The curse of perfectionism
‘Perfect is the enemy of the good.’ This is one of my favourite quotes, and one that I had on a constant loop when I was on MasterChef – a reminder that serving the judges a dish that was a 7/10 under the intense pressure of the competition was sometimes a better outcome than trying to strive for the perfect 10 but running out of time and failing altogether. This is a difficult concept for perfectionists to understand – knowing when something is good enough, and when to settle for something that seems like less than perfection. It’s not an easy skill to master. And it’s even harder in the health care setting.
Society wants health care professionals to be perfectionists. We trust them to make the correct diagnosis, select the most appropriate treatment, and where required perform precision surgery. There is a reasonable expectation that they should strive to achieve the best possible outcome for each and every patient. But the dilemma for perfectionists is setting the bar so high that it creates unrealistic expectations.
And unrealistic expectations is they are exactly that – unrealistic. When expectation and reality clash, that causes us distress. Perfectionists are prone to catastrophizing if they think that they have failed at something. What will other people think? There is a sense of shame in failure, worried that others (especially colleagues) will perceive you as flawed or unworthy of acceptance. Which goes to the heart of our identity as a health professional.
Perfectionism becomes a problem when we move beyond the pursuit of excellence – which is entirely legitimate - to the belief that perfection is possible and failure is unacceptable. Indeed, research shows an association between both perfectionism and a ‘Type A’ personality and an increased risk of burnout. There is a distinction between perfectionistic striving, which has been defined as a self-oriented striving for perfection, and perfectionistic concerns that relate to making mistakes, fear of negative social evaluation, negative reactions to imperfection or concerns about the discrepancy between expectation and performance. The research seems to suggest that perfectionistic concerns are more likely to be associated with burnout.
It's worth reflecting on how we tend to celebrate perfectionism as a positive train in successful people and consider whether there is an element of survivor bias in what we observe. From tennis players like Roger Federer and Serena Williams, to a filmmaker like Stanley Kubrick (famous for holding the record for the most retakes for a single scene with dialogue – 148 times) or Steve Jobs, whose perfectionism meant it took Apple more than three years to develop the original Macintosh computer. Their attention to detail and drive to succeed by leaving no stone unturned leads us to believe that perfectionism is a positive trait, and a fundamental key to success. But of course we don’t hear of all of the perfectionists who didn’t succeed. Indeed a recent meta-analysis found that there was no link between work performance and self-oriented perfectionism.
Overcoming perfectionist traits is difficult – particularly because it is often a defining characteristic that has contributed to success. Behavioural science tells us that the anticipation or fear of failure is far worse than the pain you experience if things don’t go right. We also have a tendency to overestimate how others will perceive us if we do fail. One key is to learn to recognise when you reach the point of diminishing returns. Sometimes it’s important to just get the job done.