Trust Me

Imposter syndrome is a concept I am hearing discussed more and more often, usually in relation to women, defined as a feeling of being a fraud, inadequate, undeserving of our successes despite the hard work that it has taken us to get to our positions.

Last night I finally got around to watching the first episode of Trust Me, a TV program about a nurse who steals her emmigrating friend’s identity and qualifications, to start working as a middle grade doctor in an accident and emergency department.

There were many aspects of it that I found unrealistic. The fact that there only seems to be one nurse working in their department! The relaxed way in which they stroll around, rule one in ED – always walk fast! Even if you’re not actually busy it will look like you’re busy so that you don’t get interrupted every two seconds. The lack of constant interruptions was also laughable. Working in ED is worse than living with a toddler. It is impossible to have a conversation without ten different people asking you to do something else for them throughout.

The biggest falsity, and the thing I probably find hardest about real life emergency medicine, was after their big traumatic trauma cases, they retired to the coffee room and talked about it, and let off steam and threw something. In reality you would be straight back into the twenty other patients waiting for you, having to apologise to each of them for how long they’d had to wait, keeping that smile and sympathetic look on your face at all times.

There were many things that totally resonated though. I have felt exactly those feelings that that character has felt, on a fairly daily basis.

Don’t worry. This isn’t where I make some big confession. I did go to medical school. I have two degrees to back me up, and several hundred people watched me graduate. I have lots of people who could back up that I was in those lectures, those exam halls, those clinical sessions. Friends who could confirm the many hours I sat holed up in my room studying, the endless practicing physical examinations. I have done all that. I have the certificates.

And since then? Well since then I have twelve years of actually being a doctor under my belt. I have seen and done so much. I have practiced my craft over and over and I literally can do it in my sleep, as almost every dream I have had in the past twelve years has been patients and emergencies and clinical dilemmas.

And yet, I can still totally understand that feeling of being an imposter. It is something that hits me at some point in most shifts. That sense of fear and anticipation when the team is stood in resus awaiting a trauma patient, not knowing quite what will appear as the ambulance trolley crashes through those doors, wondering for a second if you will be enough for the situation which will face you. That combined adrenaline of every member of the trauma team standing there in those seconds before the patient arrives, that is a very potent chemical state!

I think there is a strong element of the nature of our medical education which can foster this imposter syndrome. For any non-medics reading this, the principle message of medical school is “See one, Do one, Teach one.” Which means that somebody shows you something once, the next time you are expected to do it yourself, and the time after that you apparently have the skills to teach somebody else. Now this is becoming less relevant these days and training has become more rigorous, but there is still that mindset floating around.

The first time I reduced a dislocated ankle, something the character on the program had to do, I was an orthopaedic SHO with my registrar in bed on the other end of the phone. His advice was, “look at where the bones are, then put them back where they’re meant to be.” That was the sum total of his practical advice. So that is what I did. And the patient was ok, as was his ankle. I have honed my technique considerably since then, and do my very best to be slightly more supportive and instructional to my juniors.

The character also had to do a trauma chest drain, one of my least favourite procedures ever. If anything she made it look far too easy. It is hard work having to push a totally blunt pair of forceps through somebody’s chest wall. And I always get a moment when my finger is inside somebody’s thoracic cavity, a moment of total disbelief that this is what I do. There is a moment in Robin Hood Prince of Thieves, where Alan Rickman’s deliciously loathsome Sheriff of Nottingham talks of digging Robin’s heart out with a spoon. I hear that line in my head every single time I do one. I have now taught other’s how to do them on a regular basis but that sense of disbelief stays with me.

I’m sure that my Imposter Syndrome is a massive factor in my decision to sit my fellowship exams, and hopefully pursue consultancy at some point in the future. I feel that I need exams, certificates, outside validation to prove to others that I really can do it. I got tired of people saying nice things to me, telling me I was a good doctor, and not managing to really feel it inside. I’m not sure if any amount of qualifications will totally take that feeling away, but I’ll give it a go.

The revision’s going well though. I am really loving engaging my brain again. I feel more like myself with revision notes all over the walls and a timetable of revision topics stretching ahead of me.

Doing it with children is so hard though! They are almost as distracting as those ED nurses interrupting every five minutes!! It’s going to be a very hard slog, my sanity may not survive,  but it’s something I need to do.