HealthMarch 20, 2020

Physician self-confidence: Why it matters and how to build it

By: Stacia Dearmin, MD

We physicians have a different relationship with self-confidence than many professions. On one hand, self-confidence is often identified as a key trait of a great physician. On the other hand, most of us struggle at some point with "imposter syndrome," a sense that we are pretenders, that our hard-won role is not rightly ours or that the sum total of our effort, talents and abilities does not justify our success.

What creates this juxtaposition between our need for self-confidence and our tendency to experience imposter syndrome? And what can we do to manage that gap?

Why do physicians need confidence?

There is a fascinating body of research on the qualities patients consider to be essential in an excellent physician. Among those qualities, self-confidence often ranks high. Why? Not unexpectedly, self-confidence in a physician tends to engender trust in the patient. After all, if you needed medical treatment, wouldn't you prefer a physician who seemed to know exactly what they were doing? I would.

At the same time, we physicians operate in a realm of great uncertainty. The human body is enormously complex and medical science seemingly infinite. No one is more aware than we are that there is much we do not yet know. Furthermore, it doesn't take long on the job to realize that even seemingly simple situations can surprise us. Young physicians quickly learn there is no crystal ball.

With all that uncertainty, it's easy to find ourselves paralyzed by indecision. However, since most physicians' work includes a constant need for diagnostic and therapeutic decision-making, we simply can't do our jobs without a certain level of self-assurance.

Where does it go?

While the uncertainty inherent in our work can make it a challenge to sustain healthy self-confidence, other challenges, some unique to our work, frequently damage a physician's self-confidence. Among these, unexpected adverse patient outcomes, surgical complications and medical malpractice litigation are at the forefront.

How physicians recover from painful patient outcomes and malpractice litigation is particularly of interest to me, having been through it myself. I can't tell you how many physicians have told me that one of the most disruptive effects of malpractice litigation is the impact it had on their confidence, regardless of whether they thought the lawsuit was merited or not. One highly respected surgeon put it well, saying, "I need self-confidence just to do my job. In order to perform surgery, I need to believe in that moment that I am the best person to be performing that surgery for that patient. Otherwise, why would I do it?"

3 Tips for strengthening healthy confidence

My time talking with numerous physicians about this experience has taught me that it's possible to recover from these challenges to your self-confidence. It may take time and patient effort, but you can restore your self-assurance. Here are three steps you can take to get started.

1. Go back to the basics

It's not uncommon for unexpected medical outcomes to throw us for a loop. A bad experience managing an airway, for example, may cause a physician to experience PTSD-like symptoms when faced with a potential airway emergency. The physician may feel an urge to leave the room or pass responsibility to someone else, even if she's the person best equipped for the task.

In that case and others like it, it can be helpful to spend time outside of the emergency situation reviewing the basics. Go over and frequently rehearse the steps you learned in training. Force your mind to imagine similar situations step by step and slowly envision things going smoothly. Seek an opportunity to practice under a mentor's watchful eye. Get thee to a SIM lab. Reinforcing motor memory may help you get beyond the unwanted excess adrenaline. It may also remind you of how remarkably knowledgeable and well-trained you are.

2. Cultivate humility

Ironically, genuine humility has a role to play in establishing or reestablishing your sense of self-assurance. True self-confidence is not synonymous with arrogance, and your patients will know the difference.

Tap into humility. Cultivate the belief that every life is as valuable as any other as well as a deep awareness of how little we control and know. Then consider stepping back and embracing your sense of awe at the fact that any of us is ever able to heal anyone else at all. It's a marvel! Thank life for the extraordinary role you have been given to play in this world, then try stepping into that role with gratitude that you've found it and for the gift of intelligence that allowed you to take it on. If you've come this far, you are capable.

3. Connect with a colleague

When our confidence is truly shaken, nothing can be more helpful than connecting with a respected colleague. Be careful about who you seek out, though. You want someone with enough life experience to know that things go wrong at times and enough heart to understand that you are hurting. Should you end up feeling worse after talking with a co-worker, try again. A life in medicine is a complicated endeavor, and when you feel your self-assurance slipping, the friendship of a colleague who respects your work can be a balm like no other.

Stacia Dearmin, MD