Amanda: Welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: And I'm Kendra.
Amanda: And today we are going to talk about something that we see quite frequently in our physician clients. And that is perfectionism.
Kendra: So perfectionism. Yes, everybody, you know, winces at that. Nobody wants to own that if you get that label. But honestly, physicians, in our training, we are taught that perfection is the only option. Because if not perfection, then lives are at stake. So perfectionism, though unfortunately, is very maladaptive. It is honestly kind of more negative than positive, or at least the outcomes of perfectionism are more negative and can be actually health harming instead of health conscious or healing. Perfectionism usually is associated with disorders like anxiety and depression, eating disorders. There are a lot of perfectionist tendencies in every criteria that people that have a diagnosis of eating disorders. It can contribute to chronic fatigue. If you're a perfectionist, you tend to take fewer preventative health measures. And, you know, in the long run that can be really detrimental to health instead of health promoting, it's very detrimental to health.
Amanda: I can already hear people being like, “BUT, BUT!” Yes, but there is a healthy kind of ambitiousness. There is a healthy kind of pursuing excellence. That would be more like a high achiever. That is what we want for you is to be a high achiever. It's this maladaptive perfectionism that we'll talk about later that we're talking about.
Kendra: Yes. So look there's a superhero at the end of the story or a superhero characteristic. So as we enter into med school, you know, we are taught a lot of information. Especially, you know, the science, the technology, all of the things, how to care for patients. However, as we're working through the med school program, we tend to hear a lot about praising flawlessness and not making mistakes. We start with a white coating ceremony and that white coat is kind of like a cape or an idol that says you are, you're the man or the woman. And so that really starts the perfectionist mentality. Because we don't talk about, you know, mistakes. There's a lot of vulnerability that is rejected because we just cannot accept that. Or, we can not cope with that or we are not taught to cope or manage that. As we go into rounds at the end of med school, before residency, we're constantly pimped on what our knowledge is and we attend grand rounds or morbidity and mortality conferences and there's a lot of shaming. There's a lot of judgment. There's a lot of public humiliation that goes on in those. All in the name of what could have been done better? What should have been done better? However, the opposite is not addressed. Like, what is a process that could be improved? Is this an opportunity instead? It's, you know, this happened, that happened and there's just no grace there. So it really does foster a judgemental attitude. Not only of others, but you start really developing a lofty thought of self and once you kind of have that maladaptive perfectionist attitude you just really avoid a lot of things, like feeling negative emotions, fear, insecurity, or doubt or any of that. So it really does breed a kind of unreliable or an unrealistic goal or an unrealistic aptitude of self.
Amanda: Well, and the fact that we don't talk about it, we prize flawlessness so much and we don't talk about the mistakes. You start to think that you're the only person who has ever made a mistake in medicine. Like it really feels that way. I mean, that's such a lonely place to be.
Kendra: Yeah. Perfectionism is really isolative in that it also makes you feel like, like, “Oh, I'm perfect.” “I do well” and praises and all that, but it's a lonely place to be because then you don't learn how to cope if you have a near miss or a miss or whatever.
Amanda: And that leads to, you know, imposter syndrome. When you think that you're the only person that is human wearing this white coat, but it's not real. So let's talk about some of the characteristics of perfectionists that we would like to try to change.
Laura: Okay. So in Tal Ben-Shahar’s book, “The Pursuit of Perfect: How to Stop Chasing Perfection and Start Living a Richer, Happier Life.” We've got some things to share from that book. We will link the book in the show notes. He says perfectionists reject failure and when we reject failure, in a lot of ways, we're rejecting progress because failure is a part of the process of growth and learning. So we have to fail to be able to grow. It keeps us stuck because we're not growing because we're so afraid of failing. We're unauthentic, like we're putting on this facade that we are, that we're perfect when we're not because none of us is. We're hiding any perceived imperfections. This leads to anxiety because let's face it, there's a very real possibility that we will fail or make mistakes. And we're terrified of that. And we need, he says, we need to learn to fail or else we fail to learn. There is no walking without falling. That is so true in every aspect of our life.
Amanda: Yeah. I mean, just think about that. They've done studies that medical students that enter medical school are still way more on the high achiever zone. They're not yet in the maladaptive perfectionist tendencies, which we saw from Kendra, that medical school tends to foster. On some level, when you're entering medical school, you know that you're going to make some mistakes, you know, that you don't know everything. But then you get to the end and you get your long white coat. And suddenly, like by magic, all of a sudden it's not okay to mess up. It's not okay to not know everything. Like how dare you not know the diagnosis yet? It's just so funny.
Laura: It's so true. I mean, even to have to look something up that you learned, you know, however many years ago, but forgot. It's like you do that in private. You don't do that in front of your colleagues. And that's just not healthy. When we are able to accept the fact that there's sometimes things that we're going to forget or fail at, it's safer. It's actually a safer environment because we can come forward with things earlier, rather than trying to hide mistakes, which in medicine you hear about that all the time. People trying to hide things that have happened.
Amanda: And business people know this. The only way to be wildly successful is to be willing to try things and fail. When we get so perfectionistic that we're not willing to, to fail. That's how we're severely limiting ourselves. And I get it. It's people's lives, but you can still be wildly ambitious and know that you're still a human being,
Kendra: I think another thing is some people might think if we don't, if we're not constantly striving to be perfect, they may think we're careless or lazy. Like, what do you mean? You strive, you continue to push for perfectionism and if you are not seen as that, then somehow we think, “Oh well then, we're just not trying to be the best doctor we can be.” And that's not really it at all. Perfectionism has nothing to do with delivering quality health care or patient care.
Amanda: Well, and I've had this discussion with clients multiple times. Do you really think if you gave yourself a break and gave yourself grace for being a human being that you would suddenly start being sloppy and lazy. It's not even possible for these people. It's not even possible but instead of wallowing in your self-criticism, if you really didn't make it a personal failure, you would go read, you would go be better instead of sitting there and flogging yourself.
Laura: Yep. So perfectionists reject negative emotions. They can't consider themselves happy unless they're happy all the time. I'm sometimes guilty with this particular, like, I think we see perfectionism in all of us. I personally had so much negative emotion growing up just from my family circumstances. I definitely got in the habit of just pushing it down, pushing it down. I can overcome anything. I can be happy all the time. And while we want to choose positive emotion, when we can, if negative emotion is there and asking to be felt it's just so much healthier to just process it. Feel it then. Instead of trying to shove it down.
Kendra: It's normal. It's a normal thing to not always have positive experiences 365.
Laura: I'm sure we'll talk about that in the feelings episode. But half the time, half the time we're not going to be feeling positive. But to be perfectionistic means that we're rejecting those negative emotions and not allowing them. In a sense, rejecting ourselves. And it stifles the human experience when we don't feel those negative emotions as well and makes it, makes it so that we're not even giving ourselves permission to be human because we're rejecting that half.
Amanda: So the third thing that Dr. Ben-Shahar talks about is that perfectionists reject success. So first of all, they reject failure, but they also reject success. And the reason why, well, there's several reasons, but one of them is that perfectionists tend to be very, very all or nothing. Very black and white. You don't get, you know, if you do an operation and there is a small complication, the whole thing was terrible. So even if you got 97%, unless it's 100%, there is a tendency to be like it's a hundred or zero. So the other thing is that they tend to make it very difficult for themselves to succeed like an unrealistic expectation. One of my clients was upset that, you know, things didn't go well at work. And I asked her like, what does a successful day at work mean? She said the patient has to be happy. I have to not over order labs, but I can't miss anything. The consultants, when I call them, they need to be understanding and be happy about the admission. That's never going to happen! Those 95 requirements in order for it to be a good day? It is impossible to ever hit that. I am an emergency physician and I'm not happy to be called by my own people sometimes, even in residency. So how is that going to work? It's just funny, but she had never said it out loud. Like her requirements for a successful day were impossible. Even when they do somehow hit these unrealistic expectations, they don't sit with it. They don't celebrate their success. So in a way they're always feeling frustrated and inadequate because they're not allowing themselves to experience success. And the last thing is that they reject reality. Perfectionists live in a world where it's possible to have the perfect spouse. Where it's possible to have the perfect job. The perfect boss. There is an expectation when they're going towards a goal that it will be a direct straight line. That's not reality. Reality is messy. So what we need to do is to understand that we are humans living on earth and that's messy. And so now what do you want to do with it? So all of these things, if we can start to be okay with failure on our way towards a goal. If we can give ourselves permission to be human. If we can accept success, set ambitious and realistic goals. We're not trying to tell you not to be something other than you are. Continue to be that ambitious, wonderful person, but let it be realistic and then appreciate it when you achieve them. And then understand that Earth has been messy since the beginning of time. And so now what? If we can work on those things. Then that's going to be a step away from the maladaptive perfectionism and more towards the high achiever that we want to be.
Kendra: As we talk about this today, we know that small steps make all the difference. So just like we said in the last podcast, if we could just move towards neutral that's progress. You know another important thing that I want to just make you aware of that we all have perfectionist tendencies as physicians. That's kind of, like, what makes us so good at our job. But just know that flawlessness is not tied to your worthiness. You were worthy before you became a physician. You were worthy before you went to med school. You were worthy before you went to college. You were worthy before you went to any school and just know that we value you for what you do bring to our field, what you do bring to health care and what you do bring to your patients' lives. So until next time, you are whole, you are a gift to medicine and the work you do matters.