Perfectionism.

This could be a book, not a blog post. And my inner critic, the perfectionism gremlin, has already arrived, “helping” me by finding fault in how I started and thus grinding future progress to a halt. 

Perfectionism seems to help us succeed in school and in training. 

Chasing perfection appears to be the only possible standard during that time, where all mistakes loom large as failures that could derail our careers before they even begin. And once we are in our careers, errors are dissected as aberrations by committees and even colleagues. At least that is the impression gained during training at morbidity and mortality conferences. 

But after we arrive at our intended destination–medical practice or wherever we work–perfectionism can make our life miserable if we continue to adhere to it. Not just work life. All life. It is no way to create a happy life because it adversely affects not only our experiences but also all our relationships, both with ourselves and with others. 

To be honest, I really never thought of myself as a perfectionist. I was not usually “the best student”, nor did I actively strive to be. I wanted to perform well but not necessarily outcompete everyone else, as some of my classmates did. There were always people who seemed better, smarter, and more talented than I. And I was ok with that, so I couldn’t be a perfectionist.

In short, I was no Hermoine Granger. I did what I needed to do to get where I wanted to be. That included getting into medical school and residency, but I wasn’t concerned about “the best medical school”. I wasn’t concerned about “the top orthopedic residency”. (Plus, those all included Saturday morning didactics. No thanks.) 

But then I learned the characteristics of perfectionists. Not actually being perfect, which is impossible, but being perfectionistic, which is common in our culture at large, and perhaps even more ubiquitous in the culture of medicine. In fact, medicine selects for perfectionism and then reinforces it until becomes the way of life.

Tal Ben Shahar, who has lectured and written extensively on perfectionism, identifies these characteristics as all-or-nothing thinking, where something is either perfect or it’s terrible; where the focus is on the destination and there is an imperative to get there as fast and as directly as possible; having a paralyzing fear of failure; always finding faults with ourselves and others, and yet getting defensive with perceived criticism; having a need for control and an intense dislike of change. 

He contrasts this with the optimalist, who has the ability to think about complexity and variation; to focus on the journey; who understands getting to the endpoint may take a circuitous route; who accepts failure as part of learning; who finds the benefits in situations and people; who is open to suggestions; is able to forgive self and others; and finally, who is adaptable in challenging situations.

In short, the optimalist has given themselves the permission to be human rather than perfect. (Something I wrote about here and here.

I know in which description I see myself and so many of my colleagues. 

But isn’t focusing on the destination, being goal-driven, and being able to delay gratification good? Yes. But. When every small inadequacy is treated as a failure and not the learning opportunity that it is, then most things in life will lead to disappointment and a sense of personal inadequacy.

Because the real truth about perfectionism is that it’s not about striving for being the best we can be, striving for excellence.

(Excellence is something we can work towards and is often cited as an alternative to perfectionism.)

Perfectionism is about running ahead of the fear and dread that you are not now and never will be good enough.

If you stay ahead of the fear, if you control enough, the truth of your inadequacies can remain hidden from view or maybe even conscious awareness (which is why projecting criticism onto others is ubiquitous in perfectionism). But because, as a living, breathing, thinking, feeling human you are inherently not perfect, imperfection will eventually catch up with you. Being hypervigilant will not save you. But it will cause a lot of rumination and stress.

Being an optimalist gives you the permission to be human, the ability to accept your faults, and to learn from any perceived failings so that you are constantly improving professionally and personally. 

One of my coaching courses also introduced the idea of mastery as an alternative to perfectionism, where one of the goals of ANY endeavor is to always learn something. If you’re always learning, then you actually cannot fail with this attitude. 

It still means setting big, and even scary, goals, but also having backup goals.  One backup goal can be a performance short of our ideal goal but maybe feels more achievable, less of a stretch. And then setting an additional goal. A goal of learning and improving, because in any given situation, we can always and intend to improve in the future. 

Carol Dweck calls this a “growth mindset”, which contrasts with the fixed mindset of perfectionism. A fixed mindset relies on natural ability and therefore if you fail to perform perfectly, you have failed to achieve your goal and redemption is impossible (all or nothing) because you are a failure. However, a growth mindset relies on learning and improving as the main goal, therefore you can always succeed.

Why not accept the reality of imperfection now. Set your sights on moving toward being an optimalist. On mastery or on excellence. Because that is an ideal you can not only meet, but can experience and sustain for a long and rewarding time.

Looking for insight into your perfectionistic tendencies? Take this quiz from Psychology Today, here.

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