The Dunning-kruger effect is well known in psychology as a type of cognitive bias that links confidence and competence graphically. In short, overconfidence is rooted in stupidity. The graph depicts the stages in which knowledge and wisdom is acquired and the self-realization of our own shortfalls.
I think if anywhere, the Duning-Kruger effect is so important in clinical medicine. By studying and understanding where along the spectrum we lie, we realise our gaps and aim to build on them. Ego and arrogance take a backseat and allow introspection and growth to take over.
My time as doctor has given me the opportunity to meet people in various stages of the curve. Some people (younger and fresher) appear to be in the beginning stages, some set up permanent camp on Mount stupid while a select few are guru’s in their fields. The delicate balance of confidence-competence-humility is so tricky and yet I’ve met tons of doctors who have aced it. I personally feel I am lingering in the middle of the curve, trying my best to reach the wisdom of the plateau.
Imposter syndrome is common in all fields but more so significant in medicine. Let me tell you why. Doctors are extremely territorial beings. We chose our niche and protect it so fiercely.
Doctors take things very personally, that’s a fact. We spend our lives trying to learn the art and science of medicine, dedicating eons and lifetimes. Our knowledge and skill is all we have. We are the product, the service and the return on investment.
No fancy gadgets, equipment or machines matter if you don’t know the basics of clinical medicine. Theres just no substitute for the humanly touch of a doctor. And when people tell you you’re wrong, it hurts. Some people choose to self reflect, learn and be better while others chose not to. But either way the process is often a painful one.
If my time in clinical medicine has taught me one thing, its that sometimes (mostly) things don’t pan out as smoothly as one hopes. As much as we doctors love standing by the bedside, engaged in deep discussions and problem-solving, making endless notes and plans on ‘history and progress’ sheets, its a very rare situation when those plans proceed as wanted.
As a fresh-neck doctor, I would be so agitated when plans didn’t work out and patients began complicating in front of my myopic eyes whilst I stood by and observe helplessly. The complications would send me into a panic for obvious reasons. Complicated patients mean complicated interventions, tons of extra time, effort and energy, and in the end, poorer outcomes and a fat slap on the cheek for all the work you’ve tried to do for the patient.
During the era of 2018, I had lost my mojo in a bad way. Its a difficult concept to explain to a non-medic. Everything i would attempt to do, seemed to go wrong. I was in a bad head space, mentally and physically burnt out. I was failing at the simplest of procedures and proceeded to mentally thrash myself thereafter. I dreaded waking up and going to work because I felt as useless as indicators on a BMW.
“You can’t even put up an IV line in one go”
“And Look at those bulging veins!”
“You can’t even fight for an ultrasound for the patient!”
“You’re missing simple diagnoses”
“You’re making bad plans”
In short, I was defeated. My morale had reached and all time low and I could feel its negative effects in every thing I attempted to do. I would look around me and intentionally see confident, experienced and competent doctors who fail at nothing. Comparison surely is a thief of joy. How could I possibly compare my skills to a doctor who has been in practice for 10 years? Thats Ludacris.
I told myself I had completed internship and was in the middle of community service. I had thought the worst of my growing pains was over, yet there they were all over again. Manifesting as pure failure and self perceived incompetence.
The negativity and breeding of complicated patients sent me wandering into a toxic waste ground of self-doubt. Looking back, I realise i had allowed imposter syndrome to define me.
I convinced myself I didn’t deserve to occupy the space I was in, I took my failures (everyone has them every single day) and used it as a dagger to my own self esteem. The work I grew to love became a tiring chore and I began to resent it.
I eventually recovered but It took me a long while, alot of mental effort and a tribe of supportive people to help me climb out of the hole of self-doubt. A big part of that tribe, were patients.
The thing about medicine is the moment you let self doubt creep up on you, you automatically make things significantly worse for yourself. Your mind starts revving into 6th gear, you’re overthinking everything, doubting yourself, and the things that you know well, and used to excel at, quickly become your worst nightmare. Everything that goes wrong becomes your fault and you get sucked into this circle of doubt where you’re hunting for misfortunes to fuel your untrue notion.
“There, see. I was right. I cant do anything right, its all my fault”. The satisfaction of being right about your own incompetence turns into a cruel joke on yourself.
The years you spend trying to perfect the craft you’ve chosen, dissipate under the cloud of self-doubt.
I think every doctor experiences the pain of self-doubt but rarely share it with each other. Why would i want to expose my incompetence to my colleagues?
I know and feel stupid but I don’t want anyone else to know that too!
Medical personnel in general hold themselves to such inappropriately high standards, taking every failure as a personal attack on your knowledge and skill. Its easy to preach compartmentalization- the strict idea of “work stays at work” when youre not in the system. Work is not just work when work is life. That too, Your mothers, sisters, brothers, fathers, daughters life.
I have observed the sea of personalities in medicine. Despite the differences in people, one stark similarity stands out.. most doctors are addicted to some form of self punishment and abuse. Whether its holding yourself to impossible standards, perfectionism or idealism, its a life of chasing after ideas that end up being unreal. Its a matter of chasing, running, huffing, puffing, trying to outrun pathology, poverty, psychosocial downturns and reaource- deprivation. Its just a matter of who survives the rat race the longest, but in the end, something has to give. And most of the time, it’s you.
Poverty doesn’t ease. The mother who is unbooked, remains so for the next pregancy. The baby who has been abused, has a sibling who is malnourished. The number of beds may increase, but so do patient numbers. The HIV PCR’s don’t stop being positive. The number of taxis that need to be taken, don’t decrease.
The obstacles are infinite. But you are not. Your youthful years start fading. Your family stops asking you to come for weddings and funerals because you are always on call. Your nephews and nieces start recognizing you as the absent aunty. You lose track of ages and birthdays over time. You implement life style changes that end up as failed diets, gym time and yoga sessions. Your stetoscope becomes heavier every day. You become slightly aggressive in your tone because the system has moulded you to be so. Until you look back at the choices you’ve made, and realise they are profoundly expensive ones. And the financial cost is not what I’m referring to. Medicine is expensive. It expends every aspect of your life to such an extent that you wake up one day, 40, grey and years have flown by.
I belive that The paradoxical irony of imposter syndrome proves in so many ways, that you do in fact deserve to be in those life-saving spaces. If you can humble yourself to an extent in which you question your motives, free from egotistical fallacies and arrogant ways, you’re already showing stark qualities of a person with good intention to serve.
By virtue of you questioning if you are “good enough”, makes you more than enough.
It shows strength of character and acknowledgment of the deep responsibility that lies in front of you. You’ve taken cognizance of the fact that lives are at stake and you have an active role in saving or losing them.
My only advice to whomever is reading this, is to not allow imposter syndrome to define you. You’re not an imposter, and if you truly believe you are, then we all are too. Settle into the depths of self reliance and confidence with gentle u-turns into self reflective moments.
Please Know this- It’s completely normal to dip your toes into the sea of self- doubt now and again,
don’t drown in it.