Ballet dancers and doctors are essentially the same people. Long before I entered medicine, ballet taught me the skills that made me successful in my clinical practice. I was a life-long learner. I improved my skills with daily practice. I was creative with limited resources. I strived for excellence and was rewarded for these efforts. The skills I learned as a professional ballet dancer prepared me well for medicine. There was tremendous pressure from within myself and my environment to do better, be better, and strive harder. My professional success, salary, and performance were tied to my achievements, and the line between my success and self-worth quickly blurred. Similarly, when I became a physician, I was taught to value precision, perseverance, and flawlessness at any cost, specifically at the cost of my own sanity, health, and safety. This perfectionism was reinforced by the implicit and explicit messaging of, “Don’t your patients deserve your best?” Perfectionism is the belief that things can, and should, always be better. That you could be happy or worthy if you do better or are better. It is striving for flawlessness and perfection while doubting and judging yourself and worrying about what other people think of you. Unlike high achievers who are motivated by curiosity, determination, purpose, and commitment, perfectionists are driven by fear of failure, self-doubt, shame, and worthlessness. Being a high-achiever made me look great on paper, but perfectionism made me miserable. In an effort to be flawless, zero my inbox, and have infinite medical knowledge, I created burnout through a tidal wave of workaholism. I believed that if I could be better and do more, I would feel better, but there is no limit to “better.” It was a graceless, self-loathing, exhausting life that left little room for joy. Perfectionism nearly ended my career in medicine by ignoring the cost of flawlessness – my own well-being. Like many perfectionists, I did not identify as a perfectionist because I largely focused on my imperfections: I’m not a perfectionist because I do not do things perfectly. My life can always be better. I could (and should) be a better doctor, parent, friend, partner. I will feel good about my body when I’m thinner. I will be happy when I achieve work-life balance. Perfectionism ties our worth, contentment, and self-acceptance to a fantasy goal in the future. Fantasizing about these goals gives us the dopamine rush of success without experiencing the human experience of the journey. Perfectionists avoid the honest reality of vulnerability, failure, rejection, fatigue, or discomfort that is necessary for growth outside of our comfort zone. This all-or-nothing thinking blinds us to the very real joy, success, contentment, and pride of who we currently are while eternally seeking to be or do better. Despite common perception, perfectionism undermines performance, inhibits growth, and diminishes happiness. Perfectionism robs us of our fullest joy and success by connecting our worth to impossible standards or achievements. Perfectionists live in a future fantasy, believing that when they reach their goal, then they can feel better. When I get my charts done, then I can relax. When I get married (or divorced), I will be happy. When I finish med school/residency/fellowship, then I will be confident. I will be a great doctor when I can save all of my patients from dying. For example, a perfectionist might think, “I will be confident when I’m a better doctor.” The unspoken definition of “better doctor” might include never missing a diagnosis, never making a surgical error, never having patient complaints, or getting one’s inbox to zero every day. This thought might seem very true and believable, and at the moment, it seems noble and worthy. In the flood of dopamine associated with the fantasy of one day reaching “better doctor” status, the perfectionist does not see that this is an unattainable goal because we are humans who will inevitably miss a diagnosis or make an error or have patients who simply don’t like us for reasons outside of our control. Then, in the attempt to reach this unattainable goal, they fall short and criticize, procrastinate, and worry, which then creates misery. In an attempt to overcome this discomfort, they promise to do better next time, thus repeating the perfectionist cycle. Ultimately, perfectionism is our brain’s attempt to keep us safe. It is its way to solve discomfort, but it, unfortunately, is a self-fulfilling cycle. Have you ever wondered why you can’t achieve “work-life balance?” The perfectionist fantasy of “I will be happy when I have work-life balance” assumes that there is a magical destination of no stress, no overwork, always present for your patients and loved ones, time for exercise and nutritious meals, and sleep and self-care. Guess what? This destination does not exist. You can be happy today, even if your inbox is not at zero. In fact, you are missing out on the amazingly messy, beautiful, uniquely human experience of today to fulfill this fantasy. To be clear, I am not advocating that we stop striving for excellence and provide poor care to our patients. I am suggesting that we devote our energy to what really matters – human connection and communication, creative problem solving, curiosity, boundary setting, authenticity, honesty, and determination. We can work towards a perfect A in these domains and deliver B-minus work (clearly still above average) in the imperative but not value-added areas – charting, paperwork, and Yelp reviews. My fantasy is that every first-year medical student will be given a stethoscope, white coat, and compassionate instructions for when, not if, they make mistakes. We will teach them self-compassion, curiosity, forgiveness, and how to recover when they fail. They need to know how to care for themselves while they care for patients, that they are their most important patient. I hope this is not a perfectionistic fantasy. Take it from this dancer turned doctor – perfectionism is limitless, and it will limit your performance and contentment. Everything you want to feel in this profoundly human life is available to you now. You don’t have to be anything better, do any more, or achieve another thing to experience that. Source
