With the pandemic raging on, we’re all aware of how hard healthcare providers are working. Intensive care units pushed beyond capacity, insufficient protective equipment, people caring for patients with great risk to their own health. It’s appropriate that we think of these brave individuals as heroes. Yet, in client after client that I coach, what I hear is that many don’t consider themselves that way. In fact, many bristle at the term. Let me share one such individual who I’ll call Susan.
When Susan left her ED shift at an NYC hospital in the middle of April, she did not feel like a hero. She had intubated 3 COVID pts, an 88-year-old man, a 65-year-old woman, and a 45-year-old mother of two teens. Two of these patients were transferred to the ICU. The mother of the two teens was not. She died in the ED. Susan was overcome with grief. In her 10 years of working as an emergency physician, she’d had never had shifts like this one.
As she drove home, a profound sense of exhaustion came over her. She was so exhausted that she wasn’t sure she’d make it from her driveway into the house. Not sure if she’d have the energy to sit with her own teenage daughters. Not sure if she’d be able to return for her next ED shift.
And when she stopped off to pick up the groceries her husband had texted her about, a neighbor and the checkout woman started clapping and proclaiming loudly that she was a hero.
But Susan thought to herself:
“I am not a hero. Heroes save lives. And I was unable to save that 45-year-old mom.”
“Heroes are selfless—they put others first, and don’t worry about themselves. All I could think about during this shift was what if I become infected? What if I infect my family?”
“Heroes are never afraid. I’m terrified that I’m going to end up dying of this too.”
“I am definitely not a hero. At best, I’m some kind of imposter hero. And I can’t stand when people refer to me as if I am.”
Avoid Physician Burnout: You Don’t Have to be Perfect to be a Hero
In addition to all the anguish and uncertainty health care providers experience as a result of the pandemic, there is also, for many, a sense that if we’re unable to help or save every patient we treat, that we’re somehow falling short. Susan had difficulty focusing on the lives she saved; instead, her focus was on the ones she could not save. It was not so much on what she was able to do to help her patients, but more on what she was not able to do. Her lens was on the ways she was failing to live up to an unrealistic standard of perfection.
And if we look at others who are considered heroes, it turns out that this may simply be part and parcel of the experience.
Take, for example, Japanese retired police detective Yukio Shige. He regularly goes to Tojinbo Cliffs, infamously known as “suicide cliffs,” and together with a group of volunteers, looks for people who are experiencing so much darkness that they are contemplating taking their own lives. While his work has saved hundreds of lives, when interviewed he says that he was only doing what anyone should do.
Or Marine Sargent Dakota Meyer, who received the Presidential Medal of Honor for his service during the Afghanistan war. Rather than stay at a relatively safe distance from an intense fire-fight in which fellow Marines and Army soldiers had been caught in an ambush, as he had been ordered to do, Meyer went time and again into the killing zone. During a six-hour battle, he evacuated 12 of those pinned down, provided cover for another 24 to withdraw to safety. Yet, when asked about his service, he claimed that he was not a hero, that the true heroes were the ones who saved everyone.
Imposter Syndrome = the Opposite of Resilience
While it’s not just healthcare workers who can feel like an imposter, is it possible that medical and nursing training makes physicians and other healthcare workers particularly susceptible? There are a few aspects of training I’ve heard about from the hundreds of physicians I’ve coached.
- Never show weakness
We’re taught in our medical training to never show weakness, always have the answer, and always be in command. If we deviate from any of these, we learn that we’ve come up short, that we’ve failed. We’re not taught that doing our best is good enough. Instead, we’re taught: if we’re not perfect, we’re a failure.
- Focusing on deficits
Our medical training sets us up to focus more on what we’re not doing well than on what we are. When I ask colleagues whether their training focused more on their strengths or their weaknesses, they uniformly say it’s the latter. Instead of chief residents and attendings seeing all the ways they’d applied themselves, tried so hard to learn new material, and did well, what stands out for most is the episodes of being told that they weren’t good enough. This focus on our deficits carries into having difficulty appreciating the good we’re doing during the pandemic.
- Making comparisons
The hierarchy inherent in medicine is something trainees learn to internalize: surgeons are better than pediatricians, and the medical specialist is higher up the ladder than the generalist. These comparisons and fixed beliefs around worth also set physicians up to feel like they’re imposters.
All of these factors combine to fuel a sense of being an imposter. And, as I show in a recent Harvard Institute of Coaching CoachX I gave, the Imposter Syndrome is an under-recognized cause of physician burnout. And, here’s an infographic I’ve developed on this topic:
How can Mindfulness Build Resilience?
1. First, we have to train our minds to focus on what we are accomplishing, as opposed to what we are not. It’s just too easy for our minds to gravitate to what we think we could have done better, or to what remains undone. That’s the negativity bias in action.
Fortunately, however, we can teach our mind to focus more on the positive. One simple strategy to do so is, at the end of every day, write down three things you’ve accomplished, small or large. This provides a mental reminder that can help shift where you focus.
2. We also have to challenge our imposter beliefs. We can be overly attuned to inadequacies in ourselves and equally hyper-focused on what we perceive others are doing well. Thus, we generate an artificial divide between where we believe we are and where we believe others are. We create a “delta” that we then reinforce by where we focus our attention. In a sense, we filter out data points that don’t fit with our beliefs. This is actually the definition of a cognitive distortion.
And while we may pride ourselves on our objectivity, these cognitive distortions fuel the imposter syndrome by the subjectivity they generate. Vanquishing the imposter syndrome requires pushing ourselves to look for objective data upon which we base our self-assessment.
3. We need to be compassionate with ourselves. Susan, and everyone else in health care, is working extraordinarily hard each and every day. The more we can put aside self-criticism and be as kind to ourselves as we are to our patients and loved ones, the more we can see the full truth of our experience.
For Susan, following these three steps helped her shift her focus to the good she was doing in each and every shift.
We can’t always change the impact the pandemic is having on the lives of our patients, but we can build our ability to give ourselves credit for all the good that we accomplish.
Recent COVID-19 related well-being and resilience posts and resources
If you’ve missed any previous posts in our popular Mindfulness In Medicine Series, here’s a list of them for your convenience.
- Managing the difficult co-worker
- Patient satisfaction in healthcare and mindfulness
- Mindful parenting
- Self compassion mindfulness for physicians
- Mindfulness and non-physician healthcare administrators
- The top 10 common myths about meditation
- Doctor stress, overwhelm and physician burnout
- Being present with patients
- Mindfulness leadership for physicians
- How to prevent medical errors causes and physician burnout
- Beat imposter syndrome anxiety symptoms with mindfulness