‘I thought it was just me’: Registrars and impostor syndrome

Evelyn Lewin

23/01/2020 4:14:09 PM

Feeling like a fraud is common for general practice registrars, but the issue is often shrouded in secrecy.

Young doctor checking notes
Some registrars get so overwhelmed they spend all night going over their notes, according to researcher Hugh Kearns.

‘I have no idea what’s going on.’
‘Maybe I’m not very good. I can’t do this.’
‘I feel like an impostor.’
These are the kinds of statements Mr Hugh Kearns, a researcher at Flinders University, has become used to hearing from general practice registrars.
The author of The Imposter Syndrome, Mr Kearns runs workshops for registrars, during which he asks the training doctors whether they can relate to feeling like an impostor.
That is, whether they have ever felt like a fake and have been worried people will discover that, even though there is no evidence to suggest it, they are a fraud.  
When he asks that question, every single registrar admits to having such feelings.
While the responses do not surprise Mr Kearns, he is always amazed at how much solace the young doctors gain when they hear their colleagues to admit to sharing such thoughts.
‘They all give a huge sigh of relief when they realise everybody else is feeling the same thing,’ he told newsGP.
‘[They say], “I thought it was just me”.’
Mr Kearns is always pleased to see registrars share these feelings.
‘Because the interesting thing about the impostor syndrome is that it’s a secret,’ he said.
‘You can’t really ever put your hand up and say, “I feel like an impostor”, because you’re worried that [other people] are going to say, “Yep, we were thinking the same thing [about you] ourselves”.
‘And you’re worried you’re going to be found out because you can’t admit it.
‘So when you have a whole room of [registrars], 30 of them, going, “I feel like that”, it’s usually very relieving for them to realise everyone is the same.’
Admitting to feeling like a fake does not mean there is anything wrong with those who feel that way.
‘It’s really normal,’ Mr Kearns said. ‘Almost everybody experiences impostor syndrome at some point’.

Researcher Hugh Kearns says impostor syndrome is extremely common in general practice registrars.

While the issue can affect anybody, it is particularly prevalent among registrars for a number of reasons.
Mr Kearns believes that when a patient presents to a registrar, they are aware the patient thinks of them as a ‘real doctor’ who ‘knows everything’.
‘And of course this poor registrar is thinking, “I have no idea what’s going on… I hope I can work this out”,’ he said.
‘They have to look like they’re confident, of course, so the patient can feel good about them, but they’re thinking, “Maybe, I won’t know [what to do]”.’
Working alone in a consulting room can exacerbate such feelings.
‘Being a GP, or registrar, is very private,’ Mr Kearns said. ‘You’re sitting in a room with this patient, no one else knows what’s going on, so you don’t really know if you got it right or not. You’re not quite sure if someone else would have done this differently.’
That problem is compounded when a registrar discusses patients with their supervisor, inevitable comparing themselves to the way their supervisor would manage them.
‘That will again lead to some of those doubts like, “Maybe I’m not very good. I can’t do this”,’ Mr Kearns said.
One of the reasons registrars are particularly prone to impostor syndrome is the fact doctors are often high achievers and perfectionists, both characteristics that can exacerbate such feelings.
An although this is a common issue, Mr Kearns warns it can interfere with functioning as a practitioner.
‘I’ve come across registrars who have decided not to go on with their training to become a GP because they’ve become so paralysed by the worries and fears and doubts,’ he said.
He recalls one registrar who was so overwhelmed with feelings of being an impostor that it affected her career and her mental health.
‘She would spend hours rechecking her notes, going over everything. She spent all night going over her cases,’ he said.
She then became anxious and depressed.
‘So it can affect your mental health,’ he said.
While Mr Kearns said there are many reasons general practice registrars in particular can struggle with feelings of being an impostor, there is no quick fix. However, being kinder to yourself can help.
‘[Tell yourself], “I’m not meant to know everything. I’ll do the best I can. Sometimes things go wrong and that’s okay”,’ he said.
If such thoughts become overwhelming, Mr Kearns recommends seeing a psychologist or counsellor for a more objective opinion.
But for most registrars, simply becoming aware of how common it is for others to share such thoughts is helpful, Mr Kearns said. In fact, he is passionate about talking about this topic in training GPs for that very reason.
‘Because one of the ways it becomes difficult for people is the secrecy. You think you’re the only one [who feels that way],’ he said.
‘Everybody else looks confident. You look at all the other people and they’re all smiling and happy and looking like they know what they’re doing, but inside they feel the same as you.
‘[When] everybody is aware of it, you can fess up and say, “I feel like that, too”.
‘And that helps. You realise it’s not just you. It’s normal.’
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Dr Marshall Francis Antony Donnelly   24/01/2020 8:53:58 AM

This is an extremely common feeling amongst
Training registrars and is also common amongst practicing GP’s also

Dr Dharminder Jit Singh   24/01/2020 10:16:04 AM

I had the exact same feelings at times. I guess it stems from believing that patients expect their doctors to know everything. It is reassuring to know that I am not the only one.

Dr Diana Domenica Sampson   26/01/2020 10:28:16 AM

I am writing down those helpful affirmations and make sure to discuss with our registrar. I think it also affects GPs.

Dr Nicole Jayne Higgins   27/01/2020 7:26:20 AM

This is common amongst all doctors as we transition through our various career paths. For doctors in training this is even more so.
The Imposter Syndrome came out of research in the late 1970's where it was found that amongst high achieving women there was this sense of 'fraud' - they didn't deserve to be there. Further research has shown that it crosses gender and culture and is a common experience for many.
I still have moments of feeling like an accidental tourist in my medical career. It is what keeps me humble and on my toes.