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DO you remember being a wide-eyed and impressionable medical student?
Do you remember looking up to certain doctors who had the “right touch”, who seemed to glide into every interaction with wit and charm, who the nurses swooned over and patients loved?
They stood out because of their deep compassion for their patients and balanced this with sharp clinical skills and approachability.
Contrast that with the frustrated, angry and burnt out doctor who didn’t acknowledge your existence; who snarled impossible questions at you and didn’t even bother to ask for your name. Your hair stood on end when they approached, nothing ever seemed to be right and patients were often confused and unhappy with their interactions.
Did you know that both these doctors have played a part in shaping the type of doctor that you are today?
Whether good or bad, we are the composite of our teachers and clinical experiences.
From those doctors kind enough to help and who have had a direct hand in our clinical career to those who we have admired from afar, we mirror the best and sometimes the worst of what we’ve seen and learned.
The question is, how do we steer our careers and lives towards being doctors who truly make a difference?
I believe the one thing that will allow you to have a long and meaningful career is using the power of self-reflection. Being able to self-reflect allows us to enhance and sharpen our best skills, and stop self-sabotage and other elements of our behaviour which are keeping us from progressing.
If you want to be the type of doctor who attracts opportunities, you need to be the type of doctor who others want to be around. It is that simple.
We’ve all seen brilliance wasted and lives broken because of the relentless pursuit of power and prestige and the failure to stop, reflect and self-care.
The one question that we as medical leaders must start to ask is: “What is the one thing that others would say that I need to change about myself to be the type of doctor who enriches the lives of others?”
One year ago, I left general practice to undertake the Clinical Diploma of Palliative Care, balancing this with my anaesthetic practice.
I knew that this work would be emotionally and psychologically challenging and, due to my history of burnout, I organised a monthly clinical supervision session with a senior colleague.
To my surprise, the conversations in our sessions did not focus on palliative care, but rather on the most glaring and distressing aspect of my personality.
Perfectionism.
Every clinical story that we dissected and reflected upon almost always came back to my insistence on perfection.
While I had perfectly administered over 200 epidural and spinal blocks in 6 years as a GP anaesthetist, I couldn’t let go of having two failed spinal blocks that recently occurred in quick succession of each other.
While I had perfectly tried to help several patients with severe depression, I couldn’t let go of those who had harmed themselves.
While I had perfectly organised my life to ensure balance, replenishment and happiness, I continually failed, in my eyes, to feel rested and enjoy my days.
Further from my clinical life, perfectionism was hurting my family, affecting the way that I was raising my sons, with rigid rules, unfair expectations and increasing harshness against their tender spirits.
But most of all, it was hurting my wellbeing, leaving me increasingly anxious, hypervigilant and incapable of self-compassion.
The blue sky that I found was in my clinical supervision sessions around the concept of being a “good enough doctor”, which was first observed and written about by British paediatrician Donald Winnicott in his observation of thousands of mothers and babies, when he described the “good enough mother”.
Good enough wasn’t about being mediocre or above average, but about continual improvement and excellence rather than the illusion of perfection or “being the best” (here and here).
This one thought brought freedom to my clinical work and personal life. It allowed me to practice self-compassion inwardly, and outwardly offer it to those in my world because I was indeed a “good enough doctor”.
Applied to all areas of my life, I began to pursue mastery rather than perfection, as grounded in mastery is the ability to adapt, learn from mistakes and, most importantly, offer yourself self-compassion, which fuelled my drive to continually improve.
Just as a coach skillfully helps to guide a world class athlete, who is helping us as doctors to self-reflect and guide our own careers?
The most important thing that doctors can do to have a long and meaningful career is stop and practise self-reflection. It is the one thing that allows great doctors to leave an even greater lasting legacy.
Live intentionally.
Dr Jonathan Ramachenderan is a GP/Anaesthetist from Albany, WA
Parts of this article originally appeared in Defence Update.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless that is so stated.
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I could not agree more with Anonymous (February 4, 2019 at 10:34 am). There are some who come into medicine who wish to do service to others. You can identify those that put their patient first, and have keen interest in the well being of their patients. There are others that don’t care about their patients, and it doesn’t appear to hinder their careers. Those that treat patients preferentially based on circumstances of the patient. Here is one example: the oncology registrar (actually not an advanced trainee, but a person fulfilling this role), who refused to treat a patient with SCLC because “they were still smoking”. The patient was anaemic with Hb of 67, presenting with exacerbation of dyspnoea. A simple blood transfusion and discharge home was all that was required. Yet, all the registrar could talk about was his contempt for this person because they still smoked. Unfortunately, even working only as a training doctor, I have many other such examples.
As someone who has been on the “other side”, with my mother dying age 37 from renal cancer, I know what it is like from both sides of the medical system. Some in the medical profession are so disheartening.
If you are seen as someone who is committed to their patients (and, not to the detriment of own mental health, but rather as a source of genuine compassion for others) – you get labelled a perfectionist. (At least my anecdotal experience).
Also, having come from low socioeconomic circumstances – a statistical anomaly in the medical profession. (Over 60% of medical students come from families in the top quintile of household income, with only 20% coming from families who earned in the bottom three quintiles) – American data, but I have read similar data in Australia (WA, from memory). There is a definite disparity on how medical professions treat patients based on their socioeconomic circumstances.
If only we could treat everyone with similar respect. Patients enter the medical system often at a very vulnerable time. Provision of health care should be more about them, and less about us.
It is OK to be a perfectionist, but it is necessary to be able to forgive ourselves for not being perfect (at least not all the time).
It is the second but I have struggled with!
Nice article! It’s all about being human.
Fantastic insight as always Jonathan. Why do we continue to give all our concentration and self angst to the occasional mistake rather than realising we actually do a good job. We definitely need to be kind to ourselves to facilitate longevity and function as doctors.
Excellence is easier to achieve than perfection
I also applaud this article. Counselling myself to accept that close to perfection was as good as one will ever get, and that good enough is all one can cope with long term, definitely helped me cope with 40+ years in the job. The flip-side to the above, and which is one of my favourite sayings now. Especially since I spent 16 years for my recreation happily refurbishing an old trawler style coastal cruiser, is the old but so true saying…”if it ain’t broke, don’t fix it!”
Well done Jonathan, and very timely as I ruminate and self crucify myself over my own perceived inadequacies. Patients are happy, why do we find it so hard to let go!
Anyway as I was cleaning up the house, I came across a pre medicine bucket list and one of them was “save a life”. Well I have certainly done that!
We choose what we reflect upon and the emotions to keep and the ones we need to let go.
Once again a fantastic circumspect on the troubles surrounding a practising doctor. I have suffered at the hands of many an administrator, a wife, and AHPRA for being a perfectionist. It is not accepted by bureaucrats that trying your absolute best for the patients is what is required by modern day practitioners. Administrators are more about saving money and retaining staff than any care of patients. I recall being told by a medical administrator at Cabrini Hospital to “fuck the patients”. As a naive surgeon, I thought that this was the worst possible thing that anyone involved in patient care could possibly say. It shook me to the core and increased my resolve to look after patients even better. From then on, I learned never to trust bureaucrats that do not come in contact with patients. I regard anyone who attempts to pervert the cause of ultimate patient care to be the lowest of the low life. I have written “The Need for Creed” which outlines the doctrines of
1. The patient always comes first
2. Never accept mediocrity
3. Never let your frustrations turn to apathy
It is however devastating to find individuals who not only do not share the same philosophies but go out of their way to inflict harm to those who wish to seek perfection in their patient care.
Persecution by laziness?
Well written article. I loved the way you wrote that we learn from our good experiences and bad and that shaped / shapes who we are as doctors. It is indeed an art as much as it is a science and that is the beauty of medicine. Now I know why it’s called practice of medicine… we never stop learning , it’s a constant and delicate dance we play balancing personal and professional lives.