This reflective essay was written by Stephen Clare, Editor-in-Chief of the RCSI Student Medical Journal (RCSI-SMJ), during his first year in the Graduate Entry Medicine programme at RCSI. Drawing on his background in the performing arts, Stephen explores themes of identity, empathy, and impostor syndrome in medical training, offering a deeply personal yet universally relevant perspective on what it means to grow into the role of a doctor.
The Theatre of Medicine: Performing as a Doctor
My name is Stephen, and I am a first-year Graduate Entry Medicine student at RCSI. I am 27 years old. I recently won the Sheppard Memorial Prize in 2021 for a short essay about identifying domestic violence in GP practices and outpatient settings.
When I was asked to write a piece for this newsletter, I reached reflexively in my mind for a topic that I think about with depressing frequency: imposter syndrome among medical professionals. The insidious feeling of inferiority that can plague both students and clinicians alike. And though I wish to speak personally, it is not my intention that this article be about me. I sincerely believe this is something many students and professionals can and do identify with. I also believe strongly in writing what you know – and though I am but a fledging medical student with limited knowledge – I do know intimately the feeling that one doesn’t belong in one’s own career.
Prior to starting my medical studies I worked for several years in the performing arts. I read spoken word on stage and performed in street theatre. I wrote poetry on an old typewriter, on demand, for anyone willing to throw some money in my proverbial hat. At festivals, farmer’s markets, weddings, hotels, I would perch and chat with people about their lives. No topic off-limits, and once the conversation was spent I’d type up a small poem saying little more than ‘I heard you’. Part fortune teller, part therapist, part curious oddity, I’ve never known how to describe my years in the arts to other people. I certainly never considered myself poet by any meaningful metric. Once, an older writer gave me some sage wisdom: you can consider yourself a poet when other people start calling you one.
Who we are is so often reflected in the gaze of others. Each person we encounter affords us an opportunity to see a facet of ourselves through their lens and vice versa. I believe this to be the root of empathy, and also an integral component to the art of healing. It was certainly the root of my modest success as a performer. Most remarkably, it is possible to create hope in others simply by seeing it – soothe pain simply by recognizing it. For those of us who are starving, lonely, lost, or sick, the strength to push forward is so frequently drawn from the faith of our fellow humans; and when we fall, it is often for them that we get back up. Even with no goal in sight, we may strive endlessly if we believe in the vision others have of us. It is that ability to validate both that there is a desirable future – and that it is within grasp – that forms the basis of many humanistic therapies today, as well as being a trait of many great leaders and healers throughout history.
I am just beginning my medical training and I have found myself meditating frequently on what it means to be a doctor. I certainly struggle with a sense of imposter syndrome, neatly described as “the persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills”. I certainly am not alone. This feeling is rife within medicine, experienced by both medical students and practicing clinicians. According to the literature it is more common in female doctors, and in minorities; and it has a documented negative effect on career progression, mental health, leadership, and burnout. In one study, several physicians self-assessed their own careers as “rising to the level of your incompetence”. I wonder how many are unable to appreciate the view from the height of their success, so worried are they with looking down over the edge.
So when does one become a competent doctor? Harking back to the words of my old mentor: when other people start calling you one. Imposter syndrome and feelings of inadequacy are so often described using individualistic terms. It is an personal issue, due to poor mental health, a lack of resilience, etc. However, I am coming to think that this is a fallacy. Without a measure against which to set ourselves as inferior, would we still feel inadequate? Possibly yes, given that medical careers seem to draw personalities prone to perfectionism and neurosis. However, given the disproportionate number of women and minorities affected by these feelings, I am inclined to think there is something deeper at play. A sense, perhaps, of being miscast – of finding oneself within a play where one doesn’t know the lines, and a sinking feeling that you are in the wrong role.
Medicine, like so many other things in life, is a performance. There is so much cultural significance imbued into the role of doctor. And despite the cold and comforting precision of science, the ritualistic role of healers in society is very well-established if still poorly understood. From the clearly measurable placebo effect, to the anecdotal stories people often share of doctors who witnessed them during their darkest time, there is an undeniable emotional weight to the practice of medicine. I think this weight is felt most acutely, if not always consciously. I have already seen students and clinicians aggrandise and mythologize their role, while also encountering doctors in my life who seem emotionally deadened to the
suffering they witness daily. I cannot judge the coping mechanisms individuals may use to interpret the practice of medicine and their place within it.
Still, I am struck by how isolating the medical community can seem. Though we are ostensibly comrades in arms, it seems that each person I have met negotiates a very personal and individual relationship with their identity as a doctor. Certainly for people of colour, for women, for LGBT individuals, and for anyone who may not fit the societally prescribed mental image of “doctor” there is a sense of having to figure it out as we go. I do not know the kind of physician I wish to be, but I know the kind I want to avoid becoming: the kind that has left me unheard and unseen in moments of crisis; who could not recognize my pain, nor see within me the hope of which I was so desperately in need.
It is not my intention to romanticize medicine. In theatre and performing arts, it is that very tendency to picture an ideal role, an ideal actor, an ideal method, an ideal delivery, that ultimately leads to paralysis in moments of pressure. I do not know when, if ever, I will feel as though I am capable. Certainly my feelings can change with the weather. However, I do think there is a place for vulnerability in the medical community. Though it is vital to project confidence and competency toward patients, I sincerely believe that there is no one more understanding or capable of uplifting you as your fellow medical professionals; and though it is terrifying to admit error, weakness, or a perceived lack of competence, there are few people better equipped to see hope within you and your practice as your fellow physicians.
Certainly as a student, it is the recognition of competency from my colleagues that pulls me back from the edge; and without being mawkish, when I fall it is with them I get back up. I am coming to see imposter syndrome as something of a Gordian knot, a challenge best faced with bold and decisive action in the face of seemingly impossible and overwhelming circumstance.
I think about those doctors who feel they have risen to the level of their own incompetence. I sincerely wish to thank them for standing tall and bearing the weight of their role even as they doubt themselves. I would like recognize the strength and wisdom they draw upon day after day to show up despite their self-doubt; their ability to practice medicine with grace, humility, persistence, and skill; and that through their fearless vulnerability they have commensurate power to lift up both patients and colleagues alike.
