We work in an impossibly depleted health care system and under impossibly high expectations of perfection from society. We hold our peers, our team members, our trainees, and most of all, ourselves to rigid, lofty ideals of flawlessness. By glorifying perfectionism in medicine, we have effectively dehumanized ourselves.

The oath we take is “Do No Harm.” It is not “Try your best to do no harm.” Is it appropriate to expect such absolute perfection from mere mortals? Is it any surprise that when unintended harm does occur (because we ARE human), while working in our current broken health care system, clinicians are left struggling in their shame and guilt in silence and loneliness.

These are tough conversations. It is hard to admit how the culture of perfectionism is harming us, our trainees, and our patients.

Looking back on my own life, it seems all the highs and lows were tied to the relentless pursuit of perfection. It fascinated me how much my performance-based identity and how I appeared to the outside world took precedence over how I felt in reality.

In this article, I hope to share reflections from interviewing researchers and high-achievers and from giving a TEDx talk on the topic of perfectionism, “Perfectionism has a solution: It’s not what you think.”

Redefining perfectionism

In my TEDx talk, I offer a different perspective: “These days, we all experience this constant dull ache of consistent comparison and inferiority. And that dull ache is perfectionism.”

To build on that further: “Perfectionists operate from a deficit mindset.”

You consistently believe there is something wrong with you, and you must conceal it under all circumstances to appear flawless. This creates a constant fear of exposure (hello impostor syndrome).

The three dimensions of perfectionism

While most of us are familiar with, or have heard of, the terms adaptive and maladaptive perfectionism, I feel these ways of defining perfectionism leave out key components of how we encounter Modern Perfectionism because they may not explicitly account for the context of our lived experiences. I prefer Hewitt and Flett’s model:

• Self-oriented perfectionism: Internally driven, “I must be perfect.”
• Other-oriented perfectionism: Being hypercritical of people in my vicinity, “I expect those around me to be perfect.”
• Socially-prescribed perfectionism: The whole world, society, culture, strangers online, “EVERYONE expects me to be perfect.”

While all types of perfectionism are on the rise, socially-prescribed perfectionism is rising the fastest and is the most harmful. It is also the type most strongly tied with maladaptive psychological distress. While perfectionism has been largely considered an individual’s problem or a personal trait, Modern Perfectionism can be viewed as a social problem.

Reflective pause: As you read the above types of perfectionism, I invite you to reflect on where they may have been showing up for you and those around you. All three of them have shown up very strongly in my life. From berating myself for having a human moment (like the need for sleep during a night shift), to knowing my attending will want rounds executed flawlessly, to my patients expecting me to bend time and fit their every need in a 15-minute primary care visit. Adding further context, knowing that as a South Asian woman, I am expected to operate and execute all of the above, plus my cultural roles, without any room for error.

The Expectation Gap of Perfectionism™

I recognized a pattern emerging from interviews with experts and high achievers who shared their journeys and research. This led me to coin “The Expectation Gap of Perfectionism.” It is the widening gap between our true, authentic human selves and the airbrushed image society expects us to project. This Gap is why we feel perpetually restlessly inadequate. This Gap is also what billions of industries target to manipulate and incessantly market products to us.

Glorifying perfectionism out of ignorance

Just like you, I, too, have held up my perfectionism like a badge of honor. I have been ignorant. Perfectionism is a transdiagnostic risk factor for mental health issues. It is linked with anxiety, depression, eating disorders, loneliness, burnout, and sleep disruptions. For me, it was a huge barrier to seek mental health care when I needed it the most.

“Perfectionism is the belief that something is broken: you. So you dress up your brokenness with degrees, achievements, accolades, pieces of paper, none of which can fix what you think you are fixing.”

Perfectionists are not the best hires

Stepping back and looking at research (Curran 2015) and just plain common sense, it is clear that perfectionists are not the best hires. They are more likely to burn out and struggle with aspects like delegating, accepting feedback, and handling failure.

Confusing perfectionism with excellencism

By this point in the article, you are likely skeptical and concerned. How can I “let go” of my perfectionism while being a conscientious clinician? What about my life’s ambitions? Do I have to accept mediocrity?

There is nothing wrong with pursuing excellence and setting the goal to “Do No Harm” while simultaneously acknowledging our innate humanity. That is excellencism. When you become an excellencist, there is a subtle but obvious shift.

Excellencism is rooted in your values. I “want” to be the best clinician and care for my patients in the best possible ways. Perfectionism is rooted in “fear”; I must not make any mistakes because of how it will “look,” or I will get sued, or I will be found out as a fraud.

Excellensists pursue growth and the mess that comes with it, accepting learning curves. Perfectionism demands flawlessness from the get-go. Remember your first day on a new rotation or as an attending. What did you ask of yourself, and what did others ask of you? Did you and everyone around you expect immediate mastery?

Excellensists focus on progress over time. You can desire to be the best clinician possible, and that takes time. Perfectionists obsess over mistakes in the moment and are extremely self-critical.

Excellencism is motivating while perfectionism is paralyzing. The focus shifts from a performance-based to a value-based identity.

Excellencism leaves space for grace. Perfectionism only allows for guilt.

Creating Your Courage Bridge™

To move forward from perfectionism and to constantly reground ourselves, I invite you to tap into your bravery. The framework I created, offered as a gentle suggestion, is called The Courage Bridge.

• Step 1: The courage to examine your intentions: Pausing to examine the reasons why we do what we do is critical. Are our goals and actions stemming from a need to cover our imperfections and seek external validation? Or are we moving towards our mission, our values, and joy?
• Step 2: The courage to fail with self-compassion: In my TEDx talk, I asked a question that has sparked a lot of interesting conversations: “How well do you fail?” Perfectionists run low on self-compassion and high in self-criticism. When we are consistently tearing ourselves down, how can we succeed? I remember actively berating myself as a sleep-deprived post-call intern when I made a small stumble presenting a patient to the morning team. Looking back, I wish I had given myself the same grace I would give any other peer or human. I hope you can as well.
• Step 3: The courage to model your humanity: Lastly, I want to remind you that how you and I are experiencing the Expectation Gap of Perfectionism is not happening in a silo. We are all breathing the air of socially-prescribed perfectionism. If more of us modeled our humanity in simple ways, it would ripple far and wide in validating our shared human experiences. This does not mean you have to over-share or add another item to your ever-growing to-do list. It can be very simple words and acts in passing.

“Perfection is isolating. Humanity is magnetic. We don’t connect through someone’s polish. We connect through their truth.”

Amna Shabbir is an internal medicine physician.