Christina Rowan, PhD, ABPP
Board-Certified Clinical Health Psychologist
Akron Physician Wellness Initiative
My own struggle with perfectionism began in elementary school. As early as age 9, I remember studying diligently for each exam, starting every project and paper long before the due date, and completing my daily homework before allowing myself to relax or play. 97% was good, 95% was okay, and anything below 93% was unacceptable. Looking back, I now know that my experience, however arduous, is far from unique.
These perfectionistic traits are self-reinforcing throughout the higher education process. Top grades and standardized test scores earn entrance to a good university, which allows high-quality clinical training experiences, resulting in excellent letters of reference for a solid employer. Becoming a psychologist requires 10+ years of checking boxes, jumping through hoops, and earning the approval of those in authority. We learn that the more we strive, the better we perform, the more we are rewarded. For myself, and I’m sure for many other ECPs, we are not far enough removed from these experiences to completely shake them off. We have not yet re-written that long-ingrained script.
It’s just as well, because opportunities for evaluation do not end when graduate training is over, especially for psychologists in medical settings. Hospital systems often include additional metrics not common in private practices or university clinics, such as the credentialing process, annual performance metrics, coding audits, productivity requirements, and heavily monitored patient satisfaction ratings.
Furthermore, as I have learned from my therapeutic work with physicians and advanced practice providers, perfectionistic striving is strongly ingrained into medical culture, perhaps even more so than in the social sciences. ECPs who work alongside physicians may find overachieving so normalized that it becomes an even more significant part of their own self-talk (Paolini, 2009). For physicians, working 50 – 80 hours per week, answering calls and messages on days off, plowing through breaks without stopping to eat or drink, and double or even triple-booking oneself is commended. Providers who endlessly self-sacrifice for the sake of their patients and hospital systems are seen as the most committed and the most dependable.
ECPs in medical settings may feel even more pressure to perform than their more seasoned colleagues. They have not yet established a durable professional reputation, and may still be working to build their caseloads. This pressure is likely even greater for women, persons of color, gender and sexual minorities, and persons with disabilities, who may have to overcome systemic biases, stereotypes, and microaggressions.
For those of us, like myself, who have subscribed to an achievement-oriented way of being for nearly as long as we can remember, it can be difficult to consider that there might be another way. And yet, deep down, there is probably a part of us that longs for some respite. Having such high standards can cultivate anxiety, burnout, loss of self-confidence, and depression (Antony & Swinson, 2009).
Pushing back against the status quo, even in your own mind, will feel uncomfortable at first. But don’t give up: the more you do it, the easier it gets. This process is not about discarding your standards or your work ethic, but about acknowledging your humanity and giving it space to thrive. Here are some tips:
- Pursue excellence, but not perfection. As aptly stated by Gary Simonds and Wayne Sotile in their book, The Thriving Physician, “perfectionism in medicine is a myth. If you insist upon it, it will wear down your ego as well as all your coping mechanisms” (p. 108). It’s fine to try your best and to work hard, but it is unreasonable to expect that you will do everything top notch all of the time. Remember: Good enough is good enough.
- Put things in perspective. When I do something that feels inconsistent with the kind of person I want to be, I ask myself, “Will this matter a year from now?” In reality, it may not even matter one week or one month from now. If that is the case, practice mindfulness, and let it go. It can also help to ask yourself, “If a colleague did this same thing, what would I think of them?” Chances are you would be much more forgiving.
- Use your CBT skills. We use cognitive behavioral therapy with our clients without hesitation. But how often do we stop and practice re-framing our own negative self-talk? Perfectionists and high achievers are especially prone to all-or-nothing thinking, “should” statements, and unfair self/other comparisons (Antony & Swinson, 2009). If you find it difficult to re-write your internal dialogue, seek out counseling or talk to a mentor.
- Imagine the worst, and mentally cope with it. This is not the same thing as catastrophizing (Where you imagine the worst and then proceed as though it has already happened). Instead, think through the scenario calmly and critically. “If I get one bad patient rating, what will actually happen?” Sure, the rating might be published. Sure, someone might read it. But if the majority of your ratings are positive, will that one really make a difference?
- Understand the difference between guilt and shame. According to Brene Brown (2010), guilt focuses on the behavior (e.g., “I made a mistake”). Shame, on the other hand, focuses on your worth as a person (e.g., “I am a mistake”). It is normal, and even healthy, to feel guilt from time to time, as it guides our moral compass. The key to maintaining emotional wellness is to realistically evaluate an action or a behavior, but to keep this separate from your evaluation of yourself as a human being worthy of love, compassion, and respect.
- Develop a mantra. My mantra all the way through internship was, “All you need already exists within you.” Choose a phrase that affirms your strengths and your inherent worth as a person. Repeat your mantra often, or display it visually.
- Set boundaries…with yourself. Take a step back and evaluate whether the pressure you feel is truly external, or if more of it is internal than you realized. Within the scope of your employment contract, establish work/life boundaries that feel appropriate for you and your family, regardless of what others choose to do. Allow your documentation to meet the standards required by your organization, your state board, and insurance companies, but remember: there is no award for having the best notes. Accept projects that align with your goals for professional growth, but decline opportunities that may add a line to your CV, but have no other significant benefit.
An important lesson to learn is that there is never going to be a moment where someone in authority comes along and says, “Finally, you have arrived. Your striving is complete.” Nobody will give you permission to start easing up on yourself and adjusting your standards. This permission must come from within yourself, and there is no better time to give it than now.
References and Further Reading:
Antony, M.M., & Swinson, R.P. (2009). When perfect isn’t good enough: Strategies for coping with perfectionism (2nd ed.). New Harbinger.
Brown, B. (2010). The gifts of imperfection: Let go of who you think you’re supposed to be and embrace who you are. Hazelden.
Paolini, H.P. (2009). Inside the mind of a physician: Illuminating the mystery of how doctors think, what they feel, and why they do the things they do. AdventHealth Press.
Simonds, G.R., & Sotile, W.M. (2018). The thriving physician: How to avoid burnout by choosing resilience throughout your medical career. Studer Group.