When I was chief resident (many many years ago), I set myself up to be a sort of dorm mom, falling headlong and eagerly into one of the roles women leaders can take. On Fridays, for example, I would bring chocolates to the sign out room, and to make things more engaging, would come up with a few medical trivia questions.
One Friday, I selected three eponyms from a little book that I’d bought years before and wrote them on the board. I asked the residents if they knew any of them. Of course they didn’t. The practice of memorizing eponyms had been discouraged since 1974. Learning the name of a person who either “discovered” a physical exam finding or disease or the name of the person who suffered from it is not worth much more than Friday afternoon trivia fun although I must admit that these sorts of obscure things have always delighted me.
The use of eponyms, such as “Drummond’s sign,” a visible pulsation of the uvula in people who have aortic regurgitation, have been discouraged for a variety of reasons, including objections over their imprecision, lack of consistency across languages, ethical concerns when the person honored by the eponym engaged in racist or eugenic practices, and concerns about the cognitive load required to learn such arcane tidbits. (My friend and colleague, Dr. Alok Khorana, has made a poignant case for one exception that I’d encourage you to read if you’re interested.)
One of the third-year residents, whom I’ll call Dave, asked loudly (and somewhat obnoxiously as was his style), Yeah, but did you know that stuff ten minutes ago? No. No, I did not. And he knew it, and everyone else in the room knew it. Here’s the thing. I have to tell you that although I had just been called out for not knowing something and might have blushed and wanted to run, or freeze, or say, “Yes, yes I did,” I didn’t do any of those things. And most surprising, I did not feel like a failure, I did not feel like a fraud, and for the first time, I did not feel that I wasn’t the right person to have been chosen to be one of two chief residents.
That was the day that I saw imposter syndrome fade through my rear view mirror. Until then, I had felt that I was a physician under false pretenses. Someone had told me when I was an undergraduate student that, while I might get admitted to medical school, I wouldn’t make it through. I was told by various people that my grades in college and medical school were the result of my having “smart parents.: That I was at this medical center, in this role because I had a physician father who worked at the same hospital. Because I was “nice” and the faculty found me to be agreeable. And I knew that at any moment, I’d be found out and exposed for being, good God, average.
It’s funny, isn’t it, that thoughts of being an imposter arise when we have just achieved something wonderful, like being accepted into a college, like graduating from school, like getting a new job, or a promotion, or being selected for an honor? These types of accomplishments have been shown over and over again to cause a flare of an underlying condition.
The imposter syndrome, originally called the imposter phenomenon by psychologists Pauline Clance and Suzanne Imes in 1978, is a psychological experience that afflicts people who have achieved a great deal and yet fear being exposed as fraudulent despite evidence of their competence. As a side note, many people do prefer the original phenomenon, over syndrome, which sounds as if it’s a disorder.
I have written eleven books, but each time I think, “Uh oh, they’re going to find out now. I’ve run a game on everybody, and they’re going to find me out.”
Maya Angelou
Up to 80% of highly accomplished people, including medical professionals, live with imposter syndrome. There are actually no groups of people who are exempt. Originally described in high-achieving women, it’s since been found to affect people across genders, ages, professions, and racial groups. It is, however, more intense among women and minoritized groups. I’ll share my thoughts about why that’s the case in a second.
And the consequences are not trivial–the phenomenon is associated with anxiety, depression, low self-confidence, and burnout. We attribute our successes to luck or being in the right place at the right time rather than to our own abilities. We have a hard time taking feedback because such feedback, if positive, seems like proof we’ve fooled everyone, and if critical in any way, as further proof we don’t belong here. These feelings we have, these stories we tell ourselves, can lead to overworking, in which we raise the bar higher and higher, to our avoiding challenges from fear of failure. Or we may live lives of both overwork and avoidance.
So why did my not knowing those eponyms like the back of Smith’s hand (I just made that up) not cause a flare of imposter syndrome? And how did I shed these experiences for good? I’ve already told you that knowing eponyms is, despite my having an adorable little book of them in my desk drawer, not something we’re really expected to know. (For goodness sake, they’re not even on Jeopardy or the pub quiz at the Old Toad.)
Here’s how I put it together. I think the feelings we have about being an imposter are not merely about the fear of being found out as being deceptive. I think they arise because we don’t feel we belong.
I frequently hear people say, I don’t feel as if I belong. Or I don’t fit in. Or I’ll be asked to leave. If you’re told you don’t belong, that you won’t make it, that you’re there only because of luck, or because you’re a diversity hire, or because of your good genes, or because that was a good guess, or you’re othered or excluded or not seen and heard or interrupted or treated as if you’re less than a full-fledged whatever you are, you will feel as if you don’t belong. Many women and many minoritized people hear these very things over and over–it’s no wonder that the imposter phenomenon is more severe and exacts a greater cost.
For me, the absurdity of eponyms was just what I needed to see the absurdity of knowing everything. The thought that we belong only when we know everything or when we look like the way advertisements or old white men think we should look was so foolish that I have been able since that day to accept what I know and, the overwhelming not knowingness.
Does this mean I always feel I belong? Absolutely not. When people take credit for my idea or interrupt me or tell me that I’m “not the kind of person” who is good at such-and-such, or, and I kid you not, elbow me aside when I go to help someone who needs a doctor on a plane because they are a doctor and I must not be, I can feel small. But I wholeheartedly accept that I am not good at everything. I am good at exactly what I am good at. I know only what I know and nothing more…yet. I can always learn more and try new things and fail and still be a person of worth and value. Your dignity is your inherent worth or value. You don’t earn your dignity. You are a child of the Universe, no less than the trees and the stars. You belong here.
Photo credit: Photo by David Werbrouck on Unsplash
