Perfectionism in Physicians

Imagine that every time you need to do something you have a nagging parent or teacher who is constantly criticizing you and your results. That's how it is for many doctors because many are perfectionists. Perfectionists strive to meet high standards and seek flawlessness in themselves and others. The caricature of a  humorless, arrogant, driven physician sadly reflects this personality characteristic of many physicians.

perfectionist physician

Extreme conscientiousness is a personality trait that usually begins in childhood. Even if that nagging teacher or parent has been dead for years they have been internalized so that the perfectionist cannot escape their influence. Most perfectionists have tried hard to live up to their parents' expectations and many grow up in homes where parent's love is conditional on meeting their expectations. As a result, these children try to do everything perfectly to avoid being rejected by their parents. Always trying to please parents is often accompanied by the fear that the mother or father will criticize your achievements. Children growing up in this kind of environment worry they will never meet their parents' high standards.

Extreme stress, and conditioning during medical training, serve to accentuate this personality trait. Social reinforcement that perfection is a good thing can also lead to maladaptive or neurotic perfectionist tendencies. Perfection may be seen as a good thing by society but can lead to numerous medical and psychological problems for the physician.  It has been said that "society’s meat is the physician’s poison"(Gabbard 1985).

Perfectionism has both professional and personal ramifications. Anger is a frequent problem for them and perfectionists are more likely to make errors  because they have a tendency to procrastinate. They delay making important decisions because they fear they will be judged adversely. They often are in conflict with peers and other hospital  staff and may find themselves disciplined by hospital disciplinary committees or even state medical boards. Perfectionists get upset over mistakes and worry that others will think badly of them. As a result they do not  seek help to correct errors and are more likely to cover up mistakes. Most perfectionists feel uncertain when a job is finished and are often reluctant to give up on tasks. They sometimes need to be told to 'leave it alone…now'. Doubt can make perfectionists very indecisive.

Both normal and neurotic perfectionists often set high standards that they feel compelled to meet. Setting such high personal standards may be a factor in anorexia nervosa. 

The damage to a physician's personal life is enormous. The constant fear of failure and anxiety about exposure causes them to be hypercritical and judgmental not only of themselves but also those around them.  As a result their personal relationships suffer. Many illnesses such as alcoholism, coronary heart disease, obsessive-compulsive disorder (OCD), obsessive-compulsive personality disorder (OCPD) and even suicide have been associated with perfectionistic behavior patterns.

Tidiness is usually a quality but perfectionists often take it to extremes and tend to be fussy and exacting. They may have a preoccupation with making everything neat and tidy and their high standards can be difficult to live with.

Perfectionistic physicians are often helped by simple coaching measures, like cognitive behavioral coaching, to point out their all or nothing thinking patterns.  Some need referral to a psychiatrist, psychologist or counselor.


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