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Wellness 911: The Price of Perfection : Emergency Medicine News


perfectionism, well-being, mental health


Doctors should be perfectionists, right? It really depends on the kind of perfectionist.

Adaptive perfectionists, who we call high achievers, have high standards, set ambitious goals, and work tirelessly to achieve those goals. They are success-oriented but flexible enough to allow for occasional mistakes.

Misfit perfectionists, who we call perfectionists, leave no room for mistakes, are driven by fear of failure, and need to cover up imperfections. Maladaptive perfectionism is associated with anxiety, depression, eating disorders, chronic fatigue, and taking fewer preventative health measures.

Newly admitted medical students are initially high achievers with relatively low perfectionist tendencies compared to the general population. Medical training, however, ignites the tinder of perfectionism in many. Medical trainees take on the persona of mentors who value the above reproach. Shame-inducing scenarios (pimping tours, lectures on morbidity and mortality) fuel the fear of humiliation that is prevalent in perfectionism. Even the white coat as a symbol of an infallible doctor and well-meaning friends and family who expect omniscience can contribute to perfectionist tendencies.

Tal Ben-Shahar, PhD, a Harvard-trained psychologist, describes what separates high achievers from perfectionists in his book, The pursuit of the perfect. We can begin to move towards a happier, healthier outlook as we gain awareness.

Perfectionists reject failure: No one likes to fail, but there is a difference between normal aversion and the perfectionist’s intense fear of failure. The most successful person prepares thoroughly and works diligently, knowing that mistakes happen. The perfectionist procrastinates or completely avoids trying difficult tasks, fearing failure. Ironically, it makes failure more likely or inevitable. Being human means there will be mistakes. Mistakes are how we learn and grow. No one learns to walk without falling. We believe that perfection in medicine is the only option because lives are at stake.

People often think that we might suddenly become careless if we accept anything less than perfection. But be honest: is that even a possibility? Unlikely. But we create shame and miss the lesson by making human error mean something about our character. A perfectionist believes their value is tied to perfection, so self-esteem suffers when perfection isn’t possible. To pursue excellence rather than perfection is to do your best, but learn from a rare mistake rather than blame yourself. There is nothing wrong with granting grace to the human who is doing his best.

Perfectionists reject negativity: Perfectionists expect to experience a constant, uninterrupted flow of positive emotions if they live their lives “well.” A perfectionist must be happy all the time to consider herself happy. A high achiever, on the other hand, knows that being human means experiencing sadness, boredom, anger, and restlessness, and that feeling them is actually a good thing. Life is going to be a mixed bag. We are still taught, when we were children, to look on the bright side and be grateful. Negative emotions are discouraged and perfectionists are great learners of this lesson. ER doctors are experts at putting on happy faces despite the most horrific of circumstances. Many learn to numb their feelings with Netflix, online shopping, social media, and overeating and drinking.

We create other problems for ourselves by using emotional buffers too frequently. Negative emotions don’t go anywhere until they’re felt, like trying to hold a beach ball underwater: it takes a lot of effort and the ball often slips away anyway. But we also inadvertently numb the positive emotions in our lives by numbing the negative. The bad times, in a way, make you appreciate the good ones. If every moment was positive, the positive would become the new neutral.

Allowing yourself to feel negative emotions doesn’t mean you have to act on them. Some people may fear that allowing themselves to be sad will make them sad, but often the opposite happens. Resistance to feeling sadness can create a lot more suffering. We deny our humanity by denying negative emotions and thus reject ourselves. A perfectionist who expects endless happiness is surely unhappy because it is not compatible with life on Earth.

Perfectionists reject success: Perfectionists think that everything they do is not good enough. They have set near impossible expectations, which makes it incredibly difficult to succeed. Perfectionists who achieve their goals trivialize accomplishment and quickly move on to the next thing. Abundant objective evidence to the contrary, the perfectionist never allows himself to feel successful. A high achiever, on the other hand, sets high expectations rooted in reality, and they truly appreciate and celebrate their success once they achieve a goal.

Perfectionists reject reality: A perfectionist expects her life’s journey to be smooth, unobstructed, and direct. The fact that it does not correspond to reality leaves the perfectionist frustrated, so she is never satisfied. The perfectionist’s unrealistic expectations create unhappiness in his life. Rejecting failure leads to anxiety because the possibility is always there (and probable), and rejecting negative emotion intensifies suffering. Rejecting success leads to endless dissatisfaction. The successful person, on the other hand, can get the most out of life by accepting the reality of failure, negative emotions, and savoring the success.

Clockwise from top left:Dr. Dinsmoreis an emergency physician in Springfield, MO. She completed an Integrative Medicine Fellowship and is a Certified Physician Wellness Coach.. Dr Cazieris an Emergency Physician in Huntsville, AL, and a Certified Physician Wellness Coach. Dr Morrisonis an emergency physician, medical director of a free-standing emergency department in Springfield, MO, and clinical professor at Kansas City University College of Medicine. She has additional training in integrative medicine and wellness coaching. Together they own The Whole Physician, a company dedicated to optimizing the well-being of physicians ( Follow them on Facebook (, instagram@thewholephysician, or Twitter@WholePhysician.