Self Concept

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‍Elevating Your Self-Concept in Medicine

Imagine this. You’re less than a year out of training in your very first job as an attending otolaryngologist. You’re employed by a hospital, but the extent of your support isn’t entirely clear. Patients present with every level of complexity, and you figure it out on the fly. Two questions run constantly through your mind:

1. Can I manage this?
2. Do I need to call for help?

It’s the middle of afternoon clinic on a Tuesday in May, and you don’t need the EMR to tell you your next patient’s chief complaint; you can hear it while finishing a note in one of the exam rooms. A sharp, biphasic whistle cuts through the wall like a fire alarm. You drop your dictation device and step into the hallway.

Across the corridor, a woman with a markedly swollen neck grips the doorframe for balance. The medical assistant beside her glances at you, brow furrowed, lips pressed into a thin line.

What do you do?

This is what happened to me more than a decade ago. After admitting the patient through the ER, I eventually performed a total thyroidectomy with the help of cardiothoracic surgery. We never found her right recurrent laryngeal nerve, and she awoke with a right vocal cord paresis. She recovered well and was discharged home, then ultimately lost to follow-up. Though I don’t know if she ever regained full mobility of her cords, I do know she has an airway.

Regardless of your specialty, you’ll face moments like this—moments when you must act outside your comfort zone. These moments don’t just challenge your clinical skills; they challenge your self-concept.

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The Split Mind

In high-stakes moments, your brain splits in two. One part tells you that you’re a fraud, not good enough, and about to fail. It offers you worst-case scenarios so vivid that your body reacts as if they’re happening in real time, complete with a flood of anxiety, self-doubt, inadequacy, and paralysis.

But there’s another part of you too: the part that trusts your training, judgment, and authority. That part asks not, “What could go wrong?” but “What could go right?”

Your work is not to silence the anxious part, but to engage with it compassionately. Often, that anxious voice is a younger version of yourself—a PGY-1, perhaps, or even a medical student. Instead of suppressing it, you can respond:

Of course you’re worried about making a mistake. That’s your job right now. But I’m not a 27-year-old resident anymore. I’m an attending. And this isn’t about me. It’s about the patient. So let’s put our energy where it belongs: on serving her.

When you engage with the anxious part of yourself, you step outside of it. You stop identifying with fear and start leading from clarity.

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What Is Self-Concept?

Self-concept answers the question: Who am I?

You build it from your beliefs about yourself and from how others have responded to you throughout your life. Physicians hold a unique dual self-concept: who we are as humans, and who we are as doctors. Many of us feel like entirely different people once the white coat goes on.

It took me nearly a decade to discover who “Dr. Thacker” really was. I realized she’s an extrovert (while Mel the human is a colossal introvert) who cherishes authentic connection with patients and staff, leads with service, and checks ego, agenda, and judgment at the door. Now, when I put on scrubs or a white coat, I consciously step into her. If you are not sure who your doctor alter ego is yet, nothing has gone wrong. It’s just a matter of trying things on and paying attention to what feels natural and aligned to you.

Notice, this has nothing to do with others’ opinions or your inner critic. It has everything to do with how your body feels. Your body is an exceptional truth and lie detector. Once you learn how to read it like a compass (through practice or coaching), it becomes very simple:  a “NO” from your body feels tight and icky, while a “YES” feels open and relaxed. Along the same lines, anxiety in your body always means there is a lie in your brain. Anxiety, by definition, lives in the future and is not actually happening in real time.

During training, culture tries to mold you into an “ideal resident.” You may start to confuse that imposed identity with your authentic self. For some, it fits. For most of us, it feels deeply unnatural, leading us to believe “Something’s wrong with me” or “I don’t belong here.” Please don’t believe those lies. When those thoughts come up, it only means there is a disconnect between who you truly are and who you believe culture wants you to be. Your work is to step into your authenticity and find the courage to show up that way everywhere you go.

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Stretching Your Self-Concept

Once you know who you are, you’re better positioned to stretch your self-concept in moments of challenge—whether in the OR, on rounds, or in life outside of medicine.

Here’s the sequence I use:

1. Step out of trauma response. Confusion feels unsafe to the brain. Left unchecked, it will trigger fight, flight, freeze, fawn, or flop. You can’t solve problems from that state. Instead of thinking “I don’t know”, you can choose “I’m going to figure this out”.
2. Generate curiosity. You cannot feel anxious and curious at the same time. Curiosity pulls you out of catastrophizing.
3. Find the “who” before the “how.” Ask yourself, “Who would I need to be to solve this?” For the thyroid case I described above, I stepped into the identity of Dr. Donovan, a mentor from training who’s calm confidence and thyroid technique I admired. When I would perform parotidectomies early in my career, I embodied Dr. Hessel at MD Anderson, one of the most humble and brilliant surgeons I know. In sinus surgery, I often ask, “What would Prof. Wormald do?”

When you focus on the who, the how follows naturally. The mental exercise of elevating your self-concept opens up an energetic portal to new thoughts and ideas that you would not have access to if you had remained in confusion or self-doubt.

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Why This Matters Beyond Medicine

The principle applies to every domain. Take dating, for instance. If your self-concept is “I am unworthy of love, and I need someone to meet my emotional needs,” then even with the right apps and strategies, you’re likely to end up in unhealthy relationships. But if your self-concept is “I’m whole and sufficient as a single person. I love myself unconditionally, and I’d like to share my life with someone,” the same how—apps, dates, social events—produces a completely different outcome. You’re much more likely to find a lasting relationship when you work on your self-concept before you start swiping on Bumble.

The same is true for writing, speaking, podcasting, surgery, entrepreneurship, or even fixing a leaky pipe. The “how” is secondary. The “who” makes all the difference.

I’ve practiced elevating my self-concept in every area of life, and it’s the single most powerful tool I know for creating results. Instead of letting my brain default to insufficiency, imposterism, and confusion, I consider who I need to be to create the necessary result. I’ve used this in challenging clinical scenarios like the patient I described above, on the TEDx stage, and every time I sit down to record a podcast or write a passage for my memoir. And here’s the best part: I am not special. You, too, can elevate your self-concept and step into the physician—and human—you’re meant to become.