Imposter syndrome again and again and again and again

 I thought that after 3 years of med school and 2 years of residency the imposter syndrome would fade, not strengthen. Not the least of which because I'm expected to go into practice as a fully functioning family doctor at this point were it not for this +1 year. 

Yet here we are. My imposter syndrome has fed on what I can only assume is a steroid laden buffet of self-doubt and come raging out in full force. Yet this isn't quite the same beast I'm used to from the days of clerkship. Standing before a senior resident on internal rounds and being told to rattle off the costs of pancreatitis (I GET SMASHED) and only making it as far as "I GE" is imposter syndrome combined with simple lack of knowledge due to lack of experience. 

(Incidentally, I tried to use Google voice search to get the list of causes of pancreatitis appropriately summed up as the mnemonic above, and instead got recommended a list of ways to stay sober and manage a hangover. I appreciate the thought and the potential contribution to public health, but at <24hrs before my licensing exam it was less appreciated). 

These days the impostor feeling is associated less with my own work and knowledge base. I don't feel bad about the work I've done in the last two years and the associated knowledge and practice I have accumulated from it. In an average family medicine patient I'm pretty confident in my diagnosis, treatment, and bedside (tableside?) manners. 

What I do doubt is other people's confidence in my confidence. I've been developing literal shakes while waiting for a new set of preceptors (and a different one every day) to review my work and give me the go-ahead. I haven't been told by any of them in the last 3+ mths that I'm grossly incompetent, and have received very agreeable, constructive feedback that I can take into practice, but impostor syndrome does operate as such. 

I know part of it is that over the last year I've come to thoroughly understand the way my last preceptor prefers to work, I know her style and her approach to many diseases and treatments. She came to know mine as well, and as we shared an office side by side we developed a very cohesive working style. By the end her reviews of my patients were very much: "good, good, good, good, agree, yep" - which it should be for an end of residency student. 

I now accommodate the working style and preferences of at minimum 5 different physicians per week, across all different environments and systems. It's a little bit like being on tether hooks; never being comfortable in a single place/never feeling like I've quite got it right. 

I hope at the end of June next year at least some of this will go away, but who knows. The only thing every physician I've worked with has ever agreed on is that the impostor syndrome never goes away. Maybe I should look into buying some confidence...Think the wizard of Oz is available still? 

Checking privileges

 Today isn't the first time I've noticed the extraordinary privileges that I've grown up with, but I felt pangs of yuppie guilt on a subject I never have before. Being a first generation immigrant usually meant disadvantages and was sometimes a point of pity when I interact with those born in Canada. 

I had the extraordinary privilege of having parents who are both highly educated at post secondary levels, of coming from a solidly middle class and academic family in China (a boon not to be underestimated in a country with huge wealth disparities) and coming to Canada with legal approval.

By the above statement I mean I did not have to cross a border illegally. I at no point needed to fear deportation from my new home. I was welcomed first as a landed immigrant then a citizen. I proudly hold the blue passport of Canada (not incidentally one of the most powerful passports in the world). I have a citizenship card tucked in a drawer of documents somewhere. I have the freedom to travel in Canada and the privilege to work in legal employment. 

I do not have to accept substandard wages and poor working conditions because I am legally protected as a citizen. I do not have to avoid seeking medical care because I don't have health protection through immigration laws. I do not fear encountering the police on grounds that they might realize I am staying on a fake/expired visa. 

And what I learned today: if ever incarcerated, I would be much more equipped to navigate the system than someone who does not speak the language. 

For protection of identities, I will leave out significant details. 

There is no detention center for those facing deportation due to immigration issues and who are not currently under sentencing/have served their sentences. They stay in a prison until border services is able to escort them back to their home country. 

There is apparently minimal language support for those who are not fluent in English. I'm no stranger to working with those who do not speak fluent English, but I've had the much appreciated resource of interpretation services. These services are, apparently, not employed regularly by the correctional center I visited. 

This person had been in the prison system for some time without the access of any interpretation services. I happened to be visiting for a different reason and chance someone noted that I speak the same language as them. Coincidentally, we're from the same region of China. 

Setting aside many major concerns of the experience of this person in the prison system, the very fact that they couldn't navigate how to make a phone call out of the prison nor understand how to buy food and basic toiletries (again, setting aside the fact that these aren't provided in a center). Small things that in any bad day for me are things that make me feel more human. Things that many of us currently sitting comfortable in our stable homes take for granted. 

What most struck me about this person's story is their terrible guilt and shame in not being able to bring home gifts for their ailing family member. This family member (who due to medical issues has decreased cognitive functions) innocently requested chocolates and milk powder. And this person was desolate that they couldn't even bring home chocolates and milk powder to their family. The very basic of basic gifts that families usually request when a relative returns from abroad. 

On our first trip back to China after immigrating we also bought chocolates. The Walmart ubiquitous Pot of Gold chocolate boxes. These days my relatives have long come to expect designer purses and brand name jewelry, but they still request and receive the occasional boxes of chocolates and milk and protein powders. 

It's impossible not to draw parallels between myself and this person. We're from the same part of China, we both moved to Canada, but on sitting across from each other in a meeting room, I felt pangs of guilt. The pangs of guilt of having privileges that I never had to fight or work for. Guilt of being simply born into a privileged family where they were not. Guilt that I can buy a box of chocolates without any thought or concern. 

One of the people I visited the center with, upon hearing my thoughts on the above, made a point that I hope to keep in mind. What matters is that I do more than simply acknowledge my privilege. I am using the privileges I have (in this case being bilingual) to help those with less. 

So to conclude a long rambling, the prison system is terribly flawed, but hopefully the language services of this particular institute is something I can advocate for so that no further inmates have to guess what they're being held for. I'm also extraordinarily privileged to be a legal immigrant and now Canadian citizen instead of having to come through and live under constant fear of deportation and lack of basic human rights that citizenship of the country one is residing in grants. 

Being an immigrant is still a great privilege. 

Getting back into things

 5 weeks and a Labrador later I'm finally back to routine clinics. 

Some interesting patients as always, though today's the first day I had to work without an electronic system. The EMR is great but we've become so dependent on it that I couldn't physically see patients without it.

It's also the first time myself and the other resident in this program finally got matching schedules and sat down for dinner. Prior to this we've literally always been in different provinces. It's incredibly validating to have someone else say "oh yeah that was brutal" and "nope! Never knew that either". 

It can be a very lonesome experience being the only resident going through something. I thought I left the impostor syndrome in first year residency, turns out it was just on vacation. It's come roaring back full force - to the point of me having nightmares nightly of providing subpar care while in Labrador. One bad clinic day is enough to call in question all that I thought of me as comfortable and competent in. 

So it's very nice to hear someone say they still find it a struggle to keep up as well.