The Perils of Perfectionism

Last week I attended a wonderful lecture in Baylor’s Medicine and the Art of Compassion lecture series entitled  “The Perils of Perfectionism”.  It was presented by Dr. Glen Gabbard, who is a psychiatrist and author with great expertise in physician wellness.   I can’t do justice to the entire lecture, but there were a few key points that I wanted to share:

Compulsion is one of our our greatest assets as physicians, but it can become one of our greatest liabilities.

One of the key personality traits that physicians need to have (and/or develop) is to be compulsive.  In fact, many of us choose medicine because it’s a good fit for our basically compulsive personalities.  Unfortunately, as Dr. Gabbard pointed out, unbridled compulsiveness can lead to “excessive devotion to work and productivity to the exclusion of leisure activities and friendships.”   How do you tell if a good thing (caring about patients, being compulsive) has become an unhealthy behavior?   Here’s some warning signs that he pointed out in his lecture:

  • A reluctance to delegate tasks or work with others unless they submit to exactly the way you want it done
  • Rigidity and stubborness
  • Perfectionism that interferes with completion of the task (checking the reflexes 10 times on rounds instead of once or twice)
  • Self-doubt
  • Guilt
  • An exaggerated sense of responsibility
  • Failure to take vacation
  • Cynicism
  • Chronic fatigue
  • Emotional outbursts
  • Headaches
  • Increased alcohol consumption
  • Marital “deadness” or discord

It’s dangerous to look at the issue of physician stress with an “us-them” mentality

It’s easy to think that discussions of physician stress and impairment apply only to “other doctors” (or “other” medical students).  Unfortunately, the stress that comes with out of control perfectionism can lead to suffering for any physician.  In extreme cases, it can lead to physician impairment, destruction of relationships, burnout and physical illness.  As Dr. Gabbard pointed out in his lecture “impairment is the endpoint on a continuum.”  Every physician, when exposed to the right combination of stressors, can become impaired.  The key is to realize that all physicians are susceptible, that it’s important to watch for warning signs, and that’s it’s even more important to seek help when its needed.

“The desire to excel must be differentiated from the desire to be perfect.”

I thought this was a wonderful rule for physicians to remember.  We all want to do our best, and we all want our patients to do well.  We want to excel, but we can’t ever be perfect.  Physicians don’t have control over many outcomes – some patients will develop complications or die despite our best efforts.  And… we are human.  Mistakes will be made.  The goal is to minimize them, learn from them, and forgive yourself.

“A physician that treats himself has a fool for a patient” (William Osler)

Every physician should have a personal physician.  As much as possible, the relationship should be as “normal” as possible i.e. even though you are a doctor, you should be treated just like any other patient.  That’s not as easy as it sounds, but it’s the right approach for both you (as a patient) and the physician treating you.   Why go to the trouble of finding a personal physician?  If you become ill, it’s nice to have an established relationship with the person who will be treating you.  It’s also nice to have someone you can talk to if you are feeling burnt out.  Depression, stress, and impairment can all be treated.  It’s really no different than going to the orthopedic surgeon if you break your arm.  If you need help, talk to your primary care physician or a mental health expert.

Some of our greatest lessons come from dying patients.

Anyone who has had the blessing of caring for a dying patient has learned from them that there are only two important things in life: to live wisely and to love well.  Our family and our friends are our greatest treasures.   Learn to spend time taking care of yourself  and nurturing these important relationships.  It’s easy to fall into the trap of putting off this important work… but don’t.    “The fool with all his other thoughts has this also:  he is always getting ready to live.”  (Epicurus)

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