but you know more than you think you do. I imagine this is true for everything from parenting to running a marathon or running a business and I hope we all can give ourselves a little bit more grace in our endeavors.

https://www.ted.com/talks/elizabeth_cox_what_is_imposter_syndrome_and_how_can_you_combat_it?language=en

Clance, P.R. & Imes, S. (1978). The impostor phenomenon in high achieving women: Dynamics and therapeutic intervention. Psychotherapy: Theory, Research, and Practice, 15, 241–247.

Anna Holman, MD, is a second year resident in the Division of Family Medicine in the Department of Family and Preventive Medicine at the University of Utah. Her medical areas of interest include sports medicine and musculoskeletal medicine, ultrasound, integrative medicine, and quality improvement.