Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

What is the narrative that you hear when faced with uncertainty?

Kara Pepper, MD
Physician
July 15, 2022
16 Shares
Share
Tweet
Share

The first week of my big attending job, I saw a patient with fever, sore throat, no cough, and tonsillar exudates. Well-trained to manage septic shock, but having no idea how to practice in a primary care clinic, I crafted a vast array of infectious and inflammatory diagnoses. With a quick glance, my senior partner said, “You don’t know that this is strep?” Flushed and wanting to hide, I thought, “I am such an idiot. I’m totally going to kill all my patients. This is a disaster.”

As predicted, the July 1st transition at every stage of medical training and practice is the signal for our inner impostor to arrive. I don’t care for the term “impostor syndrome” because it pathologizes (is that a word?) the normal human emotion of uncertainty. It is important to clarify some terminology:

Uncertainty: lack of sureness about someone or something. Totally normal, helpful emotion. For example, when a patient presents with a diagnosis that you don’t quite believe, uncertainty helps you recognize that you need to dig deeper for accuracy. Uncertainty in small doses keeps us curious.

Impostorism: uncertainty + shame.  Picture being a new intern or new attending, seeing a clinical presentation you don’t recognize, and telling yourself, “I have no idea what this is. I should know this. What is wrong with me? Everyone is going to know I have no idea what I’m doing.” Impostorism creates an erroneous story about our uncertainty. It tells us that we are not worthy, everyone will find out, and we will die of humiliation.

Systems of oppression: every person/institution of power that convinces you that you are not worthy and contributes to the impostor narrative. For example, “Women don’t belong in surgery,” “Natural hair is not professional,” and “These new docs just complain. They don’t work hard enough.” These forces, through bias and exclusion, provide a narrative that we internalize (and believe) that we are unworthy and unqualified, therefore we should not try or conform, and consequently, systems of power are not disrupted.

So, what are you telling yourself about uncertainty in this new PGY stage?

What is the narrative that you hear when faced with uncertainty?

Whose voice is telling you that?

Is that story true or is it an erroneous narrative that you internalized over time?

Ultimately, our critical impostors are simply trying to keep us safe from vulnerability, failure, and exposure. If they can just get loud, we will get small and quiet and safe, thereby limiting our potential, our impact, and our power.

We can anticipate impostorism. Predictably, impostorism shows up at times of uncertainty and new responsibilities – career transition points, new leadership roles, new social environments. Of course, when you transition on July 1st and gain new responsibilities, your inner impostor will be waiting to greet you. When you look at your shiny new ID badge and feel nervous about what lies ahead, and then your critic gets mouthy, you can think, “Oh, I knew you would be here.”

Please know that there is no threshold of success that will ever eliminate impostorism.   Michelle Obama famously described how her impostor followed her to the most powerful rooms in the world. This year, as a PGY-18, I found myself thinking, “These new docs know so much more than I do. I’m totally out of date.” What? Thanks, Impostor. Not true. Not helpful.

What can you do to silence your impostor?

1. Get a hype girl/hype man. (See how that patronizing terminology contributes to impostorism? No one calls men hype boys.) Fine, get a hype-team. Who are your cheerleaders who will celebrate your strengths and accomplishments? Ask them, “What am I great at? What am I known for? What is my superpower?” Know your strengths and own them. You are not great at everything, and that’s normal. Your impostor wants to reframe “your areas for growth” as “proof of unworthiness.” Don’t believe that hype.

2. Keep a victory list – an email folder or a list in your reminders work well. Write down your victories, big and small, and come back to them when you need proof of your accomplishments. I keep a drawer with letters from patients as a reminder that the work I do matters.

3. Know that your inner impostor is doing their job – to keep you safe. With compassion, remind yourself, “Thanks, brain. I know this is scary. I’m learning to profoundly have my own back, and I’m going to do this anyway.”

4. Attendings, model healthy uncertainty for your teams. Tell them when you don’t know the answer. Tell them it’s normal to feel exposed when they are new PGY-whatevers. Tell them that uncertainty is a superpower that helps them recognize when a diagnosis doesn’t seem right.

You can never avoid the totally normal feeling of uncertainty. You can, however, decide what you make it mean. Let uncertainty lead you toward the zebra you never thought you’d see. Then add that to your victory list.

Kara Pepper is an internal medicine physician and can be reached at her self-titled site, Physician Life Coach: Kara Pepper, MD.

Image credit: Shutterstock.com

Prev

Should your child try for medical school?

July 15, 2022 Kevin 1
…
Next

Abortion debates need to happen, but both sides need some ground rules

July 15, 2022 Kevin 10
…

Tagged as: Hospital-Based Medicine, Primary Care

Post navigation

< Previous Post
Should your child try for medical school?
Next Post >
Abortion debates need to happen, but both sides need some ground rules

More by Kara Pepper, MD

  • The story of a physician, after a year sober

    Kara Pepper, MD
  • Why you should not use BMI for your New Year’s resolution

    Kara Pepper, MD
  • Perfectionism is your nemesis, not your superpower

    Kara Pepper, MD

Related Posts

  • Communicating honestly with patients about uncertainty

    Kunal Shetty
  • In the face of uncertainty, choose hope over fear

    Shreya Kumar
  • A physician’s addiction to social media

    Amanda Xi, MD
  • What you need to hear at your medical school graduation

    Pranay Sinha, MD
  • How should physicians hear back about their diagnostic errors?

    Ashley Meyer, PhD and Hardeep Singh, MD, MPH
  • Issues faced by LGBTQ individuals in the operative setting

    Indraneel Prabhu

More in Physician

  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • The dark side of medicine: an urgent call to action against greed

    Don Gaede, MD
  • Dr. Glaucomflecken for president!

    Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Are We Losing the Personal Touch Because of the Way We Staff?
  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • Pediatric ICU Cases Becoming More Complex in Recent Years
  • New Combinations Promising in Advanced Urothelial Carcinoma
  • Embryo Development Delayed in Pregnancies Ending in Miscarriage

Meeting Coverage

  • Orismilast Clears Skin in Moderate-to-Severe Psoriasis
  • New Combinations Promising in Advanced Urothelial Carcinoma
  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Use of EMR Directive Tied to Reduced Opioid Prescribing After Spine Surgery
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...