Why do so many skilled clinicians feel like they’re faking it? Clinical and coaching psychologist Dr Jo Mitchell looks at what psychology reveals about this quiet professional strain.

WRITER Dr Jo Mitchell

The patient is waiting. The test results are clear enough, the treatment plan familiar, yet a flicker of doubt interrupts the moment. “What if I’ve missed something? What if they see I’m not as capable as they think?”

People who work in eye care – optometrists, ophthalmologists, dispensers, technicians, and practice leaders – know that feeling. It rarely announces itself. It hums quietly beneath professionalism, masked by precision, competence, and care.

This is the paradox of impostor syndrome: the more capable you are, the more likely you are to doubt that capability.

THE PRECISION TRAP

Eye care is a profession built on accuracy. Judgements are measured in microns; lenses are adjusted until flawless; surgeons operate under magnification, where every movement matters. When outcomes are visible and consequences are high, uncertainty can feel indistinguishable from failure.

Yet a certain amount of doubt is not only normal in this context – it is essential. Careful clinicians pause. They check. They consult. In complex cases, doubt is often a signal of responsibility rather than weakness.

The problem begins when doubt is no longer about the task, but about the self.

In high-pressure environments, many clinicians internalise an unspoken rule: “If I don’t get this completely right, I don’t belong here.” What starts as healthy vigilance can quietly tip into something more corrosive.

Perfectionism and pressure interact in subtle ways. In corporate or high-volume settings, performance is increasingly measured by key performance indicators – appointments booked, frames sold, time per patient. In independent or regional practices, pressure can come from isolation and expectation: the sense that you are the service. Both amplify a fragile question of legitimacy: “Am I good enough – or just lucky?”

WHEN DOUBT HELPS – AND WHEN IT HURTS

Not all doubt is a problem. In fact, some doubt is protective. Helpful doubt is situational and flexible. It appears when a case is genuinely complex, sharpens attention, and then recedes once action is taken. It questions the problem, not the person.

It sounds like:

• “This is nuanced – I’ll double-check.”

• “I want another opinion here.”

• “Let me review the evidence before deciding.”

This kind of doubt improves judgement, reduces complacency, and supports patient safety. It keeps clinicians appropriately humble and curious without eroding confidence.

Doubt becomes problematic when it shifts from informational to identity based.

Instead of “What’s the best next step?” the internal dialogue becomes “What if I shouldn’t be doing this job at all?” Instead of settling after action, the doubt lingers – even in familiar or routine work. At this point, doubt no longer sharpens practice. It undermines it.

Clinicians often describe a narrowing of their professional world. Decisions feel heavier. Feedback feels loaded. Success brings only brief relief before the next wave of self-questioning arrives. This is not a failure of resilience – it is a sign that doubt has crossed an invisible threshold.

Without space for reflection, doubt and anxiety can harden into burnout.1-3

HOW IT SHOWS UP IN EYE CARE

Across ophthalmology clinics, optical stores, and research settings, impostor feelings share a common pattern. Practitioners describe excessive preparation before routine procedures, over-checking results, or discounting praise. New graduates may feel paralysed by the gap between academic clarity and real-world ambiguity. Experienced clinicians can feel fraudulent when stepping into leadership or teaching roles – believing they should have ‘outgrown’ doubt.

Even those outside clinical rooms experience it. Optical dispensers and managers report the same pressure to appear assured under scrutiny from both patients and colleagues. In a sector that prizes technical expertise and polished communication, there is little room to visibly hesitate.

The danger is that silence becomes normal. When everyone performs with confidence, few admit to uncertainty. Without space for reflection, anxiety can harden into burnout.

HOW PROFESSIONAL IDENTITY IS FORMED – AND FRACTURED

To understand why impostor syndrome takes such a hold, it helps to look beyond individual psychology to how clinicians are trained and socialised.

From early education onward, competence is often equated with correctness. Assessments reward the right answer. Errors are memorable. Feedback frequently focuses on outcomes rather than process. Over time, many professionals absorb the belief that uncertainty equals deficiency.

Yet real-world eye care does not always have tidy answers. Clinical judgement develops through exposure to ambiguity, pattern recognition, and the slow accumulation of experience. The difficulty is that the emotional experience of learning often lags behind technical competence. Many clinicians are far more skilled than they feel.

This gap between capability and confidence is especially pronounced at transition points: graduation, independent practice, subspecialisation, ownership, leadership, or teaching. Each shift reactivates the question of belonging: “Do I still deserve my place here?”.

When these questions are not named or shared, they are easily interpreted as personal inadequacy rather than a normal part of professional development.

THE PSYCHOLOGY BEHIND THE FEELING

Impostor syndrome was first described in 1978 by psychologists Pauline Clance and Suzanne Imes. They observed that high-achieving professionals often struggled to internalise success, attributing achievement to luck, timing, or the ability to convincingly ‘fake’ competence.4

Subsequent research has shown this experience cuts across gender, culture, and career stage. What links those who experience it is not inexperience, but conscientiousness. Those who care deeply about doing well are often those who doubt most whether they deserve their place.

Psychologically, impostor syndrome sits at the intersection of three processes:

Perfectionism, where self-worth is tied to flawless performance.

Attribution bias, where success is dismissed and mistakes are personalised.

Belonging uncertainty, particularly when professionals feel like outsiders – because of role, age, background, gender, or lack of feedback.

In precision-based professions like eye care, these processes are easily reinforced. Without corrective experiences, clinicians can come to believe that confidence should feel absolute – and that anything less signals failure.

WHAT THE EVIDENCE ACTUALLY SHOWS

A large systematic review by Bravata and colleagues,1 examining impostor syndrome across professions, including medicine, challenges several assumptions.

First, impostor feelings are common, not rare. Depending on how they are measured, up to 70–80% of professionals report experiencing them at some point in their career.

Second, impostor syndrome is not associated with poor performance. It is often found among high achievers with strong academic and professional records.

Third, impostor syndrome is consistently associated with higher burnout, increased anxiety, reduced job satisfaction, reluctance to pursue leadership or teaching roles, and excessive self-monitoring. In other words, it is not simply uncomfortable – it can shape careers.1,3

Crucially, the review found that external success does not resolve impostor feelings. Promotions, praise, surgical milestones, or business growth do not correct the internal narrative. Without psychological shifts, success is reinterpreted as luck or over-compensation.1

Australasian research echoes this pattern. A narrative review of Australian doctors beyond training found impostor syndrome persisted well into senior roles, particularly during transitions into leadership, teaching, or subspecialisation.5 Experience alone does not guarantee relief; it simply changes where impostor feelings surface.

SILENCE, COMPARISON, AND THE COST OF ‘LOOKING CONFIDENT’

One of the most powerful drivers of impostor syndrome is silence.

In professional environments where confidence is performed rather than discussed, individuals assume they are alone in their doubt. Colleagues appear assured. Leaders seem untroubled. Social comparison fills in the gaps – usually inaccurately.

Modern professional life intensifies this effect. Success is visible; struggle is private. Conferences showcase polished outcomes, not messy learning curves. Social media amplifies accomplishment while editing out uncertainty.

The result is a distorted mirror: “Everyone else looks confident; therefore, my doubt must mean something is wrong with me.”

Over time, this misinterpretation carries a cost. Clinicians may avoid leadership, teaching, or complex cases – not because they lack ability, but because they fear exposure. Others remain outwardly successful while inwardly exhausted.

WORKING WITH, NOT AGAINST, IMPOSTOR FEELINGS

The instinctive response to impostor syndrome is to work harder – more preparation, more checking, longer hours. While understandable, this often reinforces the cycle: success is attributed to effort rather than competence, leaving doubt untouched.

A more effective approach begins with changing the relationship to doubt.

Expertise is not omniscience – it is judgement. It is knowing how to proceed responsibly when answers are unclear: when to consult, review, refer, or pause. Confidence grows not from eliminating uncertainty, but from managing it skilfully.

Self-compassion plays a critical role here. Clinicians who respond to difficulty with self-kindness rather than harsh self-criticism show lower burnout and greater resilience under pressure.6 Crucially, self-compassion does not lower standards; it sustains them by reducing the cognitive load of self-attack and supporting reflection and learning.2

Many health professionals readily offer compassion to others but apply a far harsher lens to themselves. Shifting that stance does not require abandoning rigour – it begins by noticing the tone of one’s internal dialogue and replacing judgement with curiosity, asking what a careful, competent colleague would do next. Seen this way, self-compassion is not indulgence, but a professional skill that supports sound judgement and sustainable practice.

A CULTURE READY FOR REFLECTION

Impostor syndrome does not thrive in isolation alone; it thrives in silence. The broader system – professional training, corporate culture, and leadership modelling – plays a powerful role.7,8

When senior clinicians or supervisors share their own moments of uncertainty, it gives permission for honesty. When conferences highlight not only breakthroughs but the trial-and-error behind them, they reframe expertise as process, not perfection. And when organisations reward reflection as much as output, they protect the mental health of their workforce.

Within Australia and New Zealand’s interconnected eye care community, this matters. The sector depends on collaboration between optometrists, ophthalmologists, and dispensers – professions united by shared purpose but often separated by role and hierarchy. Encouraging open dialogue about professional development and psychological wellbeing can strengthen that collective lens.

SUPPORTING HEALTHY DOUBT WITHOUT LETTING IT TAKE OVER

At an individual level, impostor syndrome eases when clinicians:

• define expertise as judgement, not certainty,

• balance how they explain success and failure,

• reduce over-compensation without lowering standards,

• treat self-awareness and self-compassion as performance skills, and

• seek mentors who model a growth mindset, not flawless confidence.

At an organisational level, impostor syndrome eases when systems:

• make mistakes and uncertainty discussable through reflective practice,

• model fallibility from senior leaders,

• reward reflection alongside output,

• explicitly support career transitions, and

• treat psychological safety as patient safety.

Impostor syndrome does not arise solely within individuals. It is shaped – and either reinforced or softened – by professional culture.

SEEING OURSELVES MORE CLEARLY

Every day, eye care professionals help others see with clarity and confidence. Impostor syndrome reminds us that vision can blur from within.

A little doubt is not the enemy. It sharpens judgement, protects patients, and keeps professionals honest. The problem arises when doubt shifts from guiding practice to attacking identity.

Confidence is not certainty; it is the capacity to proceed with curiosity, care and integrity when clarity has not yet arrived.

Dr Jo Mitchell is a clinical and coaching psychologist, and co-founder of The Mind Room – a Melbourne-based psychology community on a mission to help humans survive and thrive. With a PhD in human thriving, Dr Mitchell uses her expertise to turn psychological science into practical ideas and applications. When she’s not writing, speaking, or coaching, you’ll find her embracing aunty life, getting lost in nature, or road-testing her own wellbeing advice – mostly with good results.

References available at mivision.com.au.

Impostor Syndrome in Eye Care

WHAT IT IS

A persistent belief that success is undeserved, accompanied by fear of being exposed as a fraud.

CORE FEATURES

• Self-doubt of competence,

• Attribution of success to luck or timing, and

• Fear of being ‘found out’.

WHY IT ARISES

• Perfectionism – self-worth linked to flawless performance,

• Achievement culture – pressure to appear certain and composed,

• Belonging threat – feeling like an outsider, and

• Comparison bias – others’ confidence is visible; one’s doubt is hidden.

WHEN DOUBT HELPS

When it sharpens judgement, prompts consultation, and settles after action.

WHEN DOUBT HARMS

When it becomes constant, identity-based, and linked to burnout or avoidance.

THE IMPOSTOR CYCLE

High expectations → anxiety/ overwork → success discounted → renewed doubt → cycle repeats.

KEY INSIGHT

Impostor syndrome is not evidence of inadequacy – it is often a side-effect of caring deeply about competence.