As with Inspector Clouseau’s guard Cato in The Pink Panther, it sneaks up on you when you least expect it.

‘You’re a fraud and you’re about to be found out. Who are you to play doctor?’

If you’ve ever experienced impostor syndrome, the self-doubt that ambushes at the worst moments, you’re not alone.

Everyone from Sir Jonathan Van-Tam to Albert Einstein, and 62 per cent of health workers globally, have felt it. Up to 92 per cent of orthopaedic surgeons in the UK say they sometimes feel like a fake.

‘I’ve been told that anyone who doesn’t feel like an impostor is likely to be a sociopath,’ says consultant spinal surgeon Iona Collins, who is also BMA Cymru Wales’ council chair.

Medicine’s high stakes – and high IQs strongly associated with perfectionism – make it the perfect breeding ground for impostor syndrome.

Yet, while it’s normal to feel like a fraud, impostorism can become crushing and tip people into burnout, or worse. ‘Fake it till you make it’ can only make things worse.

So, what is fuelling impostor syndrome and what can be done to contain it?

‘I would be lying if I said I didn’t feel it every day, two or three times every day,’ says Aditya Roy, an academic foundation year two doctor at Bangor University.

Self-doubt started early, when he was applying to study medicine. ‘You’re standing at the gates of what is a very intellectual profession and you haven’t even got A-levels under your belt,’ he says.

Impostorism has tracked Dr Roy throughout his training, launching its worst assaults in clinical settings. ‘At medical school you see a problem and you fix it,’ he says. ‘But in real life, it’s never straightforward: there’s always extra steps that someone five years my senior wouldn’t have a problem with. So, you start to think: what would someone else do in this situation and why can’t I do it now?’

He mentions the Dunning-Kruger effect – the tendency of people with low ability in a specific area to overestimate their ability and that of high performers to focus on their knowledge gaps. Medical exams’ propensity for including ‘very niche’ topics doesn’t help, says Dr Roy.

‘You obviously forget those topics when you start work but then you feel if I did the exam now, I wouldn’t pass it. Ninety per cent of the time you’re going to be OK because you know enough but there is always that uncertainty and sometimes it takes over. Those are bad days.’

The bad days get worse when more senior colleagues find ways to remind resident doctors of their relative ignorance, for reasons Dr Roy chooses to ascribe to stress and systemic pressures. ‘There are individuals that will adopt the mentality that “I suffered so you will suffer as well”,’ he says.

For Iona Collins, a touch of impostor syndrome is normal and even healthy. ‘You must always question yourself and your decisions,’ she says.

The risk comes when you really are the ‘odd one out’, when you’re visibly different – and it’s all too easy to feel you don’t fit in. 

She was only the third female orthopaedic spinal consultant in the UK when she was first appointed to the role in 2008.

The reminders that she didn’t fit in were everywhere, from the oversized surgical gowns to a theatre table that wouldn’t lower to her height, so she had to use standing stools during operations.

Years earlier, in 1999 when she was the first female orthopaedic registrar appointed to a one particular hospital, the surgical anatomy books were kept inside the men’s changing room. She had to buy her own copies.

Dr Collins has amassed many such stories over 30 years since qualifying but mentions a recent account from a female colleague on the surgical rota.

Having used the on-call room overnight, this colleague was awoken by a knock on the door. She opened it to find a nurse carrying tea and toast, looking bewildered.

It turned out the nurse had misread the rota, assuming a male surgeon was on call, as it was standard practice for the male on-call surgeons to be brought breakfast in the morning. ‘My colleague had never had this treatment or knew this was going on,’ says Dr Collins.

‘So, there is internal imposter syndrome, and then there is the genuine experience of being treated like an impostor. Both carry tangible and intangible costs, culminating in people feeling like they’re not taken seriously and that their opinions somehow matter less.

‘The necessity to constantly self-validate, to prove one’s worth, to avoid the single mistake that would provide "evidence" to a suspicious majority, is draining. Ironically, that erosion of resilience over time can impact performance as an almost self-fulfilling prophecy of inadequacy.’

Despite these challenges, Dr Collins remains determinedly optimistic. ‘Change will come, when ability is truly valued the most and the workplace naturally develops diversity. When all people can all compete on a level playing field, with society no longer assigning women to the role of  “support crew”, we will all benefit together.’ 

Hackney GP Claire Davies is also a coach working with female doctors on confidence, and impostor syndrome comes up often in coaching sessions.

Dr Davies isn’t surprised. To some extent, it’s a normal ‘flight’ response to challenging or unfamiliar situations. She felt it herself when she moved to a new practice some years ago.

But medicine as an ecosystem can leave people feeling particularly exposed, she believes.

For one, the identity of ‘doctor’ is conferred at a young age, typically in people’s early 20s. ‘When you go into medicine, you’re assigned an identity. You enter the institution and you start to develop a language and a way of behaving – before your brain and your own identity are fully formed,’ says Dr Davies.

Developing a sense of self is further stunted by an ‘achievement-orientated’ training system which focuses on passing exams ‘rather than acknowledging all the softer, personal qualities that a lot of us are using all the time, like empathy and courage’, she says.

The feedback too can be less than affirming. ‘If your portfolio is ticked off as “no concerns”, what does that say about you? It just says you’re not directly dangerous.’

Dr Davies feels that, while men definitely suffer from impostor syndrome, women are particularly prone to feeling it intensely.

‘When things are challenging and difficult, I think women are often more conditioned to start asking questions like, “Is this me?” because society’s built more around men.’

Sadly, women’s flexible and part-time working can affect colleagues’ perceptions of their competence. Likewise, women can appear ‘slower at their job’, says Dr Davies, simply because they tend to give people more time.

‘There’s evidence that women spend longer with patients and spend longer documenting and writing notes and patients expect more empathy and emotional labour from women doctors. And if you’re not self-aware, you can go home blaming yourself for doing a bad job, whereas actually, to carry on working like that, you have to show all sorts of remarkable qualities.’

Dr Davies helps women doctors to identify their inner critics – the ‘you’re not good enough’ or ‘they won’t like you if you say no’ voices – and then to recognise their skills and strengths. The latter include life experiences such as parenting, caring roles, even bereavement, which are ‘just as important as the medical skills’, says Dr Davies.

‘Often I’ll say: “Ask that negative voice to step out of the room,” and then you’ve got the person’s wiser, more confident self in charge, who’s much more likely to start making good decisions for them.’

Ultimately, the goal is turning impostorism into something more positive: awareness of your limitations and strengths.

‘If you’re showing up with humility and you’re saying: “I’m curious, I accept I don’t know everything, I want to know more,” that’s very different from, “I’m not good enough, I don’t belong here”,’ says Dr Davies. ‘You can’t get rid of those negative voices but you can work with them.’

Back in Wales, Dr Roy regularly takes to social media to discuss this kind of challenge (and to demonstrate his knitting machine). Being open about impostor syndrome, he believes, is a first step towards exposing it as a lie.

‘Until fourth year, I just thought I had really bad anxiety and then I found a name for it,’ he says. ‘My friends and I educated ourselves about it, and now we talk about it all the time, in a psychologically safe way.

‘We all think the other person knows what they’re doing, but I realised that everyone’s improvising, and that made me feel a little bit better about myself.’

Longer term, Dr Roy’s goal is medical education and to be part of what he sees as a much-needed culture change where wellbeing is prioritised and wellbeing initiatives are shaped by clinicians, not managers.

‘For now, impostor syndrome is normal: you shouldn’t feel guilty for thinking that way. The ones who feel it most are normally the ones who care the most.

‘If I could go back in time and speak to myself at the start of medical school, about all the different challenges I’d face and all the different hurdles I’d eventually overcome, I would feel guilty if I didn’t share all that. Things will only change if we all start reinforcing this positivity and push for a better culture.’