'Don't Screw Anything Up': The Epidemic of Imposter Syndrome

Ravi B. Parikh, MD, MPP, writes in Medscape:

As I walked my first patient back to the exam room, my only thought was, God, don't let me screw anything up.

It was my first clinic after oncology fellowship, at my local VA medical center. Every aspect of my schooling and clinical training had prepared me for this moment, seeing patients independently and helping them navigate what was probably the most important health issue of their lives: cancer. Nights studying for exams. Even longer nights caring for patients in the ICU. Countless hours spent discussing both scientific and spiritual concerns with patients in exam rooms. It had all led up to this.

Thankfully, my medical director started me off easy—only one visit, a follow-up for a man with advanced prostate cancer. His PSA was well controlled on enzalutamide and he was tolerating the medication well. No scan review and no need for a scan before his next appointment. We spent most of the visit talking about his family and the issue of having to wait for his medication to arrive in the mail. After speaking to one of the pharmacists, I asked him to go to the in-house pharmacy window to pick up the medication. He'd return next month for another toxicity check and to receive his androgen deprivation therapy shot.

As I walked out of my very light clinic day, I found it ironic that after years of poring over books and listening to lectures about clinical science, my first clinical decision as an attending physician was determining where to send a medication.

I also knew that my clinical encounters would only grow more challenging. And I questioned whether I was up for the challenge.