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Views And Reviews Wounded Healer

Clare Gerada: Unhealthy perfectionism

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l438 (Published 04 February 2019) Cite this as: BMJ 2019;364:l438
  1. Clare Gerada, GP partner
  1. Hurley Group, London, UK
  1. clare.gerada{at}nhs.net
    Follow Clare on Twitter: @ClareGerada

Recently, just before giving a lecture at my old medical school, I was handed my student report card. In the corner was a small passport photo of the young me, and below were the grades I achieved during each attachment, including my elective and student locum.

No comments, just grades. My scores were average: mainly Bs and B+s, a few C+s, even a C. Seeing this card nearly 40 years later was a surprise. I had no idea that each clinical firm was graded, and I’d assumed that the only scores we received were at finals. It set me thinking about how different it is for today’s medical students.

Far from fitting on two sides of A4, today’s student record (if one could unscramble the e-portfolio) would stretch across several volumes. Endless supervisor reports, grades on every aspect of training, personal reflections, and multisource feedback. Students, and later doctors in training, are in a perpetual cycle of assessment, scrutiny, grading, and comparison with peers.

I worked hard at medical school. Perhaps it’s fortuitous that I didn’t know that my grades told a different story: such was my competitive spirit, I might have worked a lot harder. And, if I had, I would’ve had no time for fun, friends, and family. Nor would I have learnt how to create the healthy work-life balance vital for my future as a doctor: given my personality, I would probably have set unrealistic standards for myself and striven for the unachievable—perfection.

All doctors have some degree of perfectionism: after all, meticulous attention to detail and the wish to get things right are desired characteristics. Healthy perfectionists set high standards for themselves but drop these when required. Doctors also develop a cognitive triad of doubt, guilt, and an exaggerated sense of responsibility.1 We don’t leave work undone, and we put patients first.

The nature of medicine, combined with doctors’ tendency to internalise high standards, means that we’re inclined to work harder, achieve more, give more to our patients, and deny our own needs.

Doctors develop a cognitive triad of doubt, guilt, and an exaggerated sense of responsibility

Even healthy perfectionism can turn against us in times of stress. It can lead to never feeling good enough, being overly self critical, and placing impossible demands on ourselves. This can cause a cycle of failure, procrastination, and seeking reassurance.23

Unhealthy perfectionism risks doctors becoming mentally unwell as they blame themselves for the losses and failures that are inevitable in medicine. Doctors at the extreme end of the perfectionist continuum find it hard to relax if they don’t continually excel. In fact, recent research has shown that perfectionism leads to more “detrimental” work and non-work outcomes.4

I was lucky. I was protected from my innate desire to do better and achieve more, although I’ve still had a fulfilling career and delivered good patient care.

We must reduce the stressors on today’s doctors, and an important step would be to create a sensible balance of scrutiny, assessment, and professionalism.

Footnotes

  • Competing interests: I am a former chair of the Royal College of General Practitioners, a partner of the Hurley Group, and shareholder of eConsult. I am also a non-executive director at University College London Hospitals and a member of the General Medical Council’s independent inquiry on gross negligence manslaughter.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

References

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