This is the Drive Time Debrief, episode 216.
Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we're talking about something almost every physician experiences, but we hardly ever talk about openly — mostly because we're not allowed to be vulnerable at work. But it's self-doubt. Not the kind that shows up once or twice early in training.
It's the kind that shows up even after you're already good at what you do. Being in medicine is one of those weird things where, as time goes on, some of us start feeling less confident. Some of us start feeling like we're more behind, which is a particular kind of torture. So you've taken the boards, you've run the codes, you've made life-or-death decisions over and over and over, and yet still, somehow your brain whispers things.
Ooh, I bet you missed something. Maybe you should have done more. Did I do everything? What if I'm not actually as competent as I'm supposed to be? So if that sounds familiar, you're not alone. Today we want to unpack why self-doubt shows up so frequently in high-performing people, and more importantly, how your relationship with it can change.
Not by eliminating doubt entirely — that's probably unrealistic — but by learning how to work with it instead of against it.
Okay, so let's start with something that might sound a little counterintuitive. Self-doubt isn't necessarily a flaw in the system. It's actually part of how the human brain evolved.
Thousands of years ago, overconfidence could get you killed. If your ancestor constantly overestimated their abilities — challenging the wrong rival or taking unnecessary risks — that might not last very long. A little bit of doubt kept people cautious and it kept them paying attention.
And when you look at the personality traits that tend to select into medicine — conscientiousness, responsibility, high standards — you end up with a group of people whose brains are constantly scanning for potential mistakes. And that's not a bug. That's part of what makes you careful with patients.
There are a couple of other psychological forces that amplify this.
One is negativity bias. Your brain is wired to remember negative events more vividly than positive ones. So you might have 20 straightforward cases in a shift, and then the one difficult outcome is the one that sticks in your head on the drive home. Your brain is essentially saying, let's review that again, just in case there's something we can learn. Unfortunately, the brain isn't always very balanced about that review.
Another piece of this is comparison. Medicine is a high-achievement environment. Throughout training, you're surrounded by people who are exceptional. And now with the internet and social media, it's easy to constantly compare yourself to someone who seems more productive, more confident, or more accomplished. But your brain was never designed to compare itself to the global highlight reel of medicine.
So the combination of responsibility, comparison, and negativity bias creates the perfect environment for self-doubt to grow. And here's the important point: self-doubt often shows up not because you're failing, but because you care deeply about doing well.
I think we can all reflect on the patients who maybe were overconfident in their abilities — to do motorcycle jumps or to jump out of buildings and things — and understand why having a little bit of self-doubt was a survival mechanism.
And there's another layer to this that shows up frequently in high performers, and that's when our identity becomes so tightly tied to our performance. And that actually makes a lot of sense for a lot of us. We definitely are gold-star achievers. Many physicians have spent years and often decades being the person who performs well. Some of us will have stories of when we were one or two years old and how our parents talked about how exceptional we were at reading or any number of little things we might have done when we were little — so it didn't start yesterday. You studied hard, you did well in school. You got into competitive programs — which any medical training program is — and you worked your way through, and it was hard, and you learned that success and performance get you the gold stars. And they start to feel like part of who you are as a person, and it becomes hard to imagine what your life would be like without them.
And there's a downside to that, and that is that we really don't have control over every outcome. And when they don't go the way we hope, we can start feeling like that's a reflection on our actual worth as a human being.
The good outcomes feel validating most of the time, and the difficult ones — sometimes we can personalize those, thinking that somebody died or had a bad outcome because of us, when usually we had no control over that situation. So instead of simply being a clinical situation with multiple factors — not the least of which is that the person came in with decades of medical problems and noncompliance with their medications for years and years — somehow we're supposed to yank them back from the edge of death. And it's just not realistic.
Our brain will interpret it — and this is a survival mechanism as well — that if there's something that could have been in my control, then I can make the world safer. Little kids do this a lot. If their parents or caregivers are abusive or neglectful, the child, instead of believing that their parents are bad parents, will often try to find a way that it was their own fault, because then they don't have to believe that the whole world is unsafe. So it makes sense that our brains do this. It makes sense that our brains will say things like, I should have done more. I should have known. Maybe I'm not as capable as people think. Maybe I'm a fraud. Some imposter syndrome comes in there.
From our perspective as coaches, what's happening there is that we are becoming very attached to outcomes. And when we become overly attached to outcomes as proof of our value, the stakes of every situation in life get amplified. And that's a hard way to live. That's an exhausting and anxiety-filled way to live, as we really have very little control over anything. People — just like the circle of control — it's very, very small.
When we're feeling like this, every patient encounter carries not just clinical responsibility, but the emotional weight of what it means about us as a person. And when patients are not happy with us, sometimes we might allow it to seep into our brains that we're not a good doctor, maybe we're not as good as we think we are. That is just not helpful. We can't control the way other people think about us. It's exhausting and it does drive a lot of burnout in doctors.
So when doctors find themselves burned out or questioning themselves, even when they're objectively doing very good work, it's helpful to look back at these kinds of thoughts and attachment to outcomes and see what's happening there. Am I trying to assume control for things that are not in my control? Am I believing that my worth is somehow tied to what my patients think of me? Not saying that you shouldn't care what your patients think at all, but if you're showing up the best you can — the kindest, most patient, most caring doctor you know how to be — and somebody is still upset with you, that's not necessarily in your control.
So the issue here is the belief that every outcome determines your worth as a physician, and that is just a false belief and will drive burnout quicker than just about anything. So we just want to be aware of that and challenge it when our brains offer it up.
Yeah, this one's so hard. I think for a bunch of us perfectionist doctors, just wanting to get it perfect every time, and then noticing every little flaw — it conflates into that whole identity of, if I didn't get this one little thing right, maybe I'm not good at this at all. Comparing yourself to some imaginary perfect doctor that exists out there who has never once missed something — it's just a painful place to be. I have been there, so that's why I'm passionate about this.
So how do we change our relationship with self-doubt? It's so built into the system. What can we do about it?
So from both psychology and coaching perspectives, the goal isn't usually to eliminate the doubt entirely. Your brain is designed that way — we've just talked about that. What is possible, though, is to change your relationship with it.
One helpful shift is recognizing that your thoughts are not the same as facts. We reiterate this over and over. It is mind-blowing to know that not every little thing your brain offers up is true. We know this because songs get stuck in your head, your brain glitches out — it just offers some stuff up. Sometimes you do not have to make it mean anything if it's not helpful.
So when your brain produces the thought, maybe I'm not good enough, it feels very convincing. It feels so true to us in the moment. But psychologically speaking, this is just a neural loop. This is just a mental event. It's your brain generating — is this what we should say here? Is this helpful? And no, it's not.
So one technique from cognitive psychology is simply creating a little distance from that thought. Instead of saying, I'm not cut out for this, you can reframe it as, oh, how interesting — my brain is offering up the thought that I might not be cut out for this. Can you feel the little bit of separation? Being able to name what your brain is offering up creates that little bit of space between you and the thought.
Another important piece of this is detaching your identity from outcomes. This one's so hard, right? The only time I was ever named in a suit — I eventually got dropped — but the lawyer that I met with said, oh, this is hard for you guys. You guys make it mean so much; your personality is your work.
And of course I was very defensive. Like, of course — you just don't get it. But now I see what he was saying: the fact that an event happened, that an outcome happened, has nothing to do with you, your worth as a human being, or even whether you're a good doctor. That took me a while to figure out, and he was trying to be helpful, but my initial reaction was defensiveness.
So we need to start recognizing that medicine is complex and no physician, no matter how skilled, is going to control every single outcome. When your identity isn't completely fused with every single outcome, it becomes easier to stay focused on the process. I'm going to make thoughtful decisions. I'm going to learn from every case. I'm going to keep improving over time — which by definition means you don't have to start out perfect. You're going to continue to improve.
There's something very powerful about reducing unnecessary comparison to others as well. This is part of the Gap and the Gain book — if you haven't read it, I highly recommend it. The only useful comparison is to you before. So now I've learned something from this. Now I've seen this presentation, now I've seen this diagnosis. Great — you're even better than you were before. Your growth as a physician is a long-term process. If the scoreboard you're using is constantly someone else's career trajectory, then it's very hard to feel like you're doing enough.
It is not useful to compare yourself versus the version of another physician that you see. You don't see what's going on in their head. You don't see their self-doubt. You don't see the times that they have missed something or learned from something. You're just comparing yourself to the Instagram version of them.
So defining your own measures of growth — like clinical skill, connection with patients, balance outside of work — can be far healthier than constantly measuring yourself against others.
And finally, it's worth remembering that some degree of doubt serves a purpose. It keeps us curious. It keeps us humble. Oh my goodness — the worst is when you think you know everything and you're wrong, and you're just committed to it anyway. A little bit of self-doubt keeps us learning. The goal is not perfect confidence. The goal is to be able to move forward even when uncertainty is present.
So if self-doubt shows up in your mind from time to time, it doesn't necessarily mean something's wrong. In many cases, it's simply the mind of a conscientious, thoughtful physician doing what it was designed to do — analyzing, reviewing, trying to improve. The key is learning not to treat every doubtful thought as a verdict on your competence. Instead, it becomes just another signal from the brain. One piece of information among many. You can notice it, you can learn from it, and you can keep moving forward anyway — because medicine will always involve uncertainty, but a healthy relationship with that uncertainty can make the work feel a lot lighter.
That's it for today's episode, friends. Thanks for joining us. If you found this conversation helpful, the best way to support us is to subscribe, so click that button now, and by giving us a review and rating, it helps other physicians find the podcast and it moves us up on the list. And we'd love to hear from you — if you've had any experience with what we've talked about today, email us at [email protected].
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So thank you for spending time with us today. Until next time — you are whole. You are a gift to medicine and the work you do matters.
