Modern medicine is no stranger to the toxic trio of burnout, stress, and dissatisfaction, and perfectionism plays the role of the puppet master.
It’s time to swap the scalpel for a mirror and reflect.
In part 1 we explored the perfectionism plague in medicine. In part 2, this article, we explore John Bowlby’s “good enough” framework which challenges physicians to redefine excellence, shifting from unattainable perfection to a sustainable “good enough” approach.
The challenge of toxic perfectionism in medicine arises from a culture that often emphasizes infallibility and exceptional performance. This culture can lead to unrealistic expectations, burnout, and a reluctance to admit errors or seek help.
Toxic perfectionism not only affects physicians’ well-being but also compromises patient care, as it can hinder open communication, reflective practice, and adaptive learning.
John Bowlby’s concept of the “good enough parent,” initially described in his seminal work on attachment theory, offers a relevant parallel to the idea of the “good enough physician” in the context of contemporary healthcare. This comparison serves as a potential antidote to the pervasive issue of toxic perfectionism among physicians, a phenomenon that can lead to detrimental effects on both practitioners and patients.
Bowlby’s theory of attachment, central to understanding early child development, posits that the quality of the bond between a child and their primary caregiver is crucial for the child’s emotional and psychological health (Bowlby, 1969). In this framework, the “good enough parent” is not one who is perfect or infallible, but rather one who provides consistent and adequate care, empathy, and responsiveness to the child’s needs (Winnicott, 1953). This concept underscores the importance of a secure and supportive environment, rather than an unattainably perfect one.
In this framework, the "good enough parent" is not one who is perfect or infallible, but rather one who provides consistent and adequate care, empathy, and responsiveness to the child's needs (Winnicott, 1953).
But we are physicians, not children, I hear you say.
Correct, but:
1) Our early childhood experiences play out in adulthood more than many of us recognize (trust me, I’m a Psychiatrist!), and
2) As adults of reasonable intelligence, we can seek to understand this framework and apply it to ease toxic perfectionism we may be suffering from
That is, if we choose to!
The concept of the “good enough physician” (GEP), inspired by Bowlby’s and Winnicott’s ideas, offers a counterpoint to this harmful perfectionism. It encourages a more balanced approach, recognizing the importance of self-compassion, realistic self-assessment, and the acceptance of human fallibility in clinical practice.
This perspective aligns with the growing recognition of the importance of physician wellness and its impact on the quality of patient care.
Further, the parallel between the “good enough parent” and the “good enough physician” extends to the dynamic of the caregiver-care receiver relationship. Just as the “good enough parent” fosters a secure attachment and resilience in the child, the “good enough physician” cultivates a therapeutic alliance that can empower and heal the patient — and themselves.
This relationship is characterized by trust, mutual respect, and an understanding of the patient’s perspective and experiences. It is also open to listening to our own needs and fears, being self-compassionate, and accepting our imperfect humanity.
Here's how physicians can apply these principles: Embrace our human imperfection... build trust... continual learning... self care and reflection...admitting and learning from mistakes"
The principles of the “good enough parent,” as conceptualized by Bowlby and Winnicott, can be effectively adapted by physicians to evolve into “good enough physicians.” This approach offers a balanced perspective in clinical practice, addressing the challenge of perfectionism which is prevalent in the medical profession. Here’s how physicians can apply these principles:
1. Embracing our human imperfection
Just as a “good enough parent” acknowledges that they cannot meet every need of their child perfectly, a “good enough physician” accepts that they cannot know everything or always make perfect decisions. This acceptance of imperfection is crucial in medicine, as it fosters a realistic approach to care and a willingness to learn and grow from experiences (Epstein & Krasner, 2013).
2. Admitting and learning from our mistakes
A key aspect of being a “good enough parent” is the ability to recognize and learn from parenting mistakes. In medicine, this translates to acknowledging errors, understanding their implications, and using them as opportunities for growth and improvement in practice (Leape & Berwick, 2005).
3. Continual learning and adaptation
Just as parenting is a journey of continual learning and adaptation to the child’s evolving needs, medicine requires an ongoing commitment to learning and adapting to new medical knowledge and practices. A “good enough physician” is committed to lifelong learning, staying updated with the latest in medical research and treatments, and adapting these to the individualized care of their patients (Montgomery, 2006).
4. Self-care and reflection
The concept of the “good enough parent” includes the parent’s acknowledgment of their own needs and limitations. Similarly, physicians must practice self-care and reflection to maintain their well-being. This involves acknowledging the stresses and emotional challenges of their profession, seeking support when needed, and engaging in activities that promote personal well-being, which in turn enhances their ability to care for patients (Shanafelt & Noseworthy, 2017).
5. Collaboration and support systems
A “good enough parent” recognizes the importance of a support system in raising a child. Likewise, a “good enough physician” values and utilizes a collaborative approach in healthcare. This involves working with other healthcare professionals, valuing multidisciplinary inputs, and recognizing the role of each team member in patient care (West et al., 2018).
A key yet under-recognized support system is peer support. We have written extensively on the value of peer support for physicians.
NB. Our free peer-support groups for medical students and physicians only are available here.
The transition from striving for perfection to striving for “good enough” in medicine can also be facilitated by institutional changes. Healthcare systems can promote this paradigm shift by fostering a culture of learning and support, rather than one of blame and shame (Leape & Berwick, 2005).
This involves creating environments where physicians feel safe to discuss mistakes, learn from them, and receive the support needed to manage the psychological toll of their work (West et al., 2018).
In summary, the transition from striving for perfection to embracing the concept of the “good enough physician” involves a shift in mindset towards accepting imperfection, being responsive and empathetic to our own and others’, building trusting relationships, committing to continual learning, practicing self-care, collaborating with colleagues, and learning from mistakes.
This approach not only enhances the well-being of physicians but also leads to more effective and compassionate patient care.
Embracing imperfection isn’t a compromise—it’s a revolution. So, physicians, trade in your capes for imperfect scrubs, and let good enough medicine be your saving grace.
