This year, I have often entertained fantasies of a physician who can “do it all.” This ideal physician is well-read and up to date on the literature, exercises four or five times a week, is personable, has a steady support system, and hardly complains about staying extra hours. If she is a parent, she can also work and raise children at the same time. She is empowered.
People have many expectations for their physicians, just as we physicians have high expectations of ourselves. And we do need these high standards — we work in life-or-death situations, after all. These constant expectations help us to compete for medical school spots, honor society inductions, and the “best” residencies for the “best” specialties. After we graduate, they help us to provide the best care possible to our patients. Because of medicine’s culture of excellence, the refined skill our jobs require, and the stamina that’s needed to complete all our tasks, doctors are held to high regard by societal standards — which most of us would agree is a perk of the job.
And yet, the expectations, no matter how necessary, can be stifling. Despite hours of coaching, mentoring, and studying, we can and do crack under the pressure of internal expectations and external demands from the likes of insurance companies, lawmakers, hospital administrations, and attendings. When this happens, we can lash out at those around us, leaving them defenseless against the torrent of frustration exploding from our shiny, cracked façades. Just ask our trainees — I would not be surprised if many of them attest that they have been a victim of the “kick-the-dog” effect. Or look at the clinicians around you: those tired perfectionists who roll their eyes at staff who bemoan a late lunch break, thinking to themselves that they haven’t eaten, let alone used the restroom, in four hours. Then, observe the “old-fashioned” attending who never fails to tell others that they “have it easy” with their duty-hour caps and EHR.
Taken together, these judgmental behaviors can make clinical environments feel unsafe for learners to make mistakes, and can discourage vulnerability and solidarity among hospital staff. Workplace environments can both contribute to burnout and become more hostile once burnout occurs. And these external environments may not even compare to the unsafe place in our heads:
Does this attending think I am as good as or even better than the other residents?
I definitely should have read more about this case before this morning.
If I had done a better job studying for board exams, maybe I would’ve remembered that piece of information.
I am not doing enough compared to this person. They are making me look like a slacker.
There are a lot of “I should’ves,” “could’ves,” and “If I hads” floating around in our brains — self-defeating thoughts about events that have already passed. This isn’t surprising; it’s only natural that a self-selected group of highly educated, perfectionist, sensitive, idealistic, and sometimes downright neurotic physicians would think of creative methods of self-punishment.
And so, what is to be done? In terms of overarching change, the odds are against us: Working in what can feel like a constant dumpster fire of a health care system, it would surprise me if every physician has not felt the weight of existential dread at least once in their career. New policies, quotas, protocols, rules, EHR updates, and employees are often being introduced, and we are still expected to work toward mastery of it all — all while trying to stomp out our every last mortal flaw.
I believe the answer lies in taking a step back and seeing the job for what it truly is — a uniquely difficult, sorely misunderstood, both overrated and underrated vocation. If we mentally displace ourselves from the whirlwind of burnout and expectations, we could come to see — and truly internalize — the following: our job is much more stressful than the average person’s; the net effect of our work on the world’s population is positive; and we still get to put dinner on the table and live comfortable lives.
When we judge ourselves and others for not meeting up to physician ideals, it might be grounds to remind ourselves (and others) that being a physician is just a job. How often do we have such far-reaching and diverse expectations for our realtor, the teenager who washes our car, the employee who stocks the grocery store shelves, or the interior designer who helps us adorn our home? While these workers make our lives easier and better, they are not typically expected to adapt their personhood to their livelihood, nor are they encouraged by external forces to go above and beyond the required task every time, the way a physician generally is. The idealization of the physician role — of us as noble, virtuous, self-sacrificial — and the perfectionism that we exercise within it can prevent us from seeing how successful and productive we truly are in our capitalist, service-oriented economy.
Even though we may not hear all the success stories, we have done so many frankly marvelous things already for our patients. It is not unrealistic or even uncommon to refer to medicine as a calling (I sometimes get involved with that sentiment), but trying to reclaim a different perspective of our profession, that we have already gone so above and beyond the requirements of a job, may lead us to practice self-compassion and ground us through difficult times on the wards.
How do you reckon with perfectionism as a clinician? Share your strategies in the comments below.
Katherine Wu, MD, MA, is a preliminary medicine resident who is interested in applying to psychiatry next year. She is passionate about women's mental health, cultural humility in health care, and addiction medicine. In her free time, she likes to tend to her plants, read books, learn about Chinese culture, and stay physically active. Dr. Wu is a 2021–2022 Doximity Op-Med Fellow.
Illustration by April Brust