Pobody's Nerfect

what is it with perfectionism in medicine?

When I went back to school (again) to study public health, I spent a lot of time looking at everything that was wrong with healthcare (and this was before COVID). No matter what the issue was that we were analyzing, we were trained to always look at the upstream factors.

If the problem at hand was increasing rates of asthma diagnoses, we were trained to look “upstream” at the factors that could lead to this (poor outdoor air quality from pollution, poor indoor air quality from old houses/rodent infestation/exposure to secondhand smoke, you get the idea). Across the board, all of the issues that we analyzed had factors upstream that played a role - and that could be a point of entry for a solution.

I’ve been thinking a lot about perfectionism lately, and how rampant it is in medicine.

The public health part of my brain makes me wonder about the upstream factors that relate to perfectionism in medicine. This field is one that attracts people with perfectionist tendencies; if you don’t already have them when you start, you are at high risk for developing them while a student.

In order to cross the academic finish line, you need to really care about reading as much as you can, completing every assignment to your absolute best ability, to absorbing information from a fire hose and being able to spit it back out at a moment’s notice. These become survival skills of a sort, and they can serve us well…for a short period of time.

This is not a job for corner-cutters.

The problem, as I see it, is that it’s really hard to turn this off when we graduate. Maybe because graduating is just one of the steps in the gauntlet between school and work; we still have boards ahead of us. All the paperwork and fingerprints and background checks that go along with licensure. And once we find the right job, the exhaustive credentialing process where you have to prove everything about your education, licensure, even your existence (that’s how it has always felt to me, anyway).

Whether the next step is residency or full time work, many of us (the majority?) start with our guards up, on the defense. When imposter syndrome shows up (as it does for pretty much everyone, even if no one talks about it), it’s natural for us to combat it with something that has worked for us before…

Perfectionism.

We will do everything we can to be self sufficient, to not need too much help or assistance, to look like we have it all together.

We will leave no stone unturned with our patients, even if that means letting them add more onto the visit - and results in us running late.

We will write the best notes that we possibly can, super thorough and detailed - A+ material - even if that means we have to work for hours and hours uncompensated. (“But I’m salaried!” you think. That’s based on working a certain number of hours per week; if you are salaried based on a 40 hour work week but take charting home for 3 hours every night, you are either diluting your total compensation, or you are working for free. It’s up to you how you describe it, but the end result isn’t much different.)

What are the upstream factors?

There is a lot of thought that perfectionism is a response to anxiety. That tracks, to my thinking. Medical education, of any stripe (nursing, medicine, dentistry, veterinary, therapy), can be VERY anxiety invoking - and we will devise coping mechanisms, whether healthy or unhealthy. Working in medicine continues the anxiety - we deal with literal life and death.

I would say that perfectionism in medicine is a coping mechanism, and I’m going to go a step further in the healthy versus unhealthy debate. I say it’s stealthy. It’s a stealthy coping mechanism; it looks good at first glance, and it does serve a purpose for a period of time. But over time, it starts to eat away at us; you have to feed the beast, and the beast keeps getting hungrier and hungrier. It takes more and more of you to get the relief that perfectionism gave you before.

Employers don’t mind if you are a perfectionist. Patients don’t mind if you are a perfectionist. In fact, bo

th of these groups really benefit from it. They’re not necessarily bad guys for letting it continue, but they are … what was that? … upstream factors that keep the wheels moving.

I don’t have a solution, but I have a suggestion.

Let’s think about how perfectionism shows up for us. Let’s think about who benefits from our perfectionism. Let’s think about whether our perfectionism serves us - or drains us.

Maybe one day we’ll look closely at those upstream factors and make some changes. Maybe for now, we’ll look at how we can make changes in our own day to day lives to move away from perfectionism.

Maybe that’s enough.

Take care,