Nobody’s Perfect

You are magnificent beyond measure, perfect in your imperfections, and wonderfully made

– Abiola Abrams

Veterinary medicine is the perfect storm for perfectionists.  A profession where, without internships or residencies, we are expected to be radiologists, dentists, maxillofacial surgeons, general surgeons, internal medicine, critical care, dermatology….you get the picture.  A few years ago, I talked with a veterinary student mentee. She knew about my online businesses and interest in marketing, so was thrilled to share with me the course she was taking on marketing.  A course taught by a veterinarian, on marketing, where the assignment was to write a newspaper advertisement (this was 2016) and to create a printed handout with the aim to distribute to veterinary clients.  Let’s just say thrilled wasn’t the word I would use.  Dumbfounded, incensed, angered, shocked and horrified about sums it up.

This tiny course on marketing for veterinary students, underscored to me the insidious message in our profession.  You can do it all.  Perfectly.

I’ve blogged before on the dysfunctional value mindset in veterinary medicine.  I see veterinarians incensed at the idea of a breeder administering vaccinations to a litter of puppies, yet shrug off hiring marketing professionals or accountants for business support.  Do they truly believe they are fully capable of doing it all themselves to a high standard?

Facebook posts in closed veterinary groups lament the client that does not follow our treatment plan, breeders who practice medicine, vets complaining about being awake at night over a Yelp review that says how “Dr. X seemed to just care about the money”.  I witness colleagues who are abused by fellow colleagues for not insisting a client participate in a “fear free” protocol.  I hear about the angst and mental turmoil when clients are dissatisfied with our services, or worse yet, suffer an adverse event with their pets.  How can we make a distinction between a drive for excellence versus unreasonable expectations of performance (perfectionism)?

Michael Brunstein describes three types of perfectionism in his book “Perfectionism” (Brunstein, 2013):

Self oriented perfectionism is directed at self (duh, obvy), where unrealistically high personal standards leads to self criticism and disappointment.  Does any of this sound familiar? This is often my internal voice after completing surgery, “Complete the spay in 1hr? I could have done it in 55 min. Happy with your incision?  Hmm.  The closure didn’t come together perfectly.  Closure looks good, but the incision could have been a bit smaller…”

Socially oriented perfectionism is when a perfectionist thinks that others have unrealistically high standards for their behaviour, that they will never meet – leading to rejection and disapproval.  I can relate highly to this one, working ER in a referral centre I was on edge that every single therapeutic decision was “wrong”.  And despite working with a great team,  I sometimes wondered if the day shift was mocking, bereating or judging every 3am decision.  Where did this come from? I worked ER for many years, including at a referral hospital, and did not start out with these concerns.  I wonder if perfectionism builds over time, like arterial plaque, building slowly, insidiously, until it makes its appearance brutally known with a crisis event like a heart attack.  For me, in many of my early ER years (I graduated in 1997), there were no “specialists” to refer to.  I was the last option for most of these patients, and I worked tirelessely to do the best I could for them and their families.  I felt it was enough.  Is our “Grey’s Anatomy” society expecting higher and higher standards (sometimes without wanting to pay for them), or is it an internal conflict that requires more introspection?

Other oriented perfectionism is like self oriented, but this time the target is others.  Why is that client refusing dental work?  Why did that vet give THAT medication?  How could the receptionist be so stupid as to forget to tell the client to…fill in the blank.  Often, other oriented perfectionists are highly critical, and can lash out verbally at anyone who does not meet the inflated, unrealistic standard of perfection.

Excessive concern over mistakes and doubts about actions, Brunstein describes, are associated with social anxiety, depression, and eating disorders.   What is excessive concern over mistakes?  When dealing in medicine, whether human or animal, mistakes will happen, and can have grave consequences.  Perhaps the “excessive” qualifier applies when the perfectionism becomes what is termed “maladaptive”.  Adaptive perfectionism is when someone uses their perfectionism to persevere to produce new discoveries and excellence in results.  Researchers suggest that maladaptive perfectionism occurs when someone becomes highly critical when goals are not achieved (Melrose, 2011).

Martin Seligman in the book Learned Optimism addresses the difference between pessimists and optimists.  A key feature of a pessimist predisposed to depression is someone that ruminates over conflicts and mistakes.  Optimists may be deluded about the reality of the control (or lack of) over events, but it seems to make them happier in the long run.

Brunstein also talks about ruminating – replaying events over and over again – with hopes that a solution will emerge, as another perfectionist tendency.  Ruminating is a maladaptation of perfectionism because the replaying actually amplifies the negative state.  Oh, the countless times I’ve replayed a conversation in my head, knowing full well that nothing can change.  At times hopping out of bed at midnight just to get my thoughts down, like a reply to that email that has been bothering me all day. It’s like I can’t even control it – I have to get it out, like a splinter.   I wonder now about those Yelp reviews that plague so many veterinarians.  Are the overly critical reviews from clients suffering from other oriented perfectionism?  Do they feel like their complaint is a splinter they need to get out?
Luckily I have learned to adapt this behaviour and refrain from sending the email until the next day.  Creativity research also tells us that if we “sleep on it” and allow our brains to ruminate silently, unconsciously, on a problem, we are more likely to come up with an “a-ha!”solution.

In the book Learned Optimism by Martin Seligman, he talks about interrupting the thoughts using techniques to shift attention, and by carefully curating and nurturing a healthier self-talk system.  I have heard other ideas where you tell your inner critic to schedule a time to worry.  For instance, “I’m not going to worry about that mistake I made – it will have to wait until 5pm”.  Negative, pessimistic thoughts are characterized by Personal (it’s me), Pervasive (in every situation), and Permanent (it’s always).  A pessimistic thought might be “I’m always late for everything” where a more optimistic self explanatory style would say “Sometimes I’m late when I schedule my appointments too close together”.

A great deal of research has illustrated that perfectionism is a trait that can make patients vulnerable to various psychiatric disorders, such a depression, anxiety suicide, and various personality disorders (Hewitt & Flett, 1993; Hewitt et al., 1992; Juster et al., 1996 in Brunstein, 2012 p 117).  Brunstein’s book is directed to therapists, which is beyond my realm of comprehension, despite my feeling and desire to jump in and learn it all, like the veterinary student in the marketing class.  In fact, my love of learning is what makes me dangerously prone to perfectionism. I know I am capable of learning about all of these interesting topics – there just isn’t time enough in the day, year, or lifetime.

Here are Some books or authors that I have found helpful in my journey to quiet my inner critic, based out of a need for expecting perfection from myself and others:
Playing Big – Tara Mohr – https://www.taramohr.com/
Brene Brown – Daring Greatly, Gifts of Imperfection – pretty much anything she writes – https://brenebrown.com/
Driven – Doug Brackmann – www.drdougbrackmann.com (Don’t get turned off by all the guns – it’s not about guns although he uses guns as a means to focus driven achievers.  Long story.)
Learned Optimism – Martin E.P. Seligman https://www.goodreads.com/book/show/26123.Learned_Optimism (a GREAT resource if you have kids with quizzes and actionable advice)

If you feel like you have perfectionist tendencies, or you struggle to know how to manage your fear of making mistakes, or thoughts of how others view you – here’s the only advice I’ll give in this article;  Get off the internet, call a counselor or therapist, and get some professional help.  Don’t be like that high school Facebook friend who messages you out of the blue wondering what they should do for their vomiting cat.

Go see your vet is the correct answer to that question, right?

Any recovering perfectionists out there want to share any tools or strategies that have helped?  Please share in the comments below.