Psst - I'm not who they think I am …


As this year's crop of newly qualified medical graduates settle into their first jobs, feelings of inadequacy are not uncommon. Although not mentioned on ICD 10, there is a condition known to psychologists that may explain what they are feeling. Impostor syndrome is the fear and self-doubt that causes people to question their abilities - even in the face of success - and to constantly search for external validation. This makes it very difficult to celebrate strengths and accomplishments. Many high-achieving people have this problem and are unable to enjoy their success. Some people (who may be envied by others for their achievements) do not feel as good as people assume they do. In fact they constantly worry that people will 'find them out', that they don't really deserve their success and that it will be taken away from them. Sound like anyone you know?

Most people who experience impostor syndrome do not actually say, "I feel like an impostor". However when they read or hear about the experience, they can understand fully. But, how do they feel? Even though they are often very successful by external standards, they feel their success has been due to some great luck, not as a result of their ability. "I'm a fake, a fraud and a phoney."

Sometimes this belief is formed in childhood when adults praise you for things that you don't think deserve the praise. An example could be parents who say: "This is a beautiful picture you drew," when you think it is awful. Alternatively it may be formed as an adult (after you have become successful) if you have poor self-esteem and feel you couldn't possibly deserve your success - given your negative opinion of yourself. Differing in any way from the majority of your peers - whether by race, gender or some other characteristic - can fuel the sense of being a fraud. Impostor syndrome seems to be more common in people starting a new project or career. So people who have just graduated or taken up a first partnership or consultant role may be particularly susceptible.

If you recognise yourself in the description of the impostor syndrome, take heart. There are ways to break free.

Talk about it: supportive, encouraging supervision or mentoring can make a difference. Sharing your feelings can help you recognise that the feelings are irrational, and not that uncommon.

Recognise your expertise: don't just look to those who are more experienced for help, however. Tutoring -eg, younger members of staff - can help you realise how far you've come and how much knowledge you have to impart.

Remember what you do well: most high achievers are pretty intelligent people. Some may wish they were geniuses, but most aren't. All of us have areas of strength, and areas of weakness. Write down the things you're truly good at, and the areas that might need work. A well thought through appraisal might help you recognise what you're doing well, and where there's legitimate room for improvement.

No one is perfect: stop focusing on perfection. Do a task 'well enough'. Rather than spending 10 hours on an assignment, why not stop at eight? It will be OK.

To help you all 'do enough' this month we have updated our guidance regarding influenza in line with the latest Green Book chapter, ready for the new season. We have also updated our pages concerning Ebola virus in light of the recent epidemic. For a full list of our updated content see: patient.info/content-updates



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