I was feeling confident — until I wasn’t.
I had been looking forward to starting residency for months, perhaps even years. In the months leading up to residency, I felt eager to enter orders without a co-signature and to concoct plans on my own for my patients.
And then I graduated from medical school in May, earned my MD, and did not feel any smarter or more special than before. After the ceremony, I could be addressed as "doctor," but I felt I had not really earned that title. Nothing had changed from the day before my graduation to the day after my graduation, but I also felt as if everything had changed.
Doubt began to creep into my mind. What if my co-interns were much more knowledgeable than I was and I was left behind? What if my residency program made a mistake in selecting me? Or my biggest fear: What if I made a mistake that harmed a patient?
Impostor syndrome — the feeling that we do not deserve something that we have objectively earned — is a real phenomenon. This feeling was discussed in my residency orientation, and I was assured that my co-interns felt similarly to how I felt, but that we indeed all belonged in our program. “Do not feel like impostors. You belong here,” we were told.
Yet I would argue that the sentiment that impostor syndrome must be quelled at all costs, while borne of noble intentions, is misguided. Of course, no one should be made to feel like they are an impostor because of their race, gender, sexual orientation, etc. Unfortunately, women and people of color feel impostor syndrome at higher rates than the general population. This difference must be purposefully addressed and corrected.
Race- or gender-based impostor syndrome aside, I would argue that the feeling that we must prove we belong is a positive on the whole, especially in medicine, where our decisions sometimes mean the difference between life and death. Having a healthy skepticism of our own knowledge base will prevent a rush to judgment and empower us to consult authoritative sources and more experienced clinicians.
Recently, I was helping to take care of a patient who ordinarily has hypertension but was having low blood pressure in the hospital. One morning, the patient’s nurse notified me that the patient’s systolic blood pressure had increased to the 170s and asked if we could restart the patient’s home antihypertensive medications. Instead of pausing to listen to the impostor syndrome on my shoulder, I impulsively agreed with this request.
Within a couple of hours, the patient’s systolic blood pressure was down to the 90s, and she required IV fluids to help increase her blood pressure. While she suffered no long-term harm, I felt that my quick decision to administer her antihypertensives that morning precipitated this event. Perhaps if I had stopped and taken a more skeptical approach to my decision making, this event could have been avoided entirely.
If I had listened a little to my impostor syndrome that day, I may have asked more clarifying questions about her symptoms and considered the various options for diagnosis or treatment of a given condition. The feeling that we may not belong in medicine helps prevent anchoring bias, as well as guard against the fallacy that we are experts who bestow our knowledge to our patients.
My feelings of impostor syndrome have also compelled me to fit in with the culture of my workplace. I quickly learned the oral presentation style of my new program as well as the structure of rounds and expectations for each member of the team. My fear that I would negatively stand out has helped me positively fit in and become a harmonious team member.
I am now about one month into my internship, and my impostor syndrome, while decreased, persists, and though it will continue to diminish over time, I am honestly hopeful that it persists. I feel like I belong at my institution, but I also know that I have so much to learn, and just because I am called doctor, I am nowhere near having all the answers for my patients. No matter how much I progress in my career, I will always know that I have more to learn and potential for growth as a physician.
Do you agree that impostor syndrome, viewed this way, can be good for medicine? Share in the comments.
Sathvik Namburar, originally from Duluth, GA and a graduate of Johns Hopkins University, is currently an intern at Yale in the internal medicine program. His writing has been published in USA Today, Boston Globe, and Baltimore Sun, among other publications. His interests include public health policy and health care equity, as well as global health. He is a 2021–2022 Doximity Op-Med Fellow.
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