You don't have to be perfect

February 1, 2008

Doctors are hard on themselves; give yourself a break.

In the final scene of the movie Schindler's List, Oskar Schindler, a German businessman, laments that although he saved over a thousand people from death at the hands of the Nazis, he didn't help enough. "I could have done more" is a line that has now become a classic.

Talking to physicians in recent months, I've heard similar self-reproach. Doctors are very hard on themselves. High standards are part of your hardwiring, and if you fall short, your self-image of being a really good doctor takes a hit.

Making a medical error is one situation that brings guilt and self-blame. Whether you were at fault or the event was beyond your control, you feel the clash between your oath to "First, do no harm," and the reality that you may have caused someone permanent damage. Our culture promotes the "doctor should be perfect" mantra. Eager malpractice attorneys, and the general consumer belief that everything is curable if only the doctor spots it in time, create the mythical image of the omnipotent caregiver. It's natural for you to buy into it, too.

"Primary care doctors are trying to cover an enormous spectrum of ailments. If they miss something, they beat up on themselves for not having caught it and worry whether they'll catch the next serious illness," says Gabbard. "So they work longer hours, read more journals, trying to be perfect."

Beyond medical errors, doctors may be hard on themselves for not being able to spend as much time with patients as they would prefer; not always going the extra step for a patient because they're bogged down with practice crises or personal commitments; making business decisions like dropping a poor-paying insurer, knowing that some longtime patients may have to find another doctor; or feeling like they've missed the mark because they earn less than they expected to.

Focus on what you believe in

One way to shed unrealistic pressure is to make sure you're plugged into your own values.

"I tell doctors to write out their five highest priorities in life, then bring out their schedule book for the past week and see how much time they've spent on them," says Gabbard. "Often, the schedule doesn't reflect their values and priorities." He suggests that you allot time every day to talk about your day with your spouse or partner, and reconnect with them. If that's not possible, make time to talk to a supportive friend, trusted colleague, family member, or mental health professional.

Accept that oversights and unexpected events will happen. That doesn't make it okay to be slapdash, but after you've done what you can to prevent errors from recurring, don't let any past failures and mistakes drag you down into chronic depression, anxiety, or loss of self-esteem.

Most important, appreciate yourself for all the good you've done, for the patients you've helped, for the family members you've been good to. You've chosen a profession that saves lives and helps make people's daily existence better. Many professionals never get that opportunity.

Forgive yourself for being human.