The Imposter Syndrome

[jfoxcpacfp]

Michael Kitces has a fantastic series of podcasts interviews of various financial planners and planning consultants who have made a difference in the profession for one reason or another. While I don't think many of the topics would be of interest to the participants here, his recent interview with Carl Richards was fascinating. The topic is the Imposter Syndrome which is quite prevalent in the community of "real" financial planners (guilty as charged). Is the same true of physicians?

iow, is it common for physicians to think that you really don't deserve the recognition you get for being intelligent and really good at what you do - that if people only knew what you were really like, they wouldn't think you as highly of you? As you are surely aware, laymen tend to label doctors as having a "god" syndrome. Deserved or not? Or do you find this hugely insulting.

And the really important question: is it "Imposter" or "Impostor"?

[LizOB]

Honestly, I feel like most (including me) would say we don't get enough recognition for being intelligent and good at what we do. I know that totally comes off as having a "god" syndrome, however we are daily battling with patients second-guessing or refusing even the most-accepted treatments/interventions/vaccines, insurance companies not allowing me to use my judgement to decide what is best for MY patient (prior auths, peer reviews, etc), and bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control).

So on the occasion I do get some positive feedback I LOVE it and accept thanks and compliments without question

[Queue]

From the stories I hear from my wife about the OR, there are some physicians (surgeons at least) that absolutely have a "god" syndrome. The stories typically include either an older male surgeon or a new male surgeon. Only once has it been an older female surgeon. But I believe these are outliers. Most docs I talk to are intelligent and friendly.

LizOB wrote:

bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control).

Click to expand...

I used to work in process improvement for a medium sized regional hospital, and the metrics some of my colleagues used to gauge performance of physicians were patient satisfaction scores. While some really good info can be taken from these, there were always a ton of bad scores due to ridiculous expectations or just plain ignorance.

jfoxcpacfp wrote:

And the really important question: is it “Imposter” or “Impostor”?

Click to expand...

I'll go with Impostor as it's been around longer than the also correct Imposter.

[Craigy]

It's common for some physicians to think that way, and also common for many docs to be assholes who think they are incredible, some deservedly.

I think most I've met fall somewhere in between.  But seriously, once you meet some of these guys that think they're phenomenal...

I have not encountered as many in the financial world.

[LizOB]

Queue wrote:

From the stories I hear from my wife about the OR, there are some physicians (surgeons at least) that absolutely have a “god” syndrome. The stories typically include either an older male surgeon or a new male surgeon. Only once has it been an older female surgeon. But I believe these are outliers. Most docs I talk to are intelligent and friendly.

LizOB wrote:

bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control). 

Click to expand…

I used to work in process improvement for a medium sized regional hospital, and the metrics some of my colleagues used to gauge performance of physicians were patient satisfaction scores. While some really good info can be taken from these, there were always a ton of bad scores due to ridiculous expectations or just plain ignorance.

jfoxcpacfp wrote:

And the really important question: is it “Imposter” or “Impostor”? 

Click to expand…

I’ll go with Impostor as it’s been around longer than the also correct Imposter.

Click to expand...

I hate satisfaction scores. You're mad you had to wait? Okay, then next time I work in a patient with a newly diagnosed miscarriage, I'll give her the bad news then say "Gotta run! I have a patient who needs a pap and it's 15 minutes past her appointment time!"  But you can't explain that to the patient who was waiting b/c it's a HIPAA violation. Yes, you should be polite, give an apology and have the staff update the patient as to how much longer it will be but some people just don't get it. Multiple other issues besides wait time (narcotics, advice to lose weight, warnings that sound rather dire when you refuse something to CYA, etc etc)

[Donnie]

I would much rather go to a physician with a god syndrome than a nervous Nellie who can't decide on anything.  Outside of a professional setting, the god syndrome gets old though.

Even on Wall Street, I think some level of insecurity combined with competitiveness drives a lot of people to continually improve.  If you are not constantly putting yourself in situations where you know less than someone else, you are probably not developing as much as you could.  In other words, I think if you don't sometimes feel like an impostor, you are not going to advance as much as others who do.  That said, people typically do not project such insecurity.

[Craigy]

LizOB wrote:

Queue wrote:

From the stories I hear from my wife about the OR, there are some physicians (surgeons at least) that absolutely have a “god” syndrome. The stories typically include either an older male surgeon or a new male surgeon. Only once has it been an older female surgeon. But I believe these are outliers. Most docs I talk to are intelligent and friendly.

LizOB wrote:

bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control). 

Click to expand…

I used to work in process improvement for a medium sized regional hospital, and the metrics some of my colleagues used to gauge performance of physicians were patient satisfaction scores. While some really good info can be taken from these, there were always a ton of bad scores due to ridiculous expectations or just plain ignorance.

jfoxcpacfp wrote:

And the really important question: is it “Imposter” or “Impostor”? 

Click to expand…

I’ll go with Impostor as it’s been around longer than the also correct Imposter.

Click to expand…

I hate satisfaction scores. You’re mad you had to wait? Okay, then next time I work in a patient with a newly diagnosed miscarriage, I’ll give her the bad news then say “Gotta run! I have a patient who needs a pap and it’s 15 minutes past her appointment time!”  But you can’t explain that to the patient who was waiting b/c it’s a HIPAA violation. Yes, you should be polite, give an apology and have the staff update the patient as to how much longer it will be but some people just don’t get it. Multiple other issues besides wait time (narcotics, advice to lose weight, warnings that sound rather dire when you refuse something to CYA, etc etc)

Click to expand...

For what it's worth, having to wait is a legitimate complaint.  Other professionals aren't allowed to essentially always run late like most docs seem to do.  Appropriate times are set for client encounters and if there's uncertainty as to how long a meeting will run, extra time is allocated.  "Working in" another client is something done in between other commitments, at lunch, or after the last appointment of the day even if it runs after business hours.  And yes, if a meeting is running over and there is another commitment, you have to end the meeting.

OB is a relatively unique field where you're literally having to deliver children and perform other emergency procedures that do not follow a set schedule, and the patient wants you to be there for those procedures, so there should be a little more understanding.  But there's no legitimate reason for patients to have to wait an hour past appointment time, every time, to see their dermatologist or ENT.  It's completely unprofessional and insulting to the client.

I understand it's the nature of the practice, with reduced reimbursement etc. docs and hospitals try to cram as many patients as possible into a day.  Also dealing with the general public you get no-shows, but that's a cost of doing business.  If doctors charged by the hour instead of by the encounter, like virtually every other professional does, this problem would be largely solved.

This isn't directed at you, but just a trigger for me.   :lol:   

 

[VagabondMD]

Craigy wrote:

LizOB wrote:

Queue wrote:

From the stories I hear from my wife about the OR, there are some physicians (surgeons at least) that absolutely have a “god” syndrome. The stories typically include either an older male surgeon or a new male surgeon. Only once has it been an older female surgeon. But I believe these are outliers. Most docs I talk to are intelligent and friendly.

LizOB wrote:

bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control). 

Click to expand…

I used to work in process improvement for a medium sized regional hospital, and the metrics some of my colleagues used to gauge performance of physicians were patient satisfaction scores. While some really good info can be taken from these, there were always a ton of bad scores due to ridiculous expectations or just plain ignorance.

jfoxcpacfp wrote:

And the really important question: is it “Imposter” or “Impostor”? 

Click to expand…

I’ll go with Impostor as it’s been around longer than the also correct Imposter.

Click to expand…

I hate satisfaction scores. You’re mad you had to wait? Okay, then next time I work in a patient with a newly diagnosed miscarriage, I’ll give her the bad news then say “Gotta run! I have a patient who needs a pap and it’s 15 minutes past her appointment time!”  But you can’t explain that to the patient who was waiting b/c it’s a HIPAA violation. Yes, you should be polite, give an apology and have the staff update the patient as to how much longer it will be but some people just don’t get it. Multiple other issues besides wait time (narcotics, advice to lose weight, warnings that sound rather dire when you refuse something to CYA, etc etc)

Click to expand…

For what it’s worth, having to wait is a legitimate complaint.  Other professionals aren’t allowed to essentially always run late like most docs seem to do.  Appropriate times are set for client encounters and if there’s uncertainty as to how long a meeting will run, extra time is allocated.  “Working in” another client is something done in between other commitments, at lunch, or after the last appointment of the day even if it runs after business hours.  And yes, if a meeting is running over and there is another commitment, you have to end the meeting.

OB is a relatively unique field where you’re literally having to deliver children and perform other emergency procedures that do not follow a set schedule, and the patient wants you to be there for those procedures, so there should be a little more understanding.  But there’s no legitimate reason for patients to have to wait an hour past appointment time, every time, to see their dermatologist or ENT.  It’s completely unprofessional and insulting to the client.

I understand it’s the nature of the practice, with reduced reimbursement etc. docs and hospitals try to cram as many patients as possible into a day.  Also dealing with the general public you get no-shows, but that’s a cost of doing business.  If doctors charged by the hour instead of by the encounter, like virtually every other professional does, this problem would be largely solved.

This isn’t directed at you, but just a trigger for me.      

 

Click to expand...

There are many reasons that doc appointments run late, and the doc is usually low on the list of potential causes. Earlier patients running late, procedures taking longer than expected, patients taking more than their allotted time, approval snafus, staff delayed by wait times, being on hold for insurance company or RBM/PBM, patients with "emergencies" that need to be seen or need procedures, staff calling in sick, etc. The idea that the doc is greedy and overbooking or maybe having a leisurely lunch at a Michelin star restaurant is laughable.

This system is not set up to allow for extra time to accommodate add-ons, appointment overruns, and other delays. If you think that the doc can simply charge more for more time spent you have no clue how appointments and procedures are reimbursed.

In my experience, no one wants to be more on-time than the doc. He/she is motivated to get to get home on time and is as disappointed as anyone when things run late. He/she also has to deal with and apologize for delays and gets to see the cranky patients who are annoyed by delays, most of which are beyond the doc's control.

Maybe in some medical utopia where docs are just paid to show up and can create a schedule that can accommodate the regular variances that occur in both the human condition and in the medical-industrial complex, wait times can be eliminated. The fact is that the generalists and specialists that have the longest office wait times (or surgical/procedural delays) are often in the greatest demand, are often overwhelmed, and some would even be happy if you went somewhere else (if there was even somewhere else to go).

Sorry, this diverges from the point of the thread, but the post struck a chord. Yes, Imposter Syndrome is indeed prevalent among docs, but the patient or public is not likely to perceive it, IMO.

[LizOB]

Craigy, I totally agree that people shouldn't routinely have to wait 1h+

I actually run on time most of the time (I'm in a group OB practice where 1 doc covers L&D for the day so I'm not running back and forth), but there are frequently issues with earlier patients being late, or urgent add-ons for first trimester bleeding.

Sorry for starting the diverging topic, but I feel like it's difficult to develop "imposter syndrome" when the complaints/people questioning me (ie do you REALLY think I need to be induced for preeclampsia? I want a natural childbirth!!) outweigh the positive feedback. And I'm OB! Others who don't deliver babies probably get even less appreciation than I do!

[fasteddie911]

Not exactly sure what type of answer OP was looking for, but what it made me think of was how there sometimes is an illusion of how good a doctor is based on what's on paper, their personality or their ability to sound smart.  There are docs who have impressive resumes: big name schools and training programs, research, extra-curriculars, etc. but who wouldn't be my first choice to care for me or my family.  Likewise, there are some who have the personality, can say the right things and sound smart to the right people, but be lazy or just awful to nurses or patients.

[jfoxcpacfp]

fasteddie911 wrote:

Not exactly sure what type of answer OP was looking for, but what it made me think of was how there sometimes is an illusion of how good a doctor is based on what’s on paper, their personality or their ability to sound smart.  There are docs who have impressive resumes: big name schools and training programs, research, extra-curriculars, etc. but who wouldn’t be my first choice to care for me or my family.  Likewise, there are some who have the personality, can say the right things and sound smart to the right people, but be lazy or just awful to nurses or patients.

Click to expand...

That's interesting to know. What I was trying to find out if there are physicians who are obviously very smart and good at what they do but, inside, feel as if they are pulling the wool over everyone's eyes and don't believe they deserve to be where they are in life. Maybe internalizing, "If you only knew who I really was, you wouldn't think so highly of me. You're just fooled by the MD after my name. They made a mistake when they let me into med school."

I confess to fighting that feeling myself and was just wondering if physicians also do. Financial planning is an inexact science and, I suppose, the same could be said for medicine (although I'm not trying to compare what I do to practicing medicine   ) The podcast I referenced really resonated with me.

[The White Coat Investor]

LizOB wrote:

Queue wrote:

From the stories I hear from my wife about the OR, there are some physicians (surgeons at least) that absolutely have a “god” syndrome. The stories typically include either an older male surgeon or a new male surgeon. Only once has it been an older female surgeon. But I believe these are outliers. Most docs I talk to are intelligent and friendly.

LizOB wrote:

bad survey or yelp reviews for refusing narcotics or long wait times (which are almost always due to factors outside of my control). 

Click to expand…

I used to work in process improvement for a medium sized regional hospital, and the metrics some of my colleagues used to gauge performance of physicians were patient satisfaction scores. While some really good info can be taken from these, there were always a ton of bad scores due to ridiculous expectations or just plain ignorance.

jfoxcpacfp wrote:

And the really important question: is it “Imposter” or “Impostor”? 

Click to expand…

I’ll go with Impostor as it’s been around longer than the also correct Imposter.

Click to expand…

I hate satisfaction scores. You’re mad you had to wait? Okay, then next time I work in a patient with a newly diagnosed miscarriage, I’ll give her the bad news then say “Gotta run! I have a patient who needs a pap and it’s 15 minutes past her appointment time!”  But you can’t explain that to the patient who was waiting b/c it’s a HIPAA violation. Yes, you should be polite, give an apology and have the staff update the patient as to how much longer it will be but some people just don’t get it. Multiple other issues besides wait time (narcotics, advice to lose weight, warnings that sound rather dire when you refuse something to CYA, etc etc)

Click to expand...

Why would that be a HIPPA issue? Unless the patient is somehow identifiable, it shouldn't be. I tell patients all the time, "Sorry about the wait to see you, a guy came in without a beating heart." They always understand and often then feel guilty if they've come in with something dumb.

[Hatton]

Johanna I will admit that I did not listen to the podcast because I prefer to read and it was over one hour.  I am familiar with the imposter syndrome and believe I had it when I was first in practice.

[Hatton]

I found that when I was still doing ob that patients understood if I was late due to a delivery.  Even now if I am late because of Gyn surgery they seem to understand. I always apologize and explain why I was late.

[jfoxcpacfp]

hatton1 wrote:

Johanna I will admit that I did not listen to the podcast because I prefer to read and it was over one hour.  I am familiar with the imposter syndrome and believe I had it when I was first in practice.

Click to expand...

I should have mentioned this - one of the best things about Kitces' podcasts is they are all dictated into printed material. I'm not a big podcast listener, either, and I'm afraid would not have paid attention if the audible versions were available only (too many books waiting for me on my Audible app). I can skim through in 20 - 30 minutes that way.