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At the heart of general practice since 1960

Two years into general practice, I feel like I know less than ever

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Last week I had the pleasure of meeting a former professional baseball player who was interested in my job as a GP. His career was ended by a serious shoulder injury and he described in incredible detail about how his ulnar collateral ligament was removed to replace a SLAP tear via Job’s procedure. I nodded sagely, afraid to let on that my shoulder anatomy knowledge is limited to that of the acromioclavicuglenospinatus joint (there may be two of those).

I suppose this is reflective of experience versus rote learning and hopefully maturation into a proper doctor

In my tumultuous pubescence, I remember feeling awestruck at how much my GP knew about health and the body - whether my sore throat needed antibiotics and, if so, which antibiotic to choose seemed like a remarkable feat of brainpower and memory. At school, I couldn’t fathom how clever people who attended university were (at the time, I thought you could study a degree in how to be a postman so it probably wasn’t hard to impress me). In my first year of medical school I can picture having a conversation with a second year who had diagnosed her grandfather with angina and marvelling at how close she was to being a doctor.

Even in my final year - probably the pinnacle of my theoretical knowledge of medicine - I looked at GPs and registrars and simply could not imagine myself having that level of clinical acumen and skill. Throughout, there is a theme of being unable to comprehend having a certain level of knowledge and ability.

Now, having been a doctor for six years and having been in and around general practice for over two, I feel like I know less than I ever have.

I find that if I was asked to write everything I knew about an illness I might fill up an A4 page but with a level of detail no more complicated than in an A-level textbook. However, put a patient with that disease (or a set of symptoms) in front of me and I feel infinitely more comfortable than I ever had anticipated. A little like becoming fluent in a new language, clinical practice now feels like a natural extension of walking, breathing, driving - largely automatic processes. I might not be able to list the 11 causes of atrial fibrillation anymore, but I’ll bet I would be able to identify Mrs Smith’s.

In some respects, I suppose this is reflective of experience versus rote learning and hopefully maturation into a proper doctor. The irony is that the further this progresses, the less ‘knowledge’ I think I have.

In fact, this experience of being objectively high-achieving but feeling subjectively like a fraud or charlatan has a name. So-called ‘imposter syndrome’ is common amongst high-achieving people and therefore probably seen amongst other doctors too. The psychological trait was labelled in the late 1970s by American psychologists Dr Pauline Clance and Suzanne Imes.

Fear not dear reader, it does not bother me a huge deal, although I still admire the knowledge more experienced GPs and my peers possess. Perhaps though, we are all feeling the same.

Dr Danny Chapman is a locum GP in east and south Devon 

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Readers' comments (9)

  • We all feel the same. Some hide it to protect themselves, others embrace it and see the objective strengths of what we all do i.e. see a patient with their words, worries and ideas and turn it into a working diagnosis with a management plan whilst balancing being nice, safe and uncertainty. All in 10 minutes. Same the wider system doesn't value us.

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  • I think impostor syndrome is very important in all sorts of ways... http://peterenglish.blogspot.co.uk/2016/01/as-profession-doctors-must-support-each.html

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  • After thirty three years as a GP I still found that I didn't know what was wrong with half the patients seen.

    "Not waving - but drowning"!

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  • Pipin Singh

    I'm not far ahead - 6 years in and can relate to this article although I do feel as though I have become an "expert" in managing risk and uncertainty. Something that underpins the work we do

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  • Dear Dr Chapman, I think it has always been the same. Years ago a Health Service Manager, always willing to learn, told me she had asked a GP if she could sit in his consulting room with him and with the patient's consent so she could get some idea what these consultations were like. The GP agreed. The first patients, a man and wife, had got permission to adopt a child, as they had been unsuccessful at having a child themselves. But the wife had now had a period unexpectedly and they were asking what should they do now please, doctor? The manager said all the consultations were like this, symptoms or conditions overlaid with big psychological, practical, relational or mental health issues. When I first registered with a GP in Worthing where I had moved, the GP - roughly the same age as me - asked me, "Why Worthing?" I replied "How long have you got, doctor?" The reasons were complex and to do with my 31 year relationship coming to an end. I did not trouble him with my personal relational matters since it was a finger injury I had come about. I wish you good luck doctor.

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  • Great blog Danny!

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  • All you have seen and heard goes into your subconscious
    It's what gives you experience based expertise
    Do not drink the sea .. Just learn to swim in it..

    Just demonstrate you took 50 mouthfuls for appraisal

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  • To Paul Bunting.. How long have you got... 10 minutes

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  • Brilliant. Never heard of imposter syndrome. Now I know how to explain an experienced consultation to my medical student!

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