Why Perfectionism May Weaken Your Relationships With Patients

In January, Mrs. P came for her first visit with me with chronically uncontrolled blood pressure and blood sugar. We were in the midst of the pandemic, and to cope with stress and anxiety, I fell back on the bad habit of perfectionism, my preferred armor when things get hard. I sent her on her way with a new medication regime and stern words about diet and physical activity and thought I’d checked all the boxes.

Mrs. P. returned a month later with no significant changes in her numbers. She wasn’t taking the medications regularly, she’d continued to eat high-salt foods and she wasn’t taking the walks I’d prescribed. Shame and exhaustion overcame me. I thought I’d done everything right but I had failed my patient. This wasn’t an isolated case—despite what I thought were my best efforts, I was frantically checking boxes for many patients and still failing to support their health.

My instinct for as long as I can remember, has been to work harder to be even more perfect whenever I felt vulnerable. There were times when it was helpful, but more often than not, perfectionism was a losing strategy. For many in healthcare, perfectionism is how we got here. It’s how we passed the exams and aced residency or clinicals. It’s how we try to reduce the risk of a mistake killing someone to as close to zero as possible.

However, it’s no secret that shame is a straight shot to burnout in our profession, and using perfectionism in a vain attempt to defend against it is just another path to failure. It dehumanizes our patients and ourselves. When patients are nothing but scorecards, indicators of how well we’re playing the game, it becomes impossible to have a human connection. Patients end up feeling alienated and we end up feeling hollow.

I’d been doing a better job avoiding the perfection crutch until the pandemic pushed me back to old habits. My “scores” were failing. Patients weren’t taking their meds correctly, didn’t see the specialists I recommended, and used the ED inappropriately. They seemed to be out eating all the salt and carbs they could find while laying around on their couches all day. I was resentful and exhausted and nothing was getting better.

Mrs. P.’s follow up visit reminded me that there was a different way. I let go of the need to be perfect and let myself be human, even if those boxes didn’t get checked every time. I asked her what was on her mind that day, how things were going, and I listened. We shared humor in the absurdities of life. We brainstormed about her food access challenges and we road tested her medication regimen so that it would work well with her shift-work schedule.

When she left, I resolved once again to measure my success by the quality of my relationships with patients instead of by their compliance with my treatment plans. And I found that, most of the time, focusing on a personal process improved outcomes anyways. When I stopped trying to medicate and educate my patients into submission and instead listened to their stories, it became easier to find more effective ways to reach them. And day after day, my joy in practice was rekindled and my resentment faded.

Mrs. P. even said it out loud. At the end of that follow up visit she said, “I almost didn’t come today because I didn’t really like you before, but now I’m glad I did. You are a lot better when you are really here.”

A month later, her blood pressure was under control. It was perfect.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.