Do you have this nagging worry that you are not quite “good enough” at work? How about at home? Are you constantly criticizing yourself—perhaps more lately? Do you feel you are not smart enough or as competent as your physician colleagues?
Consider this—are you suffering from anxiety at work?
This constant concern of about being judged is detrimental to your personal, professional and emotional health. Your feelings of insecurity are preventing you from achieving the life that you want for yourself and your family. It is causing you to burn out.
It doesn’t have to be so. I am here to help.
Where does it come from?
The inherent problem with insecurity in the workplace is the way that it is viewed. The insecure physician sees their insecurity as a character flaw or a personal failure. This constant concern of being judged stifles the physician and leaves the physician retreating inward. Unfortunately, while the physician retreats inward, the insecurity only worsens as he begins looking for external validation of his accomplishments.
This physician constantly is seeking praise or admiration to “prove” to himself and his colleagues that he is valuable in the organization. These external factors, though, are short-lived and only worsen the feeling of the insecure physician because he feels that he is fooling everyone around him.
He begins feeling like an imposter.
Imposter Syndrome and Physician Anxiety
In all aspects of medicine—from the first year intern to the chief medical officer at a large tertiary care hospital, there are high achieving physicians who believe they are imposters. To outside observers they have it all. They have achieved so much and received accolades far greater than their peers. Often, they are sought out to lead a group or organization. However, these physicians feel that they are imposters.
There is a subset of imposter syndrome that describes this physician well—the neurotic imposter. Psychiatrists describe it as “neurotic impostors feel that they have fooled everybody and that they are not as competent or intelligent as others think. They attribute their success to luck, compensatory hard work, or superficial external factors, such as physical attractiveness or likeability.”
Psychiatrists further describe it as “[individuals] cannot accept that they have real intellectual gifts and ability, and experience a constant fear that their imposterous existence will be found out, that they will not be able to live up to others’ expectations and catastrophe will follow.”
To some extent, we are all imposters. We put on a persona to the outside world and only share our intimate details with our loved ones and close friends.
Resources
While imposter syndrome can be seen at all levels and training in medicine, it is more typically seen in the younger physician—the new intern or junior attending. This doctor is trying to prove herself in the vast expanse of medicine while being fraught with anxiety and waiting to be “found out” for the fraud that they perceive themselves to be.
- Reflections on Character and Leadership: On the Couch with Manfred Kets de Vries
The Paradox of Choice
Years ago, when I was a young father, I was driving home from a day shift, and my wife called and asked to pick up some diapers as we were running low. I happily agreed but went to the local Target rather than the usual spot we used to go to. To my dismay, I got to Target and found that they didn’t carry the particular brand of diapers that we bought. Also, to my dismay, there were 294 different brands of diapers, each with its own sizes, leak protection, colors, and “benefits.” I left there more upset than happy and drove to the local grocery store and just picked up the ones that I needed.
In his book, The Paradox of Choice: Why More is Less, Schwartz recalled a similar story about his local grocery store and the 175 choices he had with salad dressing. He further recounts a scenario with which we are intimately familiar: the doctor-patient relationship.
Simply, he recalls that years ago, a doctor would tell a patient what they had and offer a solution or a prescription. Nowadays, he recalls a recent visit to a doctor involves giving a patient a suspected diagnosis with various treatment options, and the patient is left wondering, “well, what should I choose” where the doctor would go over the risk and benefits of each modality and place the burden of choice back onto the patient. And this dance goes on back and forth, and ultimately no satisfying decision is made.
This is the crux of the paradox of choice, and it’s destroying our wellness as physicians.
There is a Way to Overcome Physician Anxiety
Having insecurity or imposter syndrome at work is not the inevitable reality for the physician. It can be overcome. As with many things in life, recognition is key but for imposter syndrome, this is not a problem. The physician knows that he is anxious at work.
As such, you are the best—and often the most appropriate—person to evaluate yourself. You are the best person to assess the source of your problems and triggers.
1. Self-assessment
What are the specific triggers that make you anxious at work? Is it a particular patient complaint? Is it the stress of documentation? The electronic medical record? What are your triggers and take the time to write it down. This simple act is incredibly freeing and immensely powerful.
This would be a great time to unlock the power of journaling. Make journaling part your morning or your evening ritual. First, having a dedicated time to sit and reflect will exponentially improve not only your insecurity at work but will reap great rewards for your overall well being.
Resources
- Daily Journaling to Prevent Physician Burnout
- 5 habits for a better morning–The ARISE Ritual
- 6 Ways to Sleep Better Tonight–The SLEEP Ritual
2. Set SMART Goals
Goal setting builds confidence. More importantly, it focuses on you, the physician. When setting SMART goals understand that these are your goals—not what your superiors want. Remember, your goals are just that—yours. Having a roadmap on where you want to be in 6 months or 6 years provides you a sense of control in the perceived chaos of work.
When setting goals understand that this is not a manifesto or thesis, it is meant to provide an achievable challenge that will allow you to grow personally and professionally. Of the many products in the market, Michael Hyatt’s Full Focus Planner stands head and shoulders above the rest.
The Full Focus Planner has daily, weekly and quarterly goals for you to strive for. I have been using it exclusively for several months and can’t image a day without it. Give it a try.
Resources
- Goal Setting for Physician Wellness
- Full Focus Planner by Michael Hyatt
3. Seek Mentors
“Mentorship is a key factor in promoting and maintaining fulfillment in medical practice. Senior colleagues who share your clinical, research, administrative, or community service interests should be approached early in your formal training. An open and honest dialogue can be instrumental in setting your professional goals, defining its trajectory, and learning how to overcome barriers by adopting successful strategies” says Dr. John Fromson for NEJM Career Center.
Yet, so few of us seek these mentors out? Why? Is it overconfidence? Anxiety? Unsure of how to approach a mentor or where to even seek one out?
Mentors are all around you. Look for a role model you would like to emulate. What is it about that physician that you admire? Is it their research? Their bedside manner? Their critical thinking skills? You will naturally gravitate toward a particular physician so build on that relationship. If you are younger in your career, seek additional responsibilities and have them get to know you better. Most importantly, if you feel that you have a connection with them, ask more questions.
Learn about your mentor’s path. What made them choose medicine? What made them choose a particular specialty. Likely they may have similar questions and challenges you may be facing. Be open with your potential mentor and express your interest in being mentored. They may say no but more likely than not, they will be happy to mentor you.
Physicians naturally want to help people and given the opportunity, the large majority of physicians will be happy to mentor a junior colleague.
Resources
4. Don’t Ignore It
According to the Anxiety and Depression Association of America, women are twice as likely than men to suffer generalized anxiety disorder and panic disorders. Dr. Cynthia Chapman, PsyD, a clinical psychologist specializing in anxiety disorders, mentions that “Being a really ‘nice’ person and a high achiever may predispose [someone] to anxiety. They put other people’s needs first, put their needs on the back burner, and have a perfectionist list of ‘shoulds’ and ‘have-to-dos,’ writes Varci Vartanian, in her article for The Muse.
Also, seek the help that you need and deserve. Being diagnosed with anxiety is not a failure as many physicians may feel. I understand the hesitation that many physicians have with being diagnosed with a mental health diagnosis but this is critical to your life. Don’t delay this. Seek the care that you need.
Dr. Pamela Wible, physician, TED Speaker, and activist on preventing physician suicides has become a leading voice on this topic. In her most recent closing keynote at Psych Congress 2019, she reveals the results of her 7-year study looking at more than 1300 physician suicides.
More importantly, she is leading the charge in removing some barriers for the physician seeking mental health care. She offers 3 simple solutions to begin this:
- Remove Mental Health Questions from Medical Licensing Boards and replace with current impairment questions such as “Do you currently have a condition that impairs your ability to practice medicine safely?”
- Encourage Nonpunitive, Confidential Care
- Share your story
Resources
It’s often said that a person’s strengths can also be his weakness. This rings true to physicians as well. By our very nature, we are empathetic, eager to help others and high achievers. In that, we can suffer from anxiety in the workplace which can derail our wellness and lead to physician burnout and ultimately the loss of the very things that drew us into medicine.
Be bold and honest with yourself. Know that you are not an imposter and that you exactly where you need to be. Grow in your personal and professional life. Join me on this journey. Together we can win at work and life. My mission is to give you the tools, resources and habits to do so.
I hope you enjoyed this podcast. I ask one thing from you. If the content I provide you helps you–helps you become a better version of you, then please share this with a colleague or friend. The share buttons are just below.
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Until next time, be good to yourself and each other.
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