We operate within an exceedingly depleted health care system and face impossibly elevated expectations of perfection from society. We impose stringent, lofty ideals of flawlessness on our peers, team members, trainees, and most importantly, ourselves. By idolizing perfectionism in medicine, we have inadvertently dehumanized ourselves.
The oath we take is “Do No Harm.” It is not “Try your best to do no harm.” Is it reasonable to anticipate such absolute perfection from mere humans? Is it surprising that when unintended harm occurs (because we ARE human), amidst our broken health care framework, clinicians find themselves grappling with shame and guilt in isolation and loneliness?
These conversations are challenging. Acknowledging how the culture of perfectionism is detrimental to us, our trainees, and our patients is difficult.
Reflecting on my own experiences, it appears that all the peaks and valleys were linked to the unyielding quest for perfection. I was intrigued by how much my performance-driven identity and external appearance overshadowed my actual feelings.
In this article, I aim to share insights from discussions with researchers and high achievers and from delivering a [TEDx talk on the subject of perfectionism](https://www.youtube.com/watch?v=oNIzzM4Vg3s), “Perfectionism has a solution: It’s not what you think.”
**Reconceptualizing perfectionism**
In my TEDx presentation, I provide an alternative viewpoint: “Nowadays, we all endure this persistent dull ache of constant comparison and feelings of inferiority. And that dull ache is perfectionism.”
To elaborate: “Perfectionists function from a deficit mindset.”
You perpetually feel there is something inherently wrong with you, which you must hide at all costs to present an image of flawlessness. This fosters an ongoing fear of exposure (hello impostor syndrome).
**The three facets of perfectionism**
Although most are familiar with the terms adaptive and maladaptive perfectionism, I believe these definitions overlook essential aspects of how we experience Modern Perfectionism, as they may not fully address the context of our lived experiences. I favor Hewitt and Flett’s framework:
– **Self-oriented perfectionism:** Driven internally, “I must be perfect.”
– **Other-oriented perfectionism:** Being excessively critical of those around me, “I expect others to be perfect.”
– **Socially-prescribed perfectionism:** The entire world, society, culture, strangers online, “EVERYONE expects me to be perfect.”
While all types of perfectionism are increasing, socially-prescribed perfectionism is escalating the most rapidly and is the most damaging. It is also the type most closely associated with maladaptive psychological distress. Though perfectionism has predominantly been viewed as an individual problem or trait, Modern Perfectionism may be considered a societal issue.
**Reflective pause:** As you read about the types of perfectionism above, consider where they may have manifested in your life and that of those around you. All three have played a significant role in my life. From chastising myself for having a human moment (like needing sleep during a night shift), to the awareness that my attending expects flawless execution during rounds, to my patients anticipating I will meet all their needs in a 15-minute primary care appointment. Adding further context, as a South Asian woman, I am expected to fulfill all these demands, alongside cultural roles, with absolutely no margin for error.
**The Expectation Gap of Perfectionism™**
I observed a trend emerging from my conversations with experts and high achievers who shared their narratives and research. This realization prompted me to coin the term “The Expectation Gap of Perfectionism.” It encapsulates the widening divide between our genuine, authentic selves and the polished image society demands we project. This Gap explains our relentless sense of inadequacy. It’s also what countless industries exploit to manipulate and continuously advertise products to us.
**Idolizing perfectionism out of ignorance**
Just like you, I, too, have worn my perfectionism as a badge of honor. I have been unaware. Perfectionism is a transdiagnostic risk factor for mental health problems. It correlates with anxiety, depression, eating disorders, loneliness, burnout, and sleep disturbances. For me, it was a significant hindrance to seeking mental health support when I needed it most.
“Perfectionism is the conviction that something is broken: you. Therefore, you mask your brokenness with degrees, accomplishments, accolades, and credentials, none of which can mend what you believe you are fixing.”
**Perfectionists are not the best hires**
Taking a step back and examining research (Curran 2015) and basic common sense, it becomes evident that perfectionists are not the most desirable hires.