Transcription:
Breaking Down Imposter Syndrome

Prakash Chandran (Host): You are listening to Pediatric Insights, Advances and Innovations with Children's Health. Imposter syndrome is a condition which causes an individual to doubt themselves and the significance of their achievements, regardless of their experience. It can affect physicians and professionals at all levels, driving them to hold themselves to sometimes impossible standards.

We have two experts here to discuss imposter syndrome today. And our first one is Dr. Preeti Sharma, Pediatric Pulmonologist at Children's Health, Co-director of the Cystic Fibrosis Care Center at Children's Health and UT Southwestern and Associate Professor of Pediatrics at UT Southwestern. Our second guest is Dr. Folashade Afolabi, Pediatric Pulmonologist at Children's Health and Assistant Professor at UT Southwestern. My name is Prakash Chandran. And Dr. Sharma and Dr. Afolabi, so good to have you both here today. Dr. Sharma, I would like to start with you. Can you just start with a high level description around what imposter syndrome is?

Preeti Sharma, MD (Guest): Of course. So imposter syndrome is this phenomenon, or syndrome in which people who are high-achieving often have this feeling or a psychological pattern where they doubt their skills and their talents. And they feel as though at some point they're going to be exposed as being a fraud, that they don't know as much as they thought they did and that they don't do as well as they thought they could. And it blends to kind of everything that they do in their daily practice or in their daily job.

Host: Yeah Dr. Afolabi, expand on that a little bit.

Folashade Afolabi, MD (Guest): I agree with that. And I feel that one important part of imposter syndrome is that it's a sense, a false belief oftentimes.

Host: So Dr. Afolabi you talked about it being a false belief. How common is imposter syndrome? And I'd also love for you to talk about some of the signs that you might be experiencing it.

Dr. Afolabi: So imposter syndrome is extremely common and everyone suffers from it at some point in time. But as far as signs, oftentimes it's anxiety, a feeling of discomfort. You're second guessing yourself. Those normal things that sometimes we, feel when we are just considering are we doing the right thing, but once it gets to a point where it turns into a cycle, is when we sometimes consider it more of an imposter syndrome. like I said before, these are things that everyone feels. These are things that everyone goes through all the time. So when you ask, how frequently is it? It's ubiquitous. It's everyone. No matter how old you are, what stage in life you are, how much you've achieved. It's seen in everyone and I read somewhere that there are people as preeminent as Sonia Sotomayar, who is a Supreme court justice. And she also experiences this and she's reported that she's experienced imposter syndrome in the past before as well. So it's everyone, it's all over the place. It's just when it gets to the point where you're having problems with actual functioning, that's when it's an issue.

Dr. Sharma: I think you made a great point that it happens to all of us. That's and particularly in healthcare, doubting yourself is sometimes important. Right. Am I doing the right thing? That's a really important question to ask when caring for patients. But your other really valid point is that it's when those feelings really affect your performance and you can't make decisions any longer, or you feel paralyzed in your ability to make decisions that need to be made or it's significantly more problematic.

Host: Dr. Sharma, I do want to unpack how imposter syndrome can affect performance. But one of the things that I wanted to address is it might sometimes feel like a slippery slope. I'll give you an example. When I first became a podcast host, I had no radio or podcasting experience and I had really serious imposter syndrome especially being a physician or in medicine, I imagine that sometimes it's difficult because it isn't always clear whether it's a false sense of security versus actually there might be some truth to what you're feeling. Dr. Sharma, do you feel like there's any truth to what I just said?

Dr. Sharma: Absolutely. And that's so pervasive in medical training, right? It starts with why am I a resident here? This is such a great program. Why did they hire me? And then as you get more comfortable in that role, as a member of a care team, your role changes and there's a period of adjustment and your performance is affected by your self doubt. And then even for those of us who are faculty or attending physicians, and we lead teams of healthcare providers; there are always things that bring back that feeling of inadequacy, right? So it's almost like a flashback. Oh, this happened when I was a resident and I didn't do very well at that.

Am I going to make it through this situation now? They're sort of the good feelings of doubt, which sounds strange to say, but sometimes doubting yourself is making sure you're doing the right thing for your patient, but when it becomes so frequent that you doubt yourself in every situation, that's when it really becomes challenging to do your job. And then there are always those periods of time where things come floating back to you. Whether it was, you took care of a patient as a resident with a similar pathology and you felt like you couldn't manage it then. And that comes rushing back to you, even though you're significantly better trained and you're prepared for it now.

Dr. Afolabi: I agree. That's very true that in some ways, doubting yourself is really healthy and really good, but there comes a point sometimes where you just can't function. And that's when it becomes a big issue and a big problem. And I think sometimes we call that an imposter syndrome. Sometimes that's just plain anxiety. I'm not a psychiatrist. I'm not a psychologist, but I am someone who's suffered from anxiety in the past. And honestly it was anxiety. It wasn't necessarily imposter syndrome though that's what I had interpreted it as at that point in time. I do think that we're lucky to have colleagues and to work in teams that work well together because those are the teams that help support us when we are going through those times and help confirm that we're doing the right thing or question us if we're not. I think that we, as pulmonologists in our particular division are very fortunate that we work with a stellar group of women and men that allow us to bounce these ideas off of, and these questions off of, in a very collegial and nonthreatening way.

I do think that there are times, especially as women, when we approach people. Because we have questions, because we are wondering if we're doing the right thing and that's not necessarily imposter syndrome. That's us trying to be good clinicians and really make sure we have all of the information where sometimes we do not always face those collegial people and were doubted even more. And I think that sometimes that does augment imposter syndrome. When we feel we're actually asking the right questions, we're actually moving forward in the right direction. And then we're questioned even more by others. I think that women are especially prone to that. And I hope that one day that's going to change, but I think as we, as women move forward and live stronger in our power, that happens much less.

Dr. Sharma: I think you made such a great point about the fine line between where feeling self doubt and feeling like a fraud turns into anxiety. Cause I think the more frequently you're faced with sort of the microaggressions in the workplace or being made to feel inadequate or not having the support that you just described leads to the vicious cycle of more feelings of inadequacy, more questioning of oneself. And then that leads to anxiety and potentially depression and things that will then further change how you perform in your role.

Dr. Afolabi: I agree, a hundred percent.

Host: Yeah. And Dr. Sharma, to expand on that a little bit, as one thing leads to another, I imagine that there is a relationship between imposter syndrome and then anxiety to eventually burnout. Is that the case?

Dr. Sharma: Absolutely. There's only so long, you can spend questioning yourself, doubting yourself, not feeling supported, then traversing into that anxiety and depression before you just can't do your job anymore. And you feel so exhausted and so burnt out by just the day-to-day in your role.

Dr. Afolabi: I also have to say that I think that a lot of burnout has less to do with our own inadequacies and more to do with we spend so much time doing things that by its nature makes us doubt that we're able to do our job. Peer-to-peers, certain requirements for things. I think that just that, it makes us feel almost as if we're not able to do what we came here to do, we're not doing that patient contact and interaction.

We're not interacting with our colleagues to better care for our patients, but we're doing a lot of the paperwork and the administrative work, that can be a little disheartening for someone who that's not their primary job. And I think that can lead to burnout as well, where it builds a sense of anxiety and a sense of inadequacy and in a sense of imposter syndrome.

Dr. Sharma: I'm so glad you brought that up because it's exactly like, as I finished saying those words, I was like, wait a minute. What about all the other day-to-day tasks that really are just so overwhelming in how challenging they are. Where do you fit them into the day of patient care, other things that have to happen, and how challenging are those tasks that we didn't train for?

Exactly. As you said, you go to medical school and you do a residency program and you do all this training to then argue over getting the appropriate care for your patient. It just spirals out of control. So, that you feel like am I really doing the right thing for my patient? And I can't do this anymore. It's just, it's too much.

Host: You both are bringing up amazing points, talking about when you're trying to do the right thing and advocate for your patient. How does one that is feeling imposter syndrome, or just going through some of the emotional struggles that we're talking about? How does one even begin to start overcoming it?

Dr. Afolabi: That's a great question. And in some ways, so hard to answer and so easy to answer. I think, as easy in some ways as knowing who you are and believing in yourself. Sometimes it's as hard as reaching out and seeking help. And I think reaching out and seeking out, is really challenging. For some people, it might be very easy. For me, it's a big challenge. But as far as standing in myself and standing in my confidence, I do a lot of reading and that's one of the things that I do to center myself on a regular basis. And then when I have those feelings of inadequacy, sometimes I move to reading those encouraging words that are very helpful to me.

And of course, there are multiple quotes by Oprah and Maya Angelo and Toni Morrison. But I have to say, I read Brené Brown all the time, and she is all about vulnerability and shame and those things together and how important it is to really live in your vulnerability and accept it and that's how you're able to be a good leader. While living in vulnerability and accepting your vulnerability means asking for help. Right? So in the end I think it's both standing in yourself, but also reaching out for help. And whether that's a family member, a friend, a colleague, a physician, that remains to be seen by that particular person. I honestly think it needs to be all of those people just in different ways, at different times.

Dr. Sharma: I think that's exactly it. Being able to reflect on your talents as well. And to remember how far you have come and what you've built, and also to look to all of those outside sources for help is really vital. Like you had mentioned a moment ago, where we practice, we are really blessed to have great colleagues who we can lean on and look to for advice and assistance.

And for me, at least, that's been really important to being able to get over or to move past some of those feelings of inadequacy or burnout when I get to that point. But it's hard. It's hard to ask for help. It's hard to know who to ask for help or how to ask for help. And so you brought up a good point about, finding those resources.

Dr. Afolabi: I can't agree more about our group, that those people that we work with on a regular basis, I can go to them to ask them clinical questions that I have to questions about my daughter.

Dr. Sharma: Yeah.

Dr. Afolabi: And I feel like this is a group that is built on supporting each other. And I think support and avoiding burnout or overcoming burnout is really important and it's vital. And I can't believe that I work with such a group of wonderful people.

Dr. Sharma: Right. Exactly.

Host: I mean, it sounds so amazing hearing you talk about the support system that you have there for one another and overcoming the feelings of imposter syndrome and Dr. Afolabi, you mentioned the two things of having self-confidence and then also reaching out and seeking help. And I think it's important for the audience to know that those are not mutually exclusive. You can have self-confidence and confidence in your abilities, but you can also be proactive about reaching to that support group that's around you. Dr. Sharma wouldn't you agree with that?

Dr. Sharma: Absolutely. I think it's a really important point that those things are not mutually exclusive, that you can be confident and amazing practitioner doctor, whatever your employment or whatever your skill may be and still need the help. That's okay.

Dr. Afolabi: That's so true. And like I said, I get that sometimes from books, but I also get it from my colleagues as well. And I get it from my family. And one of the things that I love to be is a cheerleader and I don't think I could ever be a professional cheerleader. Because I can't jump, but if it meant yelling from the sidelines and that's all I had to do, I would love that. And people ask what type of mentor are you? And I say, I'm the cheerleader mentor when I am a mentor.

And I will love encouraging people and letting them know that they are amazing people. And they really are. I don't have a single mentee that I don't think has extraordinary ability. And sometimes I have to remind them of that as they traverse these challenging times and moments, especially in the middle of a pandemic when we've really had to change the way that we live our lives.

Host: We have talked about how imposter syndrome can affect performance. And I think, that calling out some of the ways that happens is important because there may be people listening to this that don't even realize that the imposter syndrome is affecting them. So, Dr. Sharma, are you able to highlight some ways that imposter syndrome might affect performance?

Dr. Sharma: So I think, one of the examples that I have of kind of found myself in, or one of the traps I have found myself in with kind of feeling inadequate is particularly related to something that, that Dr. Afolabi, you mentioned a moment ago, which is you're sometimes caught in an interaction with another person, usually regarding patient care, but where perhaps you are the person who is better able to speak to a solution or a prescription or something that needs to be done for this patient. And yet you feel so intimidated or so inadequate in your own decision-making that the other person in this interaction and that interaction is happening in a way that doesn't feel comfortable or collegial; you end up perhaps just giving in, even though that you had the best plan or you have the right plan, you struggle to put that out there because you feel as though you don't have the right, you don't have the training, you don't have the ability to make that suggestion.

I feel like for those people who are caught in this cycle of feeling inadequate and feeling like a fraud, that restricts not only how they take care of their patients, but also how they offer themselves up to volunteer for other opportunities, they may say, well, oh, there's an opportunity to be a part of a research project but oh, I'm probably not good enough for that. So, it restricts their forward movement in their career. It impacts patient care and how they feel about the patient care they're delivering. And it impacts how they interact with their peers, with their colleagues, where they may not feel as though they have the ability or the right to stand up for something they believe in.

Host: So Dr. Afolabi, you've probably come across people that have suffered from imposter syndrome quite a bit. You may have even suffered from some yourself, especially earlier on in your career, out of everything that you've learned, if there's one piece of advice that you could leave our listeners with, what might that be?

Dr. Afolabi: So I suffer from imposter syndrome all the time. I have doubts my ability, but in the end I trust my ability to think through these challenging events and times, and to seek the help that I need. And I think the vulnerability and humility to ask for help is really the biggest key to me, to being able to really stand in myself and in my abilities.

And I'm not seeking affirmation when I ask for that particular help. I'm seeking guidance and kindness, I think in some ways, because sometimes it's hard to be kind to yourself. And I think a degree of imposter syndrome is that we're not always kind to ourselves.

Host: And Dr. Sharma, what about you? Are there any final words of advice or things that you've learned about overcoming imposter syndrome that you'd like to leave with our audience.

Dr. Sharma: I think that Dr. Afolabi took all the words out of my mouth. She said it perfectly, which is, I think we've all suffered from it. And continue to do so. And that's a normal part of doing our jobs, but it's how do you be kind to yourself as she said, and seek the resources that you need to stay healthy and to continue forward and be the leader a team of medical professionals, the best way you can and take the best care of your patients as you can.

Host: Well, Dr. Sharma and Dr. Afolabi, really great conversation today. Thank you both so much for your time.

Dr. Afolabi: Thank you.

Dr. Sharma: Thanks.

Host: And thank you to the audience for listening to Pediatric Insights, Advances and Innovations with Children's Health. You can head to children's.com for more information.