Sunday, 23 November 2008

Being perfect

For your interest I copy part of the BMA News report on the proceedings of the 19th International Conference on Doctors' Health held in London this week.

Brian Marien (associate specialist in psychological medicine) said that doctors faced 'double jeopardy' since they constituted an at-risk group for stress-related illnesses and alcohol misuse but were more reluctant to seek help than the rest of the population.

Julia Bland (consultant psychiatrist) suggested that a 'harsh internal voice' is part of the personality structure of doctors and leads to high standards. But high family expectations, narcissism and perfectionism are potential factors that may have a harmful influence on doctors' mental health. She said that perfectionism among doctors leads to a kind of black-and-white thinking: “if I am not perfect, I am no good”. Dr Marien added that it is important for doctors to guard against sinking into a kind of 'rumination' that focusses on worry and guilt.

Paquita de Zulueta (senior lecturer in general practice) said she believed medical students are particularly vulnerable to a fear of failure that is dangerous to their health, and suggested that those responsible for the education system should include 'emotional awareness' in the curriculum.

I can certainly relate to that. Unfortunately the spirit of the age is firmly set against these ideas. Doctors (and indeed anyone in a position of responsibility) are expected to be perfect. Heaven help the social worker or doctor who makes a mistake in one of the few child protection cases that achieves notoriety. The medical defence societies remind us constantly to avoid mistakes. The requirements of revalidation currently being worked out are bound to demand that we demonstrate our high standards in rigorous detail. It is certain that no-one responsible for these requirements will err on the side of laxity or “good enough” doctoring. And the judgements of the GMC sometimes suggest that that organisation likes to shoot a doctor from time to time pour encourager les autres.

But I must stop ruminating!


Jellyhead said...

I suppose the point is not to become lazy or slack, but to acknowledge that although we can try our best, make the best judgement call we can on each occasion - we are not infallible. Which does fly in the face of our professional pride. We like to be able to pat ourselves on the back for a job well done, and feel that we are always Good Doctors. But inevitably there will be times when we make the wrong call, or make mistakes. As awful as that is for patients, and for us.

Of course, I can say all this rationally, but if there is ever any adverse outcome with a patient, I feel sick in my stomach, and immediately begin to run over all the details to see if it is my fault in any way. I often think that if I ever have a patient death that is quite clearly attributable to my actions, I will find it hard to continue working. Perhaps impossible.

Our job weighs so heavily sometimes.

I really went to town in commenting on this post, didn't I? It must have struck a chord. I'll be quiet now and let someone else talk.

Anonymous said...

If you want to watch highlights of the conference there is a webcast on the BMA website. The last presentation address by Prof Gautam was an hour well spent.

Anonymous said...

I thank you for posting this blog, its because of you that I could watch the conference highlights.

XE said...

Interesting. One of my psych professors suggested that the reason for womens' substantially higher rates of clinical depression is that we have a much greater tendency to ruminate, especially on negative experiences. Makes sense then, with what you've said.

Hope you're well!

Anonymous said...

I grumbled mildly to friends on another website about my GP (just a problem with appointments and prescriptions) and was immediately exhorted to change my GP. What are we supposed to do, play musical GPs in search of the elusive perfect GP? That's what some people seem to think is the way forward. Personally, I'd rather just have a bit of a grumble once in a while and accept that my GP is human.

Anonymous said...

Happy Christmas.

XE said...

Happy Christmas Dr. Brown!

Elaine said...

Happy New Year, Doctor Brown.

It must be about time you wrote something up again. Miss you.

Emmett said...

Happy New Year Doctor Brown!!

Anonymous said...

I thank you so much for this posting.It has shed some light on so many things for me in my personal and professional life.I find that my patients are very satisfied with me, because their comment is that i am so "normal".I tell them often that I do not know everything,that noone does.And if I do not know what is wrong with them, I tell them exactly this.Then I tell them i will do everything possible to find out.They appreciate the honesty, and the human side they see in me. I think i have much less problems, and much more support because of this.However,I sit up and study and read and will not stop until i can find an answer.I do the exact opposite from what i tell my patients in caring for oneself. Often it is the patient who is talking to me and worried about me because they know i care TOO much, and try TOO hard to be perfect.I do not feel as alone now after reading this. I think if we did not do this to some extent,we would not deserve to be in this field at all. Thank you again.

Dr Andrew Brown said...

Thank you everyone for your comments, which are fascinating as (nearly) always.

Jellyhead: Spot on! I too don't know how I'd cope if a patient died as a direct result of my actions.

Xavier: the interesting thing is that depressives have an accurate view of nature, optimists are deluding themselves. On the other hand, optimists enjoy life more and live longer. It really ain't fair!

Nutty: I was really cheered up by your comment. You are right, neither patients nor doctors are perfect and a bit of tolerance on both sides is no bad thing.

jbb,fnp: It's a question of balance isn't it. Work hard, but don't make yourself ill in the process.