Acclaimed author Neil Gaiman recounts being invited to a gathering some years ago of the great and good somewhere in the US – artists, scientists, writers and discoverers of things.

He was standing at the back of the hall thinking at any moment they would realise he didn’t qualify to be there, when he started talking to a very polite elderly gentleman about several things, amongst others their shared first name.

And then the gentleman pointed to the hall of people and said words to the effect of: “I just look at all these people and think, what the heck am I doing here? They’ve made amazing things. I just went where I was sent.” And Mr Gaiman replied: “Yes, but you were the first man on the moon. I think that counts for something.”

And at that moment he realised if Neil Armstrong felt like an impostor, maybe everyone did. That feeling is close to my own heart having experienced it, on and off, many times in my own life and the practice of dentistry.

What is Impostor Syndrome?

Impostor Syndrome is that internal monologue that plays inside our heads and whispers to us that, any time now, I’m going to get that tap on the shoulder and be told “I see you … I know you’re a fraud … you’ve been found out!”

And while it’s reassuring to know that even Neil Armstrong experiences Impostor Syndrome, what do we know about its prevalence? The literature says that it doesn’t discriminate on the basis of gender, race, age or occupation. It is not some kind of abnormality and, important to note, not necessarily tied to depression, anxiety or measurable low self-esteem.

In dentistry there are a number of areas where Impostor Syndrome can play a role, for better or for worse.

First off, to state an objective truth, as dental professionals we have, to most outsiders, significant evidence of competence to do the job. It is mutually understood between patient and practitioner that there was a high threshold to entry and then a significant amount of study and testing to be done to get the golden ticket – the certificate on the wall.

We have a job, which means somebody has seen fit to hire us or we’ve gathered enough resources to start our own business. We wear a uniform, have elaborate equipment, use technical language and are reasonably well remunerated – by most metrics of success in modern society we are high flyers.

Yet at the same time once we graduate, if it hasn’t been made clear at dental school, it dawns quickly that the qualification is really only the beginning. The practice of dentistry, in whatever field you work in, is a lifelong journey of learning on the job, continuing education, mentorship and discovering the limits of your capabilities, only to repeat and keep learning and growing.

Certainly, I was never told this when I graduated, and the early days of practice were a significant struggle for me – the certificate on the wall telling me I’m a bona fide, fully qualified dentist – the diagnostic dilemma or the tricky procedure slowly going wrong telling me otherwise.

Impostor Syndrome in dentistry

We are proceduralists, working in confined dark spaces to very fine tolerances – anecdotally I believe that dental professionals, as a general rule, have a tendency to perfectionism.

Combine these and you have fertile ground for the flourishing of Impostor Syndrome, especially in the early days of practice.

However, once the penny drops, and we realise the qualification is only the start of the journey and not the final destination, then it becomes easier to put things in perspective – we are destined to always be on a learning journey.

Indeed, over 25 years after receiving the golden ticket I still learn something every day of practice – whether it be a subtle tweaking of a procedure, how to better use a new material, or some way I communicated more effectively to a patient that I can use again in future.

And the question of perfect – to be blunt, perfect doesn’t exist – not in dentistry and not in any other aspect of life. Perfect is like unicorns and the tooth fairy – a fiction.

Another aspect of the modern world that can feed Impostor Syndrome is social media and the known impact it can have on self-esteem. If “comparison is the thief of joy”, then social media has the potential to be the echo chamber that distills all our insecurities and holds them up like a mirror to our face.

The beautifully curated Instagram cases, on the ‘perfect’ patient, with the cusp carving and fissure staining are easy to compare with our real-world scenario of struggling to achieve a tight contact and grinding down all our barely adequate anatomy to match a worn dentition. How could I not be an impostor? Wouldn’t my patient be better served by seeing someone as good as the Instagram practitioner?

Again, some perspective is needed. I’ve read and listened to some of the prominent social media posters say that it has taken years and years of education and training, along with trial and error, to get to the point of being able to post these ‘perfect’ cases. It takes a single-minded dedication, is something I really admire and can be gratifying to aspire to when I am well prepared, working on an optimal patient with my best assistant and no time pressures. Yet for me, most of the time, I am comfortable running my own race and at the same time appreciating what can be done and taking a few tips here and there.

Overcoming Impostor Syndrome

So how do we push past Impostor Syndrome and grow as practitioners? We need to continue making progress, at a bare minimum keep up to date and not remain stagnant or fall behind in standards required to remain compliant with our regulator.

It is important to say that there is no one solution as everyone’s circumstances will be different, while also having influences from individual past experiences, upbringing and culture.

While some practitioners we see, especially in the early days, may be too bold in launching into ventures and cases that they shouldn’t, for the practitioner prone to Impostor Syndrome there will be an inherent bias towards holding back, biding their time until they feel they are good enough.

The only suggestion I can posit is to consider, like Neil Armstrong, that most of us feel slightly out of our depth, especially when it comes to important work and breaking new ground.

We need an optimal amount of caution – enough to keep progressing yet not so much as to slip drastically beyond our scope or skillset and risk harming our patients. This tension and balancing are a good thing.

To feel like an impostor means that you care, are conscientious and will give your best effort with all resources available to you at the time – this can only be a virtue and a measure of the type of practitioner I would like to see if I were a patient.