Happy, Healthy Docs and Health Professionals

Perfectionism and Medical Errors: What's the Connection?

  After my last post on “Perfectionism:  An Unacknowledged Source of Stress” (below), I was asked to conduct Grand Rounds on this topic.  (Having only been a blog post, the stress of creating a perfect seminar on perfectionism was great.)  At its end, a participant told me it was a great talk, as it was a topic never discussed anywhere in medicine – an arena in which everyone is expected to be perfect.  This expectation attracts perfectionists into medicine, which in turn creates perfectionistic medical leaders who train new doctors to be perfect.  
    The low self-esteem (and fear of making errors) that underlies perfectionism can ironically be transformed into arrogance – the flip side of the same coin – when compounded by the rigors of medical training and sometimes accompanying demanding, highly critical clinical trainers.  Initially fearful residents who drive themselves very hard into becoming highly skilled practitioners, may eventually find themselves saying, “Me?  Make a mistake?  I DON’T MAKE MISTAKES!  I’M PERFECT!”  This creates a closing off to constructive criticism and feedback from others.
    My seminar discussion went onto that track.  An attending shared he had mistakenly mixed up medication orders for two patients.  A resident realized it, and kindly said:  “Dr. Smith (name changed), in looking at these two patient records I think there may be a mistake in your medication orders you might want to look at.”  Dr. Smith was very grateful to this resident.  She averted a possible disaster.  He was humbled by this and saw that despite his high skill level he was still capable of making medical errors.  He was aware of his humanism and imperfection.  
    He further shared stories of famous doctors, experts in their fields, who write the teaching manuals, create the training videos – and who still make mistakes and get sued for malpractice.  He said, “Wouldn’t it be great, if when a nurse says to such a doctor, ‘Doctor, please take a second look at the paperwork, as I believe you may be about to remove the wrong organ,’ that physician could respond with, ‘Thank God you noticed!’ vs. ‘Don’t question my authority!’?”   
    Dr. Smith's point was that BECAUSE no one is perfect, it’s vital for medical team members to stay humble and open to receiving constructive feedback from each other no matter what their status – AND to feel safe in giving it.  My point is the cure for perfectionism is to work on raising your self-esteem.   These two things work together.  True self-respect – vs. arrogance – creates a comfort level with one’s own imperfections and an openness to admit mistakes.  It also creates respect for others – a vital need for a functioning medical team that ultimately results in fewer errors and optimizes patient care.

Perfectionism: An Unacknowledged Source of Stress

   As a very smart child, I typically got 100%'s on school tests.  With the occasional 98% came my mother's (may she rest in peace) inevitable question:  "What happened to the other 2 points?"  Excellence, I was taught, would not do - it had to be perfect.  As an adult, a woman I know once suggested I strive for 75% accomplishment in my life's tasks.  I looked at her as if she had five heads.  75%?  At least 90% was necessary.  A third wise woman later told me perfectionism is an illusion - it does not exist.  I wanted to throttle her.  After a lifetime of striving for perfection, and all the stress, time and energy this entailed, I was angry at and disappointed by the thought that it was an impossibility to achieve.

If you had a similar upbringing, perhaps you know of this drive to be perfect.  What you may not realize is that what may underlie it is low self-esteem.  Perfectionism is an unconscious attempt to overcompensate for feeling bad about yourself.  It's a way to get external validation from the world.  If you look good, sound eloquent, achieve, save others, etc., you MUST be valuable.  If not you're not, and you've somehow failed.  We create high standards for ourselves and thereby in others.  This causes stress within us and in those close to us.  It strains our relationships.  No one can live up to such standards.  And when we focus on what's wrong vs. on what's right in us, it only makes us feel worse about ourselves.

The other day I had an epiphany.  Looking around my apartment, I wondered what life would be like if I no longer existed.  My home and the things in it suddenly seemed empty.  My existence had made them what they were.  In that moment I had a deep knowing that I mattered.  I was completely unique and left my own imprint on the universe.  I had value - intrinsic value, not based on grades or what I achieved.  My stress level suddenly decreased.  The pressure was off.  I was perfectly acceptable AS I WAS.  I was ecstatic!  What a relief!!