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The Imposter Phenomenon: The Hidden Presence in the Room

Writer's picture: Wanjiku NgigiWanjiku Ngigi

"You seem a bit too young to be a doctor, when did you graduate?"


I nervously chuckled and punched at the keyboard a bit more aggressively. Maybe my patient meant what they asked, maybe they were trying to evade their own tension (because I delivered heavy-hitting news a few seconds prior). Whether light or not, this patient dug at a sensitive place in my heart.


Unbeknownst to him, I had been crying almost daily that week on my way to and from work. I wondered whether I deserved the title "doctor". I felt like I made too many mistakes to progress professionally. Each call from a consultant made my head spin.


"Hello, is this Dr Wanjiku?"


In my mind: "Is this when I get found out?" "Have I missed anything this time?"


Call ends: a series of instructions for the night shift.


My Mind: "I hope the patient does not die because of me..."


This patient did not know.


The Imposter Phenomenon is More Common than You Think


Imposter Phenomenon (IP) is a behavioural phenomenon which involves doubting your capabilities and failing to attribute success to your ability. People with IP attribute their excellence to external factors and not their strengths. In simple terms, it is self-doubt. It leads to psychological, physical and emotional strain on those affected by it. It is crippling and reduces productivity. IP is associated with high-functioning individuals, which makes healthcare practitioners an unsurprising group of people affected (Huecker et al.)


According to a paper by Iktidar et al., the prevalence of the Imposter Phenomenon is over 30% for healthcare students. The high training stresses and expectations and the pressures of daily living may create unhealthy expectations for those affected to perform well across the board. When we consider this, we realise that this thinking is not realistic. We are human beings who expect to fail from time to time.


A stressed healthcare practitioner
The Imposter Phenomenon is common and is highly correlated with poor mental health

The Imposter Cycle


The Imposter Cycle describes the processing in the mind of someone affected by IP. The Imposter Cycle is exemplified when there is a task at hand. Individuals suffering from IP will either procrastinate or over-prepare. Procrastination mainly happens because of the fear of failure or being 'found out' as a fraud. What follows is a last-minute delivery which may be exemplary. However, despite the praise and accolades received, the individual may feel like a failure for procrastinating and may feel like they would have done a better job had they prepared earlier. This perpetuates an unhealthy cycle.


Over-preparation involves a painstaking effort of overanalysis and the feeling that the individual must work harder than their counterparts. They, therefore, over-exert themselves, possibly experiencing negative effects on their professional and social circles. A lack of excessive effort makes the individual feel like a fraud.


Both procrastination and over-preparation are harmful ways of coping and are associated with mental health illnesses and suicidality according to a paper by Johansson et al. It is also notable that people struggling with IP may become more withdrawn, and overly competitive, develop mood lability in the workplace and have strained interpersonal relationships. These worsen the fragility of their emotional states, thus worsening their mental health outcomes.


Predisposing Features of The Imposter Phenomenon

Here are a few predisposing features to the Imposter Phenomenon:

  1. Being hyper-competitive and perfectionistic

  2. Super-heroism (desiring to be seen as the saviour of the day)

  3. Fear of failure

  4. Feelings of inadequacy

  5. Unhealthy comparison

  6. People-pleasing

  7. Excessive sensitivity to criticism



You Can Flip the Script


Hope is not lost. Through commitment and self-awareness, you can overcome IP. I recommend a few things that have helped me so far:


  1. Speak to your mind: Speak kindly to yourself and do your best to frame situations objectively. Example: You get a patient with complex symptoms. Acknowledge the complexity of the patient's symptoms and remind yourself that you are part of a team and can reach out to your team members if there are any challenges to providing care. Remind yourself that you are in a learning process and you have the support you need. When you do this, you remove the pressure of achieving results for yourself

  2. Be gracious to yourself: If you make a mistake, redirect your mind gently. You are learning. Remember this

  3. Lean on support systems: Reach out to systems of support. This can be a licenced therapist, counsellor, trusted friends and family and so on. Tell them what is on your mind and allow them to give you objective points of view to balance out your thinking

  4. Pray: I have so far experienced much success through spending time with God in prayer. I have taken time to speak His Word to myself and have seen God reveal Himself to me as my help. I do not work for myself, nor do I aim to achieve results for my glory. I am being perfected by a living god who cares for me and who desires me to rest in Him. Knowing this keeps me grounded and keeps my mind in a healthy headspace concerning tasks.


I would like to know your experience with IP in the comments below! And if no one else has told you, allow me to remind you that you are not alone and you are a capable and productive healthcare practitioner.

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