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Are you suffering from GP imposter syndrome?

Are you suffering from imposter syndrome (IS)? I am - but having just spent a day on an associate trainer’s course with a delightful group of East Anglian GPs, I find I’m not the only one.

Many of you - most likely those who don’t suffer from this irksome neurosis - will have heard of the phenomenon, first described by psychologists Clance and Imes in 1978.  To those cerebral GPs, I doff my impostor’s mask. 

Though I recognise the symptoms, I had, until yesterday, never heard of it. To explain, IS (a handy acronym) is a peculiarity where, despite objective evidence to the contrary, the sufferer is convinced that they are a fraud who has fortuitously and undeservedly found themselves in a role for which they feel unworthy. Put more succinctly, they cannot internalise their achievements.

Allow me, if you will, to introduce the exact opposite of IS: the DKE (or Dunning-Kruger effect). 

Interestingly, sufferers of DKE are grossly incompetent but, despite masses of evidence supporting the inarguable fact, they remain blissfully convinced of their own competence.

IS and DKE clearly aren’t concepts specific to GP land. Indeed, they tend to plague high-achievers across a multitude of disciplines.

I consider myself a healthy GPISS (GP Impostor Syndrome Sufferer): I have it, but I am aware of having it and seek occasional and appropriate reassurance from colleagues that I’m doing OK. But if you’re strongly GPISS positive, you can begin to frustrate and eventually annoy colleagues. These obsessive types will tend to over-run, over-stress and over-think, all the time. If this is you, please discuss with a colleague, as they’re probably slightly GPISS positive too, and sharing is cathartic.

But GPWDKE (still with me?) are a deadly, and thankfully rarer, breed. We’ve all met them too: they’re rhino-skinned, inexplicably confident and worryingly slapdash. GPWDKEs can often be found in front of Deans and GMC panels.

Incompetence is one thing, and potentially rectifiable. Outright denial of incompetence is frankly dangerous.

We GPs on the course drew reassurance from one another, as a group of happy GPISSers. We deal with patient’s lives and feelings every day, and, when kept in check, IS acts as a safety net.  With the breadth of medicine we encounter, I suspect GPs suffer to a greater degree than most of the specialties. Thankfully, annual appraisal offers a wonderful opportunity to reduce your IS load. 

GPWDKEs may squeeze through appraisal hoops, but let’s hope these ignorant chancers get culled at revalidation.

Tom Gillham is a GP in Hertfordshire and Specialty Doctor in A&E. You can follow him @tjgillham.