A favourite personal pastime of mine is watching animal documentaries. I am always amazed in particular to observe the confidence of lion prides as they hunt. It is quite remarkable to see how they use teamwork and team confidence to achieve their common goals: collaborating to feed the pride and teach the young. During the hunt, the lead lion starts the process, and the rest of the team follows, each team member having learned their role and the calculated manoeuvres required to carry out that common goal.
Similar to the pride, physicians work together as a team for an ultimate goal, although conversely, theirs is to ensure quality healthcare delivery to patients in our communities. But like the lion, physicians should tap into their individual and group confidence to deliver that quality and thereby instill confidence in their patients as well.
The Merriam-Webster dictionary defines confidence as feeling that you can do something well or succeed at something.
Self-confidence is defined as the state of being clear-headed either that a hypothesis or prediction is correct or that a chosen course of action is the best or most effective. “Confidence” comes from the Latin word “fidere,” which means "to trust"; therefore, having self-confidence is having trust in oneself.
Patients want their physicians to be self-confident; any perception of loss of confidence rapidly erodes trust in the physician. The implication of loss of physician confidence is far-reaching and detrimental to patient safety and public confidence in the profession.
Unfortunately, situations do sometimes happen that could affect physician self-confidence.
There is evidence in literature of the prevalence of loss of self-confidence among physicians. Early in their career, many medical students graduate with a significant loss of confidence because of some unique experiences in their medical school. Trainers must support the positive self-esteem and promotion of self-confidence among our trainees. Physician learners who graduate with poor self-confidence are future physicians who may be critical of others, have low self-esteem, and cannot lead and effectively coordinate the team. Ultimately, this leads to poor performance, reduced patient confidence in the physician and public confidence in the profession.
Impostor Syndrome (IS) is another kind of insecurity among physicians and physicians in training. While this is not directly a loss of confidence, it is similar. In a study of family medicine residents and the impostor phenomenon in Wisconsin by Kathy Oriel et al., 41 % of women and 24% of men scored as impostors using the Clance Impostor Scale. This study concluded that about one-third of family medicine residents believe they are less intelligent and less competent than others perceive them to be.
In another review of impostor syndrome among physicians and physicians in training, a meta-analysis of existing literature on impostor syndrome among physicians and physicians in training, most studies utilized the Clance Impostor Phenomenon Scale and cited rates of IS ranging from 22% to 60%. Studies found that gender, low self-esteem and institutional culture were associated with higher IS rates. In contrast, social support, validation of success, positive affirmation, and personal and shared reflections were protective. Overall, IS was also associated with higher rates of burnout.
Yet, loss of self-confidence can happen to any physician, regardless of their place along their career path and/or regardless of their unique specialty. From the intensive care unit and operating theatre, where there is the required command of high medical knowledge, to the generalist world, whether urban or rural, loss of self-confidence is possible and does happen. In addition to experiences during medical school, it may happen over the course of a physician’s career, when sometimes things do not go as expected. Physicians have been known to miss diagnoses that resulted in patient harm. Sometimes, even if you did your very best, things still did not turn out as expected. Take for example the ICU physician managing a COVID patient only to have that patient succumb to their illness. Or, you may have performed that surgery to your best abilities, yet complications still arose. Situations such as harm to a patient, disciplinary proceedings from regulatory bodies, and litigation from a patient could all have an impact on the self-confidence of practitioners.
While some data from a January 2021 survey reveals that 41 % of Americans lost confidence in their health care systems, Canadians have placed the highest level of trust and confidence in their health care providers.
To maintain that public confidence in the profession, individual physicians must possess sound self-confidence balanced with adequate humility and convey that to those they care for.
High workplace confidence has also been associated with high patient satisfaction ratings. A study by Katie Owen on exploring workforce confidence and patient experiences discovered that higher workforce confidence in the patient experience resulted in higher patient ratings. Physician leaders must therefore be confident in their ability to provide quality and cost-effective health care to our communities. Leaders must promote team and workplace confidence. They must effectively deal with every obstacle that undermines their skills and confidence in health system administration. They must also foster confidence in health system administration and consciously promote physician team confidence and psychological safety in their workplace. Physician executives can elevate our health care systems to a domain of excellence resulting in public safety and excellent patient satisfaction. Many physician chief executives successfully manage many high-performing organizations, including healthcare systems in North America.
Medical school trainers and supervisors of internationally trained physicians should appreciate the value of building the self-confidence of their trainees and be sensitive to promoting the confidence of their trainees during the process of training and/or supervision. Let us focus on constructive criticism of poor performance and appreciate and reward good performance. We must balance healthy criticism with coaching to help skill acquisition and improvement. Mentors should focus on building the self-confidence of their mentees and not destroy their self-esteem in the process of mentoring.
When situations go awry, individual physicians should not lose their self-confidence, but rather learn from their failures. With humility, reflect on your weakness and grow that area of weakness and skills to improve future performance. Winners do not quit, and quitters do not win. Restore your self-confidence – do not throw it away! - and move on.
While it may on occasion be necessary to impose corrective measures, physician leaders must do this with room for restoration. Physician leaders who are health care administrators must be supportive and give opportunities for growth, personal self-improvement and repair of self-confidence of the physician experiencing struggle. Physician leaders must be proactive and put programs in place to boost the self-confidence of their team. Given the complexity surrounding our profession, physician leaders must understand that any physician, whether great or struggling today, is at the risk of losing self-confidence and as such, should create a culture of support to restore self-confidence. When things go wrong, we must all be humble to learn, be supportive and create an atmosphere of restoration. Praising good performance, a warm thank you message, and creating an atmosphere of trust and self-reflection will promote self-confidence.
When it happens to the leader of a medical team, loss of physician self-confidence affects the team confidence and leads to poor performance of the group. The ripple effect of loss of physician confidence is significant, therefore leaders and physician colleagues must work hard to promote and support the self-confidence of our physician providers. The tendency of destroying others' self-confidence to boost personal ego is counterproductive and contrary to healthy team confidence. Physicians and physician leaders must support one another to maintain professional self-confidence. Always treat your physician colleagues with respect and always do your best to boost their morale. This support will improve the future of medical practice, improve public safety, enhance team confidence and promote public confidence in the profession.
Do not lose your confidence. It is one of the most important tools in your doctor’s kit. With it, you can be a great administrator of our health care system.
 Katie M. Owens, Stephanie Keller, Exploring workforce confidence and patient experiences: A quantitative analysis. Patient Experience Journal 2018 5(1): 97-105