Individuals drawn to a career of medical service generally have a unique set of personality traits. We are, by nature, intelligent, caring, inquisitive and sensitive. These traits are central to our professional lives, and help us succeed. But we are also competitive, obsessive-compulsive, Type A personalities, and perfectionists. While some of these traits also help us deal with the challenges of our profession, they can cause us considerable grief. This, the first of a two-part series, will help you to look at the various personality traits typical of physicians, and evaluate their effect on your current life.
Overcare: Caring and Needing to be Needed
Doc Childre and Howard Martin, in their book, The HeartMath Solution, describe a chronic emotional state very common among physicians, which they call “overcare”. In essence, overcare is caring run amok. When you care for someone, it is energizing. When you are cared for, this too is energizing. When you overcare, it is ultimately exhausting.
Have you ever sat up at 3:00 a.m. worrying about a patient’s diagnosis or a treatment decision you’ve made? Now ask yourself, does this worry really serve you? Does it really serve your patient? No. It is draining, plain and simple. You have less energy the next day, yet you’ve done nothing that truly benefits the patient. Your own fatigue may actually be a disservice to them. This is a prime example of overcare.
The emotional energy keeping you awake contains a mix of concerns: Did I do enough? Did I do the right thing? Is there something I don’t know that I should? At bottom, the question really eating at you is, “Am I a good enough doctor?” In this sense, the issue may not have much to do with the patient at all.
Not only do we overcare, we are also addicted to being needed. As doctors, we get love from our patients in many forms. When a patient says thank you and goes out of the way to show appreciation, we feel a ‘high.’ We feel valued, we feel adequate, validated, and loved.
The problem is that this is a form of intermittent gratification. In the Skinner model of reinforcement, this is the most powerful motivator of appreciation-seeking behavior. We spend so much of our day feeling undervalued that we look for the ‘love’ from our patients and don’t often get it. This then leads to us extending ourselves and often spreading ourselves too thin, in order to be appreciated. In the language of addiction, this is co-dependency. We are so busy caring for others that we no longer take care of ourselves.
The solution is one of the most difficult of human tasks: to learn to love yourself enough to know that you are enough. If you come close to this, you no longer need external validation to get your ‘highs’.
Perfectionism
Perfectionism is ubiquitous among physicians. We excuse it because we often deal with life and death issues. This fosters the belief that mistakes are inexcusable; if a physician is imperfect, he/she is a bad physician. Yet we are all fallible, we all make mistakes just like the rest of the humans on the planet.
If you see 25 patients daily, 5 days a week (for many of us, it is more), 48 weeks per year, for 50 years, that’s roughly 300,000 clinical decisions made (How many of you perfectionists checked my math?). What is the likelihood that one of 300,000 decisions was wrong?
The Dean of Medicine at University of Toronto once told his incoming class that, “Half of what we teach you in the next 4 years is wrong, and the problem is, we don’t know which half.” Medicine is always changing; what is ‘true’ today may not be ‘true’ tomorrow. This brings your average ‘hit’ rate down to 50%. If you add the fact that we are fallible, and also that people vary widely in their responses to our treatments, you may be correct just 30–40% of the time. Don’t feel bad, though. In baseball, the Greats only have batting averages around 40%, so you are still up there!
It is also important to realize that we generally have no one to discuss our mistakes with. We are afraid to talk to our co-workers because we don’t want to be seen as imperfect and we know we’ll be judged. We don’t want to trouble our spouses, figuring they won’t understand. We may fear their judgment as well. All of this reflects our insecurities. Again, the underlying question is, “Am I good enough?”
Where does our perfectionism come from? Much of it is learned from our parents. Rachel Naomi Remen, a wonderful physician and author, describes a scene from her childhood, which exemplifies this perfectly. She recalls excitedly coming home to her father with a test score of 98. His response was, ‘What happened to the other two points?’
Our parents may hold lofty goals and expectations for us and they often believe it is in our best interest to push us into ‘going for the gold’.
On a superficial level this may seem valid. But look at the effect that can have on a child. In Dr. Remen’s story, the child is excited by her achievement. If she receives support from her father, she will be motivated to continue this good work; it serves her goal of feeling loved and validated. She will develop healthy self-esteem and will continue to learn without anxiety. She will likely have greater confidence and creativity to bring to the relationships in her adult life.
A child in a situation like Dr. Remen described is taught to question her own validity and will thus feel insecure. She will, no doubt, continue to seek her father’s love and support by pushing herself harder. But since no child is perfect, there will be other less-than-perfect academic outcomes and therefore continued paternal disappointments. She becomes an adult who is very successful but burdened by constant insecurity. She will push herself hard toward perfection, but rarely, if ever, feel satisfied with her performance. This will adversely impact her adult relationships. She will be highly critical, expecting perfection of others.
One way this process manifests is in seeking socially significant goals, such as a career that is difficult to enter, rigorous to live, socially admired, and financially rewarding. Sound familiar? Many of us choose medicine to please our parents.
There are often other expectations we try to meet. If you were married during your training, you may feel guilty for the difficulties your spouse and maybe your children had to live through, on your behalf. You may feel obliged to ‘pay them back’ with a nice house, fancy car, or lavish vacations. This appears to be valid on a social level, but it may not be particularly healthy for you—or them.
If you feel overworked because you are trying to do “good” things for your family, in essence, to be ‘the Great Provider,’ you may want to check in with them and ask if they would prefer more income and more “perks” or rather, more of your time, attention, and love. You may be shocked to find out that time spent with you is more important than the new car or vacation. And you won’t know until you ask. In a Wall Street Journal survey, 54% of children aged 3–12 years said they would prefer their parents be less stressed and tired from work. You can’t ask for a more honest authority than your kids.
Perfectionism breeds harsh judgment of others. It is rampant in medicine. The Ivory Towers of academia foster disdain for ordinary practicing physicians. How many of you remember hearing or making judgments—often unfair—about the “LMD” (local medical doc) during your training. Suddenly, you are now an LMD yourself! How does it feel to know someone may be judging you at this very moment? It certainly isn’t energizing and it’s not ‘fair’. Only we can stop that process, by accepting each other’s vulnerabilities and limitations.
Most of my clinical and research work is in cardiovascular disease prevention. I haven’t a clue about the latest antibiotics or chemotherapeutic agents, yet when someone asks me about these things, I used to have a twinge of guilt for not knowing. At times, in order to seem perfect, I would even confabulate answers. Now, when I’m feeling centered, I can answer such queries by uttering the three hardest words in medicine: “I don’t know.” And if it is useful or necessary, I will look it up and try to find out.
The inability to admit not knowing an answer is a learned behavior. As a young child, you were encouraged to ask questions and concede when you didn’t have the answers. You presumed the adults had the answers. Then, in your early teens you probably heard, “You are old enough to know better”. This attitude was reinforced throughout your youth. Medical training only made it worse. On rounds or in ‘morning report,’ it was simply unacceptable to not know an answer. We were made to feel inadequate if we didn’t know. Not knowing generates tremendous anxiety in medical types!
The “cure” for our perfectionism syndrome is at once very simple and extremely difficult: Learn to accept your self as imperfect. Learn from any errors you make. Apologize if needed, and move on! Learn to say, “I don’t know, but if you’d like I can find out for you.” Personally, I would choose to be happily imperfect any day of the week; it’s much less stressful. Just simply acknowledging your imperfection can be tremendously freeing. You will feel less pressured and the people you serve will appreciate your integrity and your desire to serve them. Not a bad trade off for a little imperfection!
Keep an eye out for the Spring 2005 edition of Holistic Primary Care, in which we’ll take a closer look at competitiveness, Type A behavior, and other important facets of the physician personality.
This essay is extracted and adapted from the forthcoming book “Finding Balance in a Medical Life.” Dr. Lipsenthal leads workshops, seminars and lectures on the subject of personal well-being, life balance, and performance enhancement for physicians and their families. The Finding Balance in a Medical Life programs are created with the intention of bringing clarity, flexibility, and balance to physicians’ lives. The Finding Balance Program can help physicians and their families survive transition, manage stress, enhance performance, gain “emotional intelligence,” understand and modify personality traits, deepen interpersonal connections, refine communication skills, develop intuition, strengthen personal relationships, manage errors and plan for the future. It fosters each individual’s own process of growth and change, and serves as a doorway to greater self-awareness, improved productivity, and greater personal and professional satisfaction.
For more information about “Finding Balance in a Medical Life” please contact Larry Cooper at Health Classics, 1-800-769-0638 or 805-898-0089 or visit www.healthclassics.com.
