Working in emergency medicine requires skill, knowledge, and the application of this under pressure. It attracts hard workers with strong values about helping others, often at the expense of themselves. But, in order to be the best for others, you have to be the best for yourself too and that means being kind and generous to yourself. Unfortunately, we can be driven to do our best by traits that develop out of a need to be perfect at a task or any task.

There is a difference between the healthy pursuit of doing a job to the best of your ability, even to excel at it, and the unhealthy striving for perfection that erodes resilience and increases the chances of experiencing poor mental health. The unrelenting and self-critical thinking of a perfectionist increases internal stress levels considerably and erodes confidence. 

Has anyone ever told you that your standards are too high? Do you ever feel frustrated, anxious, or angry while trying to meet your own expectations? Do your standards ever get in your own way of meeting deadlines, or trusting others? If so, then read on.

When awareness is raised about the downfalls of being a perfectionist, perfectionism can be adapted into endeavour or aspiration and setting value-led goals without excessive self-criticism, to work smarter, not harder. 

How perfectionism makes us ill

Perfectionism is one of those traits that it’s usually ok to admit to because working hard (and perfectionists certainly do that) has a kind of kudos attached to it in any workplace. There is a big downside to perfectionism: it can become maladaptive and put you more at risk of developing stress, anxiety, and depression, and makes you more vulnerable to burnout. It lowers self-esteem and self-confidence and feeds on itself.

Behind the hard-working ethic of perfectionism is a fear of making mistakes, never being good enough, and being found out for that. Making mistakes and learning from them is at the heart of self-development and personal growth, and so perfectionists ironically undermine their own potential.  

Of course, in a medical setting, the fear of making a mistake that could impact someone’s health negatively is different (and more costly) from the fear of making a mistake in a more general setting. The task for a medic is to differentiate between these mistakes and to notice when and what mistakes you beat yourself up for, so that the less important ones can be more accepted as part of learning.

Letting the imposter in

The lack of confidence and low self-worth associated with perfectionism can lead to an intense crisis of self-doubt, feelings of inadequacy, and a fear of being found out that you don’t know what others think you know. A false sense of not knowing what you are doing is reinforced and leads to a fear of making mistakes and being found out as an imposter that shouldn’t be there. The imposter augments the already self-critical inner voice of perfectionism and so the spiral goes on.

Types of perfectionism

There are typically three types of perfectionism. See if you can work out which one you may be susceptible to. Perfection can be:

Self-oriented: “I demand nothing less than perfection from myself.” Their expectations are often unrealistic and can make them feel shame or guilt for failing to meet them.

Other-oriented: “If I ask someone to do something, I expect them to do it flawlessly.” They can be critical and may come across as dominating or bullying to others.

Socially-oriented: “People expect nothing less than perfection from me and I must meet that expectation.” They often feel compelled to perform at a high standard for fear of being hurt by or disappointing significant other people in their life, from the past or present.

The language that perfectionists use with themselves tends to be extreme, demanding and self-critical, and increases stress. Here are some of the negative thinking patterns that can indicate a problem with perfectionism: 

Black-and-white thinking. “Anything less than perfect is a failure, it has to be just right”

Catastrophic thinking. “If I make a mistake, I won’t be able to survive the humiliation.”

Probability overestimation. “Although I spent all night preparing, it won't go well”

Should statements are common too. You might tell yourself, “I should never let anyone see me make a mistake” or “I should never come across as nervous or uncertain”.

3 ways to change perfectionistic thinking

First, Aim for realistic thinking. Replace self-critical or perfectionistic thoughts with more realistic and helpful statements. This takes practice, so commit to trying this regularly.

Some examples of helpful and realistic statements are: 

“Nobody is perfect.” “All I can do is my best.”

“Making a mistake does not mean I’m stupid or a failure. It only means that I am human and I will learn and grow from it.”

 “We all have bad days” 

Second, Consider your perspective. Learning to view situations as other people might see them can help you to change unhelpful beliefs.

You can challenge yourself with perspective-taking by asking yourself:

• How might someone else (e.g. a close friend) view my situation?

• Are there other ways to look at this?

• What might you tell a close friend who was having similar thoughts?

And third, Look at the big picture. People with perfectionism tend to get bogged down in details and spend a lot of time worrying about ”the little things”. One helpful strategy to worry less about details is to ask yourself the following questions about general situations (not for medical emergency situations): 

• Does it really matter?

• What is the worst that could happen?

• If the worst does happen, will I survive it?

• Is the worst case scenario a likely outcome? 

Identify the obstacles to overcoming perfectionism. These could be: 

• Minimising how much of a perfectionist you are and that it’s not a problem

• Fear that loosening your high standards will reduce your chances of success and that you won’t be in control of your life

• Extreme self-criticism through not achieving your goals

• There is too much going on in life to focus on this

Write down why it is important to overcome these obstacles and what are you going to do to overcome them. 

Summary and takeaway tips 

Now you have raised your self-awareness, keep the following key points in mind:

Instead of ‘practice makes perfect’, practice not being perfect.

Think of the people you admire, and remember they are not perfect. It is possible to be healthy, happy and successful, without being a perfectionist.

Lowering your very high standards does not mean having no standards. The goal is to set realistic standards that help you do your best without risking your health and self-esteem. 

It is okay to ask for help. Ask a supportive person you trust to help you with setting new, realistic standards.

We learn by making mistakes. People stop learning and developing when they're constantly afraid of being wrong. If we don't want anyone to know we make mistakes, then we are not showing people our true self.

Reward yourself with good self-care opportunities - time to eat, sleep and play instead of work, work, work.