1. PERFECTIONISM by Roland W. Gray, M.D., F.A.S.A.M. Medical Director Tennessee Medical Foundation Physicians Health Program

2. Consequences of Perfection Burnout Burnout Depression and suicide Depression and suicide Problems with self-care Problems with self-care Marital problems Marital problems Substance abuse Substance abuse Professional boundary violations Professional boundary violations

3. Disclaimer Perfectionism is not the sole cause of these problems Perfectionism is not the sole cause of these problems It is a common thread in many cases and a character trait of most physicians It is a common thread in many cases and a character trait of most physicians

4. Compulsiveness & Perfectionism “The most important quality of a physician is compulsiveness.” “The most important quality of a physician is compulsiveness.” Society’s meat is the physician’s poison Society’s meat is the physician’s poison

5. Compulsive Traits Excessive devotion to work and productivity to the exclusion of leisure activities and friendships

6. Compulsive Traits (cont.) Reluctance to delegate tasks or to work with others unless they submit exactly to his or her way of doing things

7. Compulsive Traits (cont.) Rigidity and stubbornness Perfectionism that interferes with task completion

8. Triad of Compulsiveness Self – Doubt Self – Doubt Guilt feelings Guilt feelings Exaggerated sense of Exaggerated sense of responsibility responsibility -Gabbard, 1985

9. Perfectionism Despite cultural sanctions, perfectionism is not adaptive. Despite cultural sanctions, perfectionism is not adaptive. Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. Perfectionism is a vulnerability factor for depression, burnout, suicide, and anxiety. The desire to excel must be differentiated from the desire to be perfect. The desire to excel must be differentiated from the desire to be perfect.

10. Individuals with compulsive and perfectionistic traits are attracted to medical careers. Individuals with compulsive and perfectionistic traits are attracted to medical careers. Stressors in the environment of an academic setting do not create these personality features—they exacerbate pre-existing traits. Stressors in the environment of an academic setting do not create these personality features—they exacerbate pre-existing traits.

11. Prevention Differentiate between the wish to excel and the wish to be perfect Differentiate between the wish to excel and the wish to be perfect Build leisure time with spouse and children into schedule Build leisure time with spouse and children into schedule

12. Prevention (cont.) Professionalism education in medical schools Professionalism education in medical schools Early identification Early identification Remediation programs Remediation programs -Papadakis, 2004

13. Prevention (cont.) In marriage or partnership, make time to talk, no matter how tired In marriage or partnership, make time to talk, no matter how tired Attend to one’s health by regular visits to personal physician Attend to one’s health by regular visits to personal physician The great lesson we are taught by dying patients: cultivate and nurture relationships The great lesson we are taught by dying patients: cultivate and nurture relationships