The Great Pretender

Imagine each of the following scenarios:

You’re a newly trained provider, who’s inherited the practice of a recently retired colleague. One of that colleague’s patients comes in for a refill of their medications, and their med list includes a drug you’ve never prescribed before. You tactfully ask the patient why they’re taking it, and they say: “I don’t know--you’re supposed to be the doctor.”

You’re an older physician with many years of experience. One of your younger colleagues asks you for a curbside consultation on a patient they’re seeing. You tell them how you’d handle the situation, and they inform you that UpToDate considers that approach outdated.

You’ve just been promoted to Medical Director at the clinic where you’ve worked for years. There’s been a recent change in your company’s compensation formula that will benefit the younger providers, but adversely affect more experienced providers. You’re about to go into a meeting with your long-time colleagues, who now report to you, and deliver the news.

Besides raising your blood pressure a few notches, what do these three scenarios have in common? They’re all fertile ground for “imposter syndrome.”

Imposter syndrome is a term coined in the 1970s by psychologists Pauline Clance and Suzanne Imes to describe a deep, gnawing sense of inadequacy and incompetence, despite evidence to the contrary. Since then, it’s been studied extensively, and found to be pervasive in certain professions and certain personality types. Spoiler alert--physicians are among the most consistent victims.

Paradoxically, imposter syndrome is most frequent in high achievers. This is especially true when that achievement is forged in a crucible of competition and external reward. It turns out that a certain amount of self-doubt is useful (and perhaps inevitable) if you’re under the microscope of constant critical evaluation. Unfortunately, that self-doubt has a cost as well.

What did you feel as you imagined yourself in those three hypothetical situations? Stress? Anxiety? Shame? Defensiveness? How would that have affected your communication style? Your relationship with others? Your sense of wellbeing?

After a lifetime of trying to have all the answers, there’s one dirty little secret that we can’t hide: we aren’t perfect. Luckily, there’s an antidote to imposter syndrome, and it’s both surprisingly simple and maddeningly difficult. The only thing that really works is vulnerability.

Our impulse, at times of self-doubt, is to raise our shields. We double down on our position, or assert our authority. But even if we manage to save face, that only deepens our shame. Maybe we fooled the others, but we can never fool ourselves.

Instead, we need to lower our shields and shed our armor. We need to stop supplying answers, and ask some questions instead. What can I learn from this situation? What can others teach me? What contribution can I make? What do others really need from me? Once we stop asking how we should be judged, we can get curious about the questions that really matter.