“I am not going to apply for that position/promotion/raise because I know I am not qualified.”
“Why waste the time applying to give that presentation at a national meeting when I know I’m not going to get it.”
“How long will it be before people figure out I don’t deserve to be here and remove me?”
“I’m not surprised I wasn’t picked to do that course with my colleagues/professional friends…I’m not good enough, or liked enough, or obviously did not have something they were looking for or they would of chosen of me.”
“OMG! I can’t believe I approached my boss like that about how to fix our histology floater issue! What was I thinking? Obviously, I don’t know enough, or he/she would have asked me.”
Have you ever had any of these thoughts? All of these thoughts? Similarly veined thoughts? I certainly have and I can tell you so have many of my physician friends I’ve spoken with about it.
Self-Under-Appreciation Phenomenon: Different Name, Same Game
Imposter syndrome has been recognized for years and has been called by several different names including imposterism, imposter phenomenon, and fraud syndrome to name a few. In recent years, it has been highlighted for its prevalence in high achievers in general, and in medicine specifically. Imposter Syndrome is a misnomer, because it is not a syndrome, disease, or even a medical condition. In fact, if you have Imposter Syndrome you aren’t actually an Imposter.
A better name proposed by Dr. Jennifer Hunt’s in her recent book Unlocking the Authentic Self (highly recommended, no financial interest) is "Self-Under-Appreciation Phenomenon”. The concept is that many professionals, physicians included, consistently under-value and under-appreciate their own skills, talents, and value, often at odds with the actual evidence to the contrary. It is interesting to note that being as adaptable and successful as we are, we often manage to hide these thoughts and feelings from even our closest friends and we usually don’t realize the detrimental effects these negative beliefs can have on our professional and personal lives, not to mention our mental well-being. Dr. Hunt takes 200 pages to help address these issues and how to work to alleviate them in ourselves. However, I have around 1,000 words. Needless to say, this will be a high-level overview. I encourage all of you to read more and explore your own self-depreciation habits and evaluate their validity or lack thereof. It will make you a happier person and more successful as well.
Normal Self Doubt verses Extreme Self Criticism
First and foremost, it’s normal to experience self-doubt once in a while, to question your competence or worry you are in over your head, or criticize your actions after making a mistake. These are part of the healthy adaptations that allow us to learn and grow and help prevent overconfidence. But it’s how you use them, how often you use them, and how truthful are they that can become a problem. If your self-criticism becomes pervasive or incapacitating or prevents you from pursuing a new position or endeavor, these thoughts are no longer helping keep you grounded, they are holding you back and preventing you from getting things you may truly deserve and being happy with where you are/what you have.
We have been talking about people who self-depreciate, but do you know anyone who over-appreciates themselves? That colleague who thinks they are better than they are at diagnosing, teaching, or mentoring. Humans are notorious for not being able to objectively review themselves and it goes both ways. There is definitely a spectrum of appreciation, if you will. That is why feedback is so important (at all levels) and having a growth mindset is critical…but that’s a talk for another day. It’s interesting to know that the most skilled and competent people often under-estimate themselves and those that overestimate their abilities are average at best. It’s important to note though, that studies have shown that working on your imposter syndrome will not turn you into one of those people. We don’t go from self-appreciation to blindly ignoring our faults and developing narcissistic personality disorder. So rest assured, you can be free of some of your self-doubts and be more fulfilled at work and in life without fear of becoming an insufferable git.
Women Really Do Suffer More
As a woman, I feel it would be remiss for me not to mention that studies have shown that Imposter Syndrome has been shown to be much more prevalent in women than men. This is not to say men do not have these thoughts and feelings ever, or that they are not ever held back by them. But objective studies have shown that men are more likely to be the over-estimators, not the self-doubters. For example, they are significantly more likely to apply for a position they are only partially qualified for, where women won’t apply unless they meet all the requirements; men are more likely to ask for promotions and raises even if the data shows they are not as productive or engaged, and men more often evaluate themselves higher than others evaluate them. This does not apply to an individual man any more than the classic imposter syndrome does not apply to an individual woman, but on average, by statistics / percentages, women suffer more from self-doubt than men. I think this is important for women and men alike to be aware of so that we can all do our part to try to counteract the negative consequences. When everyone in our department is functioning at their highest and happiest it is best for us all.
You Are Not Broken
People with imposter syndrome are not broken and we don’t need to be fixed. This article is not meant to make anyone feel bad or point out how "messed-up" your thinking is. It is meant to help people recognize where their thoughts might be more of a hindrance than an advantage and to bring to light that there are steps you can take to try to mitigate these thoughts. These tips and tricks are too much for a short white paper (I refer you again to Dr. Hunt’s book among others, articles, Ted talks, and podcasts). If you feel like you are constantly down on yourself, if you’ve talked yourself out of applying for something you really wanted, if you’ve worried you are going to be ‘discovered’ any day for the fraud you believe you are…then I implore you to do more diving into Imposter Syndrome and ways to lessen the effects. You will be happier and feel more fulfilled and you will thank yourself for it.
Dr. Riddle is a senior pathologist for Ruffolo, Hooper, and Associates, providing services at Tampa General Hospital, the academic center for the University of South Florida (USF) Health Morsani College of Medicine, where she is also the pathology residency site director. There, she does general anatomic pathology with a focus in bone and soft tissue, neuropathology, and dermatopathology. She is also associate professor, associate residency program director, and program research liaison for the USF Health Department of Pathology and Cell Biology.
Heavily involved in organized medicine, Dr. Riddle is active within the CAP, the American Medical Association, the United States and Canadian Academy of Pathology, and her state pathology and medical societies. She has a special interest in high reliability medicine and creating a culture of quality and patient safety. Dr. Riddle was selected for the American Society for Clinical Pathology’s 2018 40 under Forty “Top Five” and Pathologist Magazine’s “Power List.” In 2021 she was honored with the CAP Resident Advocate Award.