Perfectionism is defined as refusal to accept any standard short of perfection. It is a broad personality style characterized by a person’s concern with striving for flawlessness and perfection and is accompanied by critical self-evaluations and concerns regarding others’ evaluations. It is best conceptualized as a multidimensional and multilayered personality characteristic, which can cause many positive and negative aspects. Perfectionism drives people to be concerned with achieving unattainable ideals or unrealistic goals that often lead to many psychological problems, such as depression, anxiety, obsessive-compulsive disorder and low self-esteem. These psychological problems may lead to suicidal thoughts and tendencies and influence or invite other psychological, physical, social and further achievement problems in children, adolescents and adults. Although perfectionism can create a false sense of control, as it may feel as if it reduces stress, anxiety, and panic, the evidence proves differently. Recent data show that perfectionistic tendencies are not only an issue with adults, but are also on the rise among recent generations of young people.

Perfectionists strain compulsively and unceasingly toward unattainable goals. They measure their self-worth by productivity and accomplishment, and some tendencies even lead to distraction from other areas of life. If the focus is to be perfect at school or work, how are they able to maintain healthy relationships at home, with a co-worker or a friend? Perfectionists pressure themselves to achieve unrealistic goals that inevitably lead to disappointment. If the sole focus pertains to everything that needs to be fixed in order to be considered perfect, then it’s hard to know that they will truly be happy with themselves. In particular, perfectionists tend to be harsh critics of themselves, their work, and when they fail to meet their expectations.

Each year in the United States, roughly 300-400 physicians die by suicide. In the United States, suicide deaths are 250-400% higher among female physicians when compared to females in other professions. There has been a 5% increase in burnout in physicians overall, from 42% in 2020 to 47% in 2021, with an increase in ER physician burnout from 43% to 69% last year. Most physicians say that burnout permeates most aspects of their lives, with 54% indicating that the impact was strong to severe, including with their relationships. Physicians say that they cope by exercising (48%), isolating from others (45%), eating junk food (35%), and drinking (24%). Perfectionistic tendencies frequently lead to burnout and moral distress, which may allow for thoughts of self-harm, which may eventually lead to suicide. Thus, addressing perfectionism is often the first place to start to prevent this downward spiral.

Many of our perfectionistic tendencies are directly related to events that occurred during childhood that left indelible marks on our psyches. Something happened to us that caused an emotional response that we could not understand at such a young age, and we responded in a way that allowed us to feel better in an attempt to prevent the event from reoccurring, and allowing us to safely interact with others in our relatively small world. As adults, we react to similar situations with the same childhood responses, which may be inappropriate for the situation at hand, but occur almost instantaneously as a knee-jerk reaction to what is happening in our adult lives. We then shame ourselves for our response to these situations, and start to chastise ourselves for how we are showing up in the world. This can manifest itself through our perfectionistic tendencies as adults, which may include always feeling the need to be perfect, right, or the smartest person in the room. We may feel the need to be the “best“ physician (whatever that may mean), see the most patients, do the most surgeries, make the most money, or simply quietly “kill” ourselves with obsessively working on our medical records, which leads to spending less time with our families, friends and much less taking care of ourselves. This leads to a repetitive downward spiral, wherein we feel the need to continue outperforming others and overachieving in order to feel loved, special, cared about, or important in our work. Over time, these tendencies can contribute to burnout or moral injury and can make many of us unhappy in our current occupations.

After having spent many years and hundreds of thousands of dollars in the process of becoming physicians, many of us start to question whether or not we chose the right profession and start to think about how we might be happier doing something else with our lives. However, our indebtedness and need to achieve often keep us stuck in our same roles and make it difficult for us to be happy with our choice. Certainly, for some physicians, that may mean leaving the practice of medicine altogether, but for the majority of us, it simply leads to unhappiness, feelings of shame and/or guilt, and may cause distress in our personal relationships and relationships with our children. Imagine how this downward spiral can contribute to burnout or moral distress!

One of the most important concepts that I have learned through my own coaching with a peer Physician Coach is that circumstances are simply circumstances. They are neutral events and do not carry any specific meaning unless we give them meaning. We then have a thought about the circumstance, which creates a feeling inside of ourselves that we may or may not recognize. We then have a reaction or choose to take some action related to that feeling, which leads to our results. As you can imagine, we frequently, subconsciously make up stories about our circumstances to justify our results, but this can lead to a vicious cycle of unhappiness and lack of fulfillment in our chosen profession.

Once we realize that we are in control of our thoughts and feelings about our circumstances, we can start to change our reactions and actions, and therefore our results. Doing this work is certainly something that can be done independently, although many people, particularly physicians, find this work to be difficult without the assistance of someone else. Many people choose to do this work with a therapist, although many physicians have great discomfort and unwillingness to ask for help, particularly from a therapist. This can stem from shame, guilt, embarrassment, feeling the need to be OK rather than not OK and concerns about the attestation on our licensure applications and re-applications. Some physicians choose to work with a peer Physician Coach, as coaches who are physicians understand in a unique way that no one else can, how our upbringing affects our lives as physicians, in addition to the challenges that we face on a daily basis in our medical practices.

I became involved in a wellness project at Providence Portland Medical Center in Portland, Oregon that involved 12 didactic sessions that essentially taught me the principles of Cognitive Behavioral Therapy. This program included six group coaching sessions with other physicians, as well as six individual coaching sessions, all of which were lead by physicians. During these sessions, I recognized how events that happened in my childhood formulated how I think, feel and react as an adult. Although this work was difficult, I gradually was able to see how the choices that I was making in my daily life were not serving me. For me, I recognized that as a child, I felt that I needed to “earn“ love from my parents by being the smartest person in my class, getting straight A’s, being the first chair flute in the band, and being my high school class valedictorian. Of course, going to medical school only “sealed the deal.” As an adult, I was still feeling the need to “earn“ love by being the best physician, writing the best chart notes, and documenting all of the HCC Medicare codes, which took a significant chunk of time away from my own personal life. I found myself not caring for myself or about myself, becoming more distant from my husband, who is also a physician and unfortunately deals with many of these same issues. In addition, I felt like an inadequate mother to my two daughters, because I did not feel that I could be the “best“ physician and the “best“ mother at the same time. Although it has been difficult, I now see how these thoughts impacted my life in a negative way, and through my experience with receiving coaching, my self-esteem and my life overall have improved.

I am grateful for having been introduced to this opportunity, as I would most likely have never realized on my own the negative spiral that I was in. I have learned to recognize the thoughts behind my feelings, which allows me to change my thoughts, which ultimately changes my results. Although I am certainly a work in progress, I am no longer concerned about being the “best“ anything. I certainly do not need to be the “best” physician, and I really am unable to define what that means anyway, I worry much less about how my chart notes look, because I recognize that nobody reads them anyway, and I’m trying to help to teach my partners about HCC coding, rather than worrying about having the highest RAF scores in my group. Baby steps, I know, but with my continued work with my coach, I expect to uncover more issues over time. I have found this process to be inspirational and uplifting, as I now feel that I am aware of how my brain automatically thinks certain thoughts, and I am now able to choose how I want to proceed, rather than being a slave to my brain’s irrational thinking.

When we do not take care of ourselves, we are unable to take care of our patients or our families, but the erosion of these relationships happens so slowly that we do not realize it happening, and eventually we find ourselves “stuck“ in a situation that we feel that we did not create that clearly makes us unhappy. There is an image of frog in a pot that comes to mind wherein the water temperature gradually increases over time, and the frog does not realize it in the moment. However, if a frog is dropped into a boiling pot of water, the experience is instantaneous. Thankfully, this type of experience rarely happens to most of us. Our lives gradually become eroded by the water temperature slowly increasing over time and eventually making us miserable, which leads to burnout. I currently serve as the chair of the Providence Portland Medical Center peer review committee, and I see this happening to

physicians all of the time, which results in poor behavior and bad choices on their part. It can result in addictions, including drug and alcohol use, gambling, sex, overeating, shopping, self-harm, and other forms of self-destruction that can lead to an endlessly downward spiral. This certainly occurs much more frequently than I would ever have previously imagined before I started serving in this capacity.

I want to encourage each of you to look at your lives with a magnifying lens and start to identify those areas where you may not be functioning as your authentic self. This is very difficult to do, as our perfectionistic tendencies get in the way of allowing us to be truthful with ourselves, but if we truly do this work, we can begin to change the patterns that we have adopted as adults and truly start to make changes in our lives that ultimately result in us being better people, better physicians, better partners and better parents. As a result of my own personal experience, I decided to become certified as a peer Physician Coach, and I have chosen to work with other physicians to help them to achieve similar goals. I feel so passionately about this work that has truly given me a new lease on life, as I also feel that I have passion for my career as a physician once again, despite having been practicing for more than 30 years. I am eager to help any physician who may be struggling with these types of issues, or even those who are struggling but are unaware of it, as together, we can uncover issues that may be holding each of us back from achieving our full potential. My motto is for each of us to “live our best life,” and my mission is to help to make that happen one physician at a time.

Please feel free to reach out to me on my website: physiciancoachingwithanne.com or at 503-567-9443. I truly encourage you to contact me, and we can do a free consultation to see if it makes sense for us to work together to help you to achieve your goals. My only goal is to be able to serve you in your own personal growth. I look forward to hearing from many of you.