Fighting Hepatitis in Cambodia: Impostor Syndrome

11 May 2017

Theresa is a doctor from the USA. She's currently based in MSF's hepatitis C clinic in Phnom Pehn, Cambodia. Here she blogs about self-doubt, white coats, and finding her feet.

In the middle of the third week on assignment, I found myself suffering from a moderate case of Impostor Syndrome.

I suffered from Impostor Syndrome years ago, when I was fresh out of residency and working as an attending physician for the first time. I kept looking over my shoulder to see if anyone was checking my work, because I hadn't accepted the idea that I was, against all odds, in charge of the patients. After a while I outgrew these initial self-doubts, but they crept back up on me after I arrived in Cambodia.
Hello, Doctor Impostor
In the United States, hepatitis C patients usually have a gastroenterologist (a doctor specialized in diseases of the digestive tract) coordinating their care. Here in Cambodia, a group of Cambodian primary care doctors oversees the medical management of the hepatitis C patients in MSF's treatment program. Several of them have experience treating HIV and tuberculosis in earlier projects run by MSF, but all of them are, like me, hepatitis C novices.
 
I couldn’t help but wonder if my Cambodian colleagues were hoping I'd bring more specialized knowledge with me. We discussed the approach to treating chronic kidney disease patients with the direct-acting anti-viral drugs (DAAs) used in our clinic, the pathophysiology of the liver and how it responds to DAA treatment, and the complicated immunology of Hepatitis B and C co-infection--things I’d read about in books but never explored deeply in real life.
 
Hello, Doctor Impostor.
 
I was wrangling with this identity problem when the White Coat Issue arose. The doctors at the hepatitis C clinic wear white coats when they see patients, so once I arrived, I was given one to wear.
 
The problem was: I can’t stand wearing a white coat. They never seem to fit me well, being always too long at the hem and in the sleeves. I look like a little girl playing dress-up when I put one on. In the tropical climate of Phnom Penh, they trap heat near the body, which left me feeling sweaty and miserable. Worst of all, they magnify the anxiety of the Impostor Syndrome. When children dress up as doctors for Halloween, they put on a miniaturized uniform of scrubs, a stethoscope, and a white coat. The coat is an essential element in the act of impersonating a doctor. 
 
Once I was out of residency, I got rid of the white coat once and for all. For thirteen years of practice, I’ve been wearing ordinary clothes, a name tag, a stethoscope, and my own brand of professional demeanor, which consists of kindness and the best state of knowledge I can bring to a patient. I’ve worn this uniform, if you want to call it that, into the rooms of the sick and the healthy, into rooms where death was imminent, into rooms where a safe birth was fervently hoped for. I have been my best self wearing this so-called uniform. I would never want to bring anything less to the patients at MSF’s hepatitis C clinic.

This might be the greatest garment ever designed in human history

So I worked up the courage to discuss the White Coat Issue with the Medical Activity Manager, my most experienced Cambodian colleague. All he asked was that I wear something that clearly identified me as a member of the clinic staff. A co-worker suggested I try an MSF vest:
 

Theresa's MSF waistcoat has pockets for two phones, a torch / flashlight, pens, and even a peanut butter and jam sandwich!

Theresa's MSF vest. Vests like this one are worn by staff in our projects around the world. Photo: Theresa Chan / MSF

This might be the greatest garment ever designed in human history. The vest has five pockets and slots for three pens. I can carry the MSF phone, my personal phone (loaded with medical references), and a small flashlight, which has been quite useful during the occasional power outages we suffer in our basement clinic. There is a pocket which is slightly larger than half of a peanut-butter sandwich, which will surely be useful at some point during my assignment. The vest is light and I don’t feel hot when I have it on. Best of all, it is screen-printed with the MSF logo, which is something I can wear with pride.
 
The truth is there is no article of clothing which will make you feel like you’re ready for a new challenge. To overcome this recent bout of Imposter Syndrome, I had to get to work. I read acres of articles and bent my mind to the mysteries of hepatitis. I listened to the patients and to the staff. I laid my hands on the work, and allowed myself to be touched by it in return. With a bit of effort and a lot of faith, I found I can be myself in the middle of this important project. No matter what happens, it’s a comfort to know I have that flashlight in the pocket of my vest, so I can always find my way through the dark.
 
 
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