By Gail Gazelle, MD, MCC
June 25, 2020
When Jeff left his ED shift at a New York City hospital in mid-April, he felt like anything but a hero. He’d intubated three COVID-19 patients: a 63-year-old businessman, an 82-year-old woman who reminded him of his grandmother, and a 45-year-old mother of two teens. The elderly woman and the businessman were transferred to the ICU. The mother of two teens was not; she expired in the ED.
By the end of his shift, Jeff felt a crushing weight of sadness and anguish unlike anything he’d experienced in his 15 years as an emergency physician—this shift was now his new norm.
While driving home, Jeff stopped off to pick up the groceries his wife had texted him about. A neighbor who saw him and the checkout woman started clapping and shouting out that Jeff was a hero.
But Jeff did not feel like a hero.
As a certified coach for physicians, I met with Jeff in a coaching session. He told me:
“Heroes save lives. I was unable to save that mother of two.
Heroes are selfless—they put others first, without worrying about themselves. All I could think about during my shift was what if I become infected and what if I infect my wife and kids?
When people call me a hero, I just feel like an imposter.”
What is a Hero?
In addition to all the anguish and uncertainty health care providers experience as a result of the pandemic, there is also, for many, the discomfort of being labeled a hero.
You see, Jeff’s focus was not on the lives he saved, it was on the ones he could not save. His focus was not what he was able to do to help his patients, it was on what he was not able to do. In thinking that he needed to be selfless to truly be a hero, he focused on the ways he was failing to live up to an unrealistic standard of perfection.
The Root of Imposter Syndrome
As I think about why this might be, three aspects of medical training come to mind:
- Never show weakness
We’re taught in our medical training to never show weakness, always have the answer, and always be in command. If we deviate from any of these, we learn that we’ve come up short, that we’ve failed. We’re not taught that doing our best is good enough, we’re taught: if we’re not perfect, we’re failures.
- Focusing on deficits
Our medical training sets us up to focus more on what we’re not doing well than on what we are doing well. When I ask the physicians I coach whether their training focused more on their strengths or their weaknesses, they uniformly say it’s was the latter. These physicians remember that instead of chief residents and attendings seeing all the ways they’d applied themselves, tried so hard to learn new material, and did well, that what stands out most was the episodes of being told that they weren’t good enough. This focus on our deficits carries into having difficulty appreciating the good we’re doing during this pandemic.
- Making comparisons
The hierarchy inherent in medicine is something trainees learn to internalize: surgeons are better than pediatricians, and the medical specialist is higher up the ladder than the generalist. These comparisons and fixed beliefs around worth also set physicians up to feel like they’re imposters.
So what can we do to right this imbalance?
- We have to train our minds to focus on what we are accomplishing, as opposed to what we are not. One simple strategy for doing so is, at the end of every day, writing down three things we’ve accomplished, small or large.
- We have to challenge our imposter beliefs. We can be very attuned to inadequacies in ourselves and equally hyper-focused on what we perceive others are doing well. We fuel the imposter syndrome by the subjectivity these appraisals generate. Vanquishing the imposter syndrome requires looking for objective data upon which we base our self-assessment.
- We need to be compassionate with ourselves. Jeff, and everyone else in health care, is working extraordinarily hard each and every day. The more we can put aside self-criticism and be as kind to ourselves as we are to our patients and loved ones, the more we can see the full truth of our experience.
For Jeff, following these three steps helped him shift his focus to the good he was doing in each and every shift. We can’t always change the impact the COVID-19 pandemic is having on the lives of our patients, but we can build our ability to take credit for all the good that we accomplish.
Explore Harvard Medical School’s COVID-19 resources:
- COVID-19 as a Catalyst for Improvements in Health Care Delivery [Livestream CME]
- COVID-19 Resources for Providers
- Peters M, J King J. “Perfectionism in doctors.” BMJ 2012;344:e1674.
- LaDonna, Kori A., Shiphra Ginsburg, and Christopher Watling. ““Rising to the level of your incompetence: what physicians’ self-assessment of their performance reveals about the imposter syndrome in medicine.” Academic Medicine93, no. 5 (2018): 763-768.
- Gazelle G. Harvard Institute of Coaching CoachX. 10/18/19. https://www.youtube.com/watch?v=fulXfXOHT0Y.
Gail Gazelle, MD, MCC is a part-time assistant professor of medicine at Harvard Medical School and a master certified coach focused on helping physicians and physician leaders build the growth mindset, emotional intelligence, and mindfulness they need to be effective leaders and avoid burnout. Dr. Gazelle’s book, Everyday Resilience, comes out in August 2020.
*OPINIONS EXPRESSED BY OUR GUEST AUTHORS ARE VALUABLE TO US AT LEAN FORWARD, BUT DO NOT REPRESENT OFFICIAL POSITIONS OR STATEMENTS FROM HARVARD MEDICAL SCHOOL.