“I’ll never be good enough”

“What am I doing here?”

“I don’t deserve this”

If any of these phrases sound familiar to you, you may be suffering from imposter syndrome. Imposter syndrome is a psychological phenomenon where you feel like you don’t deserve you own success. It’s that gnawing voice of self-doubt that only criticises and focuses on your flaws, or that fear of being outed as incompetent. It’s feeling like a fake or as though you don’t deserve your success, putting it down to good luck and timing instead.

 

If you relate to this self-doubt and fear of being revealed as a fraud, you’re not alone. Imposter syndrome is highly prevalent, with up to 70% of people experiencing at least one episode in their lifetime. In fact, I have a sneaking suspicion that it may be even higher in the high-achieving cohort of medical students and healthcare professionals where you’re surrounded by people who excel and the stakes are high. I’ve seen it in my friends, my peers, and it’s something I’ve often seen in myself. After my very first exam in medical school, I remember the fear of not belonging at medical school, of being revealed as some dumb high-schooler who had conned the interviewer into admission, despite the HD I had just recieved. Now at the end of my medical degree with internship fast approaching, these doubts still haunt me – I fear that I will be an incompetent intern, a deadweight dragging down my team.

 

Looking back over my years at medical school, I’ve now realised that this has been a massive source of stress, anxiety and low self-confidence, and I know that this will only get worse once internship and “real” responsibility starts. In addition, while imposter syndrome isn’t a diagnosable mental health condition, it can be linked to depression and anxiety. As such, what can we do to combat imposter syndrome?

 

How to overcome it?

Unfortunately there is no quick fix for imposter syndrome, but it can be overcome with ongoing, conscious effort. Some strategies I personally believe would be useful include

• Gathering hard, objective evidence about your successes: write down a list of your achievements and skills. This isn’t bragging or tooting your own horn, it’s acknowledging that you are capable and deserving of your own accomplishments.
• Talk with your peers in a safe environment: it can be really helpful to voice your thoughts – often you’ll find they share the same concerns, which helps normalise your feelings and lets you know you’re not alone

 

At the end of the day, remember: you are better than you think you are. You know more than you give yourself credit for. You have value. You are worthy. You are enough.

 

The warmth of the quilt enveloped me, as a blaring cacophony erupted in the background. It was 5:45am and unlike the four days prior it took everything to leave  my sheltered cacoon and step out into the world. Practically inhaling breakfast, it was another day I left my watch behind as I raced to make the bus. It was running late. Predictable.

Now doe eyed and eager, I brushed past the worried faces at the hospital elevator, racing up four flights. Can’t be late. Empathising with our COPD patients, I puffed into the empty doctors’ office. Drat. Why didn’t we start at the same time every day?

‘So what did the physiotherapist say?’, the registrar asked. Illegible, more illegible writing. It was already 2:30pm and we’d barely seen half the patients. ‘It’s just one of those days’ I told myself. ‘Just keep smiling’.

3pm. ‘Isn’t that your patient in Bed 5?’, the nurse yelled, as we finally sat down to lunch. It wasn’t my first MET call. It wouldn’t be my last. Plastering myself to the wall I watched the herds flocking to the scene like sheep. ‘Can’t breathe, can’t breathe,’ the patient gasped.  Only yesterday she had been telling me how upset she was her son hadn’t visited her in hospital yet. A moment I had cherished, congratulating myself for finally finding the time to truly get to know a patient. She remained surrounded. Lines, masks, leads.

‘Increase the oxygen, why isn’t there an alcohol swab here.’ With doctors and nurses engrossed in their individual roles the patient’s eyes moved to me. It took everything to muster my courage and give her a smile. We both knew, but neither said a word. Silence. Flat lines on the ECG. A life lost. My eyes darted over to the corner as her young son and his wife ran into the ward. A single tear trickled down his face. A missed oppurtunity.

 

Within moments I was rushing to grab a progress note as we moved to the next patient, the only remnant of our previous encounter being my quivering hand as I began to write. It was funny how I forced a smile.

‘Hey, hey, what’s wrong?’ I heard. It had only been a few hours; couldn’t I have smiled a little longer? How did they know? I felt angry. Why was I staring into space whilst the rest of the team continued to deftly craft intricate management plans for our complex patients?

My colleague stood me outside the room, as the team proceeded to see the next patient. ‘You have to learn to forgive yourself’ I heard her say ‘We all knew you knew her better than any of us.’ ‘It’s ok, you are allowed to feel this way’.

Maybe I had needed to hear that a few hours ago.

Maybe the smile wouldn’t have been so forced.

My hand may not have quivered.

We always expect ourselves to work at our best, despite the circumstances. We compare our responses and reactions to others, often more experienced. We feel guilty about taking our own time to process our emotions. Why? Maybe it is our internal drive, maybe we learn it from our environment and peers. But can we really bring the best care to our patients unless we are functioning at our best?

So…

 

Forgive yourself.

Take your time.

Realise.

You don’t always have to keep smiling.

In February 2014, I was on top of the world. I just received my offer to study medicine. My life’s hard work had finally paid off. The rest would be a breeze; studying medicine is easy, a bit of memorizing, that’s all, and everyone gets a job at the end. My life was sorted! I became the model student, everyone’s goal, everyone’s dream.

I went into medicine full of joy and excitement, absolutely confident that I had more than what it took to ace this course. I was ready to live the dream, ready to become an excellent doctor…

I am still unsure when the turning point happened, when the dark hour of self-doubt began to settle in. It might have been sometimes before my first end of year exams, when I realised that I could simply not study enough to cover the scope of what could be tested.  It might have been outside the door of many OSCE stations, where I was paralysed by topics that I was not prepared for.

Or it might simply have been the daunting realization that I was not as dedicated, gifted and hardworking as I had thought…As I sit in front of my laptop, too tired to concentrate on studying after a day at placement, I think of my many fellow medical students who achieve higher grades than me, and who through their dedication to juggling uni with extra-curricular and research activities, also enjoy the benefits of having glowing CVs. As I struggled to answer my consultants’ questions, I resigned to the fact that I simply did not have the knowledge to impress doctors and build the social connections that everyone seem to value so highly.

Now, edging towards the end of my time at medical school, I have more questions than ever. Would I be able to cope with the demands of internship next year? How do I determine which one of those multitude of medical specialties suits me the most? Would I ever be good enough to overcome those increasingly difficult challenges that stand between junior doctors and training programs?

 

Through all my doubts and uncertainties however, there is one thing that I am confident about: I have had struggles and self-doubts through medical school, yet I have overcome them. My lists of achievements through medical school may not be less glowing as it was back in high school, but through each and one of them I have learned to strive to be a better version of myself, and these moments of personal growth would allow me to overcome the bigger challenges to come.

My achievements in school have given me confidence and pride, but I was so sheltered that I believed I no longer needed improvement. Medical school has allowed me to know that there is always something to aspire to and strive for, and that is a great feeling.

The journey as a medical student and doctor is long and meandering. Self-doubt and uncertainty are often intertwined with this path. If you ever find yourself feeling doubtful about your abilities, please remember that you have all accomplished so much to get to where you are today, and there is no reason why you wouldn’t continue to do so. Additionally, the greatest achievement is a journey, not an endpoint and I wish you all the best on this amazing journey.