We Belong: Imposter Syndrome and How to Remedy It

Imposter syndrome – the belief that you do not belong or that you are not good enough – is more common that people think, especially in the medical field. Endocrine News spoke to experts on this dilemma who discuss common solutions to get past these feelings of self-doubt.

 

Some of the most well-known and accomplished famous people in the world have talked about experiencing imposter syndrome, including Michelle Obama, Starbucks CEO Howard Schultz, actress Natalie Portman and former director-general of the World Health Organization Margaret Chan, who is quoted as once saying, “There are an awful lot of people who think I’m an expert. How do these people believe all this about me? I’m so much aware of all the things I don’t know.”

What is imposter syndrome and what can you do if you deal with it?

Defining the Imposter Issue

Neither a mental health or a psychological diagnosis, imposter syndrome is instead “a set of feelings and perceptions that can lead to effects on behavior,” says Maureen Gannon, PhD, the associate dean for faculty development and professor of medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

Believing you aren’t good enough is a serious issue that can follow people for a lifetime unless they work on getting it under control. It can manifest as feeling like you don’t measure up to your peers, or that you’re not really a competent and highly trained professional, or that it’s only a matter of time before others realize just how little you know.

Ignoring these feelings can lead to stress, anxiety and gastrointestinal problems, Gannon adds. “If you are so worried all the time that people will regret hiring you, you will be stressed out,” she adds.

“You may not be the best endocrinologist in your state, city, or country, but perhaps you are good enough and that’s okay. You’ve got to survive the marathon of this career. The more your mind gets caught in the berating, the less stamina you will have to weather the marathon of being a physician.” – Gail Gazelle, MD, assistant professor of medicine, Harvard Medical School, Boston, Mass.

Imposter syndrome is not a lack of confidence, either. Instead, it stems from feeling different, particularly in people whose socioeconomic, racial, or other backgrounds differ from those around them. Maybe your parents were elementary school teachers and you’re the first in your family to go to medical school, and your classmates all appear to be from families filled with physicians. Imposter feelings can also occur when experiencing transitions, such as moving from college to medical school, or into a new residency, or from residency to an early career position.

“You come from a different world than where you find yourself now,” Gannon says. “It’s that you feel you don’t really belong in this environment, particularly if you don’t see others who came from the background you came from.”

The intense training required to become a physician can compound feelings of imposter syndrome, says Gail Gazelle, MD, a former hospice physician, a part-time assistant professor of medicine at Harvard Medical School, and an expert on physician burnout and imposter syndrome. She offers a free guide to dealing with imposter syndrome on her website.

“What we learn in our training is that if we aren’t perfect, we are a failure,” Gazelle says. As a physician, “you learn early on that we have to stack up well, not just with peers but in all specialties. We become hyper focused on what we think others are doing well, and we are always comparing ourselves to others. This magnifies the difference of the cycle of perceived inadequacy, and this fuels imposter beliefs.”

In coaching more than 500 physicians over the past decade. Gazelle says she has never met a doctor who hasn’t admitted to feeling like an imposter in some way. “I teach at Harvard Medical School and every single one feels like an imposter,” she says. “Everyone is at the top of their game. At an elite institution, you can feel like it, and at a smaller name place, you can also feel that way because ‘I’m not at Harvard.’ It’s really a mental trap.”

When your whole identify is shaped around being ‘the smart one,’ and you’ve been told at an early age that your worth is in being smart, imposter feelings can surface if you experience a challenge on a board exam or during teaching rounds, Gazelle says.

“You may not be the best endocrinologist in your state, city, or country, but perhaps you are good enough and that’s okay,” she adds. “You’ve got to survive the marathon of this career. The more your mind gets caught in the berating, the less stamina you will have to weather the marathon of being a physician.”

How It Hurts

Imposter syndrome can limit a person’s career opportunities as well as his or her self-esteem. If you are always worried about making a mistake or disappointing someone because you feel you do not measure up, “you can set a lower bar for yourself and you may not reach the pinnacle of your career that you could have achieved,” Gannon says.

This may mean not asking for the lab space you need to perform your best work, or not negotiating for a higher salary or better job benefits. “That fear and stress of trying to be perfect can really be a barrier to career advancement,” Gannon adds. “Instead, learning how to overcome such feelings and to recognize that everyone makes mistakes will help you be more proactive in your own career.”

Also, perfectionism does not help. “This is the fear that in order to feel like you do belong, you have to be perfect,” Gannon explains. “You feel like you can’t make any mistakes or you’ll be found out that you don’t belong here. People who tend to be perfectionists feel like their failures will define them, will make people regret they hired them, or got an opportunity in leadership, or leading a committee, or giving a presentation, or rising up in leadership ranks.”

Feeling like an outside influence helped you gain an advantage, rather than relying on your own intelligence, expertise, or knowledge, leads to feeling like you are always waiting to be uncovered as a fraud.

“In a place where everyone gets a trophy, how do you know if you did a good job? People have a hard time internalizing their accomplishments. When you tell someone without feeling that they did a good job, they will excuse it and brush it off. But if we get better at giving constructive feedback, it will help others with gaps in their skill set to see what I can work on. That way, when you tell someone that was great without reservation, they will believe you.” – Maureen Gannon, PhD, associate dean for faculty development; professor of medicine, Vanderbilt University Medical Center Nashville, Tenn.

“In a lot of cases, people will feel like they got to that opportunity because of something that happened outside their control,” Gannon explains. “If you got a full scholarship because of family, economic, or a certain percentage of people need to be female, you may think ‘am I the best person, or am I only here because I’m a woman or because of outside influences, not necessarily because of skills and expertise. How did I get here? Did I get here because my parents had no money?’”

Coping with Imposter Syndrome

Both Gannon and Gazelle have a lot of advice on how to live with—and maybe overcome—imposter syndrome and its tendencies:

  • Write a list of all your accomplishments and successes, Gannon says. Don’t use adjectives or qualifiers; be objective. “If your best friend saw that list, what would you say that person,” Gannon asks. “Look at the data; what have you accomplished?”
  • Consider the concept of creative visualization, as detailed in the book of the same name by Shakti Gawain. “It helps you visualize how you want to be in your career and things you do in life,” Gannon says. “For example, you can visualize how you get up and do a presentation: you are clear. The audience is nodding their heads and getting what you are saying. When you get there, you feel like you’ve almost done it already.’ Doing these sorts of exercises is very helpful,” she says.
  • Focus on mediation and examining your thinking patterns, which can help you recognize that thoughts are just that—thoughts. “Our minds are very good at spinning stories about all kinds of things; largely about ways we aren’t good enough,” Gazelle says. “It’s just a mental story — nothing more. With mindfulness, we get to think, ‘What are minds about? Is it even true that I’m an imposter?’ So much of staying out of burnout and building resilience is mindfulness: paying attention to what is going on right now and doing it with less judgement. The core of what we need to do is to shift mental patterns that do not serve us.”
  • Learn from your mistakes and know that everyone makes them. Particularly when working with trainees or mentees, it is important to be honest about when people make a mistake or fail, Gannon says. “Talk about, ‘How did we overcome from it?’ This helps others learn that everyone makes mistakes. This is how we grow. You don’t have to be perfect to have success in this career.”
  • Focus on your strengths and make a daily list of three good things that you did that day. “This shifts us from feeling like, ‘I’m never good enough’ to ‘what did I miss today,’” Gazelle says.
  • Give honest feedback. “In a place where everyone gets a trophy, how do you know if you did a good job? People have a hard time internalizing their accomplishments,” Gannon says. “When you tell someone without feeling that they did a good job, they will excuse it and brush it off. But if we get better at giving constructive feedback, it will help others with gaps in their skill set to see what I can work on. That way, when you tell someone that was great without reservation, they will believe you.”
  • Similarly, do not try to qualify or brush off praise others give you. “When you get a compliment, say thank you,” Gannon advises.
  • Remind yourself that all you can do is be good enough and try your hardest. “It takes a lot of reminders,” Gazelle says.

“You don’t have to live this way, like you’re an imposter,” Gazelle says. “You don’t have to live with the constant accusation of yourself that you’re not measuring up.”

Alkon is a Massachusetts-based freelance writer who is the author of the book, Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby. She wrote about good habits for being on call in the November 2020 issue.

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