Healthcare (HC) is the perfect profession for enabling perfectionists. Ask me, I know! Where else is perfectionism not just desirable, but actually deemed essential? That’s like crack for perfectionists. In this context, we are expected to be perfect not just for our own internal satisfaction, but for matters of life and death. HC is a comfortable spot for perfectionists because it fosters this illusion that perfection is a desirable and attainable goal. As perfectionists, we are comfortable with feeling like everything we do or say or produce is up for judgment. Fear of being or appearing imperfect is real and feels untenable, like we won’t survive if we aren’t perfect. HC just feeds our belief that perfection is not only possible, but necessary. Because the real-world stakes are too high if we mess up, or even just appear to mess up – people may be hurt or die or sue us. We could lose everything – money, profession, reputation.
There’s the rub though – perfectionists may strive for perfection = an absence of errors, but we won’t make it. In HC or anywhere else. Why? We are human. Understandably, patients have bought into this illusion that perfection is possible in HC. Their expectation is that medicine can cure all and providers won’t make any mistakes. And they are not shy about taking legal action or threatening to, if things don’t turn out the way they think they should. No matter how unrealistic. This has led to a dilemma in HC where even if you don’t know something or you make a mistake, it may be tempting to keep quiet and at least continue to appear perfect in order to avoid retribution for being human. HC and patients demand the maintenance of this illusion. I guess a similar situation might be with airline pilots. I know intellectually that they are human and thus will make mistakes sometimes. But I don’t want to think about that possibility too much or have it happen when I am on their plane!
What makes it all the worse is that the culture of HC does not allow us to talk to each other about this. I suspect all HC providers feel the onus of perfection to some extent, but we cover it up with bravado. We talk “shop”, many of us enjoy the sound of our own voices and like nothing more than to ask questions that will stump the presenter and showcase our own superior intelligence on whatever matter is being discussed. But can we make ourselves vulnerable and talk to each other about our mistakes, the times we didn’t get it right or our fears about shouldering this ridiculous amount of responsibility everyday? I’ve been in 23 years and I have yet to have a real, open, honest, meaningful conversation with a colleague about this stuff. We just don’t go there. Is it the type of deal where we don’t want to speak about even the possibility of failure for fear it will be invited into our lives? All I know is it is pretty fucking lonely.
I picked the greyest area of HC in which to practice on purpose because I find rigid, garden variety black and white decision-making kinda boring. I like variety and challenge and using my brain, but even here in hospice I struggle with my own perfectionist tendencies. As a HC provider, I make oodles of decisions on a daily basis. Some big, some little, but all involve the care and well-being of humans. That’s some pretty heavy shit. I can’t afford to have bad days, I’ve got to be on at all times collecting, analyzing, synthesizing what information I have and putting together a plan to hopefully help and not hurt someone who is counting on me to care for them. There are days where I wear that responsibility lightly; I’m in the flow and enjoying my work as a combination of pleasant puzzle/problem solving, education and advocacy. And then there are the other days. The days when I am second guessing every decision I make, where I feel at a loss about what is the best thing to do, when I over research and overanalyze in an attempt to bring myself some measure of peace about what I’ve done or am about to do. That sucks. And then sometimes, I continue this pattern in my sleep and either dream about it or wake up at 3 am thinking about it, going over everything again, did I do the right thing? Is that patient going to be ok? Do I look like a complete idiotic buffoon to my peers? How would a lawyer demonstrate my culpability in this situation if things go wrong? It can be exhausting. And I’m not going to tie it all up with a neat bow and tell you that is it hard work but worth it because I get to help people. None of that martyr-y bullshit. I am altruistic at my core and I do enjoy helping people, but sometimes it does not feel worth it. At least not to me. Sometimes it feels like a much too heavy burden to have all of those people (including myself) counting on me and expecting me to be able to make 10,000 decisions without a single error. The recovering perfectionist in me is tired out and ready to hand it all over to somebody else.