A Bad Combination – Low Self Esteem, Anxiety and Imposter Syndrome
Impostor syndrome (also known as impostor phenomenon or fraud syndrome or the impostor experience) is a concept describing individuals who are marked by an inability to internalize their accomplishments and a persistent fear of being exposed as a “fraud”.
Before I begin writing anything, I would like to apologise to any of my professors and/or teachers who may see this and shake their head in outrage when they see I’ve used Wikipedia as a source.
Now, to the actual blog post.
Imposter syndrome. This is perhaps the most common thing that the majority of my Medical Student colleagues are feeling. For me, being on my first clinical placement, I end up feeling as though I know absolutely nothing. A lot of my time is spent thinking: “Do I really belong here?” This then progresses to: “I know absolutely nothing; what’s the point?” Eventually, that ends up progressing to: “Why on Earth did I decide to do Medicine?”
Unfortunately, having anxiety on top of that is not helpful. I have talked many times about the clouding of my vision that happens with anxiety. Then, low self-esteem makes it even worse. All it ends up doing is makes me put myself down. This further exacerbates the feeling that I don’t belong.
But why do I feel as though I am a ‘fraud’?
Feeling useless on the wards
As Medical Students, there is not much use that we have on the wards. Well, third year medical students that is – the fifth an sixth years who I have seen around seem so much more useful. Essentially, I feel like a mere parasite in the hospital. I am not there to do much to help out but rather, I am there simply for my own learning.
Many doctors are also more than aware of this. Sadly, it leads to many of them ignoring us or in some cases, them frankly telling us to just go away. Then my anxiety kicks in. If I don’t stay on the wards and learn, will I forever be doomed to be like this and end up becoming a useless doctor? What if me not being on the wards on this very day means I miss something that will end up having very bad consequences on my patients in the future? It is all, of course, completely irrational and simply me catastrophising.
But then this makes my self esteem lower. Why did this or that doctor tell me to go away? What is it about me that makes me very useless on this ward? Why can’t I simply be of more use?
Am I a fraud to be here in the first place?
Trying to figure out what’s wrong with a patient
Sometimes when the ward round isn’t that busy, I am asked to go and take a history from a patient. Often, I will spend a lot of time with the patient trying to work out what’s wrong with them. Far too long, in fact, to the point that some of the staff end up getting annoyed.
Then, the consultant will come up to me and ask me to present. I’ll start of: “I took a history from an x year old gentleman who presented with chest pain” and then go from there.
Then the conversation goes:
Consultant: “OK, what about their risks of coronary heart disease?”
Consultant: “What is their cholesterol intake like?”
Me: “Erm…I’m sorry, I didn’t ask.”
Consultant: “OK, what about their physical activity?”
Me: “Erm…I don’t know.”
Consultant: “Mmm. Do they have a history of diabetes maybe?”
Me: “Yeah, maybe.”
Consultant: “Oh, so you didn’t ask?”
And so on. I end up asking lots of questions in my already too-long histories but still manage to forget asking all of the important stuff. Then, it’s the consultant’s turn to go and speak to the patients. Three minutes later after asking only 2 questions, he goes: “Ah ha! This is what it is!”
I’m left standing in the background rather foolishly.
OK, to be fair, I am slowly getting better at this.
I was poking and prodding a patient, trying to get bloods from him. The first bottle filled perfectly, but the others were not filling at all. It was he fourth time that I had stuck a needle into this poor patient’s arm. From the corner of my eye, I could see the patient’s family shaking their head slowly and whispering. I tried to ignore it.
“I’m so sorry, Mr X,” I said. “But I think I’m going to have to try again.”
“What, for the sixth time?” Mr X asked angrily. He was very entitled to feel angry.
“Erm…yes,” I said.
Mr X sighed and I tried to palpate a vein. I couldn’t feel any, however, so said that I would go and find someone else to help me. The nurse who I brought in was hardly happy to be disturbed on her busy shift and, after seeing all the plasters on Mr X’s hand, proceeded to scold me by saying: “Oh now look what you’ve done, all the good veins will be gone!”
Mr X and his family seemed very satisfied that I had been scolded. Again, fair play to them – I had, after all, just stuck a needle into him many times without much success.
Eventually, the nurse managed to extract blood. Suddenly, I was feeling rather sheepish again. The patients and the nurses must have thought that I was extremely incompetent. My self esteem was once again beginning to decline. And, once again, I thought to myself: Why am I even here?
But you’re new on the wards!
Logically, saying that does make a lot of sense. I am still very new so perhaps I am putting unfair pressure on myself. That seems to be the case in general with anxiety or low self esteem, however. No matter how much we try, we always seem to manage to catastrophise in one way or another and make ourselves out to be much worse than we actually are. Thankfully, I do manage to eventually talk myself out of it, for which I can thank my psychologist for all the techniques they told me.
What helps me feel better?
There are a few things which I have learnt which can help. As with most people, however, I am a bit of a hypocrite when I list these things. Most of these things I am still learning to do myself but when I can manage to pull them off, it does help.
- Talking to someone who I trust about how I feel. I am lucky that there are a few people on my firm who are always happy to listen to me and help. They end up giving me a lot of praise for when something does end up going right, which is always welcome!
- Taking a step back and just putting things into perspective.
- Talking to my CPN and psychiatrist. After all, they too were once in my position as a healthcare student so can put things into perspective.
- Talking to a nice senior (i.e. everyone for me!) about how I’m feeling. Often, they share their experiences and make me feel as though I’m not alone. The fact that a senior felt like that before too is helpful in that it reminds me that I’m not uniquely bad. Most people were at my stage.
- Stopping the cycle. We are going very much into CBT here but for anyone who has gone though it, they’ll know what I mean (trying to contemplate more on my feelings and thoughts before they impact other things)
Medicine is a team game. Reading the list above, a lot of what helps me is simply talking to others who I feel are trustworthy.