Some people would argue that they would prefer their doctor to be on the perfectionist side as they want to ensure they are treated with care of the highest standard and with great attention to detail.  To an extent that’s true, but you need to consider if your perfectionism is positive and healthy (adaptive perfectionism) or if it has a significant downside and turns out to be unhealthy for you and your work (maladaptive perfectionism).

Healthy adaptive perfectionism can ensure that doctors continue to keep up their sense of responsibility and professional standards but it is not driven by continual fear or anxiety.  This doctor knows the boundaries of what is reasonable and possible in their work and may accept that they did their best in any situation.  They derive satisfaction from their work.

Maladaptive perfectionism, however, drives the doctor to keep on trying harder and not delegating enough and feeling guilt and shame that they are not managing things well enough.  They can end up with chronic doubt, chronic guilt and an overblown sense of responsibility.

A recent literature review on perfectionism and mental health by Thomas and Bigatti showed that maladaptive perfectionism in medical students and trainees has a significant positive correlation with:

• Depression
• Anxiety
• Hopelessness
• Suicidal ideation
• Neuroticism
• Burnout

Their review also showed that the strongest predictor of psychological distress, depression and anxiety in medical students is maladaptive perfectionism.

A large study of maladaptive perfectionism has shown that it has increased over time between 1989 and 2016 in college students from USA, Canada and UK.

There is no one agreed way of managing perfectionism.  It would be helpful to treat the causes of it as well as the effects – however, on their own, there is little an individual sufferer can do about the environmental and cultural conditions that contribute to it.  You can look at what you can do as an individual to make things better for you, personally.

Antony and Swinson’s book on perfectionism (When Perfect Isn’t Good Enough) provides a useful approach for managing perfectionism in an individual, focusing on the associated thoughts and behaviours.  They describe four areas you could start working on:

Making an assessment of your perfectionism

• Keeping a perfectionism diary to identify the sorts of perfectionistic thoughts behaviours you tend to do and what the triggers of these tend to be

• Evaluating the helpfulness (or not) of your standards and how they impact on your life and the people around you. 
• Watch out for the tendency to see things in all or nothing terms.  This produces a worry that if you slacken some of your standards, you will end up doing sloppy, suboptimal work and you will be criticised, blamed or even sued.
• You can also learn to see that standards for work generally lie along a continuum and are not simply categorical – i.e. excellent or not good enough.

• Listing all the costs and benefits of your perfectionistic standards currently and what these would be if you relaxed some of your standards
• Making clear, well-formed goals for what you want that’s different from now

Working on your perfectionistic thoughts

• This takes a similar approach to cognitive behavioural therapy (CBT).  You learn to identify perfectionistic thoughts and catch yourself doing it and then cross- examine them
• List possible alternative thoughts
• Consider the advantages and disadvantages of the original and alternative thoughts
• Find more realistic, beneficial ways of viewing the situation
• One example of a CBT approach is to focus in on your polarised beliefs and assumptions about yourself and others, using the CBT continuum approach (see resources for a link).  Getting one’s thoughts and beliefs down on paper (rather than just thinking or talking about them) can help you examine them more fully and identify more useful and realistic beliefs

Working on your perfectionistic behaviours

• Realising that if you continue to do the behaviours associated with perfectionism it will just keep the perfectionistic beliefs and predictions going strong
• Gradually learning to to put yourself in the situations that you avoid because of perfectionism and learning that the outcomes aren’t in fact as bad as you fear (e.g offering to give a talk to your department and seeing what actually happens)
• Gradually learning to stop yourself from doing the behaviours that perpetuate the perfectionism (e.g. staying behind at work for three hours to check all the tests were ordered and done and not delegating to the night team)
• Stopping your habitual procrastination and trying to do things in smaller chunks that are less overwhelming and more easily completed

Accepting Imperfection

• Learning to see that many perfectionistic behaviours are actually attempts to get more control over situations and your negative emotions
• Practising mindfulness can help bring you back into the here and now and stop the habitual flight into the future and the awful things that might happen there.  There are many useful resources available online now for helping us learn how to practice mindfulness
• Acceptance and commitment therapy may help with this too (see Wilson and Dufrene’s book below).

Doctors tend to be self-sufficient and are trained to work things out for themselves.  This is useful for the type of work they do and the responsibilities they have.  However, don’t try to struggle on alone with problematic perfectionism.  It is a common issue with doctors and should not be seen as a sign of weakness or failure (even though your perfectionistic thoughts might try to tell you this).  To seek help and support is actually a sign of wisdom.

Help and support is available from allied healthcare services – like CBT sessions with Practitioner Health or applying for coaching at Professional Support Unit.  At the PSU, we see many doctors who struggle with various degrees of perfectionism.

If you are suffering with associated anxiety and depression, again, seek support from your own GP or through services like Practitioner Health or DocHealth.