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Your plane is about to take off. Like most folks, you are just a little anxious about flying. It is very rare, but you know a lot of bad things can happen to the machine that carries you at 30,000 feet above sea level. Consider this: Would you rather the mechanic who inspects your aircraft be absolutely conscientious to every minute detail, be exquisitely perfectionistic in his examination of the aircraft, even if he has to work overtime and miss the family dinner? Or would you prefer that he be a happier mechanic, one more attentive to his family, who will clock out routinely at 5 p.m., quitting time, no matter what?
Personally, I'd prefer the guy who misses the family dinner. I'd prefer the perfectionist mechanic who will not go home until they are certain that the airplane is in tip-top shape to the best of their ability.
I think a lot of our patients would prefer their physicians to be the same.
Many articles on have addressed the "perils of perfectionism" and its negative impact on physician well-being. I am not going to address here what is obviously a pathological perfectionism: the person who flushes the toilet five times before they can leave the bathroom or spends 15 minutes repeatedly checking the grammar of a routine email. I am talking about everyday perfectionism, the kind just about all of us must have to enter the medical profession.
Nor am I discounting the importance of work-life balance. I am a retired physician. I spent over 40 years working in frontline neurology clinics. I was also a leader of our organization's physician health and wellness mission. I coached and counseled scores of physicians on these issues. Trying to attain work-life balance in the medical field is a tremendous challenge. The lack of it can be devastating.
Let's put these issues in perspective.
Let's say it is 6 p.m., but you have two patient telephone callbacks, nine email patient messages, seven radiology reports and 15 lab tests to review, plus 11 prescriptions to refill, all awaiting your inbox attention.
What are you going to do? Go home? You haven't had dinner with the family all week. And you had promised Junior to help him with his algebra. Can you put off till tomorrow this inbox overload? Or should you stay late in the clinic, miss another family dinner, break your promise to Junior, but take care of business?
After all, you are a physician. Patients depend on you. What will it be like for them anxiously awaiting all evening that doctor phone call that never comes? And if you decide to put off the work till tomorrow, if you choose to go home for the family dinner, will you feel happier? More content? More in balance with yourself? Or will you feel guilty about leaving your patients hanging in the lurch? Will you awaken at 2 a.m. in a cold sweat, imagining that the chest x-ray you didn't review might reveal incipient pneumonia?
Here are my responses to the two main arguments against perfectionism.
The first is that perfectionism is rooted in fear. I agree. But so what? Fear is a great motivator. If we have a healthy fear of making a mistake in our medical care, then that fear may inspire us, like the airplane mechanic, to be extra careful, extra studious, and extra conscientious. Fear of making a mistake, of doing harm to a patient, may motivate us to be more competent physicians and thus, bring our patients to healthier outcomes (or at the very least minimize careless medical errors). Frankly, I am grateful that a healthy fear has been part of my physician psyche. I would wonder about those physicians who lack it.
The second "anti-perfectionism" argument is that perfectionism will make one unhappy and unfulfilled. But what is our primary mission as physicians? To be happy? To be fulfilled? To leave work at 5 p.m. and do a Pilates class on the way home? To be better life partners and parents? Yes, those, of course, are worthy goals. But will we really feel happy, will we really feel fulfilled if we clock out at routine quitting time and fail to complete our work? Will we feel happy and fulfilled knowing our patients may be spending a sleepless night awaiting a promised biopsy result that was never delivered?
I don't have the answer to perfectionism. I don't have the answer for work-life balance. It may well be different for everyone. But the challenges of physician life are real. With every fiber of my being, I want to see my fellow physicians productive, happy, and fulfilled. And while I may not have a solution, I do know this: The answer will not come from obliterating perfectionism from our physician DNA.
If we attempt to do this, if we don't live up to our internal standards and abandon our deeply held value of giving our best effort, we may set ourselves up for moral injury. And it is this moral injury that may lead us down the path to burnout.
But if there is an answer, I believe it will come from accepting, not denying, the authentic perfectionism within us. I believe it will come from accepting our perfectionism with all of its perils and positives and negatives. Yet, in the face of this, somehow, we must learn to make that authentic perfectionism work for the benefit of ourselves and our patients.
The next time you are flying 30,000 feet in the air or the next time you are a patient yourself, think about it.
Scott Abramson, MD, is a neurologist.
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