Sometimes, growth is hindered by a lack of self-support and confidence. Such is the root of imposter syndrome, acting as if a wall that hinders us from achieving our full potential. Talking about defeating these limiting thoughts with Melanie Parish is Jehaan Ilyas, the Lead Psychiatrist at the Hamilton Family Health Team. Together, they discuss how to get rid of self-doubt, how each gender handles imposter syndrome, and why rising beyond your incompetence can lead to a better self. They also talk about the adjustments of the medical industry in virtual consultations and some self-care tips.

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Jehaan Ilyas On Defeating Imposter Syndrome

I’m here with Dr. Jehaan Illyas. He’s a practicing psychiatrist and he is the lead psychiatrist at the Hamilton Family Health Team. Jehaan joined the Hamilton Family Health Team in 2015 after graduating from the McMaster Psychiatry program. Jehaan has always had the passion for collaborative care which was fostered throughout his residency by the likes of Dr. Lindsey George, Dr. Nick Kates and Dr. Jon Davine. It’s great to have Dr. Illyas on my show.

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Jehaan, I am happy to have you on my show.  

Thank you for having me, Melanie.

It’s great to have you. I would love to know what you’re working on in your work right now?

I work for the Hamilton Family Health Team. I’m the Lead Psychiatrist there. There are a lot of different things going on at work. A lot of moving parts trying to pivot to the pandemic, which is always a moving target. We’re trying to maintain care, knowing that a lot of our patients are going through a difficult time. We make sure that we’ve got our resources mobilized so that we’re there for them. At the same time, look after our team and making sure that we’re all doing well.

Imposter Syndrome: Virtual care was always there but underutilized.

I can’t imagine the pressure that you must have been under, leading psychiatry in a time of a global pandemic. What are some of the things you’ve been experimenting with?  

On the face of it is virtual care. Virtual care was there but it’s underutilized. It’s more so as a tool to expand our reach, for example, to get psychiatric care to Northern populations and do it virtually. It’s mostly through services like the Ontario Telehealth Network. The pandemic thrust everybody into this realm, which a lot of us were not prepared for and not ready for. Philosophically, it changed the face of the psychiatric interview because instead of all that rich information that you get sitting in the room, face-to-face, that feeling and all the non-verbals that you get from people, all of a sudden, you have to adjust to that if you’re fortunate enough to do it over the video. Also in most cases, trying to adjust to that over the telephone. That’s the biggest challenge to work. It’s both a system and infrastructural challenge. A challenge for the patients but also a personal and professional challenge for us as a specialty.

What have you been learning as you experiment? What are some of the data that you’ve come up with?  

It’s interesting to think about a diagnostic term we use known as an adjustment disorder. At the moment, it’s felt like a disorder but it’s been a significant adjustment. For me, it’s been a good experience. I’ve been quite pleasantly surprised on the one part, about how I’ve been able to adapt to it. It dispelled some myths that you could only get rich information and what you need in a consultation interview in-person. I come from a lot of my training in psychotherapy. For a lot of psychotherapies, there’s that richness of the interview of the nonverbal cues of those things and feelings that you get in the room of building that relationship. I’ve found that you’ve been able to do that virtually. That was the most surprising thing.

Secondly, seeing the individuals that I’m talking to, seeing my clients and my patients adapt as well. In some cases, it worked out better. Some of the other areas that have been beneficial to the patients, I took for granted how hard it would be sometimes for them to come to my office for a visit. Now that they can do it from home, there was a convenience factor to it which also helped. One example of an area that was surprising was how much quicker you can get into deep and informative information over virtual platforms. It seems like people are more willing and more ready. That’s something I wasn’t anticipating. Your ability to make that therapeutic alliance seemed to come a lot quicker. I was not at all expecting that.

I’m finding this fascinating to know what you’re discovering. For the first seventeen years of my twenty years in coaching, I did everything by phone. I found it amazing. I remember when I was first training as a coach, they said, “You’re going to coach by phone.” I thought, “No way. How will you connect all these things?” I loved that connection by phone. Sometimes, I think I’m a better coach by phone because there are fewer distractions. The visual cues sometimes distract us from deep listening and things like that. I’m on Zoom most of the time and I like the human connection of it, but I do miss the deep listening that happens on a telephone call. I’m not sure if Zoom gives us what we think it gives us sometimes.  

It’s an interesting thing too when the numbers were a bit better before the second wave. We were opening up our services. We had a focus on equity and trying to get to those people that we weren’t reaching because they couldn’t do virtual platforms. However, for those who still could, we gave them the option. We said, “I can see you in person, on the phone or over video.” I was surprised at how many people preferred to keep it virtual. It’s understandable because we’re still in a pandemic, but also be preferred to do it over the phone as opposed to a video.

When I schedule a client in person, I have to add fifteen minutes on either end. Whereas if I do a virtual phone call or a Zoom call, there’s a hard stop and a hard start. From an efficiency perspective, I notice it in my practice. I can’t transition people in and out of my office, which is a home office. I’m not seeing people that way, but I have to add time.

We’ve also found that the efficiency piece has been eye-opening to the point where we’re always trying to chase our wait times, reduce those, and gone a multitude of factors with the pandemic that have allowed us to catch up. We’re also on the other end of it where we’ve caught up. We’ve never been in that situation before. We know people are suffering too. It’s almost like, “What else can we do?” We have the capacity to do that, which is a unique situation that we’ve never been in before so we’re learning as we go.

Why do you think you caught up during COVID?  

Imposter Syndrome: When you’re fighting against waitlists and you have to set these hard boundaries, there’s an inflexibility that you feel like you’re in this rat race.

Back in March, for a lot of us, everything was locked down. There’s an element of fear of the pandemic and people not understanding or realizing that their family doctors were still working. A lot of practices trying to pull back and scale back to ready themselves have enough protective equipment, infection control procedures, and then adapt to virtual care themselves. We saw a drop in referrals because of that. We were catching up on the backlog and working through that. It’s interesting because there’s a difference between how one might utilize a psychiatrist versus another mental health professional. A lot of what we’re seeing are issues that are not necessarily psychiatric issues as we might define them.

We’re not seeing as many referrals. In the community, we have a different role as opposed to a more academic center where we’re trying to work closer with the family doctors and with the practice teams. We’re also trying to be available in any way we can. When you’re fighting against these wait lists and you have to set these hard boundaries, there’s an inflexibility that you feel like you’re in this rat race. We’ve been able to open ourselves up now and be a lot more flexible in how I can help and find innovative ways of working closely as a team. It’s been interesting coming out of those challenges.

As a leader, how do you orient your mindset to a landscape that’s like this? What do you think of in your own mind during a time like this?  

First is breathing for myself. The intention, focus on the overall plan, and flexibility have been the three things that I’m trying to guide myself day-to-day. I see my role and the way that I’ve worked on seeing my role as a guide, and guiding the team on that overall broader vision and on that bigger scope. I’m fortunate that I have a team that is autonomous, hardworking, diligent and innovative. They’re leaders in and of themselves. It’s almost making sure that the ship is sailing. That allows me to keep my focus on the horizon and what we’re looking at, knowing that all the component parts are doing their things. I’m extremely fortunate as a leader in my role to be working with the team that I have for that reason.

I want to shift gears a little bit. One of the reasons that I wanted to have you on my show is to ask you if you might help us unpack the idea of imposter syndrome a little bit. I’d love to have you ponder or share your initial thoughts about what you notice in leadership, what you see in others, how you see them grappling with imposter syndrome and overcoming it. 

In leadership in general, imposter syndrome is on a more extreme end of the spectrum of self-doubt. It’s an extreme form of self-doubt where one feels that they shouldn’t be in this role, they’re not worthy of being in this role, or they’re not good enough to be in this role, when in fact they absolutely are. From my experience in medical culture, there are internal and external factors. If we look at the literature, that’s what it will talk about. The environment that you grow up, you gained that. I speak from the medical perspective, but it’s applicable outside of that. As you advance through, you have this ongoing struggle within to say, “Can I do this?” Some argue that it’s on a spectrum of doubt and insecurity versus a humbleness or trying to stay humble to make sure that you’re able to continue doing what you’re doing.

How do you see imposter syndrome block people’s ability to do their work? How might it block their ability to do their work?  

The spectrum of it, if we’re focusing more on those feelings of anxieties and insecurities, what that can do is foster a sense of avoidance. When you don’t think that you’re good enough or you may not go after something. What it hampers are those opportunities, especially when you’re trying to rise through the ranks. Sometimes those opportunities aren’t as clear and they’re more chance opportunities. The door opens unexpectedly, it’s who you know or something to that effect. If you’re coming from that place with imposter syndrome being extreme and you don’t feel worthy, you may not walk through that door and therefore miss an opportunity. In some cases, around promotion and movement, but also in terms of asserting yourself and defining yourself as well. It can make someone a little bit more apprehensive to do that.

Are there any gender differences that you know of with imposter syndrome?  

There’s a rising literature on that. Some of those external factors lead to some of those systemic inequities. I’m going to speak to the medical literature. There were some surveys of women physicians asking more questions. They’re appearing more inquisitive because that was a way of showing competence. That inquisitive nature doesn’t necessarily show confidence in the same way that a male will. A male is expected to know, to be too confident versus a woman who is not. It also goes for racialized populations as well. There’s a sense of being an underdog that happens in some of the racialized populations and even in some of the gender disparities that brings you from that position of inferiority.

Imposter Syndrome: Imposter syndrome is an extreme form of self-doubt where one feels that they shouldn’t be in this role, when in fact, they absolutely are.

I have to do more or I’m not good enough are some of the themes that can then foster that self-doubt and that feeling of imposter syndrome. There are emerging efforts to have better representation at higher levels and upper levels. That also paints a picture of something that you can strive to. Seeing someone in a management position or in an executive position is also an area of opportunity for modeling and dispelling some of the underdog mentality or the negative aspects of it.

My brain is churning and I’m thinking like, “That’s interesting.” I don’t understand the inquisitiveness. Is it asking questions because they’re unsure about the female physicians?

What they found was that it’s the position. It’s a more passive stance, even though they know. Even though they’re more than confident, capable or understanding of the knowledge aspect, they still have to come across as being more inquisitive, which can foster that self-doubt of, “Maybe I’m not good enough.”

The societal structure holds them to a place where they can’t say, “We should do X.” It’s more of, “Maybe we should think about or could we possibly?” Is there other research we should talk about?  

In the past, there are studies that have looked at those internal mechanisms. The self-doubt, where that comes from in terms of anxious predisposition. A stance of being more avoidant or being more passive, is that something that fosters on the extreme end of imposter syndrome? Historically, a lot of the literature was looking more internally at the individual. Therefore, the focus on wellness and how that individual perceives themselves, their sense of themselves, and self-esteem was more the focus of intervention. As we talked about the external factors, how can we shift systems? How can we set the stage to make it better, more equitable, and also better able to model the appropriate confidence that an individual should have for their station?

It’s interesting to think that it’s not all about the internal landscape, but the external landscape as well. You wouldn’t think that imposter syndrome could be solved with more equity. As you draw those lines, it becomes clear that that’s a part of grappling with imposter syndrome. If you were talking to an individual and giving them advice on what they could do if they were suffering from imposter syndrome, what advice might you give them?

I’m going to start with rising to the level of your own incompetence. It pervades other areas as well. It’s this sense of high achievement and perfectionism, which are traits and character traits that often foster the imposter syndrome or those qualities of imposter syndrome. It’s the acknowledgment of that within oneself. Doing that self-reflection, understanding, and getting at the roots of why and where are those insecurities coming from would be one of the big factors, and exploring one’s own wellness. There’s a protective nature to it, but then there’s also potentially a pathological nature to it. It’s being able to tell the difference between the two. The protective nature is using it to stay humble, to allow yourself to always learn, and to foster growth as opposed to the more pathological insecurity, anxiety, avoidant, and those kinds of factors that break down instead of build-up.

If we can move to another area, and I’d love to get your take on it for yourself, what do you do for self-care in your life?  

A moving target is always something that evolves. I was fortunate to learn before medical school with some work that I did abroad working in a psychiatric hospital, was how to leave work at home. In my job, you’re dealing with a lot of difficult content that you’re trying to intervene and to be helpful with, but sometimes that doesn’t turn out that way. That can be difficult. Learning how to separate is the first thing that I do. It’s something that I do on my drive home. That’s where it begins. On the flip side too, it’s also learning how to separate from home on my drive to work and to prepare myself. It’s the intentional presence and trying to make sure that when I’m home, I’m attending to my family, my loved ones, and myself. When I’m at work, I’m here for a purpose and for the individuals that I’m trying to support. I’m going to respect their time as much as it’s my time. I’m there for them and being able to separate that is the biggest thing that I would do for self-care.

It’s been amazing to have you on my show. Thank you for your generosity in talking about all of this. Is there anything else that you want to say about any of these topics before we conclude?  

Imposter Syndrome: Critique is giving constructive feedback that can help an individual with growth.

To come back to the discussion around imposter syndrome, one thing that struck me was some of those external factors. In medical education, in particular, they’re striving to look at taking a lot of the guesswork out of evaluations. Being a lot more competency-based and direct observation. One of the issues that came up with fostering the imposter syndrome was a lack of meaningful feedback. That works both ways because the individual themselves, especially if they’re coming from that anxious insecure stance puts a lot of guesswork into how am I doing. Often, that’s quite a distorted thought and then that drives and fosters the imposter syndrome.

When we can give that direct and meaningful feedback and welcome evaluation, I remember a colleague in medical school. He wanted to give me some feedback and he made it clear. He said, “I’m not criticizing you, I’m critiquing you.” There’s a difference. Critique is where you’re giving constructive feedback that can help an individual with growth versus destructive and bringing them down. We could be a bit more intentional around how we do that. As leaders, that means fostering a culture of acceptance and comfort. It’s allowing your team members or those people that you may be managing to feel comfortable, to be open, and speak when they want to. To have those forums for that, it fosters individual growth.

Hopefully, reflection and introspection because then you have a team member who’s working on themselves or who’s more aware of those things. You also have a culture that allows them to be like that, which is important. From my part, that’s something that I try to do and I hope I’m doing. Also, I demand of my team to tell me if I’m not so that I can keep doing that work and checking in on myself. It’s that ongoing growth and evolution. It’s keeping in mind that this imposter syndrome thing still exists. Also being humble enough to say the irony of me even preparing for this session thinking, “Why is she asking me? Why does she want me to talk about imposter syndrome?” It’s telling. That’s what it means rising to the level of your own incompetence. It’s how can you believe that you are good enough, honor that, and then continue to do good work alongside that.

I’ve been with Jehaan Illyas. We’ve been talking about imposter syndrome and all of the interesting nuance of the research around imposter syndrome. I’m fascinated by the way that he talks about how the research shows that people who are in marginalized groups, women, people of color, ethnic and minorities all struggle with imposter syndrome in different ways. The importance that triad of imposter syndrome, equity and feedback loops so that people get a reality check on how they’re performing. Taking in that critique, as he called it, to allow us to understand our own leadership and performance in new ways. It’s been amazing to be here with Jehaan. Go experiment.

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