Today’s post is a follow-up to my last post on how perfectionism hinders your charting.
We will explore how to loosen the tentacle grip of perfectionistic tendencies via a framework as well as directly applicable strategies.
This is a coaching heavy post that I hope you will find useful!
In my last post on perfectionism, I made the point that we are all already inherently worthy, regardless of our accomplishments.
I also demonstrated that how we’re raised and trained not only fosters, but also rewards perfectionistic behavior. And we are hardwired to cultivate anything that leads to rewards (primitive brain, anyone?).
While in the long-term perfectionism hinders us, in the short- and medium-term it is beneficial in some way. That’s why we keep coming back to it—more on that later. This makes perfectionistic tendencies and behaviors challenging to unwind and unlearn.
The remainder of this post will present a framework and some strategies for nudging you away gently from your perfectionism.
Gently, like a tusk to the ass.
Helping you veer even a few degrees from your perfectionistic thinking can help you reach a brand new destination. I just ask that you approach this as always from a place of curiosity and compassion, and resist the pull to use such exercises to berate or shame yourself. Grab a sheet of paper and a pen.
Step 1: Select a Perfectionist Thought/Behavior
Pick something with which you struggle, something that’s making you miserable.
If you can’t come up with one, then maybe you’re achieved true perfection! I jest. Just look at the parts of your work day (or life in general) that aren’t working for you. Often buried in there is some perfectionist thought.
For example, I had one client whose notes took him “forever,” and it turned out he was double and even triple checking everything. Maybe you do this too?
Step 2: How Do You Benefit
You need to identify what benefit(s) you experience from this thought or behavior. There will always be some positive aspect; it is serving you in some way.
Perhaps, it validates your identity as a physician in some way.
In the above example, having a “perfect note” may help reinforce to you that you belong as a physician because it would prove to colleagues that you are knowledgeable or thorough.
In reality, you’re the only one you’re trying to convince. You’re looking for evidence that you’re worthy, and this behavior facilitates that for you (or so you think).
Step 3: What are the Negative Impacts?
How does this thought or behavior hurt you? What’s the immediate negative impact?
In our example, the thought about a “perfect note” leads to double checking work that’s already been done. This causes you to spend considerably more time writing each note.
Next, examine the downstream negative impacts. These tend to build upon one another.
Taking longer with notes means you run late seeing patients. Maybe this leads to disgruntled patients, you showing up as flustered, you being distracted and missing or forgetting things, you not leading the encounters effectively with effective agenda setting, you missing your only chance to eat lunch or relieve your bladder, you not touching your inbasket until the end of the day, etc.
Phew! That’s a long list!
I think it’s apparent that any single item from the above list can itself start the same or a similar cascade. Also note that I presented them in a linear fashion, but their impacts on one another are more complex, like an interconnected web.
And you can keep going from here, right?
All of that increased and inefficient work leads to decreased time at home, with family and friends. Taking care of ourselves—the list goes on and on.
I encourage you to pad this list with as many downstream effects this has on your life. This is the only way you’ll come to see how an often seemingly innocuous thought can derail you. You’ll see how you’re effectively punching yourself in the face
Step 4: Imagine Loosening Your Standards
I should clarify that we are not loosening standards of care!
For the next two steps, we’re going to envision a new reality, one in which you don’t stick as tightly to the problematic thought or behavior. What would that look like?
What is the cost to you of doing so? What uncertainties will you face?
In doing so, you’re trying to evaluate if the disadvantages truly exist or if they are mostly fears.
A useful exercise towards that end is to imagine what the worst case scenario could be. I know some of you are talented catastrophizers, so feel free to list out ALL the worst case scenarios. Now temper that with the likelihood that each would come to pass.
What are actually the most likely outcomes?
Chances are those worst case projections are as likely to happen to you as a shark attack or being struck by lighting. (Please note I’m not an actuary and do not know the actual risks of these things!)
I assume this, no?
Okay, okay, but in all seriousness:
My actual guesses for worst case scenarios include:
- I’m going to miss something or have a negative patient outcome.
- I’m going to look dumb.
- I’m going to be sued.
- I’ll be found out for the imposter that I am.
- Add yours here _____________.
How likely are any of these? Sure, no one wants to miss something or have a bad patient outcome, but we often treat medicine as this clean science that is black and white—that there’s always a correct answer. Conceptually, we know that that’s not the case but we often think and act as if it is.
Medicine is an imperfect science because it involves people, and, if you’ve been paying attention, people are imperfect! The histories we obtain are imperfect, both because of the patient’s lens on what’s going on and whether we elicit the best information possible with our inquiries. That’s why it’s called a science and an art.
The other scenarios above are also unlikely or unrealistic, but they are soaked in inherent perfectionism.
Get all the dark thoughts and anxieties onto paper. I think they have a stronger hold on us as apparitions flitting around from time to time in our heads than when materialized on paper.
It’s easier to confront them on paper, anyway. Bring them into the light; exposing them can decrease their potency.
Step 5: Benefits of Loosening Your Standards
What would you gain if you were free from this standard?
Typically, it’s freedom from or avoiding the pains associated with the negative impacts described in step 3 above.
So in our example, maybe you’re able to stay (more) on time, stay more confident, lead encounters more effectively, keep the patients happier, spend chunks of time addressing your inbasket, and eat food and use the bathroom.
Maybe that increases your level of work satisfaction and keeps you working in medicine longer and caring for more patients.
Step 6: Aligning Values with Loosening Standards
How can you better live by your core values and top priorities by loosening this standard?
Core values are the things that matter most to you and are generally “set in stone.” Priorities are the things you focus your time and attention on and can be short-term and can shift even day to day.
By easing up on writing a “perfect note” and experiencing the benefits above, perhaps you find more joy and meaning in doctoring, which aligns with your value of having a meaningful career. With the time saved, you’re able to prioritize time spent with loved ones or traveling or whatever else you choose.
Step 7: Use Specific Strategies to Combat
The prior six steps are designed to help illuminate the perfectionistic thoughts and behaviors plaguing you and how they create net negative results in your life. They certainly set the foundation for unwinding perfectionism.
Now with step 7, we shift our attention towards more tangible strategies for loosening your standards.
1. Establish a minimum baseline — Consciously set out the parameters for what would be acceptable to you. E.g., for a note, maybe you can accept using phrases (instead of sentences) or even bullet points!
3. B+ work — Akin to the first strategy, what constitutes work that is “good enough?” E.g., for a note, not going back to document small or insignificant “oh by the ways.” Alternatively, typing the HPI while talking with your patients may represent B+ work to you. It doesn’t to me for reasons espoused here.
3. Fail on purpose — Mess something up on purpose! No, nothing that impacts care, but something small that grates on you. E.g., for a note, leave in a typo you catch, or, better yet, purposefully add one in! Maybe a “their” for a “there.” You can do this to demonstrate to yourself what happens with an imperfection—or, more correctly, what does NOT happen (I can’t promise you won’t implode!).
4. Check the self-talk — Take note of how you talk to yourself; in these moments we tend towards innocuous comments that actually burden us. E.g., for a note, perhaps you have a scribe who enters something incorrectly and you say, “if you want something done right, then do it yourself.” Then you don’t teach the scribe about their error and instead double check everything they do moving forward with extra scrutiny. When you find yourself saying these things, pause and redirect yourself asking “how can I make this work for me?” Turn the scribe’s mistake into a teaching opportunity.
5. Affirmations — Alright, alright, I know. But stay with me here, k? Practicing positive self-talk can change your thinking—you’re breathing words into existence, after all. I’m not going to tell you how to do your affirmations, but find something that works for you.
- I deserve to be here. I earned it.
- I can be damn good and still imperfect … and that’s good enough!
- I can know a lot and still be learning.
- All the time and work I’ve put in matters, and is not negated by any work I’ve yet to do.
- I can let go of unrealistic expectations.
- I am worthy. I am whole.
Take any of these that resonate with you. Ditch the rest. Make up your own!
6. Celebrate success — Reflect on all you’ve accomplished and congratulate yourself. What you’ve done to get where you are is incredible. You’re capable of doing hard things and have the evidence to prove it (you’re a doctor, after all)! Ooh, add that to the affirmations list!
Put It into Action
There you have it: a framework for unwinding your perfectionistic tendencies and some concrete strategies to help.
I encourage you to do three things this week:
- Pick a thought or behavior about which you have strict standards and run it through the framework.
- Pick one strategy to implement in regards to #1 (and it can’t the affirmations, but of #3 below).
- Pick one affirmation—one provided here or one of your own—and say it to yourself daily. Don’t be creepy by making it an incantation.
Perfectionism must be chipped away at slowly, so have patience. Above all, remember what I said at the beginning of the post: approach this from a place of curiosity and compassion. It’s the only way that you can sustainably unwind your perfectionism.
What do you think? What did you take away? Which strategy or affirmation speaks to you? Let me know in the comments section below.
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