Perfectionism, medicine, and skewed reality

A look at how perfectionism can be a destructive personality trait and why it can leave me feeling superficial and  guilty when working as a doctor. I discuss the difficult scenarios medics are often exposed to and how as healthcare professionals we become 'numb' to the emotion that should follow the horrific scenes we see everyday.

I also discuss the recent NHS nurses strike in England and provide an insight into the reasons why they have made the decision to go on strike.

Article referenced: “The Downsides of Perfection” BBC article by Amanda Ruggeri

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Transcript

Hello everyone, happy New Year and welcome to A Doctor’s View, I’m Dr Polyvios.

It’s hard to start a medical podcast this year without first talking about the recent nursing strikes in the NHS.

Why are the nurses striking? When you look at the average pay for nurses in the UK at face value you may be thinking that the pay is acceptable and cannot understand why this would warrant a strike. There are 2 reasons why the pay is not acceptable. Firstly, the NHS staff have had a pay-freeze lasting over a decade and whilst the amount of cash nurses take home has increased over the years, the amount this buys has decreased substantially. With current levels of inflation, some nursing bands can see a real-world pay cut of up to 32% compared to 10 years ago. The current pay levels are well below the values of inflation. And when you consider the fact that politicians in the UK have had substantial pay rises over the years taking them comfortably above the levels of inflation, you can see why nurses and healthcare workers are somewhat annoyed to say the least. The second reason is one that can’t be quantified with just numbers. And that is what a typical nurse must go through each day and the number of hours a nurse must work to earn their salary. The same is true of paramedics and ambulance crew who have also recently went on strike.

Understandably there is division amongst the public. Some are in support, whilst some are angry. I can understand the anger; having a surgery cancelled or a clinic appointment cancelled is not a small thing. The frustration and difficulty it can cause is immeasurable. But…

Believe me, nursing unwell patients; people who cannot help themselves requires super-human resilience, patience and a level of compassion and selflessness that is very hard to find. Ask yourself how much you would charge to change the vomit covered bedsheets of a stranger or to clean up someone after going to the toilet, or to have to calm down a frightened patient who has dementia or to bear the brunt of angry relatives all whilst trying to provide medical care, administer medications, administering CPR when someone’s heart has stopped and be a shoulder to cry on when a tragedy takes place. And then realise that all these things I have mentioned could easily all happen in one shift. Coupled with the fact that you are working nights, weekends, bank holidays, often missing birthdays, Christmases, family gatherings. All while being short-staffed and having to take the role of 2 or more nurses during a shift. How much would you charge? Well. I promise you, nurses are earning a fraction of this. All this and at the end of the month you barely take home enough to cover the cost of basic living and often, not even that. This is why nurses and ambulance staff are striking. And please, don’t for one moment think that they want to be. The type of person to do all the things I have mentioned and more, does not generally have the attributes of a person who wants to go on strike in a healthcare setting. So to those who are angry, please understand that nurses and healthcare workers are not robots. They are human too. Please support them.

On the note of being human and working in a hospital, this fits in nicely with what I had initially planned on talking about: Perfectionism, medicine and skewed views; when our human side meets our robotic side. I’ll start with reflection… we have to reflect a lot in medicine. We even have to write personal reflections for the powers that be to allow us to progress in our careers. For those who are regular listeners to my podcast, and my sincerest apologies for not publishing in such a long time, you will have probably noticed that as well as trying to provide an informative and educational show, my podcasts are my own way of personally reflecting not just for the everyday challenges that medicine provides but also life. I use the time behind the microphone to think about a lot of the struggles that I have faced in the previous week or quite often things that have happened months before but have crept their way into my recent thoughts. What might not be obvious is that in return for receiving an informative and I hope entertaining show, you as the listener are providing me with a form of therapy. By sharing my thoughts with a number of people it feels like my thoughts have more meaning and as such might not be as ridiculous as my inner voice might suggest.

The last few weeks have been difficult with regards to seeing young, fit patients going through life-changing acute illnesses, sometimes following very innocuous injuries that you would never have thought would have resulted in such a severe condition; a scratch or a bite for example resulting in severe infection or sepsis. I’ve been involved in the care of patients who have required extensive stays on intensive care, on life-support, who 24 hours previously were living normal, healthy lives. In some of these cases the patients were young with families. Seeing the look on the families faces as they tell their sick relative how much they love them as they are being wheeled on a bed into the operating theatre is very difficult sometimes, no matter how cold or thick-skinned you might think you are, there will always be a part of you that feels sad. Even more so when the patient could very easily be you or someone you know. In some of these cases I find myself wondering how much are we actually helping; are they going to survive? And sometimes, sadly, I wonder if there is a futility to the treatment that we are proposing. But when you’re faced with a young previously fit and well patient in the prime of their life there is very little that medics won’t try to give the patient a chance. There are often instances when saving a life comes at a cost. Amputating a limb for example in a young patient because if it’s not done, they will be dead from gangrene in a very short space of time.

Why am I talking about this in a podcast episode titled perfectionism. Well, this is where being a perfectionist makes for some very hard reflection when thinking about all of the tragedies that I see on a day-to-day basis. A scratch on my laptop or a tiny dent on my car or my iCloud not syncing properly can absolutely dominate my thoughts; I can obsess for days over very small cosmetic blemishes or computer glitches this can make it very difficult for me to concentrate on anything else in my spare time. I want everything to look and function perfectly. Whilst this personality trait is useful for certain things such as at work where I want to do my job perfectly; make sure each cannulation or intubation is perfect or even just making sure that my anaesthetic chart is neat, legible and filled in correctly. In day-to-day life, perfectionism can make even simple tasks difficult, as using my free time trying to polish out a scratch or trying to get AirDrop to work can really stop me from actually doing something far more productive. Perfectionism, I believe, also contributes to my procrastination as I believe there is an inherent fear of starting something because I don’t believe the outcome can be a perfect one. We all know the person who thinks “What’s the worst that could happen?” and before you know it, they’ve destroyed their kitchen with a sledgehammer because they want to try and make the 2nd hand kitchen cupboards they’ve bought for cheap on Facebook marketplace fit and if it doesn’t, well, it doesn’t matter. No harm done. And They’ll deal with the problem of where they are going to cook when they become hungry. Me. I’m not this person. I will think through every situation carefully to try and limit destruction and end up with a perfect result. The downside to this is very little happens quickly, and sometimes, not at all. This is difficult at times; I know my perfectionism leads to a lack of productivity. It’s also one of the reasons why there can be such a long time between my podcast episodes; I’ve actually recorded a few episodes that I haven’t published because I didn’t feel that they would do well.

Maybe that’s why I like building large Lego technic models so much; I know that if I just follow the instructions, the result will be perfect. 

When researching perfectionism some researchers say there seem to be 2 different paths that perfectionism can take you. There is the ‘healthy perfectionist’ where you challenge yourself and if you fail, you learn from your mistakes. Then there is the ‘maladaptive perfectionist’ where you set yourself extremely high and unrealistic goals and when you fail you can either become obsessed and try even harder or you avoid the activity all-together. This being the mores destructive form of perfectionism. I’m not a psychologist by any means and I’m sure that psychoanalysing oneself does not produce the most accurate diagnosis but I would definitely consider myself as the more maladaptive perfectionist. And studies have demonstrated the perfectionists are far more self-critical and are therefore far more likely to experience depression and burnout. And there is also a link between perfectionism and suicidal ideation. Sadly, with the rise of Tik-Tok, Instagram and other social media platforms that portray incredible, unrealistic lifestyles, perfectionism amongst teens is on the rise, affecting those who have more self-critical perfectionism the most.

I was reading an incredible BBC article from 2018 by Amanda Ruggeri about perfectionism and she says in the article, and I’m paraphrasing slightly, that researchers say ‘healthy’ perfectionism factors like striving for excellence aren’t actually perfectionism factors. They’re just conscientiousness factors and that perfectionism, isn’t defined by working hard or setting high goals. It’s that critical inner voice. It is a brilliant article and I’ll link it in the podcast description.

Whilst however true the REM lyric of “carry each his burden” from the song ‘These Days’ is, is it is impossible to not acknowledge how insignificant your problems are when you’re driving home after seeing a patient fighting for their life, seeing all the sadness that just one sickness can cause, seeing family crying. The realisation that they would happily swap your problem of a scratched iPhone for the health of their family member in less time than it would take for you to even blink. This realisation makes it hard not to feel like a terrible person. This thought does sometimes keep me up at night; wondering what it would take for me to care less about things that don’t really matter. Is it just a quirk? Is it selfishness? Is it just being shallow? Or is it just a symptom of being a perfectionist?

I was feeling quite guilty for worrying about my so-called problems. And I had to try and come up with some theories to try and make me feel a bit better.

Medics do have a skewed view of what constitutes a normal day. There are days where you see people die. There are days where you see a young person having a leg amputated. In the operating theatre, we see people’s abdomens opened up on a nearly daily basis to relieve an obstruction or a tumour. There are days where patients are vomiting so much blood that you are struggling to replace it fast enough. Sometimes there are cases where we see entire regions of skin being removed because it’s become necrotic/dead and the resultant scenes are nothing short of something you would see in a horror film. I honestly believe that if you took someone off the street and they saw some of the scenes that medical staff see on a typical day, it would leave them with insomnia for months and nightmares that would take a very long time to forget. And yet pretty much every doctor or healthcare worker I’ve ever met forgets about what they just saw or had to deal with almost as quickly as the patient presented to them. We just drive home listening to a podcast, have dinner, watch some Netflix, go to bed, wake up, have breakfast, and start a new day. And often, the scenes I’ve described are even happening overnight whilst everyone else is sound asleep. It’s not a normal job, and I’m not even the one doing the surgery, but we make it our normal. So our normal becomes somewhat skewed. Maybe I’ve become less human and don’t think about tragedy in the same way anymore. Or perhaps, just perhaps, focussing on the problems that might seem insignificant are a form of protective mechanism so that we don’t think about the terrible things that we as medics are often subjected to. Because if we carried home the tragedies of everyday hospital life and didn’t allow the ‘insignificant’ problems to distract us, I feel that that may be equally unhealthy. Well, at least that’s what I tell myself. 

 And with that, I’ll leave you.

If you’re enjoying the show please do leave a like and some feedback on your podcasting app; it’s always appreciated. And as always, please look after yourself.

I’m Dr Polyvios, goodbye.