S8E6: Breaking the Cycle of Perfectionism and Imposter Syndrome in Medicine

Austen: Does anyone watch "Dancing with the Stars"?

Sanila: I have not been keeping up with the season.

Austen: And that's fair. Anyway, spoiler alert for anyone listening, Robert Irwin won.

Sanila: Oh my gosh, really?

Austen: Yes. And he's so tender. I forced Jade to watch the episode with me.

Jade: It was actually a very good episode to watch.

Austen: Yeah, it was good, even if you fell asleep at the end before they announced anyone as the winner.

Jade: Yes, it is true. I did fall asleep. But what I watched was really good.

Austen: There you go. Well, welcome, listeners. You are joining us here at "Bundle of Hers." For those who have listened before, welcome back. And for those who might be new to the podcast, welcome for the first time.

My name is Austen, and I'm one of the hosts of this season of "Bundle of Hers." Joining me today, we have the ever-fabulous Sanila, as well as our friend and classmate, Jade. Jade, you've been on the podcast before, so welcome back and thank you for joining us today.

Jade: Thank you. I'm happy to be here.

Austen: So this episode, I really want to take a look at perfectionism and imposter syndrome. I feel like imposter syndrome was a term that I was unfamiliar with coming into medical school, but when I was here, I feel like everyone talks about how they have imposter syndrome. And that was definitely something that I felt.

This is such an important conversation to have, because I think, oftentimes, as learners, we fall short. We make mistakes. And if we're dealing with feelings of perfectionism, if we're dealing with imposter syndrome, it can really become an obstacle to growth. It can impede our progress as learners, and it can really affect the way that we view ourselves as future providers and human beings overall.

But I was curious to know what would change if we allowed ourselves to have strengths and gaps at the same time? What would change if we viewed kind of these areas of improvement as opportunities for growth and not as hindrances to performance?

So I guess something that kind of inspired this episode is my identity as a Virgo. I don't know how anyone feels about astrology. I like to say it's my favorite pseudoscience because, while I think it's fun and silly, sometimes I think it can be fun to think about and kind of see how things line up in your life.

So, for everyone listening, I'm a Virgo. Sanila is also a Virgo. And then Jade is our resident Pisces. Just so everyone's on the same page.

As far as Virgos go, I think something that is a hallmark of the Virgo and something that my family love to point out in me as I was growing up is kind of this need for order, liking things to be organized, liking things to be done well, and kind of this trait of perfectionism.

I think it's something that I've seen throughout my life. I like things to go well, and I like to feel like I'm a big contributor to things going well. And I sometimes can get frustrated when I feel like I'm not performing as well as I need to be.

I have sometimes found myself feeling like I'm letting my team down because I'm not doing things flawlessly. And that's in my personal life, that's in my relationships with family and friends, but also it kind of can sometimes bleed into medicine, and I feel like that's something that I'm trying to actively combat.

But it kind of just got me thinking about how perfectionism can lead to these feelings of inadequacy in the clinical space, but also throughout the journey in medicine.

Like I mentioned before, it can be hard to recognize that you're doing well and that you're growing and becoming the physician that you want to be if you're only focused on your shortcomings and if you can't then recognize a way to turn shortcomings into opportunities for growth and for change.

So I guess to start off, I'm just curious to know do you guys ever feel like you're not good enough for medicine? Is this something that I am swimming in alone? Or when are some instances that you felt maybe a little bit of perfectionism or a little bit of imposter syndrome?

Sanila: And also for our listeners, just a reminder that any thoughts and opinions expressed on this podcast are our own and do not necessarily reflect those of our respective schools or employers.

Austen: Yeah.

Sanila: Definitely not swimming alone, Austen, I think. I mean, even for myself, in speaking with our peers, I think it's full of imposter syndrome. It feels like an everyday challenge of, "Do I really belong here? Did I actually get into this school?"

Sometimes I'm still like, "It was all a fluke. They accidentally spelled my name wrong or clicked the wrong button and sent me an acceptance email." So it's hard to kind of fathom that we're all here today and that our journey is going to continue and we're going to be doctors and taking care of people.

I feel like imposter syndrome, for me, really struck in our third year, when we started clerkships and we were in the hospitals having to take care of patients and work with a team. I think it feels hard to be thrown into something and not really know if you're doing it correctly.

And I feel like, for me, imposter syndrome manifests in a few different ways. It either feels like I'm somewhere where I don't belong, or I don't exactly know what I'm supposed to be doing or how to do it, or I'm afraid of making a mistake, or I attribute my past successes to some sort of luck or universe fate. And I think that sort of mindset is kind of hard to combat.

I've been thinking about this a lot now that residency interviews are underway, because I've been asked by multiple programs how I adopt a growth mindset and what that means to me. And so I've been kind of reflecting on what growth means to me and how that directly clashes with this idea of imposter syndrome and feeling like maybe I don't create the space that I need to be able to grow safely because I'm so worried about making a mistake or feel like I don't belong.

Austen: Oh, I like that. I think, Sanila, what you said is so important. You talked about all of these things that kind of contribute to this feeling of imposter syndrome, whether you're in a space you don't belong or it's difficult to own your past successes and not just be like, "Ugh, it was just random events that led to that."

I think that's so relatable, right? I think it's so easy to be like, "I'm lucky to be here. I got here by chance or by some big mistake, and everything that's led to this point has just been fate working itself out and whatever." I think it's easy to kind of overlook our contributions to our growth, our contributions to our success even.

I loved how you mentioned how sometimes it's hard to create a safe space for growth for ourselves. I think when you're your toughest critic, it is so hard to make sure that you are in a good mindset to progress. When you are constantly like, "I'm messing up, and the people around me aren't messing up," I think it's easy to just kind of prevent ourselves from reaching our full potential, and so I loved how you pointed that out. Thank you.

Jade: I agree. I agree with everything that's been said. I don't think you're alone, Austen and Sanila. I think the first thing I thought of, too, when I came into med school was the acceptance letter that I got that wasn't even addressed to me, and I was like, "Hold on a second. Am I really supposed to be here?" But then I got a readdressed letter with my name on it, and I was like, "Okay. Well, maybe I am."

But that being said, I think even throughout this whole time, especially being in the hospital taking care of patients, or at least trying to take care of patients, I think there's such a big job, but a big gap in knowledge between us as students and those who are experienced and have more practicing years under their belt.

And I think that's something that I have a hard time just remembering, is they've experienced this a lot more than I have, so it makes sense that they know a lot more than I do.

One thing that I kind of thought about a couple of years ago when I was in the car on the freeway, I was thinking, "Why am I going 70 on the freeway, and still everyone is going faster than me? Why can't I ever go fast enough?" And I realized, at that point, I was like, "Well, I'm never going to see people who are slower than me because they're always going to be behind me."

And I think that's something with this perfectionism too and just feeling imposter syndrome, is it's so easy to see people who are better, who are ahead, because that's kind of where we're facing. It's where we're trying to get. And maybe that's a good thing. We're always looking forward.

But at the same time, it's hard to realize that we also are going at a really fast pace, and if we take the time to look back and see where we have come, that kind of puts it a little bit into perspective for me.

Austen: Jade coming in with the beautiful pearls. I love that analogy of us all being on the highway, right? We're on a highway of learning, a highway of growth. You're right. You could be flooring it, you could be going 80 miles an hour and look around and be like, "Wow, all of those people are passing me. I'm still not going fast enough." I loved how you just kind of switched that perspective and were like, "Yeah, but there are a ton of people who are behind us, who are still going fast."

We're all moving in the same direction. We're all making the progress. It's just looking different for all of us. I love that. I love that sweet . . . metaphor? Analogy? I don't know what the exact term would be. But I love that.

Sanila: And it begs the question, who sets that speed limit?

Austen: Yes.

Sanila: Did I set that speed limit for myself, or is that something I feel like I should be doing because the people around me are doing that, or, as Jade said, maybe even going faster than me?

I feel like, in medicine, I'm always looking to where I should be. So when I'm working with all these physicians, like Jade mentioned, they have way more years of expertise under their belt, and I feel like I'm a little fish that was just thrown into a pond and I have no idea where I'm going.

And I guess that's the other thing, too. When you are a little fish, you can't tell if the water you're in is a pond or an ocean. Sometimes it's kind of hard to see what milestones you should be reaching, and so you kind of just set those for yourself based on what other people are doing. And so you're not really . . .

Austen: You're great. You're not for me, but I digress. And I had a feedback session with my attending, and I remember just feeling so embarrassed because I'd presented that morning about a patient, and it was a question of, "Is this reactive arthritis, or is this something else?" Anyway, I thought it was reactive arthritis.

And then to cover my butt, because I was like, "There's no way I know. I'm a fool and a half. There's no way I know," I was like, "But let's get ID involved." And the attending was like, "You want to get ID involved? So you don't think it's reactive arthritis?" And I was like, "I guess not."

And so in my feedback with her, I went in feeling so silly, and I was just like, "Ugh, she's going to give me some really hard feedback."

And her feedback to me was, "Just be confident. That is it." She's like, "I can tell that you're thinking. I can tell you're working hard. And as of right now, that's my only expectation of you as a med student. You're a learner. You're in your first year of working in the clinical space. I don't expect you to know the answer all the time. I don't expect you to know who we need to page immediately and how to put in orders or whatever. I just expect you to be thinking and to work hard, and you're doing that, and that's all you need to do. So just be confident in that."

And I think that was so incredibly helpful to hear, because I went from thinking, "Well, I need to know everything. I need to have the perfect differential. I need to have the perfect plan. And only then can I feel proud of myself and only then can I feel like I deserved to be here."

We work on teams, and we're working within this structure because we're all learning. We're all driving at different speeds on the same highway towards the same goal. And we'll all get there. There are people ahead of me, and I'm glad that they're ahead of me because they know what the world looks like and they know how to get me there safely. It was just such a great reminder.

And I think since then it's been a little easier to kind of reflect and see the things that I'm doing well and then also see the things that maybe I can improve upon but maybe feel a little less restricted by my gaps and restricted by things that I don't quite know yet.

I think it's important to realize that when we set these crazy standards for ourselves, that's when it can impact our behavior, impact our performance, impact our growth, and the way that we look at ourselves, most importantly. And I've been pleasantly surprised to find that the other people evaluating me and watching me work and watching me grow have much lower standards for me. Not lower like they think I'm an idiot, but just lower that they recognize where I'm at and they have appropriate standards for me. I think that's the biggest key.

But I kind of want to dive into why we think it's maybe harder to be kind to ourselves, why it's maybe more difficult to recognize that we're learners as opposed to when we're looking at other people.

I think when I've been working on teams before, I've been able to more easily recognize, "That person's a learner, but they're doing great. They're doing awesome." And sometimes it's a little harder to see it in myself.

Sanila: I feel like that's the age-old question. I feel like my motto recently has been "I'm just a person." At the end of the day, I just want to snuggle up on my couch and eat some macaroni and cheese and maybe watch a nice movie, and that's it. But alas, we have responsibilities and commitments, and that's fine.

I don't know why it feels so hard to give myself the same grace that I often feel like I give other people when it comes to learning something new. And I think I forget that imposter syndrome just means that you are trying something new that you probably haven't done before. And in that setting, making mistakes is a natural form of growth.

But I feel like, for me, when I am in a team setting, I have this false idea, maybe slightly delusional, that everything ends with me, that I am so important, and any little thing I do is going to make or break everyone else's day. And honestly, I just don't think I'm that important, to be honest.

I feel like the whole point of being a student is that you have the ability to learn safely in a space. And I do think that's easier when you have teachers who are willing to teach and make you feel safe to ask questions without judgment. And sometimes, in medicine, that's hard to come by.

I've definitely worked with people where I'm like, "I cannot ask that question because it's going to make me look dumb. And I will just Google it myself." And I've also worked with people who are just constantly reaffirming that mistakes are okay, that's how we learn. They want to hear all of my questions because they're in the same shoes at some point.

But I do think I have this sense of I'm kind of the means to an end when I'm on a team, and it feels harder to make a mistake and be okay with that. And I need to remind myself that that's why you're on a team, is because everyone has different levels of expertise. I feel really lucky that there are people going faster than me who, like you said, know the road ahead and can help create the way for me to get there at some point, too.

Austen: I think this is the beautiful mystery of being a med student, of being a trainee. You feel like somehow you can single handedly contribute nothing to the team, but then also be responsible for all of the team's downfall. And that is a beautiful mystery. I don't know how it works out, but I think that is such a universal experience, at least a lot of people that I talk to. We kind of all feel the same way.

Sanila: Yeah, totally. Actually, the biggest sense of imposter syndrome, or one of the biggest I've had in medicine, is wearing my white coat that I was given after White Coat Ceremony.

I mean, A, it's a size or two too big for me, so I feel like I'm drowning in it, and it makes me feel like it's bring-your-daughter-to-work day. But also, it feels weird to wear that as a student when I don't really have a solid sense of authority yet. I'm not at that level in my training, and it's hard to remember why they give us these white coats in the first place. I'm like, "Can't y'all save it for when I graduate and I actually have a reason to wear it?"

But two people have really emphasized getting over that and kind of doing an exposure therapy in wearing it. And the first is my Clinical Methods curriculum director, or I guess professor/doctor.

When we had to go into the hospital to practice taking history on patients, he would always want us to wear them, and his whole dilemma was trying to understand why no one in our group wanted to wear our white coats.

And every time we'd show up without them, he would be like, "Where are your white coats?" And we would just scratch our heads and be like, "Oh, I think it's in my locker somewhere. I must have left it at home."

But he really tried to get us to wear them, because he remembers feeling the same sense of imposter syndrome when he was a student. He would just reaffirm that, "You deserve to be here. You are given this white coat for a reason. It is okay for you to wear it."

And then, actually, on my infectious disease elective, I had an attending who expected me that I wear my white coat. And he was like, "Well, why don't you want to wear it?" And I was like, "It just feels kind of weird. I'm not a doctor yet, so it feels like I don't belong in it." And he was like, "Well, are you studying medicine?" "Yeah." "Are you going to be a doctor?" "Yeah." "Then you should have every right to wear it."

I kind of thought about it for a second, and I was like, "You're probably right, but also, I still don't know how to get over this fear I have of wearing this white coat."

But I feel like, for me, that has been a consistent symbol of imposter syndrome. Even now, it's probably somewhere in my closet, and I'm not quite sure where it is. It kind of feels like big shoes to fill, but in a white coat way, if that makes sense.

Austen: No, that totally makes sense, Sanila. And I think, just like you said, it's a perfect symbol of imposter syndrome, or it's a perfect representation of it.

With a white coat, people see you in it, and they recognize, "Okay, you're a medical provider." Oftentimes, you are a physician, and it feels like it has a lot of weight attached to it. A lot of weight and a lot of expectation as well. And I think it's easy to feel like, "I'm not worthy of this. I haven't earned it. I don't deserve to wear this."

Jade: And if I can add, I think one thing that I was thinking of too is maybe we, as learners, place too much of an emphasis on a specific destination, when, in reality, I don't know that there is a destination in our field.

And on that note, I was thinking how can we be setting standards for something that we, one, have no experience in, and two, where the destination varies for every single person? The destination might be closer in proximity if you are in the same field as your attending or the resident you're working with, but at the same time, whatever they're interested in is going to be different than what we're interested in. And so I think that's also a difficult place for us to be setting standards for ourselves.

I had a similar discussion with one of my attendings about the white coat, and I just kind of listened. I was like, "I don't know if I'm still going to be wearing my white coat any time soon. But I appreciate your thoughts, and I will think about them in the future."

But then that begs the question of in the future, when I am finished and I start to have a little bit more responsibility, am I going to be in a position where I feel like I still am qualified to wear a white coat? Because I can imagine that I will still feel that I have a huge shortcoming and I still have a lot of gaps to fill before I can "wear the white coat."

Sanila: Yeah. I agree, Jade. I think a lot of it is thinking about the destination. At least for me, I feel like a lot of imposter syndrome is me thinking, "I need to already be at where I'm trying to go."

In medicine, I feel like that is especially true because once you check one box, you're always looking towards the next thing. So once you get into medical school, now you have to work on passing all your exams. And then after that, it's getting into residency. And then after that, you have to look towards if you want to do a fellowship. You have to think about that. So it's kind of hard to be present when you're always worrying about where you need to be and how you're going to get there.

And I think, for me, that is primarily where my imposter syndrome comes into play or impacts me the most, because I'm always trying to be at the next thing. It feels like the amount of time we're given, it's hard to achieve all the things that we want to do in that, and then, at the same time, somehow it feels like a really long time. I feel like we have so many years of schooling left.

But it is so destination-oriented, and I feel like for people who are high-achieving or in similar professions, it is a matter of always getting to the next thing.

Austen: I think that's fair. And I think, just like you said, Sanila, it's easy to create this checklist in your mind or almost these checkpoints that we have to reach, right? We have these very long, drawn-out goals, and so it almost feels like we need to create these benchmarks to keep ourselves moving forward.

But I think, just like you highlighted, Jade, in doing so, in setting a destination, we can kind of set ourselves up for failure, and we can compare ourselves to people who are at these benchmarks unfairly, not really understanding their goals, not really understanding how our goals differ. And I think that can really impact how we're thinking about ourselves, how we're thinking about our growth, and how we're thinking about our mistakes.

So very recently, Jade and I were on an ultrasound elective together and, boy, was that a beautiful month. We had a great time in the ED scanning patients. And I think it was interesting being on that elective together because I would look at you, and I was always like, "Man, Jade just got the perfect view of the heart," or a perfect parasternal long, or a perfect gallbladder window. Whatever it was, I was always so amazed by what Jade was doing, like truly, jaw on the floor, gob-smacked.

And oftentimes, Jade would turn to me and be like, "Man, that was a really hard window. That is not a good image." And I would be like, "What are you talking about?"

I think it was interesting being on the outside of imposter syndrome looking in, because I am standing in awe of Jade, truly in awe of Jade, telling anyone with ears that she's the best ultrasounder that I know, and still she was like, "No, that wasn't good. Man, that took too long," or whatever. She always, I feel like, had a critique for herself.

And our attending really emphasized reframing things, reframing our critiques that we have for ourselves, and trying to make it into something positive or even just something neutral. And that kind of became a theme, I think, during that ultrasound elective, during that month.

Any time we had a critique for ourselves, just trying to take that critique and make it into at least a neutral sentence. So instead of being, like, "Wow, that was the worst gallbladder I've ever scanned," or, "Wow, that RUSH exam took me a long time" . . .

One time I was with Jade and said something along the lines of, "Wow, that RUSH exam took a long time," or whatever, and she was like, "No, Austen, we need to reframe it." And so then I was able to be like, "You know what? I had the honor of practicing a RUSH exam, and I'm still learning. And I hope next time it'll be better."

And it was interesting. As silly as it sounds, it was interesting seeing how powerful our words are and how powerful it can be just simply reframing something from being very critical, very negative, to neutral, or even positive, like, "Wow, that was my first time doing a RUSH exam. It went better than I thought it would. Hopefully, next time it's even better."

I think that was something that was so simple that can be applied, yes, when we're in the ED doing ultrasound, but also in any aspect of our life, whether we're in a clinical space, whether we're not.

I think, in reality, a lot of us are our worst critics. We are the most negative voices that we hear all day, every day, and so I think it can be a powerful reminder to be gentle with ourselves. And if you can't be gentle, be neutral with yourself. Just stop hating yourself. Stop putting all this time and effort into bringing yourself down.

Jade: One thing that I was thinking about, too, with this reframing is the ability that it has to really just ground ourselves back into who we truly are. And right now, we are learners.

Reframing that when I was able to do it just reminded me that, "Hey, I am a learner, and it is okay to not be good yet at these things." And it also gives a position for me to reflect and realize what I have been learning and the things that I have been able to do.

I think one thing that stood out for me is the opportunity that we had to teach the MS1s, or first-years, ultrasound. And as part of this, we went through some of the cases that I distinctly, in the back of my memory, remember that we did as first-years ourselves, the same exact cases.

And I remember thinking when I was a first-year, "Holy cow, what is this? How am I ever going to learn this?" And then on the back end, doing these cases with them and realizing that I actually knew the cases we're talking about. That was one reflection that I had where I was like, "Oh, maybe I am learning stuff. Maybe this whole thing is working, and I'm not doing as bad as I think I am."

I think just being able to see that was very important for me to kind of fight this imposter syndrome that I feel every single day going to the hospital.

Sanila: Jade, I agree. I think what you just mentioned about reframing our mentality and what Austen mentioned previously as well is ever so important. And I feel like, for myself, I need to remind myself that I am not necessarily competing with other people, but I'm competing with myself. I'm showing up for the younger version of myself that didn't know this was possible, and I'm also trying to be better the next time I show up to things.

So I've received lots of feedback, too, throughout clinical years, similar to your feedback on your ultrasound imaging, which I am not a great ultrasounder also. But it's helpful to know that people are telling me this because they really want to help me grow and this is something that I can use to learn and show up and be better next time. That is part of the process.

And going back to your highway metaphor, Jade, because I just think it is so well-said and profound, I feel like I oftentimes do compare the cars around me in terms of the speed they're going, who is ahead of me, who is faster than me. And I really should be comparing myself to where my car has been and where I'm at now, and then keep in mind where I'm going and where I want to go.

I think that's really hard to center yourself almost and then, at the same time, kind of decenter yourself in terms of thinking about how to not let imposter syndrome get to you.

But really, all of our journeys are just so unique and our learning processes are all different. It is hard to compare apples to oranges at times. And I do think a lot of this should be just us thinking about how we want to show up for our communities and to work or school and be better than we were before and continue to grow that way.

Austen: Sanila, Jade, you are both so full of knowledge, so full of wisdom. It has been so great talking to both of you. I feel like I've learned so much. And I love that we've been able to reflect, whether it be talking about how we can't compare ourselves to other people, because, one, it's not going to impact our learning and growth. It oftentimes is detrimental to our learning and growth. And two, there are more efficient ways of recognizing our journey. And I love how you pointed out, Sanila, looking back and seeing where you were. Both of you pointed that out.

Some of the other things that I will be noodling on for, hopefully, the rest of time is kind of this idea that being unsure, being imperfect, being a learner does not make us unworthy of where we are. It does not make us unworthy of the roles that we have and the role that we get to fill on our teams, right?

We all have a white coat, and yes, some of us feel a little less prepared to wear it. But it doesn't mean that we shouldn't wear it and we shouldn't claim it, because we've worked hard to get here, and we will continue to work hard to stay here and to improve. And I loved, loved, loved that part of our discussion.

And then, again, just when we are reflecting on our imperfections, when we're reflecting on our mistakes, there's often an equally true and hopefully kinder version that we could be telling ourselves.

This idea of reframing, of taking something that can be negative, that can be harmful, and turning it into something that is neutral or even positive to help us stay grounded in who we are, what we've accomplished, and hopefully inspire us to move forward.

So thank you both for being so amazing, for joining me on this episode of the podcast.

For our listeners, we are going to leave you with a few questions that you can noodle on. So first, we want you to reflect and think about "What evidence exists that you are more capable now than you once were or than you were a year ago?"

And then in addition to that, "What proof would you need to finally accept that you belong here, wherever you are, whatever role you might fill?"

And on top of that, "Do you already have the proof that you need?"

Hopefully, the answer is yes to that last question, but we are confident that no matter what role we fill within our communities, within our professions, we are meant to be where we are, at least for right now.

You deserve to be where you are, and hopefully, you deserve to be where you want to be, more importantly, most importantly. And so we hope that this episode has been helpful for you guys. I know it's been a great experience for me.

So for the people who've joined us for this episode, we invite you to subscribe, share this episode, and join the conversation on Instagram. You can find us . . . our handle is @bundleofhers. And just remember you can join us wherever you podcast. Thanks so much for joining us.