Abstract
Not all perfectionism is equal and for emergency physicians, the distinction between adaptive and maladaptive perfectionism may be the difference between sustainable high performance and burnout. This article draws on Tal Ben-Shahar's framework from The Pursuit of Perfect to contrast high achievers (adaptive perfectionists) with maladaptive perfectionists across four domains: their relationships with failure, negative emotions, success, and reality. Medical training is examined as an active generator of maladaptive perfectionism through shame-based educational practices, the symbolism of the infallible white coat, and cultural reinforcement of flawlessness. The authors argue that pursuing excellence rather than perfection, allowing the full spectrum of human emotion, and genuinely celebrating success are not signs of lowered standards but the prerequisites for long-term effectiveness and well-being in emergency medicine.
Key Findings:
- â—Ź Maladaptive perfectionism, distinct from healthy high achievement, is associated with anxiety, depression, eating disorders, chronic fatigue, and fewer preventive health behaviors; it is not a personality trait but a conditioned pattern that medical training actively cultivates.
- â—Ź Medical students who enter training as high achievers with relatively low perfectionist tendencies are transformed by shame-producing educational practices ("pimping" rounds, M&M conferences), the white coat's symbolism of infallibility, and cultural reinforcement of flawlessness into maladaptive perfectionists.
- â—Ź Maladaptive perfectionists reject failure so intensely that they avoid difficult tasks or procrastinate, ironically making failure more likely, while tying self-worth to flawlessness, causing self-esteem to collapse with every inevitable mistake.
- â—Ź Perfectionism's rejection of negative emotion, the expectation of a continuous stream of positive feelings, leads to emotional buffering (Netflix, food, alcohol, social media) that numbs positive emotions alongside negative ones, eroding overall emotional richness.
- â—Ź High achievers differ from perfectionists not in their standards but in their flexibility: they prepare diligently, accept that mistakes happen, genuinely celebrate success, and can tolerate the full range of human emotion making them more resilient and more effective over time (Ben-Shahar, The Pursuit of Perfect).
Four ways physicians respond to emotions and why only one works
- ❌ REJECTION 1Â
Rejecting failure → anxiety and avoidance
Ironically increases the likelihood of failure through procrastination and task avoidance. Makes human error mean something about character rather than about circumstance.
- ❌ REJECTION 2
Rejecting negative emotion → numbing and emotional flatness
Buffering negative emotions also numbs positive ones. The resistance to sadness creates more suffering than the sadness itself and the emotion doesn't go anywhere until it's experienced.
- ❌ REJECTION 3
Rejecting success → endless dissatisfaction
Perfectionists trivialize accomplishments and set nearly impossible next goals, ensuring they never feel the satisfaction that high standards are meant to generate in the first place.
- ❌ REJECTION 4
Rejecting reality → chronic frustration
Expecting life to be smooth and obstacle-free guarantees disappointment. The perfectionist is perpetually frustrated because reality never matches the ideal, the high achiever makes the best of what is.
"Pursuing excellence rather than perfection means doing your best but learning from a rare mistake rather than beating yourself up. Being a human means there will be mistakes. Mistakes are how we learn and grow. It's OK to bestow grace on the human doing her best."
Publication details:
JOURNAL
Emergency Medicine News
VOLUME / ISSUE
Vol. 44, No. 5, p. 25
PUBLISHED
May 2022
AUTHORS
Amanda Dinsmore, MD; Laura Cazier, MD; Kendra Morrison, DO
DOI
10.1097/01.EEM.0000831276.79272.d2
PUBLISHER
Wolters Kluwer Health / LWW
