When I was a junior attending physician and had been in practice for less than two years, I was invited to speak at a large conference on a panel with two other cardiac anesthesiologists. Well-known, they were distinguished senior physicians from Ivy League schools. I had heard them speak multiple times—from a chair in the audience.
My first reaction to the invitation was to email the conference planners and tell them they had made a mistake. There was no way they wanted me to speak. I was a junior expert. Just starting out. I had spoken only one other time on the big stage, and it was a ten-minute presentation. And I wasn’t from Harvard; I was from Nebraska.
Has someone ever asked you to do something big, something important, and it caught you by surprise? Your first reaction is “Me?” “You want me to speak at that conference?” “You want me to lead the committee?” “You want me to direct this initiative?”
You sit there thinking, Why is this person asking me? How could they possibly think I could do this task? How could they think I am good enough to do this? Is this a trick?
Your brain takes an inventory of your previous failures and all the reasons you aren’t the woman for the job. All the things you lack and the times you’ve messed up. Fear envelops you.
What you don’t think of are all your successes. What doesn’t cross your mind is the fact that you were likely asked to fill this job because you have demonstrated skills and expertise, which makes you qualified. So, you say: “No, thank you.” Fear wins, and the opportunity goes to someone else. What you’ve just experienced is called imposter syndrome. It’s a real thing.
Imposter syndrome, or what some call imposter phenomenon, is a serious experience. It’s like a chain tied to your ankle, keeping you tethered to a small circle of space. It holds you back. And when someone offers you an opportunity to break free from the chain, you glance down at your ankle and convince yourself you are more comfortable (and safe?) staying put.
Imposter syndrome is defined as the inability to internalize one’s accomplishments. It was first described in the 1970s and was found to be associated with high-achieving women.2 Since that time, it has been studied and published in hundreds of research articles and found that both high-achieving men and women experience it. It is mostly associated with people who possess above-average abilities. If you don’t have some measure of imposter syndrome, according to some studies you are more likely to be a low-ability person, have mental illness, or are a narcissist. In other words, if you do experience imposter syndrome, you are in good company. It means you are an achiever and have higher than normal abilities.
The mind-set that overcomes us when we experience imposter syndrome convinces us that our success is fraudulent. Somehow we have faked our way to achievement and tricked people into believing we are smarter, more experienced, and more talented than we are. It is important to recognize when you are experiencing it because research has found that those who routinely experience it are less likely to be promoted, to seek career advances, or report higher job satisfaction.3,4
Women struggle with imposter syndrome to a different degree than do men, which is why women wait until they are overqualified for a job before applying, while men tend to try for a promotion or a job change when they meet some, but not all, of the requirements. Research has found that men are more likely to be hired on their potential, while women are more apt to be offered a job based on their likability.
While both women and men may experience imposter syndrome, there are some differences in what it does to women and men, and most important, how it affects the next thing we do. Some research has demonstrated that men experience high levels of stress and anxiety with imposter syndrome. When men were given negative feedback on a task, they experienced higher levels of stress and anxiety when compared with women. It is thought this is because men have more societal pressure not to fail, as they are expected to achieve. Thus, when men believe their success is fraudulent, they have a higher chance of experiencing anxiety.
On the other hand, when women with imposter syndrome were presented with the same scenario in controlled studies, they had a different reaction to negative feedback such as being told they failed or they didn’t measure up. How did the women respond? They tried harder. Why? Because the women were more likely to believe the negative feedback from their bosses and supervisors as true. As expected.
We women probably won’t experience anxiety when we are told we failed because we tend to believe we are failures. Wow. Is this because we are prone to face obstruction to achieve, or, as my friend Dr. Julie Silver says, we are constantly trying to break through a closed gate, one that should be open for us based on our accomplishments and expertise?
When we have the skills and abilities to do the job but aren’t selected, it is a strong signal for us to doubt ourselves. It feeds our imposter syndrome. It makes us believe that our accomplishments are fraudulent, and the gig is up.
So we try harder. We do more. We earn more achievements, attain more degrees, write more papers, appear in more publications, serve on more committees. More, more, and more. And then… we burn out. Or we fail to get the next promotion or achievement, and the cycle continues.
I want you to stop for a moment. Hit pause. Go inward and think of your internal voice. Let’s do a check.
What does your internal voice say to you when you receive a compliment? “Thank you! Yes! I am so grateful for my expertise!”? Or “I am a joke. I am fooling everyone”?
What does your internal voice say when someone asks you to do something big, something new, something that requires leadership? Does it say, “HECK, YES! I am so excited about this amazing opportunity!”? Or “Um, what? Me? You’ve got the wrong woman”?
Or imagine this: Your colleague wants to nominate you for something. You instantly reject this offer and cringe at the thought of stepping up. No way, not me, you think. There’s absolutely no way I could. It’s just not me.
I want to challenge you. I want you to think about reframing your thoughts. I want you to look inside yourself and what your internal frenemy is saying to you, and change that internal voice into your internal fangirl.
To do this, we must go through a series of steps. Once we do them, we are far more well informed and able to quickly identify the frenemy voices that speak untruths to us and turn them off. Literally, turn them off.
People often say to me, “I just need more confidence, and then I could do XYZ.” The truth is, confidence comes from taking action, from doing what we may be scared to do or what we may not know how to do. Confidence does not come by doing only the things we feel 100 percent ready to do. If you never experience imposter syndrome, you are not giving yourself opportunities to grow your confidence. Remember, confidence is a muscle. You grow it only by stretching it, challenging it, and making it lift heavy things.
The following steps will help you flex your confidence muscles by reframing the thoughts that too often stop you from doing the next, scary, cool thing. The next time you contemplate saying yes to something you’ve been asked to do or desperately want to do but find yourself doubting your abilities, I encourage you to go through these steps that have helped me.
Step 1. Bravely face the fear. For example, write “I fear I will lose my words and freeze onstage.” Where is this coming from? A past failure? Past words spoken by someone? Do you have any evidence that this will happen again or at all? Writing down your fear allows you to objectively view it for what it is: just a thought. Literally.
Step 2. Talk to yourself about the truth of this fear as you would speak to your best friend. What would your friend tell you to do? What would she/he say about this fear? Talk to yourself in the same manner. Tell yourself the truth—what may be difficult in this challenge and what you’ve done in the past to succeed in similar challenges.
Step 3. Imagine the worst possible scenario. Yep, I want you to go there. Say, for example, your biggest fear is falling off a stage (this has happened to me!). What is the worst result of this unlikely event? Process it in your mind. Walk through the uncomfortable scenarios. You will probably discover that the consequences are pretty benign.
Whenever I go through this step, I instantly realize how much I am overexaggerating my fear. I am giving my fear power that I should be giving to my internal fangirl. The truth is, when I walk through the worst fear (for example, I am going to write a book and no one is going to read it, or, they will read it and give me bad reviews), I come to see that I can survive the worst-case scenario. The outcome of our fears is often what we dread the most, but they are most times unrealistic, benign, or temporary.
Let’s do the worst-case scenario exercise. Mine typically goes something like this: I am asked to speak at a conference with a few thousand attendees. I get up onstage and my slides fail to work. I am standing on stage, staring at the crowd, desperately trying to remember the order of my slides so I can deliver my talk. I fumble through it, relying on my memory, but I fail to deliver, big-time. After the talk, I check social media. Several conference-goers post that they were bummed after hearing me speak. I didn’t meet their expectations.
Clearly, if this happened, I would be devastated. But could I have controlled the outcome and made it better? Probably not. I could not control an audiovisual fail. It was outside my hand. Can I guarantee that I will deliver amazing talks every time I stand on a stage? Nope. No way. I am human. What could I do? I can bounce back. I can own the snafu and say, “Yes, my delivery wasn’t the best because of human error. Let’s move on with grit and with grace.” I have conquered a potential fear by running through the worst case in my mind, knowing I would survive.
Step 4. List all the reasons why you were asked to do this task, or why you want to step up to the challenge. Your answer is probably based on your past experiences and successes. List this evidence, and read it next to your fear list. Which one has more truth? Which one has more objective evidence?
Now, go slay your fear! Step forward, even if you are scared. You will be amazed at how much more settled you are when you objectively identify the truth of your fear and recognize imposter phenomenon. It is amazing what happens when you decide it is perfectly acceptable to be afraid and do whatever scares you anyway. It is freeing when you have already walked through all the worst-case scenarios in your mind and see the reality of how you would survive it.
“Courage is fear that has said its prayers.”
—Dorothy Bernard
I often think about the missed opportunities women have experienced. So often we let our imposter phenomenon and frenemy voices overtake us. Especially when we are young, we often say, “No, not me,” without even thinking about it because our frenemy is so loud. We pigeonhole ourselves into being not quite enough. Not strong enough. Not vocal enough. Not smart enough. Not outgoing enough. Not bold enough. Not confident enough.
And then, guess what? We start to live within those limitations. We convince ourselves that because we don’t feel 100 percent ready to conquer the challenge, we are not meant for greatness. That our personalities, our upbringing, and our past failures cannot be changed; thus, we live within the walls our frenemy builds for us.
And then we don’t get asked again, which fuels our feelings of inadequacy. I see this often in the organizations and places in which I work. “I asked her last year, and she said no. She said she wasn’t interested,” a well-meaning colleague explained when I suggested a woman for a job. I know her skills, expertise, and knowledge. I am confident she would be amazing in this position, and I know she would jump at the chance now. But because she didn’t think she was the person for the job in the past, I have to try to convince him to ask her… again.
We must give ourselves permission to grow and accept that we can do things now that we may not have been ready to do before. It’s perfectly acceptable to recognize when we have let our imposter phenomenon take over in the past, and change it moving forward.
It’s also so important to recognize that even when we do fail, when we miss the mark, we don’t have to let it feed the monster of insecurity, aka our frenemy. No rule states that our past mistakes are evidence of our future performances. Instead, we can take hold of our past failures and use them to fuel our confidence.
Wait, what? Stay with me. I promise you I have not been inhaling anesthesia gases. This will make sense in a minute.
I have failed. A lot. Big-time with big things. And I can tell you this: 99 percent of my internal growth and self-confidence have come as a result of my biggest failures. How I processed the failures, how I learned to let go of the shame associated with them, and how I allowed them to shape me, humble me, and make me brave have led to one singular truth: they have made me confident. Confident to pick myself up, confident to trust that God will meet me in whatever dire situation I find myself, confident that I will be better when I climb out of the pit. Confident that no matter what the challenge, I will survive it, even if it means I come out of the arena with horrific hair and looking like I slept on a park bench. Confident that no matter how strong my frenemy’s voice is, I possess a much stronger voice that whispers, “You can do this, and doing it imperfectly is enough.”
I want to share with you a tragic, horrible, true story. It is my story. If anyone ever told me that I would share it, let alone write about it, I would have been dumbstruck or gotten angry at even the suggestion. It is complicated, and as I write it, I cry. You see, I still feel significant sadness and grief about this story.
I always will.
I am sharing it because I have learned to let go of the shame that is associated with what for years I had convinced myself was my greatest failure, and mine alone. It involves human life and a beautiful family, whom I think of and pray for all the time. Even as I write it now, it is difficult to find the right words to bring honor to the death of a person whom God loved so deeply. I pray you are encouraged through this story.
Let me be completely clear: I am not alluding that I am in any way the victim. A precious family, who had to say good-bye to their loved one, suffered grief beyond anything I felt. While physicians may experience a phenomenon called “secondary victim phenomenon” because we often go through significant guilt, grief, and pain in silence, I by no means want to draw attention to myself with this story.5 I do, however, want to pay my respects to this precious life. In doing so I hope to bring healing to others who have experienced similar outcomes.
A few years ago, I was a young attending anesthesiologist who was very skilled and secure in my training. Although I worked with a team of doctors, one night I was in charge of the anesthesia care of a critically ill patient who needed to go to the operating room for an urgent procedure. The patient was very ill and also very small. But the buck stopped with me. The surgery was extremely high risk, I had little backup, and the surgery outcome may not be good. But I was in charge, and I depended on my training and expertise.
Through a tragic series of events, the patient passed away in the operating room. I was devastated, crushed, and in utter grief. I had never lost a small person in the operating room, one with his entire life ahead of him. All I could think of was my own two small people at home, how much I loved them, and how I had let this family down. I blamed myself. I had failed to accomplish a life-saving effort that could have possibly saved this child.
I went home and was comatose. Something changed in me that day, and it has stayed with me every day since. I was a failure—in the worst way imaginable. A life was gone. A family was in mourning. And in my self-critical, young attending physician mind, I thought I could have prevented it. I couldn’t see that I was part of a team, that the patient was critically ill, that the surgery was the highest risk of all surgeries, and that the patient suffered from diseases most likely none of us could treat.
It did not matter. None of those truths mattered. All that mattered was that I had failed, and a life was gone. The shame at times was unbearable. I walked around the hospital like a zombie for weeks, convinced people were standing in corners whispering about my failure that led to losing a life. Convinced I was worthless, I thought about quitting medicine, believing all of my years of studying and training were a mistake.
Over time my ability to work without fear improved marginally, but the shame never left me. A small child in the hospital would smile at me, and a flashback hit me. Emotions would overtake me so that I had to rush into the nearest bathroom and talk to myself to lower my heart rate. I would see a child being wheeled through the corridor, heading to receive treatment of some sort, and I experienced instant anxiety and immense panic. It was not until years later that I would realize I was suffering from post-traumatic stress disorder. I was wounded, injured, and convinced I was to blame.
During this time, my academic career in cardiac anesthesiology was successful and growing. I spoke at conferences, giving lectures around the country. The audiences became bigger and the talks more popular, but what no one knew was that inside, my frenemy was screaming at me, filling me with fear. It paralyzed me on the stage, especially once I was done speaking and the applause began. Someone is going to come up to the microphone and call me out, I would think, my heart racing. They know about my failure, and they are going to tell everyone what I already know: I am a fraud, I am a terrible doctor, and I shouldn’t be here Maybe if I continue to do enough good, I will make up for my mistake. I must keep achieving to make up for this colossal failure.
I lived like this for years, feeling as if at any time the scam would be up, and I would receive what I really deserved: shame, blame, and retribution. I punished myself internally for years. I didn’t feel that I deserved to be happy, and I thought I had to achieve, achieve, achieve to cover up my past mistake. My brave husband knew every part of my failure and loved me through all my years of anxiety, shame, and self-berating. He sat quietly with me, holding my hand and telling me how proud he was of me. I couldn’t accept his words. In my darkest hours, he never stopped building me up. Honestly, if he hadn’t been there nonstop for me, I am very sure I would not have eventually found the healing I needed. He never told me to “get over it,” and he never tried to fix me. He just kept loving me. Unconditionally.
I daily fed my imposter phenomenon with memories of this event, and I turned down several big opportunities that I believed would expose the “real me.” I felt such deep remorse and failure, and although I asked thousands of times for God to forgive me, I could not forgive myself. This lasted seven years.
For my fortieth birthday, I took a much-needed vacation to a tropical location with my husband. I didn’t want a big celebration. I craved only escape. What I really desired, though, was forgiveness… of myself. On a beach, thousands of miles from my home, I found it.
I often describe this experience as extraordinary, but, in reality, it was simply forgiveness. It was me facing my fears, seeing them objectively, working through the worst-case scenario that I had experienced, then letting go of the shame. It was me forgiving myself, refusing to feed my frenemy any more lies based on my past failure, and stepping out of the darkness I had cowered in for years.
My husband and I were sitting on the beach at the resort, reading books and enjoying the sun. An American couple was in the cabana next to us, also celebrating the wife’s fortieth birthday. We struck up a conversation, eventually talking about vocations. He was a pastor, and much to our surprise, we realized we both knew some of the same people from our college days. My husband, Lance, had gone to college with a mutual friend of the pastor’s wife. Lance and she took over the conversation.
After a few moments, Greg, the pastor, turned to me and asked a poignant question. “What do you love about being a doctor?”
Oh no. Here it comes. His harmless question revealed a deep sense of shame tied to my failure. My fear and anxiety bubbled to the surface as I struggled for my answer. As Brené Brown says, “When perfectionism is driving… shame is always riding shotgun.” 6
My frenemy’s voice was so loud, it clouded my ability to even feel authentic answering the question. I loved being a doctor and could easily list why, but for some reason, I felt honesty boiling up in me. Perhaps because Greg and I shared the same faith. Maybe because it was time to face my demons. Possibly because I had had a margarita. It didn’t matter why. It only mattered that it was time to come out with it.
I shared with this man and his wonderful wife how I loved practicing medicine, but that I couldn’t let go of this one patient, whose grief I had carried with me every day as I failed to save this person’s life. I shared with them how being a doctor wasn’t all sunshine and roses, and while I loved it, I was by no means proud of my profession.
Pastor Greg didn’t pass it off and ignore it. (Greg, if you are reading this, don’t quit your day job.) This man was lounging on vacation, yet he heard me. While I was trying my best to be upbeat and positive, he heard the sadness and defeat in my voice, even though I wore a smile. He looked at me and said, “Can I pray for you? I would like to.”
Standing on a beach in the middle of the ocean, a stranger prayed for me. He spoke wisdom over me. His words were simple yet profound. He asked God to remove the shame and guilt associated with my failure and to stop it from limiting my future. Even now as I type this, the reality of that moment is hard to explain. I can still hear the ocean and feel the tears on my face as I released all the guilt and shame associated with years of carrying this grief.
I realized how heavy the perception of my unforgivable failure was. The shame associated with it was like carrying around a ton of bricks. And at that moment, I released them. I did not plan on forgiving myself on a beach where I was trying to forget all my shortcomings and numb my pain. Yet somehow, in a moment, I was new.
I am not saying that letting go of our failures has to be a mountain-top experience with ocean waves and spiritual revelations. While I had been doing my best for years to work through this failure, my experience on the beach that day was simple yet powerful.
All the years I’d spent ruminating about what I could have done differently, a million “if onlys,” suddenly were worth something. The person’s life I failed to save was worth something all along, but only now did I allow it to mean what it should have meant from day one.
It was all worth something. All the pain and shame were forgiven, and I had to get to the point where someday I could help others by sharing this story. I had to be brave enough to share this experience—and my role in this failure—out loud with others. I had to share how hard it was to forgive myself, and I had to admit, finally, that I was not perfect. I would never be perfect, and I am okay just as I am. It was time to stop trying to achieve my way out of a past failure.
I can honestly tell you that if I had never experienced this release of shame, this book would not exist. The support group I lead for thousands of women physicians would not exist. The Brave Enough conferences, retreats, classes, and support groups would not be a reality.
The part I played in this tragic loss shaped me. Although I never wanted to discuss it for so many complex reasons, I must give credit to the truth: this tiny person who lost his precious life that day on my watch and whose face is etched in my mind forever has taught me so much.
When women share their brokenness with me, I grasp it. When doctors I train make mistakes and, in tears, share their grief, I understand it. When a patient’s family grieves, I grieve with them. When someone tells me that she can’t let go of her shame, I know she can.
Maybe you haven’t experienced a failure like mine. Maybe you have. Perhaps your fear of failing feeds your imposter syndrome and is holding you back. Whatever the case, the above steps to overcoming work. I promise you, when you deal with your past failures, you will see yourself differently. The experiences you have gone through and survived will instill in you deep gratitude and a sense of respect.
You may never get to the place where you don’t experience imposter syndrome, but you can definitely get to a point where you live without shame. You can grow to respect the past while also developing self-confidence and self-awareness. When you recognize imposter phenomenon for what it truly is, work through the steps to overcoming it. You will be amazed at what happens when you use them to your advantage.
Your frenemy loses her voice. Suddenly, you feel very comfortable living in the space between unbreakable grit and the immense grace that is needed to show up every day in your life. You find yourself living comfortably in the space of Crap! I really screwed that up and I will do it better next time. I know I will. You will smile when you look in the mirror and decide to love your body, despite the wrinkles, dimples, and imperfections. You will say yes to things that completely terrify you because you know growth lives there.
And more important, you find yourself forgiving. Forgiving others who require massive grace. Forgiving yourself, forgiving your enemies, and forgiving those who may not be sorry for the wrongs they committed.
Do the steps.
Dig deep.
Recognize the truths.
Forgive yourself.
And shut your frenemy up.
I bet you won’t hear her anymore.