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“The good news is that imposter syndrome can be quieted with increased awareness and replacing negative internal messages with positive ones. In our work together, I helped Sheila identify the voices, understand the positive role the voices fill (and there is always a positive or protective role), and find specific mechanisms for turning down the volume.
Imposter syndrome may crop up again, but she now has a toolkit to quiet the intrusive thoughts and move ahead with confidence. Not only is Sheila now waking up without dread, she’s explored several career paths and settled on one that she’s excited about.
You don’t need to stay imprisoned in the dank dungeon of imposter syndrome. With the right tools, freedom is possible. Think of all you can accomplish, and how much lighter you will feel, when a more positive set of voices fills your head.”
Here’s a questionnaire to assess imposter syndrome.
Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon.
She shares her story and discusses her KevinMD article, “Solving imposter syndrome in physicians.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Diane Shannon. She is an internal medicine physician and a physician coach. She wrote the KevinMD article “Solving imposter syndrome in physicians.” Diane, welcome to the show.
Diane W. Shannon: Thank you so much, Kevin. It’s a pleasure to be here.
Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?
Diane W. Shannon: Yes. So I started off in primary care. I only practiced for about three years and then just knew I needed to leave, and at the time I couldn’t have articulated exactly why. Years later I realized it was burnout, but at the time I didn’t know that. And I transitioned into writing, and I was a health care writer for 20-plus years, writing about the health care system, what’s wrong with it, how to fix it, patient safety, communication, all sorts of broad topics like that, health care policy.
And as part of that, once I realized it was burnout that I had experienced, I teamed up with another physician to do some research and write a book about how to prevent physician burnout. And after writing that book, the premise of it, or the broad conclusion, is that physician burnout is really driven by a lot of system factors. At the same time, I realized I wanted to do something to directly effect change, and I became a physician coach.
And that’s a little bit contradictory, to say, well, if it’s system problems, how can you help individuals? But what I found is that it’s a both-and situation. While we can advocate, and need to advocate, for system change, there are steps that individuals can take that really affect their daily life experience.
Kevin Pho: So from your years of writing and researching, what are some of the specific system failures that lead physicians to burnout?
Diane W. Shannon: Well, I think a huge one is the lack of efficiency in the system. So processes that should work easily, like rooming a patient, going through, if you’re in an outpatient setting, having that whole process be smooth, having the data you need before you see the patient, having labs come back and they’ve been checked, or there’s been the proper follow-up. So all sorts of systems like that that really need to be in place, and in many situations are not in place. But there are others. There’s the organizational culture: How communicative and supportive is leadership? So there are a lot of factors that are involved that lead to physician burnout.
Kevin Pho: Now, why is that? We’ve been spending billions of dollars on the electronic medical record systems, and these things that you’ve described, they’ve been in existence for years. I have plenty of articles on my blog over the last years talking about the same things. Why haven’t they been addressed?
Diane W. Shannon: Well, I think it’s complicated. If you think about it, just taking the electronic health record, for example, when it was developed, suddenly there was this opportunity to add other features. So when we had paper records, as physicians it was pretty clear what we were doing, right? You’re doing the SOAP note, you are ordering, you’re communicating with other clinicians who are involved. That wasn’t attached to billing, coding, quality metrics. So as those things got added on, suddenly there are more and more tasks for the physician to do. And even if you have a super-efficient communication tool, electronic health record, there’s still an awful lot to do.
And I think that just the burden of that, and the fact that it often gets in the way of your time and relationship with the patient, which, I mean, that’s why we entered medicine, right? So it’s getting in the way of our having the meaning and purpose that drew us to the profession in the first place.
Kevin Pho: So let’s talk about your KevinMD article, and it’s titled “Solving imposter syndrome in physicians.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?
Diane W. Shannon: Yeah. So I decided to write it because I’ve been working on this research project. I interviewed 30 women physicians from across the country in different fields and asked them about their challenges, about what they want, and about what’s in the way. And one of the topics that came up pretty commonly was imposter syndrome, or self-doubt. And I’ve also been working with some one-on-one clients on this, and I’ve seen the effect it can have on a person to be mired in that self-doubt, and also the benefits of addressing it. And it really can be silenced.
And so in the article I talk about an example of one of my clients, where she woke up every day in dread, right? Because there were so many decisions to make during the day, little and big decisions, but every one felt impossible because she didn’t trust her judgment, right? So there’s that constant energy drain and stress. And so over time we looked into that and what are some of the messages that are driving that belief that she’s not competent. Then she began to change that, and to see other ways, and to adopt other, more positive ways of thinking about herself. And in time, by the end of our work together, she was not waking up in dread anymore, and she could make decisions. She wanted to make some decisions about her profession and where she wanted to go, and she was able to make those decisions and move ahead. So I could see, with her and with others, what a big difference it makes to address it.
In terms of what it is, it’s called imposter syndrome because you can feel like a fraud, but it can be more than that. It’s a sense that “I don’t have what it takes,” or “I don’t know enough,” “I don’t have the credentials,” when actually the person does and is very well qualified. But it’s that constant feeling that “I shouldn’t be here. Someone else would do a better job. I’m not going to do a great job at this.” And it really wears people down.
Kevin Pho: Why do you think physicians are more prone to imposter syndrome? Because after all, these are people who’ve gone to medical school, they’ve passed three steps of their boards, they’ve passed board exams, they’ve been through residency, and yet they feel the effects of imposter syndrome. Why do you think that is?
Diane W. Shannon: Well, I don’t know that physicians feel it more than others, but they definitely feel it. And one of the elements of imposter syndrome is no matter how much positive feedback you get, it doesn’t sink in. So despite the fact that physicians are doing so well, and obviously have, or they wouldn’t have made it into medical school, through medical school, through training, the positive feedback, getting that 100 on the test, doesn’t sink in somehow. It’s like a brief blip, and then it’s moving on to something else. And so I think that’s part of it.
And also, with the profession, the truth is that it’s easy to become perfectionistic because details matter, right? We’re dealing with life-and-death decisions often, and so it can be very easy, I think, to second-guess yourself.
Kevin Pho: So you talked about some ways to address this in the story that you gave. So if you have a physician who is feeling self-doubt and imposter syndrome, what are some techniques that you recommend they do to help that?
Diane W. Shannon: Right. Well, I think the first one is to understand that it is not an inherent part of you, because those beliefs, when we hold them for a while, even though they limit us and get in our way, they feel like the truth, right? They feel like they’re an inherent part of us. So first is separating yourself from that belief. And to do that, as you go through your day, observe those thoughts that are going through your head and begin to have that space that says, “OK, this voice is saying that. That doesn’t mean it’s true.”
And then there are a number of exercises that we go through that eventually help the person to identify their strengths and really own them, to own where they are strong, what talents they have, what skills, what their credentials are, and then to replace some of those negative thoughts with positive ones, ones that they really believe. And then there’s a series of practice exercises to help that sink in.
Kevin Pho: When you talk about imposter syndrome, do you see a generational difference? Does it primarily affect new trainees versus someone who’s been in practice for a while?
Diane W. Shannon: I think in general it does affect new trainees more, which makes sense. You’ve got this huge learning curve. When you’ve just finished training, you’ve had all this support, and suddenly you’re out on your own, in many fields, making some decisions. So you do have that natural self-doubt, which, as one of the interviewees pointed out, can be a good thing, right? To have some of that questioning of yourself is a good thing.
But there are others who could be in their 60s. I have one client who just retired, and she has struggled all along with imposter syndrome, and now is seeing it. She’s not seeing it at work, obviously, because she’s retired from that, but she’s seeing how it affects her interpersonal life as she makes decisions about volunteer opportunities. So it’s not necessarily a generational thing, but it is more common, I think, in younger people as they’re just starting out.
Kevin Pho: We’re talking to Diane Shannon. She’s an internal medicine physician and a physician coach, and she wrote the KevinMD article “Solving imposter syndrome in physicians.” And what are some symptoms that physicians may have that potentially could be imposter syndrome, and at what point should they seek coaching or therapy to help deal with that?
Diane W. Shannon: Right. Well, I’ll answer your second question first, which is, I think, at the point where it is really weighing on them and they’re seeing the negative consequences. So once it’s kind of like the pain point, once it becomes enough that you have the motivation to engage in coaching or to seek out counseling, that’s the point to do something.
I think in terms of the symptoms that you can see, a lot of it is just what’s going on in their heads. So the negative thoughts, the thoughts that say, “You can’t do this. Whatever comes next, you’re not going to be able to handle it. Those other people know better than you. Why would they invite you to speak at this conference? You better not take that opportunity.” So often it’ll be those sorts of things: You’re invited to do something, and you turn it down, or you don’t pursue it, because you’re having these thoughts that you can’t do it, that you’re not confident enough to do it.
So I think if physicians can be looking around for, is there evidence of that? Does any of this resonate? That’s the time to begin to think about, could this be going on? And there’s lots of reading material online about other definitions, or larger definitions than what I’ve given, that can help people. There’s also an online assessment that a psychologist created that can help try to get a sense of, if you have imposter syndrome, how severe is it?
Kevin Pho: Tell me something that you’ve been passionate about recently.
Diane W. Shannon: Well, this research project, honestly. I’ve been really interested in this. So interviewing these women physicians from different backgrounds, different fields, and at different points in their career, what I saw was the commonality of their experience. And what really struck me was that of the 30 that I interviewed, the 22 that have either a child at home or are caring for an elderly parent, all of them mentioned work-life balance spontaneously as a top challenge, and some of the eight who don’t have those caregiving responsibilities also mentioned that. So that was just widespread, this strain of trying to balance your life and have both home responsibilities and work responsibilities and be exceptional at both. So that really came out. And again, there was a lot of the commonality of imposter syndrome and self-doubt coming out so often.
And there were some very specific areas that they found challenging. One that I was surprised at how often it came up was breastfeeding when returning to work after leave, and the challenge of doing that. So I ended up writing a blog post about that, and in the course of that found that there is an organization, UCSF, that has specifically developed a program to support physicians and other clinicians when they’re returning to work after childbirth, to help them with lactation support.
Kevin Pho: And my final question: What’s your take-home message you want to leave with the KevinMD audience?
Diane W. Shannon: I think it’s that one thing I wish I’d known in the past was that it’s OK to ask for help, and not only to think it’s OK, but to feel it’s OK to ask for help. And so I wish in the past, when I was experiencing burnout, that I had reached out to colleagues, to a mentor, to a coach, to a counselor, and I didn’t. And I’m not saying that that would have solved the problem, or that it’ll solve the problems that physicians are experiencing, but I think there’s something to knowing that that’s an option that I think is really important.
Kevin Pho: Diane, thank you so much for sharing your time and insight, and thanks again for being on the show.
Diane W. Shannon: Thank you for having me.
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