Ever feel like you don’t belong? Like, at any minute, people are going to find out that you’re not as smart or as accomplished as you appear? That your successes are undeserved or illegitimate? That’s Imposter Syndrome thinking. And if you’ve struggled with it, know that it’s more common than you may realize.

The inability to internalize achievements is one, if not the main, source of imposter syndrome. It is as though, despite external, measurable success, a person is unable to shake off feelings of worry, stress and inadequacy. Cognitive dissonance develops between what is true and how a person feels about it. And therein lies the key. It all comes down to how we think. Fortunately, this is not a syndrome in the sense of something that is fixed. It is a phenomenon, and therefore, can be changed. I know. I’ve lived it. And I’ve written a FREE Ditching Imposter Syndrome workbook for you about it. (Available on my website). But first, let’s talk.

“The problem with impostor syndrome or impostor syndrome thinking is that the experience of doing well at something doesn’t change your beliefs. And often the more you accomplish, the more you feel like a fraud. It's as though you can't internalize your experience of success.”  – Dr. Sara Dill

What You’ll Learn

• Defining Imposter Syndrome (aka Imposter Phenomenon)

• Signs and characteristics of Imposter Syndrome Thinking

• The cost of Imposter Syndrome Thinking

• Why is it so common?

• 5 steps to permanently ditch Imposter Syndrome Thinking 

Contact Info and Recommended Resources

• VeryWell Mind: What is Imposter Syndrome?
• Get Dr. Sara Dill’s FREE Ditching Imposter Syndrome workbook: saradill.com/pl/2147578172 
• Get the book “The Doctor Dilemma: How to Quit Being Miserable Without Quitting Medicine” by Dr. Sara Dill 
• Want to catch up on episodes of Stress-Less Physician?   Links and Show Notes are all housed here.

Connect with Sara Dill, MD, The Doctor’s Coach

• Website: saradill.com
• Work with me: saradill.com/coaching
• Email: sara@saradill.com
• Get a FREE consultation with Sara! Sign up here: saradill.com/schedule
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Want to know more about me and how I learned to stress less? I recorded a trailer for my podcast that includes some of these details. I’ve also included a short bio below. 

Meet Dr. Sara Dill

Welcome to my podcast, Stress-Less Physician. I’m Sara Dill, MD, board-certified dermatologist and pediatric dermatologist. Like nearly all physicians, I used to believe the way to be a good and successful doctor was to work hard, always say yes, and put patients (and everyone else) first. I was successful following that pattern but (as is typically the case) I felt perpetually stressed out, overworked and unhappy. 

Compelled by the truth that I’d worked too long and hard to simply accept stress as inevitable, I was determined to find the answer. In order to fully devote myself to discovering a solution, I took a sabbatical from my practice and studied life coaching. I completed two life coach training programs, numerous other courses, read 100s of books, and used coaching to transform my own relationship to work.

What I learned was that stress is a symptom. It all has less to do with the actual hours you work than with your thoughts about your work.

With this knowledge, I took control of my life. So can you! But you don't have to take years or go on sabbatical. I did it so you don't have to. And I’m here to help.

I’m Dr. Sara Dill, and this is the Stressless Physician podcast, episode number five. Welcome to the Stressless Physician podcast. I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work, and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feel good to you, you are in the right place.

Hey, everyone, how are you doing? What is going on? I am having a very productive weekend. Those of you who know me, know I also like to have lots of downtime and relax. But this weekend, I am recording a couple podcasts and really enjoying it. Although I also have a puppy, Teddy, he just turned five months old. And let me say that having a puppy does not lend itself to being more productive. He is adorable, but does not really understand why silence is so necessary for podcasting. And I swear the crows know exactly when I start recording and they just start making quite the racket. So hopefully, you can’t hear either Teddy, or the crows.

So today, I wanted to talk about imposter syndrome thinking. This is something that comes up a lot in my coaching practice. And this is something that I really struggled with and dealt with, as well. So, this is feeling like maybe you don’t belong. Have you ever felt like you don’t belong? Or maybe your friends or colleagues were somehow going to realize that you weren’t as smart as you seemed, somehow you were fooling everyone and in some weird way, a fraud. And also that maybe you didn’t really earn or deserve your accomplishments, your career, your achievements. That’s really what we’re going to talk about.

So, this might come as a surprise to—I don’t know, maybe it will, maybe it won’t—to a lot of my friends and colleagues. But this was something I experienced for much of my life really, until I discovered coaching. I feel like when I think back to even elementary school and high school, certainly college, medical school, residency and my early practice years as an attendee and also as a fellow, I really often had these thoughts about somehow, not really earning my way there, somehow not really being quite as accomplished or smart as people thought I did, really worrying about not knowing enough and making mistakes.

So, I had a lot of anxiety, and a lot of worry. And of course, when you have a lot of those thoughts, generally we don’t broadcast those to other people, which I think is another problem with it. So this was really something that I think contributed to my burnout as well and my decision to take a sabbatical from practicing medicine 10 or 11 years ago, and it certainly contributed to my not really enjoying practicing dermatology. I was always second guessing myself and worried I was missing something and thinking about all the things that could go wrong, and comparing myself to other people, you know, comparing my internal experience to the external appearance of others, and that took so much energy and created so much stress and anxiety for me, that it really took a lot of the fun out of seeing patients.

And I do think that, you know, being a physician takes a lot of energy. And it takes so much more energy to be a physician and take care of patients and deal with all of the complications and permutations of that. And then when you’re always worried about making mistakes and not knowing enough and feeling like maybe you’re somehow not up to the job or that everyone else is doing it better, that can take so much more energy.

And this whole feeling and really state of being is of course, in spite of your actual accomplishments and in spite of the external metrics that you might think would help you feel competent, really. So, let’s define it a little bit better. So, imposter syndrome can be defined as a collection of feelings of inadequacy that are persistent, and may be pervasive despite concrete, factual evidence of success and accomplishment. So, people who experienced this have feelings of chronic self-doubt, and maybe a sense of intellectual inadequacy or even intellectual fraudulence that overrides any feelings of success or the external sort of proof of their competence. So, people, again, who have a lot of these kinds of thoughts seem unable to internalize their accomplishments, however successful they are in their field and however successful they are on paper. So typically, high achieving highly successful people often suffer from this. And so imposter syndrome really does not seem to equate with having low self-esteem or lack of self-confidence. It’s really sort of this mismatch between how you feel and how maybe your CV looks or your resume your list of accomplishments and achievements.

So this is just a habit of thinking thoughts that are really not serving you, that are all part of this imposter fraudulent feeling state. And as you probably know by now, I believe that we can absolutely change our patterns of thinking, and change our patterns of how we feel. So we are not stuck with having these imposter syndrome thoughts forever, really, I promise. I really don’t struggle with this anymore, which feels pretty much like a miracle, I have to say. I was trying to think about it when I was preparing for this podcast. And of course, every once in a while, I’ll get like a little random thought that pops up. Like, “I don’t know, maybe you don’t really know what you’re talking about or something.” And sometimes it’s true. I don’t know if anyone has this where you sort of spout off an opinion about something.

And then I often realize I actually don’t know what I’m talking about. This is not about medicine, or dermatology. Usually, it’s about sports or something which I fully confess that I don’t know anything about. But I really generally on a daily basis, don’t struggle with feeling like I’m not smart enough, or I don’t know enough, or that I didn’t earn my way to my position. And I’m really not that worried about making mistakes a lot. I mean, of course, I don’t like making mistakes. But it’s not something that comes up a lot. So I’m going to talk a little bit later in this podcast about how to start to shift these thought patterns, if this is something that resonates with you, and that you also experience a lot of but for now, I want to talk a little bit more about this imposter phenomenon and why it’s such a big deal to experience it.

So again, imposter syndrome or imposter phenomenon thinking is loosely defined, or more loosely defined as just doubting your abilities and feeling like a fraud. And it can be helpful to know that it seems to disproportionately affect high-achieving people who find it difficult to accept their accomplishments. So, if you have it, chances are you actually are high-achieving, even if you don’t feel high-achieving so I’m just going to mention that and put that in your brain.

So, you might worry that you could be found out as a friend. Even though there is nothing untrue, or fraudulent about you, or your accomplishments, so you might know rationally or intellectually that you have achieved X, Y, or Z, but you don’t feel like it’s true, or maybe you don’t feel like it’s deserved, or that somehow, it’s not legitimate in some way, even though there’s nothing fraudulent or fake about it, that’s the weird thing. It’s like a computer programming bug or an error. That’s how I like to think about it, a thought error, a misfire of some neurons. No big deal in some ways, and yet a huge deal because of its consequences in your life.

So again, it’s this cognitive dissonance between your concrete, factual, on-paper accomplishments, and how you feel inside, how you feel about them, and how you feel about yourself. This sort of pervasive or persistent feeling, again, that you’re unqualified or not smart enough, or don’t know what you’re doing, or some variation on that. We all probably have a different flavor of this kind of imposter syndrome thinking. And so the problem with imposter syndrome thinking is that the experience of doing well at something doesn’t change your beliefs. And often, the more you accomplish, the more you feel like a fraud. It’s as though you can’t really internalize your experience of success.

This is why it didn’t matter that I graduated from Harvard with high honors, or that I got into medical school, and that I got into dermatology, it didn’t matter that I got accepted and graduated from Brown for my residency, and then went to UC San Diego for my peds derm fellowship. I seriously when I think about it, now, it sounds sort of silly, but I just really sort of thought I’d gotten lucky. Or maybe that I, I don’t know, that somehow, I wasn’t as smart as people thought I was. Even though I had accomplished all of that, you know, myself, it wasn’t, I didn’t lie, or cheat or do anything to get into those places. I mean, it was all legitimate and factual and true. It just felt somehow, like, again, I had lucked out or didn’t really fully deserve it or something like that. Which is hard to, it’s hard to explain, because it really doesn’t make sense in any factual way.

So I have a few questions you can ask yourself, if you think you might have imposter syndrome. Thinking and full disclosure, I got these online from a very interesting website. I really liked it called Very Well Mind. And then I added to them, so they are edited, but they are originally borrowed from there.

So, the first question is, do you worry excessively over even the smallest mistakes in your work or potential mistakes? Do you attribute your success and achievements to luck? Or to external factors? Are you very sensitive to even constructive or helpful criticism or feedback? Do you feel like you will somehow be found out as a phony or an adequate? Or that you don’t really know as much as people think you do? Do you downplay your own expertise, even in areas where you are genuinely more knowledgeable than others? Are you afraid that you won’t live up to others’ expectations or to your own expectations? So, some of the characteristics of imposter syndrome, thinking again, include attributing your success to external factors? So I thought maybe I’d gotten into Harvard because I came from a very, very small town, in which no one actually ever left California for school, let alone went to the East coasts or to Harvard. Also, another characteristic is an inability to realistically assess your competence in your skills. There’s a tendency to criticize one’s own performance. There’s fear that you won’t live up to expectations. Interestingly, sometimes this leads us to over achieve, or even to sabotage our own success, right, we sort of fulfill our own low expectations or fears.

Imposter syndrome is also characterized by self-doubt. And then sometimes what we do is we set very challenging goals, and then we feel disappointed when we fall short. We see it as a failure or maybe proof that maybe what we’re worried about or our feelings of inadequacy are actually justified.

So, let’s talk about why this is a problem. So first, it feels terrible, right? It’s not fun to go through life, or experience your career feeling like you don’t belong, feeling anxious, feeling worried about making a mistake or being found out to be inadequate. It’s not fun to be afraid that you won’t live up to expectations, and constantly doubting your abilities and your accomplishments. Constant self-doubt, is exhausting, who wants to have this as a constant source of stress running in the background, whatever you do, and it’s like you can’t over achieve your way out of it.

Imposter Syndrome thinking also costs you a lot. It can cost you financially in terms of burnout, in terms of leaving medicine. I mean, I took a sabbatical from practicing for several years, and that was a big financial hit. It can cost you in terms of not going after that promotion, or maybe a leadership role, and not going after whatever it is you dream of doing, whether it’s in medicine or in your personal life. Imposter Syndrome thinking has big consequences for doctors. And I would also say, maybe for your patients.

So negative experiences at work, like feeling anxious and stressed out all the time, I think, clearly contributes to burnout and to career dissatisfaction. And I would argue that it probably doesn’t make you a better doctor. Experiencing self-doubt and anxiety can cause you to take longer than maybe you need to with patience, it can contribute to running behind in clinic, to over ordering tests, to second guessing yourself, to over documentation, and then taking work home. All of that contributes to a lot of our burnout. And then just this worry, and fear again, can be quite draining. And so it can also cost you emotionally and personally. So, I just want to ask if you felt confident, if you felt competent and successful and worthy of everything you’ve accomplished, think how much time and energy you would have to put towards other things. What else would and could you do with that time and energy and confidence?

So, what causes this imposter syndrome tendency and thinking pattern? Why do some of us are most of us if the 70% figure is correct, experienced this at some point? So I went and did a little research. And many researchers associate this pattern of thinking, or really, I’m just going to call it misperception with a tendency or pattern of perfectionism, excessive anxiety and self-doubt. Others look at childhood experiences, parenting and attachment styles. There’s a lot of research, there’s a lot of hypotheses. But I think honestly, there’s not a lot of clarity and certainty. And I don’t necessarily find it helpful or useful to spend a lot of time on the why. Sometimes in personal growth or self-help, there’s so much time spent trying to understand why we are the way we are, or why we think the way we do or feel how we feel.

There’s so much time spent trying to understand the why or where patterns come from. But I don’t always think it’s helpful if you find it helpful for you. Great. But otherwise, I just sort of say, let’s assume that there are many factors and good reasons why we learned this or adopted it, or had a natural tendency to be this way. A lot of this was probably unconscious or subconscious. So, let’s just say good reasons why we are this way. And let’s focus on how to change it. That’s really what I’m interested in. So, if you Google it, you will find a lot of suggestions on how to get rid of it, or how to lessen it. There are even a few people who suggest that imposter syndrome feelings can possibly fuel more achievement, which they argue would then theoretically enhance your ability to believe in one’s accomplishments and skills. But that’s the point, external validation does not work permanently. You cannot achieve enough externally, to eradicate this misperception to eradicate your thought errors. That’s the whole problem. You can use external facts and external achievement temporarily, to sort of buffer your approval of yourself but eventually, if you have this tendency, you’re just going to sort of go back to those old thoughts. So, surprise, you have to start with your thinking, if you want to correct this.

So here are the five steps to permanently ditching your imposter syndrome patterns of thinking. So, the first step, what I want you to do is to identify and write down what are your thoughts about yourself now. I want you to start to eavesdrop on your brain. This can sometimes feel scary or painful. It can be sort of difficult. Sometimes we don’t really like to admit to ourselves that these are the thoughts we have about ourselves. You can keep this private. You don’t have to tell anyone else. But telling yourself the truth and putting it on paper is where you need to start. This is the important part.

And then I just want you to pick one of those thoughts. This is going to be your current thought. Maybe it might be something like “I’m not smart enough, or I don’t deserve to be here, wherever here is, or I don’t know what I’m doing. Could be any of those. Now, I’m going to ask you to jump ahead, jump ahead to the future, the future you and identify what would you like to believe about yourself, about your accomplishments, your abilities, your belonging, and your deserveability? I’m pretty sure that’s not a word, but I like it. Sadly, my sister is an English teacher and if she listens to this, she’s probably going to tell me that that’s absolutely not a word, but I like it. So, what do you want to believe about all of those,

As I discussed in an earlier episode on how to believe new things, sometimes I like to start by finding the opposite of my current thoughts. Sometimes, I call it my current sort of stinky thought, right? The thought that I would like to not believe. So if my original thought, right, my current thought is “I’m not smart enough,” the opposite would be “I am smart enough.” If my thought is “I don’t deserve to be here,” then the opposite becomes “I do deserve to be here.” Or if my thought was, “I don’t know what I’m doing”. That would then become “I do know what I’m doing”. So you get the picture, right, you’re going to flip it to the opposite.

It is very likely, like 100%, likely that this is not going to feel believable to you. That is totally normal. You’re used to thinking the opposite. So of course, it’s not going to feel believable. But you could just notice, would you like to be a person who believes that: “I’m smart enough? I deserve to be here. I do you know what I’m doing?” Any of those, whatever the flavor is for you. So, in any case, I want you to come up with a thought you wished you believed about yourself. For me, I often choose the opposite. But it can be anything, any thought that feels better. This is going to be your goal thought. This is going to be the thought that we’re going to work towards. So now you have your original current thought, and then you have your sort of intentional or goal thought.

And now step three, I want you to try to find some evidence, any little piece of evidence that your new goal thought could be true, or maybe even truer than your original thought. I’d actually like you to find two pieces of evidence, where there’s one piece of evidence there is to your brain is going to want to go back to the original thought. Just keep finding evidence, though. So, if your new thought is “I’m smart enough,” your evidence might be, for me, “I graduated with high honors from Harvard.” It might be “I’ve helped thousands of patients with their skin and most get better.” You get the picture. So, you can just find whatever piece of evidence feels true to you that you can find.

So that’s step three. Step four, is I want you to find a new thought. It’s probably not your goal thought—It’s probably not that big stretch thought, the opposite thought, or whatever it is—that feels believable and better than your original thought. You’re going to find a new thought that feels believable, and better than your original thought. So it might be “I’m maybe smart enough, or it’s possible, I’m smarter than I realize. Or I’m smarter than some people I know.” So these might not be pretty thoughts. I don’t know that I’d want to admit that. These are some of the thoughts, that I was practicing. But you can notice, do they feel better than your starting thought? Do they also feel believable? So you have to be able to believe them to really sort of work at changing your thoughts. So better and believable are your two metrics for this new thought. And you might just need to try out a bunch of different ones and see.

Often what will happen is we’ll find a thought that sounds good, and we think we believe it. And then when we test it out in the wild, when we’re out and about or going about our business and our brain offers as the old thought and we try to replace it with the new thought it doesn’t stick, and then you know that it was too big of a jump. You have to go back and come up with a much smaller sort of shift in your thinking. And that takes us down to step five. So, step five is practicing the new thought over and over again, putting it on a sticky note, putting it on your phone. Whenever your brain offers you the original “I’m not smart enough” thought. you catch yourself and you redirect to “It’s possible. I’m smarter than I realize. I seem to be smart enough. I’m smarter than some people I know,” whatever it is. And again, notice if it’s sort of working, right, if you can believe it in that moment, and if it feels better and helps you feel better about yourself. And then once that is your new normal thought, you do it again, you pick another better thought, and you keep moving closer to your goal thought.

So, this is something that is called the thought ladder, you can see where you just go up the rungs one by one, or sometimes it’s called a thought bridge, where you pick these little bridge thoughts that get you from one side to the other side of this sort of thought chasm—somehow, I think about it, you’re sort of going away from the thought you no longer want to believe, towards this new thought, and you need these little bridge thoughts. And sometimes the process can take a lot of time. And sometimes you can really shift your thoughts more quickly. It really varies. Sometimes we only need one or two bridge thoughts. And sometimes we need more, or one or two ladder thoughts, and sometimes we need more. But however long it takes, it is worth it. I would just offer that. That’s my thought. It’s totally worth it to do this work.

I do also think that simply knowing how common this is, especially in medicine can go a long way to helping alleviate some of the stress and anxiety you might be carrying around right now. When you can start to see it to spot it as just unhelpful and inaccurate patterns of thought that apparently 70% of your fellow physicians and fellow humans have likely experienced or are experiencing as well, you can start to believe that it is sort of normal, although unpleasant and unhelpful. And that having these thoughts doesn’t mean that there’s anything wrong with you. And that might start to already help you feel better than making it mean more negative stuff about yourself, right? Sometimes we make the fact that we’re having these thoughts in the first place mean that there’s something wrong with us.

So I often love to remind myself, that my thoughts in some ways aren’t personal, right? They don’t mean anything about me as a person. If my brain is generating 60,000 thoughts a day, who knows where a lot of these come from? Some of my thoughts are helpful, some are not helpful. We’re all stuck with this amazing human brain, and then no operating manual, right? It’s not like we got directions on how to use this brain. Our brain is amazing. We can think about our thinking and reflect on this and do all of the amazing things we do. But left to itself. It can be sort of like a toddler with a knife, or like my puppy. When he has his zoomies, I guess, I had to Google what they were, and goes crazy at night. It can be a little destructive and a little out of control, and a little painful. But coaching and the ability to change your thoughts is like learning how to upgrade your brain. We learn how to stop hurting ourselves with our own thinking. So I really hope that you can take advantage of these steps, maybe try them out. And let’s make the narrative in your head a little bit, or a lot more positive. Let all of us start believing that maybe we are amazing, just as we are. Why not? What do we have to lose?

So, on that note, go be amazing humans and take some time to do this work. If you are one of the many of us who have experienced imposter syndrome thinking. And if you need help, that’s what I’m here for. Send me an email or sign up for a complimentary consult call and let’s get you feeling better about yourself and all of your amazing accomplishments. I also made a worksheet for you and that link is in the show notes. Thanks for hanging out with me and I will talk to you next week.

If you are a busy practicing physician ready to start feeling less stressed, enjoy work more and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at Saradill.com. That’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.