The Runt of the Litter — Imposter Syndrome and the Impossible Job

Imposter syndrome is well-documented. In medicine, it’s practically an occupational hazard.

We talk about it like it’s some individual quirk, some inconvenient glitch in the psyche of an otherwise competent person. But if you’re a doctor and you don’t feel imposter syndrome from time to time — I’m more worried about that.

Because here’s the thing, you’re working in a system that:

• Demands flawlessness

• While rewarding ambiguity

• Yet expecting certainty

• While punishing doubt.

That’s not a paradox — it’s medicine.

A System That Tells You Never to Get It Wrong

Ask a patient how many mistakes a doctor should make in a day. Most of them will say “none.” Maybe a few will be generous — “Well, define a mistake…” — but the underlying assumption is clear.

We’re not supposed to fuck up. Not big. Not small.

And you know what? Fair. Lives are on the line.

But here’s the problem:

Modern medicine is built on educated guesses.

On managing uncertainty.

On picking the least-worst option and seeing what happens.

Especially in primary care — where your job is to catch zebras with a stethoscope, 10 minutes, and no bloods. That level of uncertainty does things to people. Eventually, it erodes confidence. Not overnight. Not in flames. Like a drip. Every day.

That erosion’s well known — burnout and imposter syndrome are deeply entangled, especially in under-supported specialties like general practice. And no, it’s not just about resilience. It’s about a system that punishes uncertainty but runs on it.

Welcome to Medicine: Try Not to Be the Worst One Here

When I fell out of renal training, I carried the scars with me. I landed in GP, surrounded by partners I deeply admire, and immediately found myself scanning the room thinking, “Just try not to be the worst one here.”

That was my new metric for confidence. Not being the worst.

It worked. Until it didn’t.

Because then the fear became: what if I am the worst one?

Worse at gynae? Worse at practicals? Worst at “clinical intuition”? Worst at not ordering too many tests? (Yes, I’ve heard about “Fancy Dave Wandless Investigations.”)

We all carry our own baggage. Mine comes with audit trails.

The Golem Effect and Being the “Difficult” Doctor

In renal, I was quietly told I was underperforming. Not loudly. Not officially. But enough for me to start believing it. That’s the Golem Effect — treat someone like they’re failing and they’ll live down to it.

I’ve lived with that ever since.

I now work in a big practice, with some of the best GPs I’ve ever met. And I spend most of my time wondering when someone’s going to work out I’m winging it.

Because in the background is a constant narrative:

• Doctors don’t make mistakes.

• Doctors shouldn’t struggle.

• Doctors should always be sure.

And when they’re not?

They should at least look like they are.

That mindset is toxic, and it’s taught early. The expectation isn’t just competence — it’s certainty, composure, and the ability to carry all that while the roof’s on fire.

“You’re a Doctor — You Should Know Things”

I’ve been asked to fix an Xbox because I’m a doctor.

I’ve been laughed at for not knowing how to tile a bathroom.

I’ve had people roll their eyes and say, “You’re a doctor. You should know.”

Doctors are supposed to be the clever ones. In every room. On every topic.

And sure, a lot of us are smart. But intelligence doesn’t come in one flavour. And just because you can deconstruct the RAAS pathway doesn’t mean you know how to change a tyre. Or raise a kid. Or even reliably get your printer to work.

And yet — somehow — you’re meant to carry that expectation, silently, without showing the seams. To speak up about being smart is a one way ticket to being called an arrogant prick.

Imposter Syndrome Feeds on Silence

The imposter in you whispers all the things you didn’t know.

The test you didn’t order. The clue you didn’t spot.

The colleague who always sounds more confident.

It tells you your success is accidental.

That you just slipped through the cracks.

That you’re a fraud in a lanyard.

And when the system starts to shake — when funding gets cut, when waitlists explode, when care becomes compromise — the imposter grows.

It thrives in crisis. COVID made that brutally clear. When everything fell apart, it wasn’t just workload that spiked. It was doubt. Self-questioning. Fear of being found out.

What If They’re Right? What If You Don’t Belong?

Here’s the sharp edge of it all: what if you really don’t deserve to be here?

What if you failed exams?

What if you slipped through on luck or charisma or sheer persistence?

What if you’re not good enough?

Well. Here’s a thing.

You’re still here.

You’re still turning up. Still learning. Still caring.

And if you’re reading this wondering if it’s about you — it is.

It’s about all of us.

Because imposter syndrome isn’t a bug.

It’s a feature.

It’s the humble counterweight to hubris.

It’s what keeps you careful.

It’s what reminds you you’re human.

Some of the most effective interventions don’t aim to “cure” it — they aim to contextualise it. To name it. To soften its grip.

TL:DR

You’re Not an Imposter. But You Are. But You’re Not.

That’s the paradox.

You’re not an imposteR, but the system is so broken, the training so brutal, the expectations so sky-high, that it’s entirely rational to feel like one.

And that’s why I say this:

If you’re carrying imposter syndrome — don’t fight it. Hold it. Name it. Let it walk beside you.

Use it to stay grounded, humble, curious.

But never let it be the thing that makes you quit.

Because imposter syndrome doesn’t mean you’re failing.

It means you give a shit.

And that might be the most important qualification of all.

Stay Suss

— DW