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A PCI Grad’s perspective on physicians and Imposter Syndrome

in Physician Coaching Insights

Cheers to PCI Grad Dr. Chris Miller, an internal medicine specialist with Gundersen Health System, a Board Certified-Addiction Medicine, and Certified Physician Development Coach.  Dr. Miller recently published her article in the Gundersen newsletter,  “The Vitals,”  on the topic of physicians and Imposter Syndrome.

We are pleased to share her full article here.

Will the Real Imposter Please Stand Up?
By Chris Miller, MD, Internal Medicine

“You are braver than you believe, stronger than you seem,  and smarter than you think.”
Christopher Robin  – Winnie the Pooh

Do you recognize yourself in this cast of characters?

The Expert: My primary talent is knowing everything and being able to do everything. That I know everything and can do everything is what is important to me.

The Perfectionist: My primary focus is on a task being done perfectly and that it turns out perfectly. What is perfect is what is worthwhile and what should be commended and it is what I strive for.

Natural genius: My primary gift is that I define success by having inherent intelligence and ability. My success should therefore come easily and without effort.

The soloist/rugged individualist: My primary responsibility is to be able to organize and complete a task alone. I prove myself successful by my self-reliance and independence from others.

Superhero: My primary motivation is to take on many roles. I expect myself to juggle them all well and have them all be successful.

If you recognize yourself in one of these characters, you may also recognize yourself in the character of the imposter.

Imposter: My primary script is that I can exceed and do something well on my own or with others and I never feel that it is good enough. Sometimes fear holds me back from doing something as I am afraid of being found out that I am a fraud.

Or perhaps you recognize yourself in this more specific script?

“My success was just due to luck or timing or error.”
“If I can do it, anybody can.”
“I agonize over the smallest flaws in my work”
“I am crushed by even constructive criticism.I see it as evidence of my ineptness and incompetence.”
“When I succeed, I feel like I fooled them again.”
“I worry that it is just a matter of time before I will be found out to be a fraud.”
“They are just being nice.”
“It was really someone else’s work that made a difference.”

Imposter thoughts/Syndrome: If this script sounds familiar to you, you are not alone. There is a whole cast of “imposters” walking with you each day. Of course, everyone has doubts occasionally, especially with attempting something new. The imposter syndrome is not talking about this kind of doubt but rather a more pervasive self-doubt. Imposter thoughts start weaving themselves into a person’s life when they start holding themselves to unattainable standards of competence. Falling short of these unattainable standards evokes repetitive feelings of shame and self-doubt. Shame and self-doubt erode confidence and clarity. It is with this lack of confidence and clarity that it becomes possible to adopt the distorted view of being an imposter or a fraud. There is then the ensuing fear of being found out to be this fraud.

If everyone else sees you as a competent individual and you see yourself as inadequate or a fraud, your perception of competence most likely forgets that being human means being imperfect and incomplete.

Take our cast of characters. Standing alone, they might look like something to strive for, something to achieve. Now add the absolute to each category, the character soon becomes burdened with that unattainable and unsustainable task.

Always the expert: I do not feel satisfied when finishing a task until I know everything about the subject. A minor lack of knowledge brings me shame.

Always the perfectionist: I do not feel satisfaction even when I do something well. I find myself focused on what went wrong. If I have one minor flaw, I feel shame.

Always the natural genius: I do not experience success as building any confidence as I think I should have been able to do this, it is no big deal.” When I struggle or cannot get it on my first try, then I feel like a failure which causes me shame.

Always the soloist/rugged individualist. I fear asking for help will reveal my incompetence. I often will turn down help in my attempt to prove my self-worth and that I am self-reliant and independent from others. If I need help, this is a sign of my failure, and it makes me feel shame.

Always the Superhero: I work with extreme effort to take on many tasks, and I expect complete competence in each task. If I fall short in any one area (parent, partner, profession, volunteer etc.), I feel shame.

Are you beginning to see the link between a definition of competence that is unsustainable and the Imposter Syndrome/thoughts? Are any of these characters familiar to you?

At its core, imposter thoughts or the full-blown syndrome are usually fed by an unconscious personal definition of what it means to be competent. This description usually begins with absolutes of I should, I will always, I will never. Remember, imposter thoughts begin with a comparison to a standard of competence that is unattainable and unsustainable. No matter how well the person does or how much they are praised, they are not able to attain their definition of what it means to be competent. Again, thinking they are an imposter becomes a distorted way of explaining their lack of ability to achieve their definition of competence.

Here is some more script that may sound familiar to you?

If I were really intelligent, capable, and competent I would:

  • Know everything in my field.
  • Get it right the first time.
  • Excel in everything that I do.
  • I’d always know the answer.
  • I would always understand what I am reading
  • I’d always feel confident.
  • I would never make a mistake.
  • I’d never be confused.
  • I’d never need help.
  • I should already know what I came here to learn.

The phrase imposter syndrome or imposter phenomenon, or imposter experience was coined by Dr. Pauline Rose Clance in 1978. It has taken on new importance in the last years in medicine with the focus on provider wellness. It has come to be seen to be one cause of burnout specifically and dissatisfaction with work in general.

Imposter Syndrome: Three key attributes: a sense of being a fraud, fear of being discovered, and difficulty internalizing success while behaving in ways that maintain these beliefs.

There is an overall core experience of feeling inauthentic. It affects both genders, and although it has been most studied with high achieving women, it affects all achievement levels and both genders. Many people experience symptoms for a limited time, such as in the first few weeks of a new job. For others, the experience can be lifelong.

Repercussions of living with imposter thoughts/feelings:

  1. Lack of confidence 
  2. Underachieving in order not to risk being “found out”
  3. Decreased job satisfaction
  4. Decreased job performance 
  5. Burnout 
  6. Anxiety/Fear 
  7. Depression
  8. Suicide

Or do you see yourself using these unhelpful and unhealthy strategies to keep from being found out to be a fraud?

  • Over-preparing
  • Holding back, remaining silent in the face of opposing opinions, not volunteering ideas
  • Maintaining a low profile or continually changing roles.
  • Use charm or ingratiation to win approval
  • Shower praise on others’ abilities or accomplishments instead of your own
  • Procrastination
  • Never finishing
  • Self-sabotage – show up late, don’t prepare

Did you know these famous people felt like they were imposters?

“I have written 11 books, but each time I think, ‘uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.” Maya Angelou, author, poet and Nobel Laureate.

“No matter what we’ve done, there comes a point where you think, “How did I get here? When are they going to discover that I am, in fact, a fraud and take everything away from me?” Tom Hanks

“The exaggerated esteem in which my lifework is held makes me very ill at ease. I feel compelled to think of myself as an involuntary swindler.” Albert Einstein

“If you truly want to put yourself on the fast track to feeling as bright and capable as you really are, then nothing- and I do mean nothing will get you there quicker than adjusting your beliefs about what it takes to be competent”
Dr. Valerie Young

What can be done to work with your Imposter Thoughts?

  1. Become aware of when the imposter feelings and thoughts show up. Find the patterns. Fear…failure… and the unknown are frequent times when the imposter feelings and thoughts show up. Be aware of your response to fear, failure and the unknown.
  2. Talk about your imposter thoughts and feelings with others. Sharing these feelings and thoughts and finding you are not alone are some of the best ways to alleviate shame.
  3. Become familiar with and skilled at practicing self-compassion. Self-compassion is again another antidote to shame and allows patience.
  4. Use the phrase “(I am) (It is) is good enough over and over. Be selective about where vou put your efforts…go for 100% in delivering care and decrease agonizing over routine tasks. Look for imperfections in your favorite things: nature, pets, children, food…and see that you still love them. 
  5. Counter your thoughts: If you want to stop feeling like an imposter, then you have to stop thinking like an imposter. Start thinking both/and rather than either/or…there is not always a right or wrong way, just different ways of doing or looking at things.
  6. Rewrite your version of competence so that it embodies reality, self-compassion and being a flawed human being. Know that effort trumps ability. Begin to see failures and challenges as opportunities which starts cultivating a more open mindset.

So in conclusion:

Will the real imposter: always the expert, always the perfectionist, always the natural genius, always the soloist, always the super person..
PLEASE SIT DOWN?

And will the REAL YOU…
PLEASE STAND UP?

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Imposter Syndrome Sources

1. Valerie Young: The Secret Thoughts of Successful Women: Why Capable People Suffer from Imposter Syndrome and How to Thrive in Spite of it.

2. Imposter Syndrom.com.Dr. Valerie Young: Blogs “Tips for Navigating Imposter Syndrome.” “5 types of Imposters.” “Take the Imposter Syndrome Quiz.”

3. Medical News Today: How to Handle Imposter Syndrome.

4. J Gen Intern Med. 2020 Apr; 35(4): 1252-1275. Published online 2019 Dec 17. Doi: 10.1007/s11606-019-05364-1. Prevalence, Predictors, and Treatment of Impostor Syndrome: A Systematic Review. PMCID: PMC7174434

5. Journal of Business and Psychology volume 30, pages 565-581 (2015): No You are Not a Fraud.

6. International Journal of Behavioral Science. The Imposter Phenomenon. Sakulku, and Alexander Copyright 20211 by Behavioral Science Research Institute 2011, Vol. 6, No. 1, 75-97 ISSN: 1906-4675

7. Medical Education in Review: Imposter Syndrome Among Physicians and Physicians in Training: A Scoping Review Michael Gottlieb1] Arlene Chung2] Nicole Battaglioli3] Stefanie S. Sebok-Syer4] Annahieta Kalantari

8. Clance.www.paulineroseclance.com> imposterphenomenon. Imposter Phenomenon-Dr. Pauline Rose Clance.

9. DOI:10.1111/medu.14412: More Than Meets the Eye: The Impact of the Imposter Syndrome on Feedback Receptivity. Michael Gottlieb.

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