Hello! I’m Auntie Version and I am unbelievably excited to be MSKMag’s very own agony aunt. (We’re never going to be able to keep it secret so will immediately reveal that it’s me… Jo Turner 😉)

Q: Dear Auntie Version

How can I tell if I am suffering from imposter syndrome or if I am indeed not very good at something? Sometimes I worry that I’m failing at work when I don’t get good outcomes but then start going round in circles in my head. Could this just be imposter syndrome?

Yours, Imposter?

A: Dear Imposter?

Such a good question. The difference between imposter syndrome and objectively not being very good at something is whether your feelings and internal narrative marry objective evidence.

Imposter syndrome is classically characterised by feeling like a fraud (waiting to be found out) and not being able to accept praise, attributing any success either to luck, or the actions of others. This is despite evidence that you are in fact capable.

If you are genuinely not good at something, then objective evidence or constructive feedback might support your opinion of yourself.

You reference times when you don’t get good outcomes and it is probably tempting to conclude that this is supporting evidence for your internal feelings. Particularly in healthcare however, we need to give this context. Are you setting yourself a realistic bar for ‘good outcomes?’ Are you holding yourself to unachievable standards? How do your outcomes relate to those of direct peers, with similar levels of experience to you?

The problem with imposter syndrome is that it feeds perfectionism - it has us overworking and overwhelmed as we strive to achieve the impossible. Yes, we need to be accountable and work to maintain good standards of care, but imposter syndrome and perfectionism are often evidence of the balance having tipped in an unhelpful direction.

So when you look objectively at the evidence, does it genuinely support feelings that you are not good enough? If so, where can you seek good support to gain and improve your skills? If not, the support might be better directed towards helping you challenge those unhelpful thought patterns and behaviours.

Q: Dear Auntie Version,

How do I know how much I should specialise? I get bored being too general in my clinical work but worry that I will be less employable if I pick the wrong area!

Yours, Bored

A: Dear Bored,

My immediate (and flippant) response is that if you’re bored, you’re already less employable than someone who loves their job. But I also hear your concern about becoming so specialist that employers may see that you will only be able to see a small percentage of their client base.

There is a ‘Goldilocks’ option of specialising but retaining your generalist skills - I’ve heard this referred to as a ‘T’ shape career. You can treat most things that walk through the door, but you are the go-to person for your chosen specialism. That way, you get to spend a fair amount of time working on cases that really float your boat, but everyone knows you can treat other conditions.

I would say that specialism often increases rather than diminishes employability, particularly if you can pick something that is future proof. Look at what is going on in the wider world of MSK and outside. If you can offer something that helps an employer offer up to date services that are in-line with emerging evidence and peoples’ needs in the modern world, you’re going to be very popular.

And specialism needn’t be a trap. Nothing is forever. In a long career now, I’ve enjoyed many specialism chapters.

Q: Dear Auntie Version,

I see a lot of people talking about getting their health and fitness in order in the new year, but I feel like such a hypocrite. I’m not in a position to prioritise myself right now health-wise but still have to play the ‘Mr Motivator’ role. How can I walk the walk as well as talk the talk?

Yours, Mr Unmotivated

A: Dear Mr Unmotivated,

We all know that health and fitness regimes, even in someone with great insight and commitment, are subject to fluctuation or complete derailment - cos life happens. But we perhaps don’t talk about that enough as therapists. A colleague used a wonderful phrase on a clinic WhatsApp group recently. She said, “We all know each other, we know we are juggling and struggling at times but always have the best of intentions.” Admittedly this was clinician to clinician, but I think there is a level of being real we can find with our patients, without it being an overshare.

I’m a big fan of James Clear’s book ‘Atomic Habits’ and often quote it to patients. Whilst James advocates consistency as the key factor in habit formation, he also allows for variation in output and acceptance of ‘missed days.’ His point is that habits are not broken on the first missed day. Instead of thinking we’ve failed and all is lost, much better to have compassion for ourselves and commit to trying again tomorrow, or maybe even next season.

As for being Mr Motivator, fabulous though he was that was the 90s. Maybe Mr or Ms Relater is a more appropriate icon for our times.

Q: Dear Auntie Version,

I’m a physio working in an NHS clinic and the waiting times for appointments are getting me down. If I see someone today, I’m looking at 6 weeks before I can book them in for a follow-up appointment. It’s not working for them and it’s not working for me! How can I stay sane at work whilst doing my best for the patient?

Yours, Struggling

A: Dear Struggling,

I’m certainly not going to try and persuade you that having 6-weekly follow-ups as the only option for any condition counts as good care.

Sadly, it’s a situation many readers will recognise all too well. We know the problem is systemic, and hopefully most clinicians are not blaming themselves for it, but that doesn’t make it any easier when you’re the one sitting in front of an understandably frustrated, frightened or desperate patient.

So what can you do about it?

Some people channel their own frustration into activism. Are there avenues or organisations you can use to advocate for patients and push for change? Even small actions may help you reclaim some sense of agency.

Others decide to vote with their feet. If they can’t see any prospect of change, they choose to work in a different environment, maybe for an employer whose model better aligns with the care they want to provide, or they take the leap and set up their own service. Contrary to the belief of some, most people don’t go independent to chase a mythical high salary; they do it so they can practise in a way that feels fulfilling and sustainable.

I’m not suggesting that leaving the NHS is the answer and I recognise that for some this is an ethical no-no. It’s a tough situation and I don’t believe there are any easy solutions right now. You’re doing your best in circumstances that would challenge anyone. And it’s more important than ever to hold on to the parts of your life that exist outside of your work; interests, relationships and activities that remind you of your identity beyond the therapist trying hard in a struggling system.

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